bluuebunny/crossref_metadata_2025 huggingface dataset:
Interrupted versus continuous suture for bronchial anastomosis in lung transplantation: does it matter?
Authors: Gil Barturen Mariana , Campo-Cañaveral de la Cruz Jose Luis , Crowley Carrasco Silvana , Romero Román Alejandra , Hoyos Mejía Lucas , Peyró María , Díaz Nuevo Gema , López García-Gallo Cristina , Pérez Redondo Marina , Royuela Vicente Ana , Tanaka Shin , Naranjo Gómez Jose Manuel , Córdoba Peláez Mar , Varela de Ugarte Andrés , Gómez de Antonio David
Published: October 2022

OBJECTIVES

Bronchial anastomotic complications remain a major concern in lung transplantation. We aim to compare 2 different techniques, continuous suture (CS) versus interrupted suture (IS) by analysing airway complications requiring intervention.

METHODS

Lung transplantations between January 2015 and December 2020 were included. Airway complications requiring intervention were classified following the 2018 International Society for Heart and Lung Transplantation consensus and analysed comparing 3 groups of patients according to surgical technique: group A, both anastomosis performed with CS; group B, both with interrupted; and group C, IS for 1 side and CS for the contralateral side.

RESULTS

A total of 461 anastomoses were performed in 245 patients. The incidence of airway complications requiring intervention was 5.7% [95% confidence interval (CI): 2.8–8.6] per patient (14/245) and 3.7% (95% CI: 2.0–5.4) per anastomosis (17/461). Complications that required intervention were present in 5 out of 164 (3.1%) anastomosis with interrupted technique, and in 12/240 (5%) with CS. No significant differences were found between techniques (P = 0.184). No statistical differences were found among group A, B or C in terms of incidence of anastomotic complications, demographics, transplant outcomes or overall survival (log-rank P = 0.513). In a multivariable analysis, right laterality was significantly associated to complications requiring intervention (OR 3.7 [95% CI: 1.1–12.3], P = 0.030). Endoscopic treatment was successful in 12 patients (85.7%). Retransplantation was necessary in 2 patients.

CONCLUSIONS

In summary, although it seems that anastomotic complications requiring intervention occur more frequently with CS, there are no statistical differences compared to IS. Endoscopic treatment offers good outcomes in most of the airway complications after lung transplantation.
Mixture optimization of synthesized zeolites 4A and 13X for solar adsorption refrigeration application
Authors: Sowunmi A R , Anafi F O , Ajayi O A , Omisanya N O , Obada D O , Oyedeji A N , Salami K A
Published: October 2022

In a way to overcome challenges with global warming, the use of fossil fuels in producing environmentally friendly energy towards reducing the ozone layer depletion and greenhouse gas emissions by participating countries is of interest. The adsorption refrigeration system has the advantages of a long lifespan and its environmental friendliness; however, its major disadvantage is the low coefficient of performance, which is a function of adsorbent–adsorbate, with zeolite–water as the most common adsorbent–adsorbate working pair. Zeolites 4A and 13X are the most used zeolite classes due to their higher selectivity for separating mixtures of CO2/N2 and CO2/CH4/N2 and their high-water adsorption capability, respectively. In this study, for the first time, the synthesis of zeolites 4A and 13X from natural sources (Kankara kaolin) and the mixture optimization for solar adsorption refrigeration application were considered. Raw Kankara kaolin, beneficiated Kankara kaolin, calcined Kankara kaolin and synthesized zeolites 4A and 13X were characterized using X-ray fluorescence, while the synthesized zeolites 4A and 13X were characterized using X-ray diffraction. Using the mixture simplex lattice design of experiment, mixtures of zeolites 4A and 13X were developed and characterized using Brunauer, Emmett and Teller analysis to obtain their pore size, specific surface area and pore volume. The statistical analysis produced the mathematical models of the response that were significant for pore size and specific surface area. The analysis proposed an optimal solution of 75 wt% zeolite 4A and 25 wt% zeolite 13X, which gave a desirability of 0.944.
The logic of conditionals on outback trails
Authors: van Benthem Johan
Published: October 2022

Conditional statements are ubiquitous, from promises and threats to reasoning and decision making. By now, logicians have studied them from many different angles, both semantic and proof-theoretic. This paper suggests two more perspectives on the meaning of conditionals, one dynamic and one geometric, that may throw yet more light on a familiar and yet in some ways surprisingly elusive and many-faceted notion.1
Photosynthetic decline in aging perennial grass is not fully explained by leaf nitrogen
Authors: Tejera Mauricio , Boersma Nicholas N , Archontoulis Sotirios V , Miguez Fernando E , VanLoocke Andy , Heaton Emily A
Published: October 2022

Aging in perennial plants is traditionally observed in terms of changes in end-of-season biomass; however, the driving phenological and physiological changes are poorly understood. We found that 3-year-old (mature) stands of the perennial grass Miscanthus×giganteus had 19–30% lower Anet than 1-year-old M.×giganteus (juvenile) stands; 10–34% lower maximum carboxylation rates of Rubisco and 34% lower light-saturated Anet (Asat). These changes could be related to nitrogen (N) limitations, as mature plants were larger and had 14–34% lower leaf N on an area basis (Na) than juveniles. However, N fertilization restored Na to juvenile levels but compensated only 50% of the observed decline in leaf photosynthesis with age. Comparison of leaf photosynthesis per unit of leaf N (PNUE) showed that mature stands had at least 26% lower PNUE than juvenile stands across all N fertilization rates, suggesting that other factors, besides N, may be limiting photosynthesis in mature stands. We hypothesize that sink limitations in mature stands could be causing feedback inhibition of photosynthesis which is associated with the age-related decline in photosynthesis.
Introduction
Authors: Yeager Jonathan
Published: October 2022

