bluuebunny/crossref_metadata_2025 huggingface dataset:
347 A Bit of a Headache: Management of Head Injuries in a District General Hospital
Authors: Bruce N. , Young J.
Published: February 2022

Aim

Head Injury is a common presentation in our DGH, which covers a large rural area and is now a regional trauma centre. We audited our management of head injuries against current guidelines and planned a new pathway to ensure patients receive the correct advice and follow up on discharge.

Method

Data was requested from IT for all head injury episodes in 2019, to reflect usual numbers pre-pandemic.

Electronic letters, radiology and notes were used to identify whether imaging criteria was met/carried out, discharge destinations, re-presentations, specialty discussions, and head injury advice on discharge.

Results

307 individual patients identified. 13 re-presentations. 10 required neurosurgical discussions

Destinations

226 (73.6%) discharged direct from ED. Admissions: Surgical - 37 (12%), Medical - 6 (2%), Paeds – 14 (4.5%), ITU 2 (0.7%), Did not wait – 2 (0.7%), Not Recorded – 7 (2.3%)

Imaging

100 patients met NICE criteria for CT, 100% were documented in notes and had CT. 76% reported normal, 18% had a bleed, contusion, or haematoma.

HI advice

90% of ED discharges, 16% of Surgical and 16% of medical discharges had head injury discharge advice documented

Conclusions

Guidelines were met for 100% of patients requiring imaging. Head injury advice was well documented in ED but fell down in ward paperwork. We have written a robust pathway where all inpatients have a proforma completed during admission with prompts for discharge advice and rehab referral where appropriate, this is currently undergoing a re-audit to ensure improvement and if successful will become an established part of the trauma pathway in our hospital.
68 Exploring Subconscious Bias: How Implicit Biases Can Affect Accessibility to Healthcare
Authors: Ranford D. , Miu K. , Surda P.
Published: February 2022

Aim

Implicit biases involve associations outside conscious awareness that lead to a negative evaluation of a person on the basis of irrelevant characteristics such as race or gender. This article reviews healthcare professional's display of implicit bias towards patients in a tertiary centre.

Method

We retrospectively analysed a database of 285 patients who missed surgical outpatient appointments at a London tertiary hospital. Judges were asked to categorise all 285 patients into predefined ethnic categories: White British vs Black, Asian and Minority Ethnic vs White Non-British after reading the patient’s names.

Results

In the group where ethnicity was defined based on assessed origin of names, we report significant difference in discharge rates between White British vs Non-White British groups (34 vs 48%). There was also significant difference between White British vs Black, Asian and Minority Ethnic group (34% vs 57%). Discharge rates between males and females did not differ.

Conclusions

Clinicians are more likely to provide patients with another opportunity to attend an outpatient clinic after missing a booked appointment based on the patient having a perceived ethnicity of White British, whether deliberate or not. This study shows a bias of accessibility in healthcare dependent on ethnicity with greater flexibility given to White British patients.
404 Can MRI Non-Invasively Measure Blood-Brain-Barrier Permeability?
Authors: Ali T. , Blamire A. , Parikh J.
Published: February 2022

Aim

Blood brain barrier (BBB) integrity in neurological disease is tested with gadolinium-enhanced Magnetic Resonance Imaging (MRI). Pathology studies have shown gadolinium deposits in brains with intact BBBs, thus raising concern. We propose a novel use of Arterial Spin Labelling (ASL) –a MRI technique which ‘tags’ blood-water making it a tracer– as a safer alternative in assessing BBB permeability. ASL’s ability to capture T2 (transverse relaxation time) changes of tagged water in blood vs. in tissue (post-exchange across the BBB) supports its feasibility.

Method

We developed an ASL protocol and collected data from healthy volunteers (n=5) on a 3T Achieva Scanner with the parameters: echo times (TEs) 30, 40, 50, 60, 70ms; repetition time 4200ms; field of view 240x240x47mm and post label delays (PLDs) 1,000ms and 1,500ms. We calculated mean ASL signal (arb units) from the images at each TE, and then extracted T2(ms) values for each volunteer at each PLD. The primary outcome was the change in T2 across PLDs.

Results

Calculated mean T2s demonstrated a majority of increasing T2s across longer PLDs (n=3) with mean T2 of 55.3+5.3ms at PLD 1,000ms and 62.1+10.8ms at PLD 1,500ms. However, the results are inconclusive as the sample size precluded statistical testing.

Conclusions

We developed an ASL protocol that demonstrated changes in T2 of blood water with time passage, indicating water exchange through the BBB. This supports the use of ASL in assessing BBB permeability, but more wide-scale studies need to be performed.
36 Predicting Long-Term Survival and Time-to-Recurrence After Oesophagectomy in Patients with Oesophageal Cancer
Authors: Gujjuri R. , Clarke J. , Elliot J. , Reynolds J. , Markar S. ,   ENSURE Study Group
Published: February 2022

Aim

Long-term survival after oesophagectomy remains poor, with recurrence a feared common outcome. Prediction tools can identify high-risk patients and optimise treatment decisions based on their prognostic factors. This study developed a prediction model to predict long-term survival and time-to-recurrence following surgery for oesophageal cancer.

Method

Patients undergoing curative surgery from the European iNvestigation of SUrveillance After Resection for Esophageal Cancer study were included. Prediction models were developed for overall survival (OS) and disease-free survival (DFS) using Cox proportional hazards (CPH) and Random Survival Forest (RSF). Model performance was evaluated using discrimination (time-dependent area under the curve (tAUC)) and calibration (visual comparison of predicted and observed survival probabilities).

