bluuebunny/crossref_metadata_2025 huggingface dataset:
Responding to Uncertainty
Authors: Johnson L. Syd M
Published: November 2021

There are numerous contexts, beyond disorders of consciousness, where there is a need for decisive action in the presence of unavoidable epistemic uncertainty. The ethics of uncertainty can help. This chapter examines three complex decisional contexts with intersecting, interacting epistemic and ethical uncertainty. The first is pain. Pain, like consciousness, is a subjectively phenomenal experience, the quality and quantity of which are hard to put into words. Pain sufferers encounter testimonial injustice because of the subjectivity, invisibility, and objective uncertainty of pain. The second context is vaccine research and development, and the emergency approval of COVID-19 vaccines under conditions of time pressure and uncertainty. The third context is research with conscious nonhuman animals. There are known, certain risks of harm to the animals, but the benefits of the research are epistemically uncertain. Judging the permissibility of such research requires considering inductive risks, and the principles of inductive risk.
Epidemiology and Primary Health Care
Authors: Vaughan J Patrick , Victora Cesar , R Chowdhury A Mushtaque
Published: November 2021

This chapter introduces the Sustainable Development Goals (SDGs) and Universal Health Coverage (UHC) and the central role of epidemiological concepts, knowledge, and skills in planning, management, and evaluation of district health systems in support of primary health care. It focuses on interventions to improve the health status of whole populations and shows how epidemiology is essential to support local decision-making for improvements in the population’s health. Health planning is outlined using a systems approach for high-priority health services and public health programmes delivered by district health services and programmes. The differences between interventions for clinical medicine and public health are explained. The systems approach to district planning are also explained.
Population Demography
Authors: Vaughan J Patrick , Victora Cesar , R Chowdhury A Mushtaque
Published: November 2021

This chapter reviews population measurements and the demographic and epidemiological transitions and how these may change over time. Knowledge of the population age and sex structure and distribution are essential to estimate those people at most risk and for estimating population access to services and programmes. Sources of population information are presented and factors highlighted for the quality of population data. Definitions of demographic rates and life expectancy, population growth, census procedures, death certification, and demographic surveillance are all outlined.
Outbreaks and Epidemics
Authors: Vaughan J Patrick , Victora Cesar , R Chowdhury A Mushtaque
Published: November 2021

This chapter covers understanding communicable diseases, main modes of transmission and causes of different outbreaks, and the definition of an epidemic and pandemic. Different kinds of outbreaks and their investigation and control are described. Person-to-person or propagated transmission, such as with SARS and Covid-19, can rapidly lead to an epidemic when on average one case leads to more than one new case. This is the reproductive rate or R value. It is important both to investigate and control local epidemics at the same time. Understanding and controlling major epidemics and pandemics are more complicated tasks and usually require specialist expertise. A district outbreak/epidemic checklist is provided.
Using Qualitative Methods
Authors: Vaughan J Patrick , Victora Cesar , R Chowdhury A Mushtaque
Published: November 2021

Qualitative methods can provide quick insights and information that can help to improve delivery, access, quality and coverage of health services and programmes. These methods ask questions and make observations that can complement quantitative information from routine information systems, health surveys, and quantitative studies. These quick methods help to understand people’s beliefs and why they make use and do not make use of local health services and programmes. The main methods include record reviews, observations, exit interviews, key informant interviews, focus groups, and rural appraisal. Importance of triangulation is explained.
Successful Aging
Authors: Tesch-Romer Clemens , Wahl Hans-Werner , Rattan Suresh , Ayalon Liat
Published: November 2021

Biological ageing is a progressive decline in physiological functionality, and an increase in the chances of chronic diseases and death. Ageing of the body sets in and happens progressively, exponentially and intrinsically in the period beyond the naturally evolved essential lifespan of a species. Ageing science has searched for the factors securing longevity in good health. An end to this quest is not foreseeable. For a large number, frailty and cognitive impairment is the reality of ageing, and it is by no means certain if health promotion, prevention, and other interventions will reduce the probability of its occurrence. A narrow understanding of ‘successful ageing’ as good health, full functioning, and active participation in society excludes a large portion of ageing individuals from the quest for a good life in old age. Hence, the term is highly ambivalent. On the one hand, it counteracts the deficit view of ageing and facilitates visionary thinking on what might be possible in the future. On the other hand, its ageist and derogative features have negative consequences. Striving for a good life in old age should be inclusive, acknowledging different forms and pathways of ageing. Conceptions of life worth living up to very old age can vary widely, and may include good health and functioning, and also life satisfaction, wisdom, supporting environments, and good care. The discussion on successful ageing needs a multifaceted and pluralistic spirit of discourse, which aims to integrate different models of life-course development into a new narrative of successful ageing.
The skull
Authors: van Gijn Daniel R. , Dunne Jonathan
Published: November 2021