As the introduction of this Oxford Handbook explain, evangelicalism is complicated. Evangelicals are not simply white American Protestant Christians who support the Republican Party. Instead, evangelicals are part of a multifaceted movement that has a rich history stemming from the seventeenth and eighteenth centuries. Evangelicals are Christians who emphasize the authority of the Bible, stress the need for a personal relationship with God, believe in Jesus Christ as the Son of God, whose death allowed individuals to partake in eternal salvation, and who support missionary endeavors to share this good news. Despite sharing these common traits, evangelicals often disagree on other theological matters, vary in church polity, and are not limited to one gender or race.
Puritan Legacy
Authors: Hall David D.
Published: October 2022

The seventeenth-century Puritan movement made significant contributions to eighteenth-century Protestant evangelicalism, but evangelicals also abandoned several priorities or principles of the movement. The most significant legacy was an “affective” or “experimental” (in the sense of experienced) understanding of faith, one rooted in the “heart” or inner self, not a matter of outward duties. These, too, mattered, for the Puritan movement endorsed a wide-reaching “reformation of manners” that evangelicals in the next century also endorsed. Theological method, the historic creeds of British “Calvinism,” the nature of the visible church, infant baptism, toleration or close ties between church and state—these also became points of contrast and connection.
Revivalism
Authors: Kidd Thomas S. , Gutacker Paul
Published: October 2022

This chapter analyzes revivalism as a set of beliefs and practices that undergirded the transatlantic evangelical movement. From the 1740s onward, revivalism grew out of the religious awakenings across the North Atlantic world, dramatic events which early evangelicals narrated as extraordinary works of God. The chapter traces the antecedents, development, and legacies of these revivals and maps the ways in which they were interpreted and theorized by evangelicals. It then describes the beliefs that revivalism entailed, which grew from evangelical readings of scripture, history, and current events, as well as the practices that comprised revivals, including outdoor gatherings, small group meetings, prayer services, hymn-singing, and extemporaneous sermons. Moderate and radical evangelicals differed in their approaches to revival, especially in regard to what means were appropriate and the extent to which revivals fit within or undermined the established order. Yet, until the early nineteenth century, evangelicals generally agreed on the basics of revival: the importance of prayer, the centrality of itinerant preaching, and the need to participate in the work of the Holy Spirit converting others to saving faith. The chapter concludes with a discussion of later developments in revivalism, with particular attention to nineteenth-century preacher Charles Finney, whose emphasis on technique and confidence in human capability departed from the more modest approaches of eighteenth-century revivalists.
Politics
Authors: Dreisbach Daniel L.
Published: October 2022

Protestant evangelicals were engaged in almost every political debate and controversy in the early republic regarding religion’s prudential and constitutional role in American civic life. Their political activity was motivated in large part by a belief that religion and attendant civic virtue were essential to the success of the American political experiment in republican self-government and by a fear that infidels and deists were seeking to diminish traditional Christianity’s public role and influence. A series of developments in the early republic fed these fears, including the election of President Thomas Jefferson (a purported friend of the French Revolution and advocate for church–state separation), federal legislation authorizing Sunday postal services, and a growing movement toward disestablishment in the states. Many evangelicals believed that Christianity was under assault and that they were facing an existential threat in a new secular order. In response, some religious traditionalists looked to politics to counter the perceived rise of infidelity and secularism, initiating an anti-Sunday mail campaign and proposing a Christian party. Evangelicals, however, were not a monolithic political force. They were represented on all sides of the political controversies that engaged them. This suggests that evangelicals were wrestling with the appropriate role of religion in the American constitutional regime and the propriety of their involvement in politics.
Missions
Authors: Hartley Benjamin L.
Published: October 2022

This chapter examines eighteenth-century evangelical missions as they developed in India, the Caribbean, and South Africa. Early Evangelical missionaries were involved in many other geographical contexts, but these locations were among the most formative for the future trajectory of the movement. The political contexts and evangelical mission theories and practices in these places highlight the transcontinental connections and relationships among missionaries as well as Indigenous leaders of evangelical efforts. Pietist, Moravian, Methodist, Baptist, and independent evangelical mission illustrate the diversity of early evangelical institutions, perspectives, and practices. The institutions, churches, and movements these groups established in the early years of evangelical movement profoundly influenced subsequent generations of Indigenous Christian practices around the world.
Association of socio-demographic characteristics with alcohol use initiation among never users during the COVID-19 pandemic: a longitudinal study
Authors: Sharma Pravesh , Nguyen Quang Anh , Kurani Shaheen , Holland Ashley , Maradit Kremers Hilal , Pazdernik Vanessa , St. Sauver Jennifer , Croarkin Paul , Kamath Celia , Geske Jennifer , Prasad Kavita , Glasgow Amy , Sangaralingham Lindsey , Patten Christi
Published: October 2022

Background

In this longitudinal cohort study, we examined the socio-demographic and psychological predictors of alcohol use initiation during the COVID-19 pandemic in a sample of never alcohol users aged ≥21 prior to COVID-19.