Results

This study included 4719 patients with an OS of 47.7% and DFS of 48.4% at 5 years. Sixteen variables were included. CPH and RSF demonstrated good discrimination with a tAUC of 78.2% (95% CI 77.4–79.1%) and 77.1% (95% CI 76.1–78.1%) for OS and a tAUC of 79.4% (95% CI 78.5–80.2%) and 78.6% (95% CI 77.5–79.5%) respectively for DFS at 5 years. CPH showed good agreement between predicted and observed probabilities in all quintiles. RSF showed good agreement for patients with survival probabilities between 20–80%.

Conclusions

This study demonstrated that a statistical model can accurately predict long-term survival and time-to-recurrence after oesophagectomy. Identification of patient groups at risk of recurrence and poor long-term survival can improve patient outcomes by optimising treatment methods and surveillance strategies. Future work evaluating prediction-based decisions against standard decision-making is required to understand the clinical utility derived from prognostic model use.
Knowledge and Interdisciplinary Communication of Gastroenterologists and Dentists in the Netherlands About Gastrointestinal Diseases With Oral Manifestations
Authors: Tan Christopher X W , Brand Henk S , Qaddour Oumaima , van der Bijl Paulette M L , De Boer Nanne K H , Forouzanfar Tymour , de Visscher Jan G A M
Published: February 2022

Background

Gastrointestinal diseases can have oral manifestations. The aim of this study was to investigate the knowledge of gastroenterologists and dentists about gastrointestinal diseases with oral manifestations and to assess the frequency, extent and content of communication between gastroenterologists and oral healthcare professionals.

Methods

Separate questionnaires were developed and sent to all 523 gastroenterologists and a random selection of 500 dentists in the Netherlands. Both questionnaires contained questions about demographic characteristics of the participants, 10 statements about gastrointestinal diseases with possible oral manifestations and questions about the communication between gastroenterologists and oral healthcare professionals. Additionally, the questionnaire for gastroenterologists contained 9 statements about general dentistry and the questionnaire for dentist had 9 questions about gastrointestinal diseases.

Results

Gastroenterologists answered 47.6% ± 31.9% of the questions correct about gastrointestinal diseases with possible oral manifestations and 57.5% ± 27.9% of the questions correct about general dentistry. Dentists answered 26.6% ± 20.5% of the questions correct about possible oral manifestations of gastrointestinal diseases and 50.3% ± 18.7% of the questions correct about gastrointestinal diseases. Gastroenterologists and dentists valued interdisciplinary consultation as very useful with scores of 4.07 ± 0.70 and 4.67 ± 0.49 on a 5-point Likert scale, respectively, but the frequency of consultation was considered insufficiently with a mean score of 2.88 ± 1.01 and 2.24 ± 1.05 on a 5-point Likert scale, respectively.

Conclusions

This study suggests that the knowledge of gastroenterologists and dentists about gastrointestinal diseases with oral manifestations could be improved. Interdisciplinary consultation was considered valuable for the optimal treatment of their patients but was assessed as insufficient.
BNP: Biomarker Not Perfect in heart failure with preserved ejection fraction
Authors: Shah Sanjiv J
Published: February 2022

This editorial refers to ‘Heart failure with preserved ejection fraction in patients with normal natriuretic peptide levels is associated with increased morbidity and mortality’, by F.H. Verbrugge et al., https://doi.org/10.1093/eurheartj/ehab911.
Serum antibodies to surface proteins ofChlamydia trachomatisas candidate biomarkers of disease: results from the Baltimore Chlamydia Adolescent/Young Adult Reproductive Management (CHARM) cohort
Authors: Marques Patricia X , Wand Handan , Nandy Melissa , Tan Chun , Shou Huizhong , Terplan Mishka , Mark Katrina , Brotman Rebecca M , Wilson David P , Ravel Jacques , Hsia Ru-ching , Bavoil Patrik M
Published: February 2022

We previously observed that the nine-member family of autotransported polymorphic membrane proteins (Pmps) of Chlamydia trachomatis is variably expressed in cell culture. Additionally, C. trachomatis-infected patients display variable Pmp-specific serum antibody profiles indirectly suggesting expression of unique Pmp profiles is an adaptive response to host-specific stimuli during infection. Here, we propose that the host response to Pmps and other outer surface proteins may correlate with disease severity. This study tests this hypothesis using an ELISA that measures serum IgG antibodies specific for the nine C. trachomatis Pmp subtypes and four immunodominant antigens (MOMP, OmcB, Hsp60, ClpP) in 265 participants of the Chlamydia Adolescent/Young Adult Reproductive Management (CHARM) cohort. More C. trachomatis-infected females displayed high Pmp-specific antibody levels (cut-off Indexes) than males (35.9%–40.7% of females vs. 24.2%–30.0% of males), with statistical significance for PmpC, F and H (P < 0.05). Differences in Pmp-specific antibody profiles were not observed between C. trachomatis-infected females with a clinical diagnosis of pelvic inflammatory disease (PID) and those without. However, a statistically significant association between high levels of OmcB-specific antibody and a PID diagnosis (P< 0.05) was observed. Using antibody levels as an indirect measure of antigen expression, our results suggest that gender- and/or site-specific (cervix in females vs. urethra in males) stimuli may control pmp expression in infected patients. They also support the possible existence of immune biomarkers of chlamydial infection associated with disease and underline the need for high resolution screening in human serum.
Financial Stressors and Resources Associated With Financial Exploitation
Authors: Hall LaToya , Moray Juno , Gross Evan , Lichtenberg Peter A
Published: February 2022

Background and Objectives

The prevalence of older adult financial exploitation (FE) is increasing. Population-based survey estimates of FE in the older adult population range from 5% to 11%. Given the growing prevalence of FE victimization in older adult populations, understanding the population’s vulnerability to FE has increased in importance. This study investigates a conceptual framework in an attempt to understand how financial stressors and resources are associated with substantiated FE in a sample consisting largely of Black older adults.

