bluuebunny/crossref_metadata_2025 huggingface dataset:
Two new nova shells associated with V4362 Sagittarii and DO Aquilae
Authors: Harvey E J , Redman M P , Boumis P , Akras S , Fitzgerald K , Dulaimi S , Williams S C , Darnley M J , Lam M C , Kopsacheilli M , Derlopa S
Published: September 2020

A classical nova is an eruption on the surface of a white dwarf in an accreting binary system. The material ejected from the white dwarf surface generally forms an axisymmetric shell. The shaping mechanisms of nova shells are probes of the processes that take place at energy scales between planetary nebulae and supernova remnants. We report on the discovery of nova shells surrounding the post-nova systems V4362 Sagittarii (1994) and more limited observations of DO Aquilae (1925). Distance measurements of $0.5\substack{+1.4 \\ -0.2}$ kpc for V4362 Sgr and 6.7 ± 3.5 kpc for DO Aql are found based on the expansion parallax method. The growth rates are measured to be 0.07 arcsec yr−1 for DO Aql and 0.32 arcsec yr−1 for V4362 Sgr. A preliminary investigation into the ionization structure of the nova shell associated with V4362 Sgr is presented. The observed ionization structure of nova shells depends strongly on their morphology and the orientation of the central component towards the observer. X-ray, IR, and UV observations as well as optical integral field unit spectroscopy are required to better understand these interesting objects.
An empirical bayesian approach for testing gene expression fold change and its application in detecting global dosage effects
Authors: Guo Zhenxing , Cui Ying , Shi Xiaowen , Birchler James A , Albizua Igor , Sherman Stephanie L , Qin Zhaohui S , Ji Tieming
Published: September 2020

We are motivated by biological studies intended to understand global gene expression fold change. Biologists have generally adopted a fixed cutoff to determine the significance of fold changes in gene expression studies (e.g. by using an observed fold change equal to two as a fixed threshold). Scientists can also use a t-test or a modified differential expression test to assess the significance of fold changes. However, these methods either fail to take advantage of the high dimensionality of gene expression data or fail to test fold change directly. Our research develops a new empirical Bayesian approach to substantially improve the power and accuracy of fold-change detection. Specifically, we more accurately estimate gene-wise error variation in the log of fold change. We then adopt a t-test with adjusted degrees of freedom for significance assessment. We apply our method to a dosage study in Arabidopsis and a Down syndrome study in humans to illustrate the utility of our approach. We also present a simulation study based on real datasets to demonstrate the accuracy of our method relative to error variance estimation and power in fold-change detection. Our developed R package with a detailed user manual is publicly available on GitHub at https://github.com/cuiyingbeicheng/Foldseq.
Hitchin and Calabi–Yau Integrable Systems via Variations of Hodge Structures
Authors: Beck Florian
Published: September 2020

Since its discovery by Hitchin in 1987, G-Hitchin systems for a reductive complex Lie group G have extensively been studied. For example, the generic fibers are nowadays well-understood. In this paper, we show that the smooth parts of G-Hitchin systems for a simple adjoint complex Lie group G are isomorphic to non-compact Calabi–Yau integrable systems extending results by Diaconescu–Donagi–Pantev. Moreover, we explain how Langlands duality for Hitchin systems is related to Poincaré–Verdier duality of the corresponding families of quasi-projective Calabi–Yau threefolds. Even though the statement is holomorphic-symplectic, our proof is Hodge-theoretic. It is based on polarizable variations of Hodge structures that admit so-called abstract Seiberg–Witten differentials. These ensure that the associated Jacobian fibration is an algebraic integrable system.
Integrating “Exercise Is Medicine” into primary care workflow: a study protocol
Authors: Linke Sarah E , Kallenberg Gene “Rusty” , Kronick Rick , Tai-Seale Ming , De-Guzman Kimberly , Rabin Borsika
Published: September 2020

As a major contributor to the burden of most chronic diseases, insufficient physical activity (PA) creates a significant financial burden on the health care system. Numerous interventions effectively increase PA, but few are integrated into primary care clinic workflows. Exercise Is Medicine (EIM) is a global health initiative committed to the belief that PA is integral to the prevention and treatment of diseases and should be routinely assessed as a vital sign and treated in the health care setting. This paper describes an in-progress embedded quality improvement (QI) project that integrates EIM into routine clinical practice. A combination of implementation science (IS) and QI models are used to adapt, implement, and evaluate the integration of EIM into six primary care clinics. The Practical, Robust Implementation and Sustainability Model (PRISM) guided preimplementation evaluation and adaptation of EIM protocol, materials, and delivery strategies. The learning evaluation QI model is used to design, test, refine, and implement EIM using rapid, 3 month Plan-Do-Study-Act microcycles. Learning meetings are used to obtain feedback and optimize workflow. The Stirman Framework is used to document adaptations to the program throughout implementation. Reach, adoption, implementation, effectiveness, and maintenance outcomes embedded within PRISM will guide the program evaluation to determine sustainability and scalability. Using an innovative approach of combining IS and QI methods to improve the identification of primary care patients with insufficient PA to increase their activity levels has great population health potential. Our work will inform the best approaches for EIM integration in primary care.
Progressive Lung Injury, Inflammation, and Fibrosis in Rats Following Inhalation of Sulfur Mustard
Authors: Malaviya Rama , Abramova Elena V , Rancourt Raymond C , Sunil Vasanthi R , Napierala Marta , Weinstock Daniel , Croutch Claire R , Roseman Julie , Tuttle Rick , Peters Eric , Casillas Robert P , Laskin Jeffrey D , Laskin Debra L
Published: September 2020