Methods

Our study population consisted of 56 930 patients aged ≥21, as of 30 March 2019 were collected from a pre-COVID period of 1 year before 31 March 2020, and during-COVID, a period between 1 April 2020 and 30 March 2021. Univariable and multivariable logistic regression models were utilized to examine the roles of socio-demographic variables (gender, age, education, Area Deprivation Index and rural residence) changes in anxiety and depression severity as predictors of alcohol use initiation.

Results

Age, gender, race, ethnicity, education and rural status were significant predictors in multivariable analysis. A subgroup analysis showed neither anxiety nor depression had a significant association with alcohol use initiation.

Conclusion

Women, younger individuals, those living in a rural area and people who smoke cigarettes were more likely to initiate alcohol use during the pandemic. Our study has public health and clinical implications such as the need for targeted alcohol use screening and intervention for vulnerable individuals.
Evaluation of the performance of Ca-deficient hydroxyapatite (CDHA)/MgF2 bilayer coating on biodegradable high-purity magnesium in a femoral condyle defect model in rabbits
Authors: Huang Shibo , Li Junlei , Qin Kairong , Wang Zhiqiang , Yang Jiahui , Cao Fang , Li Weirong , Liu Yupeng , Liu Lipeng , Zhao Dewei
Published: October 2022

The two most critical factors in promoting the clinical translation of magnesium (Mg) are reducing its degradation rate and improving its osteogenesis. In this study, a Ca-deficient hydroxyapatite (CDHA)/MgF2 bilayer coating was prepared on high-purity magnesium (HP Mg) rods by fluorination and hydrothermal treatment. Scanning electron microscope showed that the thickness of the bilayer coating was 3.78 μm and that the surface morphology was nanoscale. In an in vivo experiment on femoral condyle defects in rabbits, the serum magnesium ion levels of rabbits were always in the normal range after surgery, and the liver and kidney functions were not abnormal, which indicated that the CDHA/MgF2 bilayer coating has good biosafety. Micro-CT showed that the CDHA/MgF2 bilayer coating significantly reduced the degradation rate of the HP Mg rods and enhanced the promotion of bone formation. Hard tissue sections showed that the CDHA/MgF2 bilayer coating gave the bone tissue a tight contact interface with the HP Mg rod and improved the bone mass. Immunohistochemistry showed that the expression of vascular endothelial growth factor and BMP-2 was more obvious. These results confirm that the CDHA/MgF2 bilayer coating can improve the properties of HP Mg and provide a basis for the further transformation of HP Mg in the future. It also provides a new reference for the surface modification of magnesium metal.
Effect of micro/nano-sheet array structures on the osteo-immunomodulation of macrophages
Authors: Zheng Xinhui , Chen Lan , Tan Ji , Miao Jianhua , Liu Xuanyong , Yang Tieyi , Ding Zhihong
Published: October 2022

The immune response induced by surface topography crucially determines the implant success. However, how the immune response is mediated by the size of surface topography remains unclear. Hence, various biocompatible Mg-Al layered double hydroxides sheet-array films with different sizes (nano, micro and nano/micro mixture) were constructed on the biomedical titanium, and their osteo-immunomodulation effects on the macrophages were explored. The nano-sheet array structures significantly promoted the polarization of M2 macrophages by activating the PI3K-AKT-mTOR signaling pathway with high gene expressions of integrin β2 and FAK. While the micro-sheet array structures enhanced osteogenic differentiation of mouse bone marrow mesenchymal stem cells (mBMSCs) via ROCK-YAP/TAZ-mediated mechanotransduction. Moreover, the nano-sheet array structures promoted the osteogenic differentiation of mBMSCs with a high proportion of M2 macrophages through a shared medium. This study gave further information concerning integrin-induced focal adhesions in cells of different sheet array structures and their role in macrophage polarization and osteogenic differentiation of mBMSCs, which might help to design biomaterial surfaces with optimal geometry for a desired immunemodulation.
Elimination of punitive outcomes and criminalization of medical errors
Authors: Rocco Cristian , Rodríguez Ana María , Noya Beatriz
Published: October 2022

Purpose of review

The penalization of error in the health field continues to be one of the main barriers in the notification, analysis and proposals for measures to improve adverse events. Strategies should be established in order to develop a nonpunitive culture with the sole purpose of learning from mistakes and improving patient safety.

Recent findings

Strategies are established for the development of a nonpunitive culture, such as promoting confidentiality and data protection in the notification and analysis of adverse events.

Despite education, improvements in quality and safety in healthcare, mistakes will undoubtedly occur. The creation of a protected, blame-free environment that promotes systematic reporting of adverse events will provide valuable information for preventive work and the desired improvement in patient and health team safety.
The Effects of Demographic, Training, and Specialization Differences of Physicians in Coronavirus Disease 19 Treatment in Turkey
Authors: Özbilen Muhammet , Bostan Sedat , Kaya Ahmet , Kaya Yasemin , Kurt Celali
Published: October 2022

Introduction:

The study aimed to determine how physicians’ professional and institutional characteristics affect their treatment approaches for COVID-19 antiviral and supportive treatment, as well as their demographic characteristics and participation in COVID-19 trainings that may influence these orientations.