Research Design and Methods

The study uses a cross-sectional design to investigate group differences among a total sample of 142 community-dwelling older adult participants, 62 of whom sought services to address FE and 80 with no history of FE.

Results

The group of older adults who sought services to address FE was more likely to be unmarried and had fewer years of education. Measures of financial literacy and perceived financial vulnerability had protective and risk effects, respectively.

Discussion and Implications

The present study found that sociodemographic and financial stress and resource measures have significant relationships with FE. These findings support the conceptual framework describing their relationship. This new conceptual framework provides a guiding factor in better understanding vulnerability to FE in older adults. The study also adds to the paucity of research completed on FE with Black older adults.
Iterates of Blaschke Products and Peano Curves
Authors: Donaire Juan Jesús , Nicolau Artur
Published: February 2022

Let $f$ be a finite Blaschke product with $f(0)=0$, which is not a rotation and let $f^{n}$ be its $n$-th iterate. Given a sequence $\{a_{n}\}$ of complex numbers consider $F= \sum a_n f^{n}$. If $\{a_n\}$ tends to $0$ but $\sum |a_n| = \infty $, we prove that for any complex number $w$ there exists a point $\xi $ in the unit circle such that $\sum a_{n}f^{n}(\xi )$ converges and its sum is $w$. If $\sum |a_n| < \infty $ and the convergence is slow enough in a certain precise sense, then the image of the unit circle by $F$ has a non-empty interior. The proofs are based on inductive constructions which use the beautiful interplay between the dynamics of $f$ as a self-mapping of the unit circle and those as a self-mapping of the unit disk.
Effects of seed morphology and orientation on secondary seed dispersal by wind
Authors: Zhu Jinlei , Buchmann Carsten M , Schurr Frank M
Published: February 2022

Understanding how diaspore (hereafter ‘seed’) morphology and orientation affect secondary seed dispersal by wind is important to link seed dispersal and post-dispersal processes, such as seed lodging, predation and germination. This study aims to describe the effects of seed morphology and orientation on secondary seed dispersal by wind via mechanistic modelling. We extend the mechanistic model of Schurr et al. (2005) in order to describe how secondary seed dispersal by wind is affected by wind conditions, ground surface, seed morphology and orientation. The model simulates the initial landing orientations, dispersal distances and stopping orientations of individual seeds. To parameterize the model, we measured orientation-specific vertical seed projection and seed lift-off velocity (the wind speed at which a seed starts moving on the ground) of the asymmetric seeds of heterocarpous Zygophyllum xanthoxylon, and determined orientation-specific model parameters that depend on properties of seeds and/or the environment. To validate the model, we conducted wind channel experiments in which we released seeds of Z. xanthoxylon onto a sand-coated tar paper, and recorded the initial landing orientations, dispersal distances and stopping orientations of the seeds. The extended model could precisely predict secondary dispersal distance, and explain up to 99% of variation in the observed proportions of seeds which stopped in various orientations. The model predicts that secondary dispersal distance increases with wind speed and decreases with aerodynamic roughness length, and that there might be a positive correlation between dispersal distance and germination success.
Forming young and hypervelocity stars in the Galactic Centre via tidal disruption of a molecular cloud
Authors: Generozov A , Nayakshin S , Madigan A M
Published: February 2022

The Milky Way Galaxy hosts a four million solar mass black hole, Sgr A*, that underwent a major accretion episode approximately 3–6 Myr ago. During the episode, hundreds of young massive stars formed in a disc orbiting Sgr A* in the central half parsec. The recent discovery of a hypervelocity star (HVS) S5-HVS1, ejected by Sgr A* five Myr ago with a velocity vector consistent with the disc, suggests that this event also produced binary star disruptions. The initial stellar disc has to be rather eccentric for this to occur. Such eccentric discs can form from the tidal disruptions of molecular clouds. Here, we perform simulations of such disruptions, focusing on gas clouds on rather radial initial orbits. As a result, stars formed in our simulations are on very eccentric orbits ($\bar{e}\sim 0.6$) with a lopsided configuration. For some clouds, counterrotating stars are formed. As in previous work, we find that such discs undergo a secular gravitational instability that leads to a moderate number of particles obtaining eccentricities of 0.99 or greater, sufficient for stellar binary disruption. We also reproduce the mean eccentricity of the young disc in the Galactic Centre, though not the observed surface density profile. We discuss missing physics and observational biases that may explain this discrepancy. We conclude that observed S-stars, HVSs, and disc stars tightly constrain the initial cloud parameters, indicating a cloud mass between a few × 104 and $10^5\, {\rm M}_{\odot }$, and a velocity between ∼40 and 80 km s−1 at 10 pc.
The low emission mode in PSR B0329+54
Authors: Tu Z Y , Yuen R , Wen Z G , Wang N , Yan W M , Yuan J P , Chen J L , Wang H G
Published: February 2022