The human skull is the skeleton of the head and is considered along with the mandible. It consists of paired bones and unpaired midline bones that contribute to the muscular attachments for mastication and facial expression, a bony foundation for the upper aerodigestive tract and support and housing for the special sensory organs, brain and other structures susceptible to trauma. The skull without the mandible is termed the cranium and consists of the neurocranium and viscerocranium (facial skeleton). The upper third of the skull is principally formed by the frontal bones and exaggerated at the superciliary ridges of the superior orbit and smooth glabella region centrally. The paired maxillary bones form the middle third, creating the circumference of the piriform aperture between, and are separated from the frontal and temporal bones by the zygoma laterally. They house the maxillary sinuses and meet in the midline inferiorly to form the upper jaw and most of the hard palate at the intermaxillary suture.
Viscera of the neck
Authors: van Gijn Daniel R. , Dunne Jonathan
Published: November 2021

The thyroid gland is a symmetrical H-shaped endocrine structure in the lower neck. It consists of two lobes, each extending from the oblique line of the thyroid cartilage above to the sixth tracheal ring below – united by a median isthmus covered by the anterior jugular veins. The small, (usually) paired and inconsistent parathyroid glands lie behind the lobes of the thyroid gland. They measure 6mm by 4mm by 2mm and are ordinarily four in number – two superior and two inferior. They are involved in the careful regulation of the body’s calcium levels. Both superior and inferior glands are ordinarily supplied by the inferior thyroid artery. Drainage is into the venous plexus on the anterior surface of the thyroid.
The larynx
Authors: van Gijn Daniel R. , Dunne Jonathan
Published: November 2021

The larynx, trachea and bronchi develop embryologically from the foregut in the form of an outpouching during the fourth week of gestation. The larynx bridges the gap from the base of the tongue above, to the trachea below lying within the hypopharynx. It sits in the neck spanning the distance from the third to sixth cervical vertebrae. It is a complex respiratory organ composed of a cartilage framework, ligaments, intrinsic and extrinsic muscles and is lined by an epithelial mucous membrane continuous above with the pharynx and below with the trachea. Its primary function is protection of the lower respiratory tract against aspiration. It allows the generation of a high intrathoracic pressure required for coughing, straining and lifting (Valsalva manoeuvre) and phonation. The anatomy of the larynx can either be considered by its surgical division of the supraglottis, glottis and subglottis (these landmarks are important in the consideration of cancer spread).
The ear
Authors: van Gijn Daniel R. , Dunne Jonathan
Published: November 2021

The delicate yet definitive deflections of the pinna (wing/fin) of the external ear contribute to the collection of sound. The external acoustic meatus is responsible for the transmission of sounds to the tympanic membrane, which in turn separates the external ear from the middle ear. The middle ear is an air filled (from the nasopharynx via the eustachian tube), mucous membrane lined space in the petrous temporal bone. It is separated from the inner ear by the medial wall of the tympanic cavity – bridged by the trio of ossicles. The inner ear refers to the bony and membranous labyrinth and their respective contents. The osseus labyrinth lies within the petrous temporal bone. It consists of the cochlea anteriorly, semicircular canals posterosuperiorly and intervening vestibule – the entrance hall to the inner ear whose lateral wall bears the oval window occupied by the stapes footplate.
Tuberculosis
Authors: Howlett Patrick , Wilkinson Robert J. , Marais Ben
Published: November 2021

Current global situation and trends, Disease and pathogenesis, Clinical features, Diagnosis, Tuberculosis treatment, TB and HIV, TB in Children, Treatment regimens, Multi-drug resistant and extensively drug resistant TB , Lessons learned in TB treatment and control
Endocrine disorders
Authors: Levitt Naomi , Dave Joel , Ross Ian , Stevens Zane
Published: November 2021

Diabetes mellitus, Management of diabetes mellitus, Diabetes in children and adolescents, Hypothyroidism, Hyperthyroidism, Enlarged Thyroid Gland (Goitre), Pituitary dysfunction, Endocrine hypertension, Pheochromocytoma and paraganglioma, Cushing's syndrome, Gynaecomastia, Hypoadrenalism, Hypercalcaemia, Hypocalcaemia, Hyperkalaemia, Hypokalaemia, Hyponatraemia, Hypernatraemia
Ophthalmology
Authors: Yorston David
Published: November 2021