Methods:

After researching the literature and conducting interviews with the experts, a questionnaire was prepared. The convenience sampling method was used to distribute the questionnaire online to 408 physicians across the nation in January 2021. Exploratory factor analysis was used to verify the research scale, and the Cronbach’s Alpha test was used to confirm its reliability. During the data analysis, descriptive and inferential statistical tests were used.

Results:

It was observed that the physicians were willing to give COVID-19 patients the antivirals but hesitant to provide and suggest supportive care. The training status for COVID-19 treatment was varied. Female physicians prescribed more antiviral drugs than male physicians, received more training, and scored higher across the scale than male physicians (p = 0.001). The treatment approaches of physicians varied according to their specializations (p = 0.002) all over the scale.

Discussion:

The publication of current Ministry of Health guidelines on a variety of themes related to COVID-19 treatment, as seen in Turkey, is both beneficial and important. However, because all physicians, regardless of specialty, are affected by current and will be in the future pandemics, it is necessary to design and maintain a continuous training program on pandemics and their management for all physicians.
Menopause influences aortic pulse pressure and pressure wave responses to metaboreflex activation in women
Authors: Kang Yejin , Maharaj Arun , Dillon Katherine N. , Fischer Stephen M. , Figueroa Arturo
Published: October 2022

Objective

Postmenopausal women (post-MW) have greater risk of heart failure due to aortic pulsatile overload on the left ventricle associated with increased backward wave pressure (Pb). Post-MW have exaggerated peripheral blood pressure (BP) response to exercise mediated by metaboreflex (postexercise muscle ischemia [PEMI]) overactivation. Increased forward wave pressure (Pf) and Pb are determinants of aortic pulse pressure (PP) during isometric handgrip exercis (IHG) in young adults. We hypothesized that aortic PP and pressure wave responses to PEMI are augmented in nonhypertensive post-MW compared with premenopausal women (pre-MW).

Methods

Aortic BP, Pf, Pb, and reflection magnitude were assessed at rest and during IHG and PEMI by applanation tonometry in 15 pre-MW and 16 post-MW.

Results

Aortic systolic BP during PEMI similarly increased in both groups. The increase in diastolic BP was lower in post-MW (post-MW Δ6 ± 2 vs pre-MW Δ11 ± 2 mm Hg, P < 0.05). Aortic PP (post-MW Δ8 ± 2 vs pre-MW Δ3 ± 2), Pf (post-MW Δ6 ± 1 vs pre-MW Δ0 ± 1), and Pb (post-MW Δ5 ± 1 vs pre-MW Δ2 ± 1) augmented during PEMI in post-MW (P < 0.05 for all), but not in pre-MW. Reflection magnitude increased during PEMI only in pre-MW (pre-MW Δ7 ± 2 vs post-MW Δ-1 ± 2, P < 0.05) due to concurrent increases in Pf and Pb in post-MW.

Conclusions

Even in nonhypertensive postmenopausal women, increases in Pf and Pb and decrease in aortic DBP are important factors that contribute to the augmented aortic PP response to PEMI.
Chinese herbal medicine and COVID-19: quality evaluation of clinical guidelines and expert consensus and analysis of key recommendations
Authors: Zheng Qingyong , Gao Ya , Xiong Lu , Huang Hengyi , Li Junfen , OuYang Guoyuan , Saimire Wulayin , Yang Jingjing , Zhang Yu , Wang Xiaopeng , Luo Xiaofeng
Published: October 2022

Objective:

To systematically review the clinical practice guidelines (CPGs) for the treatment of patients with coronavirus disease 2019 (COVID-19) using Chinese herbal medicine (CHM), assess the methodological quality as well as clinical credibility and implementability of specific recommendations, and summarize key recommendations.

Methods:

As of April 2022, we conducted a comprehensive search on major electronic databases, guideline websites, academic society websites, and government websites to assess the methodological quality and clinical applicability of the included CPGs using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool and Evaluation-Recommendations EXcellence (AGREE-REX) instructions, respectively.

Results:

The search yielded 61 CPGs, which were mostly published in 2020; moreover, 98.4% of the CPGs were published in China. Only five CPGs achieved a high-quality AGREE II rating; further, six CPGs could be directly recommended, with most of the CPGs still showing much room for improvement. CPGs had a low overall score in the AGREE-REX evaluation, with the domains of clinical applicability, values and preferences, and implementability being standardized in 21.80% ± 12.56%, 16.00% ± 11.81%, and 31.33% ± 14.55% of the CPGs, respectively. Five high-quality CPGs mentioned 56 Chinese herbal formulas. Half of the recommendations had moderate or strong evidence level in the GRADE evaluation. The most frequently recommended herbal medicines were Lianhua Qingwen granule/capsule and Jinhua Qinggan granule; however, the strength of recommendation for each prescription varied across CPGs and populations.

Conclusions:

The overall quality of current CPGs for COVID-19 for CHM still needs to be improved; moreover, the strength of the evidence remains to be standardized across CPGs.