We investigate properties of the low emission mode in PSR B0329+54 based on four single-pulse observations at frequency centred at 1.54 GHz using Nanshan radio telescope in Urumqi. The low emission mode is characterized by an intensity drop in the central component below that of the other two components. Referred here as the low mode, it has an average duration of 3P0 and is observed in both abnormal and normal emission modes of the pulsar occupying 3.6 per cent of the observed pulses. We demonstrate that the properties of low modes are related to the two modes. We find that the integrated profile of low modes is unique to the two modes, and that low modes occur more frequently when the pulsar is in the normal mode. Analysis of the energy distribution for normal low modes suggests that the cause for the intensity drop in the central component is separated from the emission of the other two components. We demonstrate that the pulse emission characteristics in the normal emission mode shortly after a low-mode bears some similarities with the abnormal mode and gradually recovering to the original normal emission in about three pulsar periods. In addition, the occurrence rate for low modes in different normal modes is mostly consistent, which implies that the duration of low modes is related to a normal mode for this pulsar. Our results imply profile modes each corresponds to specific magnetospheric plama density in particular geometric configuration, and profile mode changing signifies distinct changes of both at different parts of the profile.
The nature of blindsight: implications for current theories of consciousness
Authors: Derrien Diane , Garric Clémentine , Sergent Claire , Chokron Sylvie
Published: February 2022

Blindsight regroups the different manifestations of preserved discriminatory visual capacities following the damage to the primary visual cortex. Blindsight types differentially impact objective and subjective perception, patients can report having no visual awareness whilst their behaviour suggests visual processing still occurs at some cortical level. This phenomenon hence presents a unique opportunity to study consciousness and perceptual consciousness, and for this reason, it has had an historical importance for the development of this field of research. From these studies, two main opposing models of the underlying mechanisms have been established: (a) blindsight is perception without consciousness or (b) blindsight is in fact degraded vision, two views that mirror more general theoretical options about whether unconscious cognition truly exists or whether it is only a degraded form of conscious processing. In this article, we want to re-examine this debate in the light of recent advances in the characterization of blindsight and associated phenomena. We first provide an in-depth definition of blindsight and its subtypes, mainly blindsight type I, blindsight type II and the more recently described blindsense. We emphasize the necessity of sensitive and robust methodology to uncover the dissociations between perception and awareness that can be observed in brain-damaged patients with visual field defects at different cognitive levels. We discuss these different profiles of dissociation in the light of both contending models. We propose that the different types of dissociations reveal a pattern of relationship between perception, awareness and metacognition that is actually richer than what is proposed by either of the existing models. Finally, we consider this in the framework of current theories of consciousness and touch on the implications the findings of blindsight have on these.
Meditation-Based Therapy for Chronic Low Back Pain Management: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Lin Ting-Han , Tam Ka-Wai , Yang Yu-Ling , Liou Tsan-Hon , Hsu Tzu-Herng , Rau Chi-Lun
Published: February 2022

Background

Chronic low back pain (CLBP) is among the most common types of pain in adults. Currently, injections and analgesic and nonsteroidal anti-inflammatory drugs are often provided for patients with CLBP. However, their effectiveness remains questionable, and the safest approach to CLBP remains debated. Meditation-based therapies constitute an alternative treatment with high potential for widespread availability. We evaluated the applicability of meditation-based therapies for CLBP management.

Methods

We performed a systematic review and meta-analysis of randomized controlled trials to evaluate the efficacy of meditation-based therapies for CLBP management. The primary outcomes were pain intensity, quality of life, and pain-related disability; the secondary outcomes were the experienced distress or anxiety and pain bothersomeness in the patients. The PubMed, Embase, and Cochrane databases were searched for studies published from the databases’ inception dates until July 2021, without language restrictions.

Results

We reviewed 12 randomized controlled trials with 1,153 patients. In 10 trials, meditation-based therapies significantly reduced the CLBP pain intensity compared with nonmeditation therapies (standardized mean difference [SMD] −0.27, 95% confidence interval [CI] = −0.43 to −0.12, P = 0.0006). In seven trials, meditation-based therapies also significantly reduced CLBP bothersomeness compared with nonmeditation therapies (SMD −0.21, 95% CI = −0.34 to −0.08, P = 0.002). In three trials, meditation-based therapies significantly improved patient quality of life compared with nonmeditation therapies (SMD 0.27, 95% CI = 0.17 to 0.37, P < 0.00001).