Global blindness?, Presenting features of eye disease?, Visual loss: refractive errors?, Cataract?, Corneal opacity?, Glaucoma?, Macular degeneration?, Diabetic retinopathy?, Red eye?, Injuries to the eye?, Red eye with no injury?, Conjunctivitis?, Corneal ulcers?, Uveitis?, Acute glaucoma?, Trachoma?, Xerophthalmia?, Ocular leprosy?, HIV infection and the eye?, Onchocerciasis and the eye?
Nutrition
Authors: Mwangome Martha M. , Campion-Smith Tim , Berkley James A.
Published: November 2021

Malnutrition, health and survival?, Measuring nutritional status?, Pathophysiological consequences of severe malnutrition?, Clinical assessment of nutrition?, Medical management within inpatient therapeutic nutrition programmes?, Inpatient therapeutic nutrition programme?, Outpatient therapeutic nutrition programme?, Supplementary feeding programmes?, HIV/AIDS and malnutrition?, Severe malnutrition in infants months old?, Pregnancy?, Nutrition in emergencies?, Recipes and formulas for management of malnourished children?, Vitamin A deficiency?, Vitamin B thiamine deficiency: beriberi?, Vitamin B riboflavin deficiency?, Vitamin B niacin deficiency: pellagra?, Vitamin B pyridoxine deficiency?, Vitamin B deficiency?, Folate deficiency?, Vitamin C deficiency: scurvy?, Vitamin D deficiency: rickets/osteomalacia?, Vitamin E alpha-tocopherol deficiency?, Vitamin K deficiency?, Iodine deficiency?, Zinc xxx, Other micronutrients?, Obesity?
Trauma
Authors: Wilkinson Douglas A. , Kingwill Aidan C.
Published: November 2021

Primary assessment in trauma: ABCDE?, Airway?, Breathing?, Circulation?, Secondary survey?, Chest trauma?, Abdominal trauma?, Head trauma?, Spinal trauma?, Limb trauma?, Burns?, Pregnant trauma patients?, Paediatric trauma?
Introduction
Authors: Denton Nathan
Published: November 2021

Fat (i.e., adipose tissue) is one of the most misunderstood, controversial organs in the body. Not a day goes by without it making the headlines or ‘breaking’ the Internet. Reports about the world’s healthcare system being crippled by preventable obesity-related diseases jostle against advocates’ calls for fat acceptance, while the masses witness improbably sculpted bodies strut along the red carpet and photographs of celebrities supposedly falling off the ‘slim’ wagon. Fat means very different things to different people and is routinely conceptualized in everything from biological, medical, epidemiological, social, economic, and aesthetic, to moral terms. This multi-dimensionality makes it inherently fascinating, controversial, and emotive, but the abundance of studies and conflicting narratives have also resulted in great confusion and uncertainty about fat. Waisted provides an opportunity to re-centre our understanding by reviewing the biology of adipose tissue, exploring its important relationship to body shape and metabolic health, and considering the myriad social meanings of this enigmatic organ.
Candour and confidentiality
Authors: Smajdor Anna , Herring Jonathan , Wheeler Robert
Published: November 2021

This chapter sets out the legal duty to preserve confidentiality and to promote candour. It explores the ethical basis for these obligations and the circumstances in which they can be breached. The recent emphasis on candour is designed to protect the position of whistle blowers. The chapter also outlines the law on data protection.
Doctors and the General Medical Council (GMC)
Authors: Smajdor Anna , Herring Jonathan , Wheeler Robert
Published: November 2021

This chapter explores the role of the General Medical Council. It explains the importance of the register and the licence to practice. It also considers how doctors can be removed from the register or have restrictions on their licence to practice. It discusses how the General Medical Council promotes candour in the profession and investigates concerns about doctors.
Human Tissue Act 2004
Authors: Smajdor Anna , Herring Jonathan , Wheeler Robert
Published: November 2021

This chapter covers Human Tissue Act 2004 and includes topics on Regulation of Human Tissue, Human Tissue: Consent by Children, Human Tissue: Consent by Adults, Prohibited Activities in relation to Human Tissue, Restrictions on Donated Human Tissue, Restrictions on donations using life transplants, and Prohibition of commercial dealings in human material for transplantation.
Mental Capacity Act 2005
Authors: Smajdor Anna , Herring Jonathan , Wheeler Robert
Published: November 2021