Graphical abstract:

http://links.lww.com/AHM/A34.
Effect of ultramarathon running on iron metabolism
Authors: Li Li-Hua , Hou Sen-Kuang , Chen Chung-Ting , Chang Yuan-I , Kao Wei-Fong , Chiu Yu-Hui , Juan Chi-Chang , How Chorng-Kuang
Published: October 2022

Background:

Iron is a vital trace element for energy production and oxygen transportation; importantly, it is essential to athletic performance. Maintaining iron balance is tightly controlled at systemic and cellular levels. This study aimed to determine serum iron tests, hepcidin levels, and cellular iron import and export activities in peripheral blood mononuclear cells (PBMCs) in ultramarathon runners to elucidate the association of systemic inflammation response and iron metabolism.

Methods:

Sixteen amateur runners were enrolled. Blood samples were taken 1 week before, immediately, and 24 h after the run. Plasma hepcidin levels were measured by enzyme-linked immunosorbent assay. The expression levels of divalent metal iron transporter 1 (DMT1), ZRT/IRT-like protein 14 (ZIP14), transferrin receptor 1 (TfR1), and ferroportin (FPN) in PBMCs were measured using real-time quantitative reverse transcription-polymerase chain reaction.

Results:

Serum iron concentrations and transferrin saturation significantly decreased immediately after the race and dramatically recovered 24 h post-race. Serum ferritin levels had a statistically significant rise immediately after the race and remained high 24 h after the completion of the race. Ultramarathons were associated with increased plasma interleukin-6 concentrations corresponding to the state of severe systemic inflammation and therefore boosted plasma hepcidin levels. The expression levels of DMT1 and FPN mRNA were markedly decreased immediately and 24 h after the race. The ZIP14 and TfR1 mRNA expression in PBMCs significantly decreased immediately after the race and returned to the baseline level at 24 h post-race. Positive significant correlations were observed between plasma hepcidin and ferritin levels.

Conclusion:

Iron homeostasis and systemic inflammatory response are closely interconnected. Cellular iron import and export mRNA activities in PBMCs were acutely inhibited during an ultramarathon.
Using Personal Activity Intelligence With Patients in a Clinic Setting
Authors: Bean Glenn , Shaheen Sabrina , Lang Gregory R. , Kozu Pam , Boespflug Julie , Krishnan Uma
Published: October 2022

Background

Personal Activity Intelligence (PAI) is a novel heart-rate–based metric used to assess cardiorespiratory fitness and quantify physical activity.

Objective

The aim of this study was to examine the feasibility, acceptability, and effectiveness of PAI with patients in a clinic setting.

Methods

Patients (n = 25) from 2 clinics underwent 12 weeks of heart-rate–monitored physical activity interfaced with aPAI Health phone app. We used a pre-post design with the Physical Activity Vital Sign and the International Physical Activity Questionnaire. Feasibility, acceptability, and PAI measures were used to evaluate the objectives.

Results

Twenty-two patients (88%) completed the study. There were significant improvements in International Physical Activity Questionnaire metabolic equivalent task minutes per week (P = .046) and a decrease in sitting hours (P = .0001). The Physical Activity Vital Sign activity increase in minutes per week was not significant (P = .214). Patients achieved a mean PAI score of 116 ± 81.1 and 100 or greater 71% of the days. Most patients (81%) expressed satisfaction with PAI.

Conclusions

Personal Activity Intelligence is feasible, acceptable, and effective when used with patients in a clinic setting.
Factors Associated With Additional Clinic Visits in the Treatment of Sports-Related Concussion
Authors: Hou Brian Q. , Yengo-Kahn Aaron M. , Hajdu Katherine , Tang Alan R. , Grusky Alan Z. , Zuckerman Scott L. , Terry Douglas P.
Published: October 2022

Objective:

To evaluate the variables associated with additional concussion clinic visits before discharge to athletic trainer (AT).

Design:

Retrospective cohort study.

Setting:

Multidisciplinary Sports Concussion Center.

Patients:

Patients ages 12 to 23 years presenting with a sport-related concussion between January 11, 2017, and January 10, 2020, and were discharged to an AT.

Methodology:

Our main outcome variable was being discharged to AT after the initial clinic visit versus those who attended additional clinic visits before AT discharge. We examined the influence of age, sex, initial visit symptom score, family and personal history of psychiatric disorders and migraines, history of prior concussions, and other variables on this outcome.

Results:

Of 524 patients, 236 were discharged to AT after the initial clinic visit, while 288 patients required additional clinic visits. The additional visit group had higher initial visit symptom scores (P = 0.002), head imaging performed more frequently (P < 0.02), a family history of psychiatric disorders and/or migraines (P < 0.001, P < 0.001), more often reported a prior concussion (P = 0.02), and was younger (P = 0.014) compared with the one visit group. In a multiple variable model, the family history of psychiatric disorders [odds ratio (OR), 3.12 (95% CI, 1.531-6.343), P = 0.002], prior concussions [OR, 1.39 (95% CI, 1.020-1.892), P = 0.037], greater initial symptom score [OR, 1.05 (95% CI, 1.031-1.058), P < 0.001], and younger age [OR, 0.87 (95% CI, 0.773-0.979), P = 0.021] were strongly associated with additional visits.