Conclusions

In conclusion, meditation-based therapies constitute a safe and effective alternative approach to CLBP management.
North Carolina Board of Nursing's Alternative Program COVID-19 Response
Authors: Bailey Alison T. , Griffith Sara A.
Published: February 2022

The North Carolina Board of Nursing (NCBON) implemented an alternative-to-discipline program (AP) in 1995 for nurses experiencing a substance use disorder. There have been programmatic changes since the inception of the AP. However, COVID-19 posed significant challenges related to balancing the NCBON's public protection mandate against COVID-19 impacts on the nurse's ability to comply with the AP conditions. The changes to the AP structure in response to COVID-19 included transition from in-person orientation interviews to virtual, drug screening process modifications, acceptance of virtual treatment and 12-step meeting attendance, and specific employment condition waiver accommodations. The NCBON identified modifications facilitated opportunities for nurses to remain compliant with the conditions of the AP while meeting the mandate of public protection.
Seven suggestions for successful SGLT2i use in glomerular disease - a standalone CKD therapy?
Authors: McQuarrie Emily P. , Gillis Keith A. , Mark Patrick B.
Published: February 2022

Purpose of review

Recent advances in the world of glomerular diseases have largely focussed on remission induction with immune modulating therapy. It is well recognised that even with the best available treatments, patients with glomerular diseases may have an increased risk of progressive renal and cardiovascular disease.

Recent findings

The arrival of large trials looking at the benefits of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in patients with chronic kidney disease (CKD) and diabetes or not has shifted the entire focus of current management and the shift needs to go further. This review summarises the background to these landmark trials and provides practical guidance for implementation of the results in a general nephrology clinic. In sub-group analyses of the Dapagliflozin and Prevention of Adverse Outcomes in Chronic Kidney Disease (DAPA-CKD) clinical trial, SGLT2i improved renal outcomes in patients with immunoglobulin A (IgA) nephropathy highlighting the potential for this drug class in glomerular disease. We also discuss where the gaps in evidence are and where future trials in glomerular diseases, be they primary or secondary, should be focussed.

The renal community has never before had evidence of this strength upon which to base recommendations for patients with CKD and we should be grasping it with both hands.
Point-of-Care Ultrasound-Guided Aspiration of the Hip Joint by an Emergency Medicine Physician
Authors: Berant Ron , Bder Moad , Kaufman-Shriqui Vered , Shahar-Nissan Keren
Published: February 2022

Objectives

Early administration of antibiotics is crucial to treating septic hip. This study aimed to describe the clinical course and outcomes of children with septic hip diagnosed using point-of-care ultrasound (POCUS)–guided hip aspirations performed by an emergency medicine physician.

Methods

A retrospective case series analysis.

Results

Between January 1, 2014, and December 31, 2019, 10 children with septic hip were diagnosed by emergency physicians using POCUS-guided hip aspirations. Six of them were female; the mean age was 4.2 ± 4.5 years, and the mean time from onset of symptoms to diagnosis was 2.9 ± 1.7 days. Seven patients (70%) had a history of fever. All the patients had elevated inflammatory blood markers (white blood cell count >12 K/μL, erythrocyte sedimentation rate >40 mm/h, or a C-reactive protein >2 mg/dL). The mean time from hospital arrival to the first antibiotic dose was 5.2 + 4.0 hours. All the children were discharged fully ambulatory and did not require rehospitalization or repeat aspiration after discharge.

Conclusions

This case series shows that POCUS-guided hip aspiration is both safe and feasible in diagnosing septic hip in the pediatric emergency department. The procedure enables rapid diagnosis and early initiation of antibiotic treatment, thus reducing the risk for complications related to delayed initiation of therapy.
A Review of the Diagnosis and Management of Acute Flaccid Myelitis in the Emergency Department
Authors: Daniels Danielle K. , Conners Gregory P.
Published: February 2022

Since 2014, biennial rises in acute flaccid myelitis (AFM) have brought attention to this rare but debilitating condition. Children with AFM typically present with acute onset, flaccid weakness accompanied by longitudinally extensive gray matter injury demonstrated on magnetic resonance imaging. A clearer understanding of the epidemiology and suspected pathogenesis of AFM may result in increased recognition. The purpose of this review article is to guide emergency physicians in recognizing key clinical features, initiating diagnostic evaluation and providing appropriate interventions for children with suspected AFM.
Arcade Suture Upper Blepharoplasty Combined With the Forceps Technique
Authors: Chuang Chih-Chao , Ma Hsu , Liao Wen-Chieh
Published: February 2022

Background

Double-eyelid blepharoplasty is the most popular cosmetic surgery in Taiwan. The creation of a small palpebral fold along with reduction of eyelid fullness makes the eye look slightly larger, thereby leading to an appearance of youthfulness, alertness, and vitality. Herein, we propose a method of combining the techniques of arcade buried suture and forceps, which is designed to create a more physiologically natural double eyelid.

Materials and Methods

We conducted a retrospective review of 45 patients who underwent double-eyelid surgery between December 2015 and December 2019. The procedures were performed by one senior surgeon using arcade suture upper blepharoplasty combined with the forceps technique. The patients' age ranged from 18 to 38 years (mean, 28 years). Ninety-one percent of the patients were women and were undergoing surgery for cosmetic reasons.

Results

Of the 45 patients who underwent arcade suture upper blepharoplasty with the forceps technique, no patients developed stitch abscess or granuloma, obvious asymmetry, disappearance of line, chemosis, and corneal injury. The follow-up period ranged from 3 months to 4 years (mean, 32 months). Patient satisfaction was very high.