This chapter covers the Mental Health Act 2005 and includes topics on The Core Test for Mental Capacity, The Obligation to Assist a Person to Gain Capacity, The Best Interests Assessment when a Patient Lacks Capacity, Non-Discrimination in Best Interests Assessment, Derivation of Liberty: General Principles, Derivation of Liberty: Life-Saving Treatment, Protection for Those Wrongly Assessing Capacity Or Best Interests, Definition of a Lasting Power of Attorney, General provisions on advanced directives, Effect of an advance decision, The Effect of Advance Decisions, Things that the Mental Capacity Act cannot authorise, and Authorising of Deprivation of Liberty.
Perseverance: An Essential Trait of Military Interprofessional Healthcare Teams
Authors: Meyer Holly S , Durning Steven J , Bader-Larsen Karlen S , Hamwey Meghan , Varpio Lara
Published: November 2021

Introduction

Perseverance—doing something despite difficulty—is an asset to healthcare professionals, yet not all providers display this trait. The literature offers no conceptualization of perseverance as it relates to military caregivers. This research sought to explore the perseverance displayed by members of military interprofessional healthcare teams (MIHTs) and to construct a framework for explaining the role of perseverance in MIHTs’ collaborative work.

Methods

Using Grounded Theory, this interview-based study collected insights from 30 individuals who had participated in MIHTs and/or led MIHTs. Participants represented 11 different health professions, both officers and enlisted military members, and three branches of the U.S. military (i.e., Army, Navy, and Air Force). Data were collected and analyzed in iterative cycles until theme saturation was achieved.

Results

We identified practices through which perseverance was exhibited by members of MIHTs: (1) humility, (2) mission focus, (3) team effort, (4) failure is not an option, (5) comfort with discomfort, and (6) continuous improvement. We then clustered these practices into three subcategories, reflecting how certain practices may connect to support MIHT perseverance.

Conclusions

These six practices appear connected in significant ways to support the MIHTs’ efforts. Humility, mission focus, and team effort can help team members collaborate as a unified and mutually supportive team. From this base, MIHTs seemed able to become comfortable with discomfort and to refuse failure as an option. These orientations then allowed the team to engage in continuous improvement. Together, these practices may enhance team perseverance and ultimately team performance.
Supermassive black holes in cosmological simulations – II: the AGN population and predictions for upcoming X-ray missions
Authors: Habouzit Mélanie , Somerville Rachel S , Li Yuan , Genel Shy , Aird James , Anglés-Alcázar Daniel , Davé Romeel , Georgiev Iskren Y , McAlpine Stuart , Rosas-Guevara Yetli , Dubois Yohan , Nelson Dylan , Banados Eduardo , Hernquist Lars , Peirani Sébastien , Vogelsberger Mark
Published: November 2021

In large-scale hydrodynamical cosmological simulations, the fate of massive galaxies is mainly dictated by the modelling of feedback from active galactic nuclei (AGNs). The amount of energy released by AGN feedback is proportional to the mass that has been accreted on to the black holes (BHs), but the exact subgrid modelling of AGN feedback differs in all simulations. While modern simulations reliably produce populations of quiescent massive galaxies at z ≤ 2, it is also crucial to assess the similarities and differences of the responsible AGN populations. Here, we compare the AGN populations of the Illustris, TNG100, TNG300, Horizon-AGN, EAGLE, and SIMBA simulations. The AGN luminosity function (LF) varies significantly between simulations. Although in agreement with current observational constraints at z = 0, at higher redshift the agreement of the LFs deteriorates with most simulations producing too many AGNs of $L_{\rm x, 2\!-\!10 \, keV}\sim 10^{43\!-\!44}\, \rm erg\, s^{-1}$. AGN feedback in some simulations prevents the existence of any bright AGN with $L_{\rm x, 2\!-\!10 \, keV}\geqslant 10^{45}\rm \,erg\, s^{-1}$ (although this is sensitive to AGN variability), and leads to smaller fractions of AGN in massive galaxies than in the observations at z ≤ 2. We find that all the simulations fail at producing a number density of AGN in good agreement with observational constraints for both luminous ($L_{\rm x, 2\!-\!10 \, keV}\sim 10^\text{43-45}\, \rm erg\, s^{-1}$) and fainter ($L_{\rm x, 2\!-\!10 \, keV}\sim 10^\text{42-43}\, \rm erg\, s^{-1}$) AGNs and at both low and high redshifts. These differences can aid us in improving future BH and galaxy subgrid modelling in simulations. Upcoming X-ray missions (e.g. Athena, AXIS, and LynX) will bring faint AGNs to light and new powerful constraints. After accounting for AGN obscuration, we find that the predicted number density of detectable AGNs in future surveys spans at least one order of magnitude across the simulations, at any redshift.
Dust destruction and survival in the Cassiopeia A reverse shock
Authors: Priestley F D , Arias M , Barlow M J , De Looze I
Published: November 2021