Sulfur mustard (SM) inhalation causes debilitating pulmonary injury in humans which progresses to fibrosis. Herein, we developed a rat model of SM toxicity which parallels pathological changes in the respiratory tract observed in humans. SM vapor inhalation caused dose (0.2–0.6 mg/kg)-related damage to the respiratory tract within 3 days of exposure. At 0.4–0.6 mg/kg, ulceration of the proximal bronchioles, edema and inflammation were observed, along with a proteinaceous exudate containing inflammatory cells in alveolar regions. Time course studies revealed that the pathologic response was biphasic. Thus, changes observed at 3 days post-SM were reduced at 7–16 days; this was followed by more robust aberrations at 28 days, including epithelial necrosis and hyperplasia in the distal bronchioles, thickened alveolar walls, enlarged vacuolated macrophages, and interstitial fibrosis. Histopathologic changes were correlated with biphasic increases in bronchoalveolar lavage (BAL) cell and protein content and proliferating cell nuclear antigen expression. Proinflammatory proteins receptor for advanced glycation end product (RAGE), high-mobility group box protein (HMGB)-1, and matrix metalloproteinase (MMP)-9 also increased in a biphasic manner following SM inhalation, along with surfactant protein-D (SP-D). Tumor necrosis factor (TNF)-α and inducible nitric oxide synthase (iNOS), inflammatory proteins implicated in mustard lung toxicity, and the proinflammatory/profibrotic protein, galectin (Gal)-3, were upregulated in alveolar macrophages and in bronchiolar regions at 3 and 28 days post-SM. Inflammatory changes in the lung were associated with oxidative stress, as reflected by increased expression of heme oxygenase (HO)-1. These data demonstrate a similar pathologic response to inhaled SM in rats and humans suggesting that this rodent model can be used for mechanistic studies and for the identification of efficacious therapeutics for mitigating toxicity.
An update on gout diagnosis and management for the primary care provider
Authors: Mbuyi Nadine , Hood Catherine
Published: September 2020

Gout is the most common inflammatory arthritis in the US, affecting 3.9% of the population. Although many effective gout therapies are available for acute flares and chronic management, it is suboptimally treated worldwide, and recurrent gout flares can cause significant pain and irreversible joint damage.
Declining Medicare Reimbursement in Orthopaedic Trauma Surgery: 2000–2020
Authors: Haglin Jack M. , Lott Ariana , Kugelman David N. , Konda Sanjit R. , Egol Kenneth A.
Published: September 2020

Objectives:

To evaluate monetary trends in government (Medicare) reimbursement rates for 20 commonly used orthopedic trauma surgical procedures over a 20-year period.

Methods:

The Physician Fee Schedule Look-Up Tool from the Centers for Medicare & Medicaid Services was queried for the 20 common Current Procedural Terminology (CPT) codes in orthopaedic trauma, and reimbursement data were extracted. All monetary data were adjusted for inflation to 2020 US dollars (USD) using changes to the US Consumer Price Index. Both the average annual and the total percentage change in reimbursement and in Relative Value Units were calculated for all included procedures.

Results:

After adjusting for inflation, the average reimbursement for all procedures decreased by 30.0% from 2000 to 2020. Total Relative Value Units during this time increased by 4.4% on average. Procedures about the foot and ankle demonstrated the greatest decrease in the mean adjusted reimbursement at −42.6%, whereas procedures about the shoulder and upper extremity demonstrated the smallest mean decrease at 23.7% during the study period. From 2000 to 2020, the adjusted reimbursement rate for all included procedures decreased by an average of 1.5% each year.

Conclusion:

To the best of our knowledge, this is the first study to comprehensively evaluate trends in procedural Medicare reimbursement for orthopaedic trauma. When adjusted for inflation, Medicare reimbursement for included procedures has steadily decreased from 2000 to 2020. Increased awareness and consideration of these trends will be important for policy makers, hospitals, and surgeons to assure continued access to meaningful surgical orthopaedic trauma care in the United States.
The Effectiveness and Safety of Direct Oral Anticoagulants Following Lower Limb Fracture Surgery: A Systematic Review and Meta-analysis
Authors: Wæver Daniel , Lewis Daniel , Saksø Henrik , Borris Lars C. , Tarrant Seth , Thorninger Rikke
Published: September 2020

Objectives:

Venous thromboembolism (VTE) is a well-established complication after many orthopaedic injuries, such as hip and lower limb fractures. The use of direct oral anticoagulants (DOACs, previously termed novel oral anticoagulants) is well-established as thromboprophylaxis after major elective orthopaedic surgery, but not in the nonelective setting. The aim of this study was to investigate the effectiveness and safety of DOACs after nonelective lower limb fracture surgery.

Data Sources:

A systematic literature search of the MEDLINE, EMBASE, CINAHL, and CENTRAL databases was conducted. No limitation was placed on publication date, with only manuscripts printed in English were eligible.

Study Selection:

Included studies were either randomized controlled trials or prospective and retrospective comparative studies. Included studies compared DOACs to conventional methods of thromboprophylaxis in the postoperative period after surgical management of lower limb fractures.