Conclusions

The arcade suture upper blepharoplasty combined with the forceps technique is a simple method for establishing a durable double eyelid without serious complication and providing excellent results.
Prognostic Role of Subsequent Thrombocytopenia in Necrotizing Fasciitis Without Liver Disease
Authors: Chen Yu-Ching , Liou Yaw-Tzeng , Tsai Wei-Hsuan , Chen Lee-Wei
Published: February 2022

Background

Necrotizing fasciitis (NF) is a life-threatening disease with a fulminant presentation. Although early diagnosis can be aided by combining physical examination, the Laboratory Risk Indicator for Necrotizing Fasciitis score, and computed tomography, a mortality rate of 30% is still reported. In the modern times, an economical and efficient biomarker for predicting mortality in NF patients is still lacking. Platelet count is typically measured in routine blood tests and aids in predicting disease severity. We aimed to clarify the role of platelet count as a predictive factor for aspects of prognosis, such as mortality and surgical outcomes, in patients with NF.

Methods

We identified 285 patients with NF between 2018 and 2020 in a single medical center in southern Taiwan. Medical records were collected for the evaluation of patients with thrombocytopenia. Univariate and multivariate analyses were performed for different outcomes.

Results

We included 115 patients with confirmed diagnoses of NF. Twelve patients died with a mortality rate of 10.4%. Patients with thrombocytopenia exhibited a higher mortality rate (20.9% vs 4.2%, P = 0.006), more shock episodes (51.2% vs 11.1%, P < 0.001), higher intensive care unit admission rate (46.5% vs 13.9%, P < 0.001), and longer hospital length of stay (37.49 ± 24.12 days vs 28.82 ± 14.63 days, P = 0.037) than those without thrombocytopenia. All patients infected with Vibrio species exhibited thrombocytopenia. In multivariate analysis, independent risk factors for mortality were thrombocytopenia (odds ratio, 4.57; 95% confidence interval, 1.08–19.25) and single gram-negative bacterial culture from the wound (odds ratio 6.88; 95% confidence interval, 1.58–29.96).

Conclusions

In patients with NF and subsequent thrombocytopenia, a higher mortality rate, greater numbers of shock episodes, higher demand for intensive care unit, and longer hospital length of stay were observed than in those without thrombocytopenia. In patients with NF, platelet count is a valuable and economic indicator of prognosis. Once thrombocytopenia developed in patients with necrotizing fasciitis, aggressive antibiotic treatment and surgical management are required to improve the chances of recovery.
Perioperative Myocardial Infarction in Free Flap for Head and Neck Reconstruction
Authors: Sou Weng-Kit , Perng Cherng-Kang , Ma Hsu , Shih Yu-Chung
Published: February 2022

Introduction

Acute myocardial infarction (AMI) is a postoperative complication of major surgical procedures, including free flap surgery. It is the most common cause of postoperative morbidity and mortality. Moreover, patients receiving free flap reconstruction for the head and neck have significant risk factors such as coexisting coronary artery disease (CAD). Our primary aim was to ascertain predictors of perioperative AMI to enable early detection and consequently early treatment of perioperative AMI. Our secondary aim was to determine the group of patients who would be at a high risk for perioperative AMI after free flap surgery.

Materials and Methods

This retrospective study enrolled patients who underwent free flap reconstruction surgery at the Division of Plastic and Reconstructive Surgery of Taipei Veterans General Hospital between 2013-01 and 2017-12.

Results

This study included 444 patients and 481 free flap head and neck reconstruction surgeries. Fifteen (3.1%) patients were diagnosed with perioperative AMI. Statistical analysis of the variables revealed that patients with underlying CAD or cerebrovascular accident (CVA) were at a high risk of developing perioperative AMI (odds ratio: 6.89 and 11.11, respectively). The flap failure rate was also higher in patients with perioperative AMI compared with those without perioperative AMI (P = 0.015).

Conclusions

Patients with underlying diseases, such as CAD or CVA, constituted high-risk groups for perioperative AMI.
Kimura Disease of the Thigh Treated With Surgical Excision and Dupilumab
Authors: Huang Hsuan-Yu , Yang Chin-Yi , Yao Wen-Teng , Chen Yu-Fan , Yu Chia-Meng , Tung Kwang-Yi , Tsai Ming-Feng
Published: February 2022

Kimura disease (KD) is a rare, chronic inflammatory disorder presenting with solitary or multiple masses. Treatment options include surgical excision, corticosteroids, and radiotherapy; however, optimal therapy remains to be established. Moreover, efficacy of a humanized monoclonal antibody, dupilumab (Dupixent), requires to be demonstrated. Here, we present a 36-year-old male patient with an enlarging mass in the left medial thigh and chronic eczema over the abdomen and lower legs. Kimura disease was diagnosed after surgical excision. Postoperative treatment with dupilumab was applied with an initial dose of 600 mg followed by 300 mg every 2 weeks for 8 months. No recurrence of KD was observed in the 1-year follow-up. The eczematous lesions improved greatly. To our knowledge, this is the first report of using dupilumab for treating KD.
A Monte Carlo based approach to the resource assessment of Jamaica's geothermal energy potential
Authors: Koon Koon Randy , Lewis Santana , Mohammed-Koon Koon Khatiza , Chen A. Anthony , Shah Kalim U.
Published: February 2022

The Eastern Caribbean chain of islands is commonly known to exhibit high-enthalpy systems for geothermal energy exploitation. The northernmost Caribbean Community member state of Jamaica possesses physical manifestations of 12 hot springs across the island. Previous investigations indicate that of the potential 12 hot springs, Bath, Windsor and Milk River springs have cogent geothermometry of their thermal fluids with estimated temperature ranges of (80–102°C), (128–156°C), and (158–206°C), respectively. The paper provides numerical findings for each geothermal system of interest and performs Monte Carlo simulations to optimize calculated findings. The determined quantitative findings are considered under the context of environmental savings and policy regime conditions for driving geothermal energy development. The three areas of interest are situated within the Rio Minho Basin, the Dry Harbour Mountains and the Blue Mountain South Basin. Through the consideration of a 25-year lifetime for production, a collective total of 94.81 MWe of geothermal power reserves can be absorbed into the national energy mix, displacing an estimated 0.38 million barrels of oil imports, resulting in approximately 0.44 million tonnes of carbon dioxide emissions being avoided per year.