Conclusions:

Among athletes treated at a regional sports concussion center, family history of psychiatric disorders, increased symptom score at initial visit, prior concussions, and younger age were each uniquely associated with needing additional clinic visits at the time of initial assessment. Understanding these variables may guide treatment protocols for optimal care.
Mortality of COVID-19 Patients Requiring Extracorporeal Membrane Oxygenation During the Three Epidemic Waves
Authors: Beyls Christophe , Huette Pierre , Viart Christophe , Mestan Benjamin , Haye Guillaume , Guilbart Mathieu , Bernasinski Michael , Besserve Patricia , Leviel Florent , Witte Pfister Alejandro , De Dominicis Florence , Jounieaux Vincent , Berna Pascal , Dupont Hervé , Abou-Arab Osama , Mahjoub Yazine
Published: October 2022

Clinical presentation and mortality of patients treated with extracorporeal membrane oxygenation (ECMO) for COVID-19 acute respiratory distress syndrome (CARDS) were different during the French epidemic waves. The management of COVID-19 patients evolved through waves as much as knowledge on that new viral disease progressed. We aimed to compare the mortality rate through the first three waves of CARDS patients on ECMO and identify associated risk factors. Fifty-four consecutive ECMO for CARDS hospitalized at Amiens University Hospital during the three waves were included. Patients were divided into three groups according to their hospitalization date. Clinical characteristics and outcomes were compared between groups. Pre-ECMO risk factors predicting 90 day mortality were evaluated using multivariate Cox regression. Among 54 ECMO (median age of 61[48–65] years), 26% were hospitalized during the first wave (n = 14/54), 26% (n = 14/54) during the second wave, and 48% (n = 26/54) during the third wave. Time from first symptoms to ECMO was higher during the second wave than the first wave. (17 [12–23] days vs. 11 [9–15]; p < 0.05). Ninety day mortality was higher during the second wave (85% vs. 43%; p < 0.05) but less during the third wave (38% vs. 85%; P < 0.05). Respiratory ECMO survival prediction score and time from symptoms onset to ECMO (HR 1.12; 95% confidence interval [CI]: 1.05–1.20; p < 0.001) were independent factors of mortality. After adjustment, time from symptoms onset to ECMO was an independent factor of 90 day mortality. Changes in CARDS management from first to second wave-induced a later ECMO cannulation from symptoms onset with higher mortality during that wave. The duration of COVID-19 disease progression could be selection criteria for initiating ECMO.
Lessons Learned, Challenges Taken, and Actions Made for “Precision” Immunohistochemistry. Analysis and Perspectives From the NordiQC Proficiency Testing Program
Authors: Nielsen Søren , Bzorek Michael , Vyberg Mogens , Røge Rasmus
Published: October 2022

Immunohistochemistry (IHC) has for decades been an integrated method within pathology applied to gain diagnostic, prognostic, and predictive information. However, the multimodality of the analytical phase of IHC is a challenge to ensure the reproducibility of IHC, which has been documented by external quality assessment (EQA) programs for many biomarkers. More than 600 laboratories participate in the Nordic immunohistochemical Quality Control EQA program for IHC. In the period, 2017-2021, 65 different biomarkers were assessed and a total of 31,967 results were evaluated. An overall pass rate of 79% was obtained being an improvement compared with 71% for the period, 2003-2015. The pass rates for established predictive biomarkers (estrogen receptor, progesterone receptor, and HER2) for breast carcinoma were most successful showing mean pass rates of 89% to 92%. Diagnostic IHC biomarkers as PAX8, SOX10, and different cytokeratins showed a wide spectrum of pass rates ranging from 37% to 95%, mean level of 75%, and attributed to central parameters as access to sensitive and specific antibodies but also related to purpose of the IHC test and validation performed accordingly to this. Seven new diagnostic biomarkers were introduced, and all showed inferior pass rates compared with the average level for diagnostic biomarkers emphasizing the challenge to optimize, validate, and implement new IHC biomarkers. Nordic immunohistochemical Quality Control operates by “Fit-For-Purpose” EQA principles and for programmed death-ligand 1, 2 segments are offered aligned to the “3-dimensional” approach–bridging diagnostic tests, drugs to be offered, and diseases addressed. Mean pass rates of 65% and 79% was obtained in the 2 segments for programmed death-ligand 1.
Bereaved Caregiver Perspectives on the End of Life in Pediatric Patients With Ventricular Assist Devices
Authors: Bui Christine M. , Schneider Lauren M. , Brown Michelle R. , Char Danton S. , McIlvennan Colleen K. , Hollander Seth A.
Published: October 2022

OBJECTIVES:

Ventricular assist devices (VADs) are increasingly used in pediatric heart failure as bridges to heart transplantation, although 25% will die with VADs. Family experiences in this population are not well-described. The objective is to understand bereaved families’ perspectives on VAD and end-of-life decision-making.

DESIGN:

Semistructured interviews with bereaved caregivers of pediatric VAD patients.

SETTING:

Tertiary children’s hospital.

PATIENTS:

Families of six pediatric VAD patients who died from 2014 to 2020.

INTERVENTIONS:

Not available.

MEASUREMENTS AND MAIN RESULTS:

Applying a grounded theory framework, interviews were coded by two independent readers using qualitative software. Themes were discussed in iterative multidisciplinary meetings. Participants were interviewed at a median 2.4 years after their child died. Three major themes emerged: 1) “lack of regret” for VAD implantation despite the outcome; 2) “caregiver-child accord” (via patient’s verbal assent or physical cues) at implantation and end-of-life was important in family decision-making; and 3) development of a “local surrogate family” (medical team and peer families) provided powerful support.