Data Extraction:

Outcomes included VTE, bleeding, wound complications, mortality, and adverse events. Eight studies met inclusion criteria, of which 7 compared direct factor Xa inhibitors (XaIs) with conventional VTE prophylaxis and one study compared a direct thrombin inhibitor with conventional VTE prophylaxis.

Data Synthesis:

Revman 5.3 (Nordic Cochrane Centre, Denmark) was used to complete the meta-analysis and generate forest plots.

Conclusions:

XaIs were shown to have lower rates of deep vein thrombosis (Odds ratio 0.59; 95% confidence interval, 0.46–0.76; P < 0.0001) and less pharmacologically attributable adverse events (Odds ratio 0.62; 95% confidence interval, 0.46–0.82; P = 0.0007). There was difference between DOACs and conventional VTE prophylaxis regarding mortality, PE, symptomatic deep vein thrombosis, or bleeding events. The results generally support the use of DOACs for VTE prophylaxis after nonelective lower limb fracture surgery, such after hip fracture. The results more strongly support the use of XaIs; however, more evidence is needed to fully assess DOACs' role in clinical practice.

Level of Evidence:

Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Advanced Respiratory Support in the Contemporary Cardiac ICU
Authors: Metkus Thomas S. , Miller P. Elliott , Alviar Carlos L. , Baird-Zars Vivian M. , Bohula Erin A. , Cremer Paul C. , Gerber Daniel A. , Jentzer Jacob C. , Keeley Ellen C. , Kontos Michael C. , Menon Venu , Park Jeong-Gun , Roswell Robert O. , Schulman Steven P. , Solomon Michael A. , van Diepen Sean , Katz Jason N. , Morrow David A.
Published: September 2020

Objectives:

The medical complexity and critical care needs of patients admitted to cardiac ICUs are increasing, and prospective studies examining the underlying cardiac and noncardiac diagnoses, the management strategies, and the prognosis of cardiac ICU patients with respiratory failure are needed.

Design:

Prospective cohort study.

Setting:

The Critical Care Cardiology Trials Network is a research collaborative of cardiac ICUs across the United States and Canada.

Patients:

We included all medical cardiac ICU admissions at 25 cardiac ICUs during two consecutive months annually at each center from 2017 to 2019.

Measurements:

We evaluated the use of advanced respiratory therapies including invasive mechanical ventilation, noninvasive ventilation, and high-flow nasal cannula versus no advanced respiratory support across admission diagnoses and the association with in-hospital mortality.

Main Results:

Of 8,240 cardiac ICU admissions, 1,935 (23.5%) were treated with invasive mechanical ventilation, 573 (7.0%) with noninvasive ventilation, and 281 (3.4%) with high-flow nasal cannula. Admitting diagnoses among those with advanced respiratory support were diverse including general medical problems in patients with heart disease as well as primary cardiac problems. In-hospital mortality was higher in patients who received invasive mechanical ventilation (38.1%; adjusted odds ratio, 2.53; 2.02–3.16) and noninvasive ventilation or high-flow nasal cannula (8.8%; adjusted odds ratio, 2.25; 1.73–2.93) compared with patients without advanced respiratory support (4.6%). Reintubation rate was 7.6%. The most common variables associated with respiratory insufficiency included heart failure, infection, chronic obstructive pulmonary disease, and pulmonary vascular disease.

Conclusions:

One-third of cardiac ICU admissions receive respiratory support with associated increased mortality. These data provide benchmarks for quality improvement ventures in the cardiac ICU, inform cardiac critical care training and staffing patterns, and serve as foundation for future studies aimed at improving outcomes.
Increased Dead Space Ventilation and Refractory Hypercapnia in Patients With Coronavirus Disease 2019: A Potential Marker of Thrombosis in the Pulmonary Vasculature
Authors: Oppenheimer Beno W. , Bakker Jan , Goldring Roberta M. , Teter Katherine , Green David L. , Berger Kenneth I.
Published: September 2020

Objectives:

Mortality rates in intubated coronavirus disease 2019 patients remain markedly elevated. Some patients develop sudden refractory hypercapnia and hypoxemia not explained by worsening pulmonary parenchymal disease. This case series highlights clinical findings and management of coronavirus disease 2019 patients with refractory hypercapnia despite maximal/optimal ventilatory support. Hypercapnia could not be explained by worsening lung disease or other common factors, and thus, a pulmonary vascular etiology was suggested. The pillars of management were targeted to improve pulmonary vascular patency via aggressive anticoagulation and support right ventricular function.

Data Sources:

Four consecutive patients with confirmed coronavirus disease 2019 infection with sudden hypercapnia and hypoxemia were included.

Data Synthesis:

There was sequential development of: 1) severe hypercapnia attributable to marked elevation of dead space without radiographic changes; 2) concomitant coagulopathy manifest by an increase in d-dimer levels; 3) progressive shunt with consequent hypoxemia; and 4) right ventricular dysfunction. Management included extracorporeal Co
2 removal, direct thrombin inhibition, pulmonary vasodilators, and inotropic support. Marked improvement in Pao
2 allowed reduction in Fio
2 in all patients, extracorporeal Co
2 removal was discontinued in three patients over the ensuing 3 weeks, and one patient was discharged home.