This article is part of the theme issue ‘Developing resilient energy systems’.
Scientific advice for policymakers on climate change: the role of evidence synthesis
Authors: Surkovic Elizabeth , Vigar David
Published: February 2022

Science has a role to play in providing the evidence on both climate change and the solutions to it. In this paper, we look at the nature of expert advice to public policymakers and examine one approach to the synthesis of scientific evidence. We focus on a series of briefings for policymakers that summarize evidence from 12 areas of science and technology which are keys to accelerating progress towards net zero greenhouse gas emissions and resilience to climate change.

This article is part of the theme issue ‘Developing resilient energy systems’.
Two cases of Leclercia adecarboxylata septic arthritis in immunocompetent paediatric patients
Authors: Arasu Ramesh , Ewe Yean Hsiang , Sundaram Abavasankar , Foley David Anthony , Campbell Anita Jane , Fletcher Timothy Robin William , Palasanthiran Pamela , Suzuki Arnold
Published: February 2022

Leclercia adecarboxylata

is a rare cause of septic arthritis in children, and has intrinsic resistance to common antibiotics. We describe two cases of

L. adecarboxylata

septic arthritis in children that required re-presentation to hospital with prolonged treatment, and highlight the importance of considering

L. adecarboxylata

as a potential cause of infection among children with penetrating injuries and associated environmental exposure.
Tremella ananatis sp. nov. and Tremella lamprococci sp. nov., two yeast species associated with bromeliads
Authors: Navarro Hector M. C. , Félix Ciro Ramon , Tavares Victor D. F. S. , de Sousa Francisca M. P. , Santos Ana R. O. , Morais Paula B. , Rosa Carlos A. , Valente Patricia , Landell Melissa Fontes
Published: February 2022

Eight yeast isolates with an affinity to the genus Tremella were obtained from bromeliads from different locations in Brazil. Although the formation of basidia and basidiocarp were not observed, on the basis of the results of sequence analysis of the D1/D2 domain of the large subunit (LSU) rRNA gene and internal transcribed spacer (ITS) region, we suggest that these isolates represent two novel species of the genus Tremella. These yeasts are phylogenetically related to Tremella saccharicola and Tremella globispora. Therefore, we propose Tremella ananatis sp. nov. and Tremella lamprococci sp. nov. as novel yeast species of the order Tremellales (Agaricomycotina, Basidiomycota). Sequence analysis revealed that Tremella ananatis sp. nov. differs by 11 and 28 nucleotide substitutions from Tremella saccharicola in the D1/D2 sequence and ITS region, respectively. Moreover, Tremella lamprococci sp. nov. differs by 15 and 29 nucleotide substitutions from Tremella globispora in the D1/D2 sequence and ITS region, respectively. The holotypes of Tremella ananatis sp. nov. and Tremella lamprococci sp. nov. are CBS 14568T and CBS 14567T, and the MycoBank numbers are MB840480 and MB840481, respectively.
First identification of bla
NDM-5 producing Escherichia coli from neonates and a HIV infected adult in Tanzania
Authors: Manyahi Joel , Moyo Sabrina J. , Kibwana Upendo , Goodman Richard N. , Allman Ellie , Hubbard Alasdair T. M. , Blomberg Bjørn , Langeland Nina , Roberts Adam P.
Published: February 2022

Introduction. Carbapenem-resistant members of the family Enterobacteriaceae are emerging as a global public-health threat and cause substantial challenges in clinical practice.

Gap Statement. There is a need for increased and continued genomic surveillance of antimicrobial resistance genes globally in order to detect outbreaks and dissemination of clinically important resistance genes and their associated mobile genetic elements in human pathogens.

Aim. To describe the resistance mechanisms of carbapenem-resistant

Escherichia coli

.

Methods. Rectal swabs from neonates and newly diagnosed human immunodeficiency virus (HIV) infected adults were collected between April 2017 and May 2018 and screened for faecal carriage of carbapenamases and OXA-48 producing members of the family Enterobacteriaceae. Bacterial isolates were identified using matrix assisted laser desorption ionization time of flight mass spectrometry. Antimicrobial susceptibility testing was performed by E-test. Whole genomes of carbapenem-resistant

E. coli

were investigated using a hybrid assembly of Illumina and Oxford Nanopore Technologies sequencing reads.

Results. Three carbapenem-resistant

E. coli

were detected, two from neonates and one from an HIV infected adult. All three isolates carried bla
NDM-5. Two

E. coli

from neonates belonged to ST167 and bla
NDM-5 co-existed with bla
CTX-M-15 and bla
OXA-01, and all were carried on IncFIA type plasmids. The

E. coli

from the HIV infected adult belonged to ST2083, and carried bla
NDM-5 on an IncX3 type plasmid and bla
CMY-42 on an IncI type plasmid. All bla
NDM-5 carrying plasmids contained conjugation related genes. In addition,

E. coli

from the HIV infected adult carried three more plasmid types; IncFIA, IncFIB and Col(BS512). One

E. coli

from a neonate also carried one extra plasmid Col(BS512). All three

E. coli

harboured resistance genes to fluoroquinolone, aminoglycosides, sulfamethoxazole, trimethoprim, macrolides and tetracycline, carried on the IncFIA type plasmid. Furthermore,

E. coli

from the neonates carried a chloramphenicol resistance gene (catB3), also on the IncFIA plasmid. All three isolates were susceptible to colistin.