CONCLUSIONS:

Bereaved families’ perspectives provide insight into quality decision-making for major interventions and end-of-life care in pediatric patients with chronic illness who face decisions regarding technology dependence.
Law Enforcement and Community Provision of Fentanyl Test Strips to People Who Use Drugs for Engagement and Referral to Services
Authors: Olson Rebecca , Case Patricia , Palacios Wilson R. , Hunter Allie , Lopes-McCoy Vanessa , Green Traci C.
Published: October 2022

Use of fentanyl test strips (FTS) to test illicit drugs has been shown to be an effective harm-reduction tool for raising awareness of fentanyl risks, increased self-efficacy to prevent overdose, and safer use behavior changes. From March to June 2020, a total of 6 Massachusetts municipal police departments piloted FTS kit distribution during post–overdose outreach visits, community outreach, and related programming. The Police Assisted Addiction and Recovery Initiative developed the kits, trained departments, and oversaw implementation. The pilot evaluation involved site observations, process measures, and interviews with staff and kit recipients. For every kit distributed, there was approximately 1 health or support service or referral provided; 320 kits were distributed. Key themes from interviews were conceptualizing FTS as a tool, collaborations, and adaptations. Police departments that partnered with community programs amplified project reach. FTS distribution is a simple yet powerful tool that community providers and police can offer alongside linkage to care services and engagement with people who use drugs and their family and friends.
Centering Health Equity Within COVID-19 Contact Tracing: Connecticut's Community Outreach Specialist Program
Authors: Johnson Kelly , Diallo Kadijatou , Hennein Rachel , Shelby Tyler , Zhou Xin , Gupta Amanda J. , Ludomirsky Avital , Weiss June-Marie , Nunez-Smith Marcella , Soto Kristen , Davis J. Lucian
Published: October 2022

Context:

The COVID-19 pandemic has disproportionately impacted vulnerable populations, including those who are non–English-speaking and those with lower socioeconomic status; yet, participation of these groups in contact tracing was initially low. Distrust of government agencies, anticipated COVID-19–related stigma, and language and cultural barriers between contact tracers and communities are common challenges.

Program:

The Community Outreach Specialist (COS) program was established within the Connecticut Department of Public Health (DPH) COVID-19 contact tracing program to encourage participation in contact tracing and address a need for culturally competent care and social and material support among socially vulnerable and non–English-speaking populations in 11 high-burden jurisdictions in Connecticut.

Implementation:

In partnership with state and local health departments, we recruited 25 COS workers with relevant language skills from target communities and trained them to deliver contact tracing services to vulnerable and non–English speaking populations.

Evaluation:

We conducted a cross-sectional analysis using data from ContaCT, DPH's enterprise contact tracing system. Overall, the COS program enrolled 1938 cases and 492 contacts. The proportion of residents reached (ie, called and interviewed) in the COS program was higher than that in the regular contact tracing program for both cases (70% vs 57%, P < .001) and contacts (84% vs 64%, P < .001). After adjusting for client age, sex, race and ethnicity, language, and jurisdiction, we found that the COS program was associated with increased reach for contacts (odds ratio [OR] = 1.52; 95% confidence interval [95% CI], 1.17-1.99) but not for cases (OR = 0.78; 95% CI, 0.70-0.88). Rapid qualitative analysis of programmatic field notes and meeting reports provided evidence that the COS program was feasible and acceptable to clients and contributed to COVID-19 education and communication efforts.

Conclusion:

A COS program employing a client-centered, community-engaged strategy for reaching vulnerable and non–English-speaking populations was feasible and more effective at reaching contacts than standard COVID-19 contact tracing.
First Responder Assertive Linkage Programs: A Scoping Review of Interventions to Improve Linkage to Care for People Who Use Drugs
Authors: Worthington Nancy , Gilliam Talayha , Mital Sasha , Caslin Sharon
Published: October 2022

Context:

In response to the drug overdose crisis, first responders, in partnership with public health, provide new pathways to substance use disorder (SUD) treatment and other services for individuals they encounter in their day-to-day work.

Objective:

This scoping review synthesizes available evidence on first responder programs that take an assertive approach to making linkages to care.

Results:

Seven databases were searched for studies published in English in peer-reviewed journals between January 2000 and December 2019. Additional articles were identified through reference-checking and subject matter experts. Studies were selected for inclusion if they sufficiently described interventions that (1) focus on adults who use drugs; (2) are in the United States; (3) involve police, fire, or emergency medical services; and (4) assertively link individuals to SUD treatment. Twenty-two studies met inclusion criteria and described 34 unique programs, implementation barriers and facilitators, assertive linkage strategies, and linkage outcomes, including unintended consequences.

Conclusions:

Findings highlight the range of linkage strategies concurrently implemented and areas for improving practice and research, such as the need for more linkages to evidence-based strategies, namely, medications for opioid use disorder, harm reduction, and wraparound services.
COVID-19 Vaccine Acceptability Among People Experiencing Homelessness in Central Florida and Southern Nevada, March-June 2021
Authors: Meehan Ashley A. , Aarvig Kathleen , Kashani Mitra , Whitton Alaina , Mosites Emily
Published: October 2022

Context:

Understanding COVID-19 vaccine acceptability among people experiencing homelessness is critical to improve vaccine coverage during the COVID-19 pandemic. Little is known about COVID-19 vaccine acceptability people experiencing unsheltered homelessness (PEUH).