Conclusions:

We speculate that thromboinflammation with pulmonary microvasculature occlusion leads to a sudden increase in dead space and shunt resulting in severe hypercapnia and hypoxemia in coronavirus disease 2019 patients. Early identification of these physiologic and clinical biomarkers could trigger the institution of therapies aiming to reverse the hypercoagulable state and support right ventricular function.
Andersen–Tawil Syndrome
Authors: Pérez-Riera Andrés Ricardo , Barbosa-Barros Raimundo , Samesina Nelson , Pastore Carlos Alberto , Scanavacca Mauricio , Daminello-Raimundo Rodrigo , de Abreu Luiz Carlos , Nikus Kjell , Brugada Pedro
Published: September 2020

Andersen–Tawil syndrome (ATS) is a very rare orphan genetic multisystem channelopathy without structural heart disease (with rare exceptions). ATS type 1 is inherited in an autosomal dominant fashion and is caused by mutations in theKCNJ2gene, which encodes the α subunit of the K+channel protein Kir2.1 (in ≈ 50–60% of cases). ATS type 2 is in turn linked to a rare mutation in theKCNJ5-GIRK4gene that encodes the G protein-sensitive-activated inwardly rectifying K+channel Kir3.4 (15%), which carries the acetylcholine-induced potassium current. About 30% of cases are de novo/sporadic, suggesting that additional as-yet unidentified genes also cause the disorder. A triad of periodic muscle paralysis, repolarization changes in the electrocardiogram, and structural body changes characterize ATS. The typical muscular change is episodic flaccid muscle weakness. Prolongation of the QU/QUc intervals and normal or minimally prolonged QT/QTc intervals with a tendency to ventricular arrhythmias are typical repolarization changes. Bidirectional ventricular tachycardia is the hallmark ventricular arrhythmia, but also premature ventricular contractions, and rarely, polymorphic ventricular tachycardia of torsade de pointes type may be present. Patients with ATS have characteristic physical developmental dysmorphisms that affect the face, skull, limbs, thorax, and stature. Mild learning difficulties and a distinct neurocognitive phenotype (deficits in executive function and abstract reasoning) have been described. About 60% of affected individuals have all features of the major triad. The purpose of this review is to present historical aspects, nomenclature (observations/criticisms), epidemiology, genetics, electrocardiography, arrhythmias, electrophysiological mechanisms, diagnostic criteria/clues of periodic paralysis, prognosis, and management of ATS.
Comparison of the Safety and Efficacy of Foam Sclerotherapy With 1:2 Polidocanol to Air Ratio Versus 1:4 Ratio for the Treatment of Reticular Veins of the Lower Extremities
Authors: Hoss Elika , Kollipara Ramya , Boen Monica , Alhaddad Marwan , Goldman Mitchel P.
Published: September 2020

BACKGROUND

Foam sclerotherapy is a common treatment of lower extremity reticular veins. The effect of different liquid–gas ratios on foam stability and efficacy has been controversial.

OBJECTIVE

To evaluate the use of 2 different polidocanol (POL) to air ratios for the treatment of reticular veins of the lower extremities.

METHODS AND MATERIALS

Patients with lower extremity reticular veins were randomized to foam sclerotherapy with POL mixed with 4 mL of room air for one lower extremity or 2 mL for the other lower extremity. All telangiectasias were treated with glycerin immediately after treatment of the reticular veins. Adverse events (AEs) and efficacy were evaluated by both subject and blinded investigator.

RESULTS

Thirty subjects completed the study. No statistically significant difference was seen in AEs between the 2 different POL to air ratios by subject questionnaire and blinded investigator scores at all time points. Subjects and blinded investigator reported a mean improvement between 0% and 50% at Day 21 and 26% to 75% at Day 90, which was not significantly different between groups.

CONCLUSION

Two different POL to air ratios, 1:2 versus 1:4, were similarly safe and efficacious for the treatment reticular veins of the lower extremities.
Development of a Simple Clinical Tool for Predicting Early Dropout in Cardiac Rehabilitation
Authors: Pack Quinn R. , Visintainer Paul , Farah Michel , LaValley Grace , Szalai Heidi , Lindenauer Peter K. , Lagu Tara
Published: September 2020

Background:

Nonadherence to cardiac rehabilitation (CR) is common despite the benefits of completing a full program. Adherence might be improved if patients at risk of early dropout were identified and received an intervention.

Methods:

Using records from patients who completed ≥1 CR session in 2016 (derivation cohort), we employed multivariable logistic regression to identify independent patient-level characteristics associated with attending <12 sessions of CR in a predictive model. We then evaluated model discrimination and validity among patients who enrolled in 2017 (validation cohort).

Results:

Of the 657 patients in our derivation cohort, 318 (48%) completed <12 sessions. Independent risk factors for not attending ≥12 sessions were age <55 yr (OR = 0.23, P < .001), age 55 to 64 yr (OR = 0.35, P < .001), age ≥75 yr (OR = 0.64, P = .06), smoker within 30 d of CR enrollment (OR = 0.40, P = .001), low risk for exercise adverse events (OR = 0.54, P = .03), and nonsurgical referral diagnosis (OR = 0.66, P = .02). Our model predicted nonadherence risk from 23-90%, had acceptable discrimination and calibration (C-statistics = 0.70, Harrell's E50 and E90 2.0 and 3.6, respectively) but had fair validity among 542 patients in the validation cohort (C-statistic = 0.62, Harrell's E50 and E90 2.1 and 11.3, respectively).