Conclusion. This is the first report, to our knowledge, from Tanzania detecting bla
NDM-5 producing E. coli. The carbapenemase gene was carried on an IncFIA and IncX3 type plasmids. Our findings highlight the urgent need for a robust antimicrobial resistance (AMR) surveillance system to monitor and rapidly report on the incidence and spread of emerging resistant bacteria in Tanzania.
Deep Augmentation for Electrode Shift Compensation in Transient High-density sEMG: Towards Application in Neurorobotics
Authors: Sun Tianyun , Libby Jacqueline , Rizzo JohnRoss , Atashzar S. Farokh
Published: February 2022

Going beyond the traditional sparse multichannel peripheral human-machine interface that has been used widely in neurorobotics, high-density surface electromyography (HD-sEMG) has shown significant potential for decoding upper-limb motor control. We have recently proposed heterogeneous temporal dilation of LSTM in a deep neural network architecture for a large number of gestures (>60), securing spatial resolution and fast convergence. However, several fundamental questions remain unanswered. One problem targeted explicitly in this paper is the issue of “electrode shift,” which can happen specifically for high-density systems and during doffing and donning the sensor grid. Another real-world problem is the question of transient versus plateau classification, which connects to the temporal resolution of neural interfaces and seamless control. In this paper, for the first time, we implement gesture prediction on the transient phase of HD-sEMG data while robustifying the human-machine interface decoder to electrode shift. For this, we propose the concept of deep data augmentation for transient HD-sEMG. We show that without using the proposed augmentation, a slight shift of 10mm may drop the decoder’s performance to as low as 20%. Combining the proposed data augmentation with a 3D Convolutional Neural Network (CNN), we recovered the performance to 84.6% while securing a high spatiotemporal resolution, robustifying to the electrode shift, and getting closer to large-scale adoption by the end-users, enhancing resiliency.
Temporally extended and reversible neuronal silencing with Aion
Authors: Rodriguez-Rozada Silvia , Wietek Jonas , Tenedini Federico , Sauter Kathrin , Hegemann Peter , Soba Peter , Wiegert J. Simon
Published: February 2022

Optogenetic silencing allows to reveal the necessity of selected neuronal populations for various neurophysiological functions ranging from specific behaviors to neuronal network activity. An ideal optogenetic silencing tool should be switchable between active and inactive states with precise timing while preserving its activity in the absence of light until switched to an inactive state. Although bistable anion-conducting channelrhodopsins (ACRs) were previously engineered to reach this goal, their conducting state life time was limited to only a few minutes and some ACRs were not fully switchable. Here we report Aion, a bistable ACR displaying a long-lasting open state with a spontaneous closing time constant close to 15 min. Moreover, Aion can be switched between the open and closed state with millisecond precision using blue and orange light, respectively. The long conducting state enables overnight silencing of neurons with minimal light exposure. We further generated trafficking-optimized versions of Aion, which show enhanced membrane localization and allow precisely timed, long-lasting all-optical control of nociceptive responses in larvae of Drosophila melanogaster.
Molecular and mineral responses of corals grown under artificial Calcite Sea conditions
Authors: Conci Nicola , Griesshaber Erika , Rivera-Vicéns Ramón E. , Schmahl Wolfgang W. , Vargas Sergio , Wörheide Gert
Published: February 2022

The formation of skeletal structures composed of different calcium carbonate polymorphs (aragonite and calcite) appears to be regulated both biologically and environmentally. Among environmental factors influencing aragonite and calcite precipitation, changes in seawater conditions – primarily in the molar ratio of magnesium and calcium during so-called “Calcite” (mMg:mCa below 2) or “Aragonite” seas (mMg:mCa above 2) – have had profound impacts on the distribution and performance of marine calcifiers throughout the Earth’s history. Nonetheless, the fossil record shows that some species appear to have counteracted such changes and kept their skeleton polymorph unaltered. Here, the aragonitic octocoralHeliopora coeruleaand the aragonitic scleractinianMontipora digitatawere exposed to Calcite Sea-likemMg:mCa with various levels of changes in magnesium and calcium concentration, and both mineralogical (i.e., CaCO3polymorph) and gene expression changes were monitored. Both species maintained aragonite deposition at lowermMg:mCa ratios, while concurrent calcite presence was only detected inM. digitata. Despite a strong variability between independent experimental replicates for both species, the expression for a set of putative calcification-related genes, including known components of scleractinian skeleton organic matrix, was found to consistently change at lowermMg:mCa. These results support previously proposed involvements of the skeleton organic matrix in counteracting decreases in seawatermMg:mCa. Although no consistent changes in expression for calcium and magnesium transporters were observed, down-regulation calcium channels inH. coeruleain one experimental replicate and at anmMg:mCa of 2.5 might indicate the possibility of active calcium uptake regulation by the corals under alteredmMg:mCa.