Objective:

To identify and describe motivators for receiving a COVID-19 vaccine and reasons for hesitancy, information sources utilized and trusted for vaccine decision making, logistical barriers to receiving vaccination, and what might increase comfortability to receive a COVID-19 vaccination among PEUH.

Design:

Cross-sectional survey design, implemented from March to June 2021.

Setting:

Two US cities: Las Vegas and Nevada (urban), and Orlando, Florida (suburban).

Participants:

People experiencing predominantly unsheltered homelessness accessing handwashing stations and other wrap-around social services at program sites managed by Clean the World Foundation.

Main Outcome Measures:

The main outcome measures assessed included survey responses about current vaccine receipt (if participants have already received one or more doses of a COVID-19 vaccine), intention to receive a COVID-19 vaccine if not already received, motivators for receiving or wanting to receive a vaccine, reasons for hesitancy or uncertainty about receiving a vaccine, sources of information regarding COVID-19 vaccines, and actual or anticipated logistical barriers or challenges to receiving COVID-19 vaccines.

Results:

Among 864 participants, 465 (53.8%) were classified as “vaccine accepting,” and 399 were classified “vaccine hesitant or undecided.” The primary motivator to be vaccinated was to protect their health (212, 45.6%). Hesitant or undecided participants reported that vaccines were too new (269, 67.4%) or they needed more information (223, 55.9%) and were more likely to receive information from social media than accepting participants (80.0% vs 58.3%, P < .001). Logistical barriers to vaccination included distance to vaccination locations (85, 21.3%), lack of transportation (79, 19.8%), and limited time (64, 16%).

Conclusions:

Vaccination efforts to reach PEUH should consider how information and logistical needs may be addressed.
A comparative study of secondary procedures after sub-pectoral and pre-pectoral single-stage implant-based breast reconstruction
Authors: Abbas Abeera , Rizki Hirah , Tanska Aleksandra , Concepcion Mae , Tasoulis Marios Konstantinos , Gui Gerald
Published: October 2022

Background:

Implant-based breast reconstruction (IBR) is the most commonly employed procedure to reconstruct the breast after mastectomy. The advantages and disadvantages of sub-pectoral versus pre-pectoral implant placement remain a matter of debate. This study compares the need for secondary aesthetic procedures between pre-pectoral and sub-pectoral IBR.

Methods:

This is a retrospective cohort study of consecutive patients who underwent sub-pectoral or pre-pectoral IBR between 2015-2018 under a single surgeon at a tertiary breast unit. The primary end-point was the number of secondary procedures performed to improve the aesthetic outcome. Secondary endpoints included the number of secondary procedures during the first year.

Results:

A total of 271 one-stage IBRs were performed (sub-pectoral n=128 in 74 patients, pre-pectoral n=143 in 84 patients). Overall, more patients required secondary procedures in the sub-pectoral group (36.5% vs 19%; P=0.014) although through longer follow-up. The commonest procedures were pocket revision and implant exchange (11.7% vs 3.5%, P=0.010; 11.7% vs 4.2%, P=0.021) while fat grafting was similar between the two groups (46% vs 40.5%, P=0.777). When adjusted for follow-up time, there was no significant difference in the number of secondary procedures undertaken in the sub-pectoral versus the pre-pectoral groups, (21% vs 16% respectively, P=0.288) at 1 year.

Conclusion:

The requirement for secondary procedures at one year was not different between groups. The need for fat grafting was not increased following pre-pectoral IBR.
Clinical Implications and Management of Non-ALCL Breast Implant Capsular Pathology
Authors: Vorstenbosch Joshua , Chu Jacqueline J. , Ariyan Charlotte E. , McCarthy Colleen M. , Disa Joseph J. , Nelson Jonas A.
Published: October 2022

The breast implant capsule is a dynamic structure that forms following the implantation of a device. Although normally benign, increased awareness of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) highlights that disease may arise from the capsule. BIA-ALCL presents as a late seroma or mass but explains few of the late seromas found in breast implant patients. To date, many of these seromas lack a clear etiology and are often described as ”idiopathic.” Several benign and malignant breast implant capsular pathologies can cause a late seroma or mass. Similar to early reports of BIA-ALCL, these conditions are rare and largely limited to case reports or series.

The purpose of this special topic is to present a narrative review highlighting capsular pathologies that contribute to the formation of late seroma or mass in an attempt to broaden the differential diagnosis and help plastic surgeons identify the etiology. Specifically, we review the presentation and management of BIA-ALCL, synovial metaplasia, capsular epithelialization, late hematoma, double capsule, breast cancer, squamous cell carcinoma, mesenchymal tumor, and B-cell lymphoma. Although rare, plastic surgeons should consider these capsular conditions as causes of late seromas and masses. Usually, these conditions may be diagnosed by following the National Comprehensive Cancer Network (NCCN) screening guidelines for BIA-ALCL. Thorough evaluation and workup of late seromas and masses may lead to improved characterization of these rare breast implant capsular conditions and improve our understanding of their pathophysiology and management.