Conclusion:

We developed and evaluated a single-center simple risk model to predict nonadherence to CR. Although the model has limitations, this tool may help clinicians identify patients at risk of early dropout and guide intervention efforts to improve adherence so that the full benefits of CR can be realized for all patients.
Exercise-Based Cardiac Rehabilitation Improves Cognitive Function Among Patients With Cardiovascular Disease
Authors: Moriarty Terence A. , Bourbeau Kelsey , Mermier Christine , Kravitz Len , Gibson Ann , Beltz Nicholas , Negrete Omar , Zuhl Micah
Published: September 2020

Purpose:

To investigate the effects of cardiac rehabilitation (CR) exercise training on cognitive performance and whether the changes are associated with alterations in prefrontal cortex (PFC) oxygenation among patients with cardiovascular disease.

Methods:

Twenty (men: n = 15; women: n = 5) participants from an outpatient CR program were enrolled in the study. Each participant completed a cognitive performance test battery and a submaximal graded treadmill evaluation on separate occasions prior to and again upon completion of 18 individualized CR sessions. A functional near-infrared spectroscopy (fNIRS) device was used to measure left and right prefrontal cortex (LPFC and RPFC) oxygenation parameters (oxyhemoglobin [O2Hb], deoxyhemoglobin [HHb], total hemoglobin [tHb], and oxyhemoglobin difference [Hbdiff]) during the cognitive test battery.

Results:

Patients showed improvements in cardiorespiratory fitness (+1.4 metabolic equivalents [METs]) and various cognitive constructs. A significant increase in PFC oxygenation, primarily in the LPFC region, occurred at post-CR testing. Negative associations between changes in cognition (executive function [LPFC O2Hb: r = −0.45, P = .049; LPFC tHb: r = −0.49, P = .030] and fluid composite score [RPFC Hbdiff: r = −0.47, P = .038; LPFC Hbdiff: r = −0.45, P = .048]) and PFC changes were detected. The change in cardiorespiratory fitness was positively associated with the change in working memory score (r = 0.55, P = .016).

Conclusion:

Cardiovascular disease patients enrolled in CR showed significant improvements in multiple cognitive domains along with increased cortical activation. The negative associations between cognitive functioning and PFC oxygenation suggest an improved neural efficiency.
A Systematic Review of the Hematopoietic Acute Radiation Syndrome (H-ARS) in Canines and Non-human Primates: Acute Mixed Neutron/Gamma vs. Reference Quality Radiations
Authors: MacVittie Thomas J. , Farese Ann M. , Jackson William E.
Published: September 2020

A systematic review of relevant studies that determined the dose response relationship (DRR) for the hematopoietic (H) acute radiation syndrome (ARS) in the canine relative to radiation quality of mixed neutron:gamma radiations, dose rate, and exposure uniformity relative to selected reference radiation exposure has not been performed. The datasets for rhesus macaques exposure to mixed neutron:gamma radiation are used herein as a species comparative reference to the canine database. The selection of data cohorts was made from the following sources: Ovid Medline (1957–present), PubMed (1954–present), AGRICOLA (1976–present), Web of Science (1954–present), and US HHS RePORT (2002–present). The total number of hits across all search sites was 3,077. Several referenced, unpublished, non-peer reviewed government reports were unavailable for review. Primary published studies using canines, beagles, and mongrels were evaluated to provide an informative and consistent review of mixed neutron:gamma radiation effects to establish the DRRs for the H-ARS. Secondary and tertiary studies provided additional information on the hematologic response or the effects on hematopoietic progenitor cells, radiation dosimetry, absorbed dose, and organ dose. The LD50/30 values varied with neutron quality, exposure aspect, and mixed neutron:gamma ratio. The reference radiation quality varied from 250 kVp or 1–2 MeV x radiation and 60Co gamma radiation. A summary of a published review of a data set describing the DRR in rhesus macaques for mixed neutron:gamma radiation exposure in the H-ARS is included for a comparative reference to the canine dataset. The available evidence provided a reliable and extensive database that characterized the DRR for the H-ARS in canines and young rhesus macaques exposed to mixed neutron:gamma radiations of variable energy relative to 250 kVp, 1–2 MeV x radiation and 60Co gamma, and uniform and non-uniform total-body irradiation without the benefit of medical management. The mixed neutron:gamma radiation showed an energy-dependent RBE of ~ 1.0 to 2.0 relative to reference radiation exposure within both species. A marginal database described the DRR for the gastrointestinal (GI)-ARS. Medical management showed benefit in both species relative to the mixed neutron:gamma as well as exposure to reference radiation. The DRR for the H-ARS was characterized by steep slopes and relative LD50/30 values that reflected the radiation quality, exposure aspect, and dose rate over a range in time from 1956–2012.
Chest Pain Severity Rating Is a Poor Predictive Tool in the Diagnosis of ST-Segment Elevation Myocardial Infarction
Authors: Supinski David , Borg Bethanie , Schmitz Katlin , Mullvain Richard , Renier Colleen , Benziger Catherine
Published: September 2020

Current ST-segment elevation myocardial infarction (STEMI) guidelines require persistent electrocardiogram ST-segment elevation, cardiac enzyme changes, and symptoms of myocardial ischemia. Chest pain is the determinant symptom, often measured using an 11-point scale (0–10). Greater severity of chest pain is presumed to be associated with a stronger likelihood of a true positive STEMI diagnosis. This retrospective observational cohort study considered consecutive STEMI patients from May 02, 2009 to December 31, 2018. Analysis of standard STEMI metrics included positive electrocardiogram-to-device and first medical contact-to-device times, presence of comorbidities, false-positive diagnosis, 30-day and 1-year mortality, and 30-day readmission. Chest pain severity was assessed upon admission to the primary percutaneous coronary intervention hospital. We analyzed 1409 STEMI activations (69% male, 66.3 years old ± 13.7 years). Of these, 251 (17.8%) had no obstructive lesion, consistent with false-positive STEMI. Four hundred sixty-six (33.1%) reported chest pain rating of 0 on admission, 378 (26.8%) reported mild pain (1–3), 300 (21.3%) moderate (4–6), and 265 (18.8%) severe (7–10). Patients presenting without chest pain had a significantly higher rate of false-positive STEMI diagnosis. Increasing chest pain severity was associated with decreased time from first medical contact to device, and decreased in-hospital, 30-day and 1-year mortality. Severity of chest pain on admission did not correlate to the likelihood of a true-positive STEMI diagnosis, although it was associated with improved patient prognosis, in the form of improved outcomes, and shorter times to reperfusion.
Comparative Analysis of Safety and Efficacy of Topography-Guided Customized Cross-linking and Standard Cross-linking in the Treatment of Progressive Keratoconus
Authors: Sachdev Gitansha Shreyas , Ramamurthy Shreyas , B Soundariya , Dandapani Ramamurthy
Published: September 2020

Purpose:

To compare the safety and efficacy of topography-guided customized corneal cross-linking (PiXL) with standard cross-linking (CXL) for the treatment of progressive keratoconus.

Methods:

In a prospective interventional analysis, the eyes of patients with progressive keratoconus underwent standard cross-linking (homogenous 9-mm ultraviolet-A irradiation of 9 mW/cm2 delivering a total fluence of 5.4J/cm2) versus topography-guided customized cross-linking (30 mW/cm2 pulsed irradiance with a total fluence ranging from 5.4 to 15 J/cm2, in concentric circles centered on the posterior float maximum). The following parameters were analyzed at the preoperative, 1-month, 6-month, and 1-year postoperative visits: corrected spectacle distance visual acuity, manifest refraction including sphere, cylinder and mean refractive spherical equivalent, corneal tomography, higher order aberration profile, and endothelial cell count. Anterior segment optical coherence tomography evaluation was performed at the 1-month postoperative visit to assess the depth of the demarcation line.

Results:

Sixty-four eyes of 45 patients (32 eyes in each group) were included. There was a significant reduction in maximum keratometry and IS asymmetry in the PiXL group at both the 6-month and 1-year postoperative visits (P = 0.001 and 0.06). Corrected spectacle distance visual acuity improved significantly in the PiXL (0.05 ± 0.08 logarithm of the minimum angle of resolution, P = 0.02) versus the standard CXL (0.01 ± 0.025 logarithm of the minimum angle of resolution, P = 0.26) group. A greater depth of a stromal demarcation line was observed in the customized CXL group (P = 0.02). No significant complications were noted in either cohort.

Conclusions:

PiXL demonstrated similar safety with significantly greater keratometry flattening and corneal regularization vis-à-vis standard CXL. This resulted in significant improvement of spectacle corrected visual acuity for eyes with mild-to-moderate keratoconus.
Preloaded Descemet Membrane Endothelial Keratoplasty Grafts With Endothelium Outward: A Cross-Country Validation Study of the DMEK Rapid Device
Authors: Wojcik Gabriela , Parekh Mohit , Romano Vito , Ferrari Stefano , Ruzza Alessandro , Ahmad Sajjad , Ponzin Diego
Published: September 2020

Purpose:

To validate the “Descemet membrane endothelial keratoplasty (DMEK) Rapid” device for the cross-country transportation of preloaded DMEK grafts preserved with endothelium outward.

Methods:

DMEK grafts were stripped and loaded in the DMEK Rapid device with tissue culture medium (TCM) or transport medium (TM) with endothelium outward. The device was mounted in a 40-mL flask and preserved for 4 days on a rocker to simulate transportation (study A, n = 24) or shipped in the TM from Italy to the United Kingdom (study B, n = 9) and evaluated within 72 hours. All the tissues were stained with Alizarin red. Viability of the cells was checked postsimulations and posttransportation and was confirmed using live/dead staining. Expression of tight junction proteins was evaluated.

Results:

In study A, the endothelial cell loss observed from the TCM group was 20.8% (±5.2) compared with 19.5% (±6.7) from the TM group (P = 0.41) after transport simulation. Alizarin red showed minimal uncovered areas in both groups. There were no statistical differences in viability between the TM (80.83%) and TCM groups (78.83%). In study B, 12.9% (±7.8) endothelial cell loss was observed after transporting the tissues from Italy to the United Kingdom with no significant difference between prestrip and posttransportation (P = 0.05). Alizarin red staining did not show any uncovered area. Live/dead analysis showed 85.16% cell viability after transportation. zonula occludens-1 (ZO-1) was expressed in all tissues.

Conclusions:

The DMEK Rapid device is safe for preloading and shipping DMEK grafts internationally with endothelium outward within 72 hours when preserved in the transport media.
Tissue Loss, Processing Time, and Primary Graft Failure in Eye Bank–Prepared Descemet Membrane Endothelial Keratoplasty Grafts Before and After Prestripped to Preloaded Graft Transition
Authors: Duong Andrew T. , Mandel Foley Lindsay , Galloway Joshua , Sales Christopher S. , Tran Khoa D.
Published: September 2020

Purpose:

To examine tissue loss rates, processing time, and primary graft failure (PGF) of “prestripped-only” Descemet membrane endothelial keratoplasty (DMEK) grafts at a single eye bank and how these parameters changed after the introduction of steps to preload tissue among experienced processors.

Methods:

Tissue loss and processing time during DMEK graft preparation as well as PGF were analyzed retrospectively at a single eye bank between 2012 and 2018. Outcomes were assessed in consecutive grafts before and after the introduction of preloading to the eye bank's standard operating procedure.

Results:

A total of 1326 grafts were analyzed, composed of the first 663 preloaded DMEK grafts and, for comparison, the 663 DMEK grafts processed immediately before starting the preloaded service. Mean processing time increased from 17.0 ± 3.9 minutes to 26.0 ± 5.4 minutes with the advent of preloading (P < 0.01). Initially, average processing time increased dramatically, with a maximum processing time of 51 minutes, before regressing to the average. No significant difference in the rate of tissue wastage was observed before versus after the implementation of preloaded DMEK (1.2% vs. 1.7%, P = 0.48). PGF occurred in 7 grafts before the preloaded service and 10 grafts after starting the service (1.6% vs. 2.3%, P = 0.47).

Conclusions:

Preloading does not affect tissue wastage for experienced technicians or the PGF rate but increases processing time. Eye banks that are considering adding preloading to their standard operating procedure may need to account for longer processing times in their daily operations.
Visual performance and patient satisfaction after implantation of extended range-of-vision IOLs: bilateral implantation vs 2 different mix-and-match approaches
Authors: Koo Oh-sub , Kang Jun-won , Park Jin-Koo , Kim Kuk-Hyoe
Published: September 2020

Purpose:

To compare the visual outcomes and patient satisfaction after bilateral implantation of an extended range-of-vision intraocular lens (ERoV IOL) (Tecnis Symfony) vs 2 different mix-and-match approaches combining the ERoV IOL with bifocal IOLs.

Setting:

Glory Seoul Eye Clinic, Seoul, South Korea.

Design:

Prospective observational nonrandomized comparative study.

Methods:

Patients undergoing cataract surgery were distributed into 3 groups based on their lifestyle and near visual demands: bilateral Symfony IOL, mix-and-match Symfony IOL with bifocal +3.25 diopters (D) IOL, and Symfony IOL with bifocal +4.0 D IOL. Binocular uncorrected visual acuity for distance, intermediate, and near, manifest refraction, defocus curve, contrast sensitivity, and subjective visual perception and satisfaction (photic phenomena, spectacle independence, and patient satisfaction) were evaluated at 1 week, 1 month, and 3 months postoperatively.

Results:

The study comprised 103 people (206 eyes). There were no significant differences for uncorrected visual acuity between groups for distance, intermediate, and near vision (P > .05). Contrast sensitivity under low and high luminance conditions was not different between groups (P > .05). Influence of glare on image perception was found to reduce contrast sensitivity more in the bilateral group for smaller target sizes (P < .05). Patients implanted bilaterally with Symfony IOLs reported photic phenomena more frequently than those implanted with the mix-and-match combinations.

Conclusions:

All combinations evaluated provided good visual outcomes for distance, intermediate, and near. The lower incidence of photic phenomena reported by patients, and the lower reduction on contrast sensitivity for low illumination levels with the presence of glare, suggest that mix-and-match approaches might be a better option compared with bilateral implantation of ERoV IOLs.
The Mental Health of Mothers Currently and Formerly Incarcerated in Jails and Prisons: An Integrative Review on Mental Health, Mental Health Treatment, and Traumatic Experiences
Authors: Stanton Ann E. , Rose Susan J.
Published: September 2020

Most incarcerated women in the United States are mothers who report high rates of mental health issues and traumatic experiences, yet their needs are often overlooked because they comprise a smaller proportion of the incarcerated population compared with men.

Objective

This integrative review aimed to synthesize the literature on the mental health, mental health treatment, and traumatic experiences of currently and formerly incarcerated mothers.

Methods

We searched PsychINFO, CINAHL, and Criminal Justice Abstracts for all research articles that were written in English; included adult mothers who were incarcerated or incarcerated and released; and contained findings related to mental health, mental health treatment, or traumatic experiences.

Results

Thirty-four articles met the inclusion criteria. Mothers had high rates of moderate-to-severe mental health problems and high childhood and adult trauma rates, especially intimate partner violence. Mothers faced barriers to treatment yet showed psychological resilience and active coping skills.

Implications

Nurses can recognize risk factors for women's incarceration and assess mental health symptoms and trauma, especially interpersonal violence. Nurses can use assessment findings to refer mothers to treatment and community resources and support their reuniting with their children. Nurses can also provide trauma-informed care and education about mental health topics and advocate for mental health treatment prerelease and postrelease. Staff education and organizational interventions to reduce burnout may remove additional barriers to care.
Using Telehealth for Pediatric, Adolescent, and Adult Sexual Assault Forensic Medical Examinations: An Integrative Review
Authors: Walsh Wendy A. , Meunier-Sham Joan
Published: September 2020

Objective

Improved access to qualified nurse examiners to perform sexual assault forensic examinations is needed. This integrative review examines the current research literature on synchronous “real-time or live” telehealth support and guidance during pediatric, adolescent, and adult sexual abuse/assault forensic examinations.

Methods

Informational databases (CINAHL, Health Source: Nursing/Academic Edition, Medline, PsychInfo, and Violence & Abuse Abstracts) were searched, and research articles including live telehealth for sexual assault survivors were reviewed (n = 98).

Results

Review of the articles resulted in the inclusion of seven studies that utilized live video telehealth during the sexual assault forensic examination.

Conclusion

The current research literature supports the premise that synchronous telehealth is a promising modality for this patient population. However, the lack of large comprehensive studies warrants additional research to understand outcomes and develop best practices. Additional research studies are needed to evaluate the effectiveness, cost, and criminal justice impact of this intervention.
The Treatment of Cholesteatomas Involving the Antrum and Mastoid Using Transcanal Underwater Endoscopic Ear Surgery
Authors: Chen Yichao , Hu Junjiao , Liu Wei , Wang Qin , Li Yajun , Peng Anquan , Zhang Zhiwen
Published: September 2020

Objective:

The aim of this study was to evaluate the feasibility and safety of transcanal underwater endoscopic bone resection (TUEBR) of the external auditory canal (EAC) for the management of cholesteatoma involving the antrum and mastoid.

Study Design:

Retrospective case review.

Setting:

Tertiary referral center.

Patients:

Pediatric and adult patients with primary cholesteatoma extending to the antrum and mastoid who underwent transcanal endoscopic ear surgery (TEES) with TUEBR between March 2016 and June 2017.

Intervention:

A rigid 2.7 mm diameter, 18 cm length Hopkins-rod telescope with an endoscopic sheath was inserted in the EAC and continuously perfused with saline during the dissection. TUEBR was performed to expose extensive cholesteatoma by using a high speed drill with curved burrs and a protected shaft. Next, removal of visible disease, reconstruction of the resected EAC, ossiculoplasty, and tympanoplasty were accomplished with TEES.

Results:

There were no intra- or postoperative severe complications such as facial palsy and inner ear injury except one patient suffering from secondary labyrinthitis. There was a negative linear relationship (r = –0.909) between the procedure time and procedure number of TUEBR. There was a weak relationship (r = 0.224) between the procedure time of TUEBR and the degree of the extension of cholesteatoma into the antrum and mastoid. There were two cases with residual cholesteatoma at 12 and 22 months follow-up postoperatively.

Conclusion:

TUEBR is a safe and efficient technique for the resection of EAC bone and transcanal exposure of extensive cholesteatoma that would otherwise require mastoid dissection.
Mobility Technicians
Authors: Lisevick Alexa B. , Kelly Stephanie , Cremins Michael S. , Vellanky Smitha S. , McCann Grace P. , LeBlanc Kathy , Derla Marlo , Comerford Erica , Sinha Sanjay K.
Published: September 2020

BACKGROUND:

Early ambulation of patients with total joint replacement (TJR) has been shown to improve outcomes while reducing length of stay and postoperative complications. Limited physical therapy (PT) resources and late-in-the-day cases may challenge day-of-surgery (POD0) ambulation. At our institution, a Mobility Technician (MT) program, composed of specially trained nurse's aides, was developed to address this issue.

PURPOSE:

The purpose of this study was to compare the effectiveness of the MT model with a traditional PT model in the early ambulation of patients with TJR.

METHODS:

Patients undergoing unilateral primary TJR at a single institution between June 1, 2014, and October 31, 2018, were included. Ambulation measures were retrospectively assessed between pre- and post-MT program groups.

RESULTS:

This study included 11,777 patients with TJR. Following the MT program, number of POD0 ambulations, POD0 ambulation distance, and total distance ambulated all increased while time-to-first ambulation decreased.

CONCLUSION:

Preliminary analyses indicate that the MT program has been successful in the early ambulation of patients with TJR.
A Case of Synchronous Malignant and Benign Granular Cell Tumor of the Vulva
Authors: Baranova Katherina , Goebel Emily A. , McGee Jacob , Walsh Joanna C.
Published: September 2020

Granular cell tumors (GCT) are rare soft tissue neoplasms, which seldom occur in the vulva. They are more commonly benign, but malignant GCT do occur. We report a case of a 50-yr-old postmenopausal woman who presented with a vulvar lesion that was diagnosed as GCT on biopsy. Imaging and clinical examination revealed an enlarged, likely positive lymph node. Pathology of the subsequently resected total deep vulvectomy specimen showed 2 histologically distinct GCTs. The larger lesion met criteria for malignancy and histologically corresponded to metastatic deposits seen in the pelvic lymph nodes. The separate smaller lesion was histologically benign. This case illustrates a malignant GCT with a synchronous, likely benign GCT both occurring in the vulva. Our case demonstrates the application of histologic criteria in the diagnosis of malignant and benign GCT with discussion on the diagnosis and treatment of this rare tumor.
Benign Brenner Tumor in an Ectopic Ovary: A Case Report and Review of Literature
Authors: Heimbigner Alex M. , Davaro Elizabeth P. , Schwetye Katherine
Published: September 2020

Supernumerary ectopic ovaries are very rare, with fewer than 40 cases of isolated supernumerary ovaries reported in the literature since their discovery in 1864. Tumors arising in ectopic ovaries are also extremely rare, with only a handful of reports in the literature. Given the rarity of this combination of findings, we report a case of a 68-yr-old woman incidentally found to have a 4.7 cm solid retroperitoneal mass adjacent to the liver, diagnosed as a benign Brenner tumor arising in a supernumerary ectopic ovary. To our knowledge, there has been only one previously reported case of Brenner tumor arising in this unusual setting.