Core-collapse supernovae (CCSNe) produce large ($\gtrsim0.1\,{\rm M}_\odot$) masses of dust, and are potentially the primary source of dust in the Universe, but much of this dust may be destroyed before reaching the interstellar medium. Cassiopeia A (Cas A) is the only supernova remnant where an observational measurement of the dust destruction efficiency in the reverse shock is possible at present. We determine the pre- and post-shock dust masses in Cas A using a substantially improved dust emission model. In our preferred models, the unshocked ejecta contains $0.6\!-\!0.8\,{\rm M}_\odot$ of $0.1\,{\rm \mu m}$ silicate grains, while the post-shock ejecta has $0.02\!-\!0.09\,{\rm M}_\odot$ of $5\!-\!10 \, {\rm nm}$ grains in dense clumps, and $2 \times 10^{-3}\,{\rm M}_\odot$ of $0.1 \, {\rm \mu m}$ grains in the diffuse X-ray emitting shocked ejecta. The implied dust destruction efficiency is $74\!-\!94\,{\rm per\,cent}$ in the clumps and $92\!-\!98\,{\rm per\,cent}$ overall, giving Cas A a final dust yield of $0.05\!-\!0.30\,{\rm M}_\odot$. If the unshocked ejecta grains are larger than $0.1\,{\rm \mu m}$, the dust masses are higher, the destruction efficiencies are lower, and the final yield may exceed $0.5\,{\rm M}_\odot$. As Cas A has a dense circumstellar environment and thus a much stronger reverse shock than is typical, the average dust destruction efficiency across all CCSNe is likely to be lower, and the average dust yield higher. This supports a mostly stellar origin for the cosmic dust budget.
MutScape: an analytical toolkit for probing the mutational landscape in cancer genomics
Authors: Lu Cheng-Hua , Wu Chia-Hsin , Tsai Mong-Hsun , Lai Liang-Chuan , Chuang Eric Y
Published: November 2021

Cancer genomics has been evolving rapidly, fueled by the emergence of numerous studies and public databases through next-generation sequencing technologies. However, the downstream programs used to preprocess and analyze data on somatic mutations are scattered in different tools, most of which require specific input formats. Here, we developed a user-friendly Python toolkit, MutScape, which provides a comprehensive pipeline of filtering, combination, transformation, analysis and visualization for researchers, to easily explore the cohort-based mutational characterization for studying cancer genomics when obtaining somatic mutation data. MutScape not only can preprocess millions of mutation records in a few minutes, but also offers various analyses simultaneously, including driver gene detection, mutational signature, large-scale alteration identification and actionable biomarker annotation. Furthermore, MutScape supports somatic variant data in both variant call format and mutation annotation format, and leverages caller combination strategies to quickly eliminate false positives. With only two simple commands, robust results and publication-quality images are generated automatically. Herein, we demonstrate the ability of MutScape to correctly reproduce known results using breast cancer samples from The Cancer Genome Atlas. More significantly, discovery of novel results in cancer genomic studies is enabled through the advanced features in MutScape. MutScape is freely available on GitHub, at https://github.com/anitalu724/MutScape.
Capabilities for transdisciplinary research
Authors: O’Donovan Cian , Michalec Aleksandra (Ola) , Moon Joshua R
Published: November 2021

Problems framed as societal challenges have provided fresh impetus for transdisciplinary research. In response, funders have started programmes aimed at increasing transdisciplinary research capacity. However, current programme evaluations do not adequately measure the skills and characteristics of individuals and collectives doing this research. Addressing this gap, we propose a systematic framework for evaluating transdisciplinary research based on the Capability Approach, a set of concepts designed to assess practices, institutions, and people based on public values. The framework is operationalized through a mixed-method procedure which evaluates capabilities as they are valued and experienced by researchers themselves. The procedure is tested on a portfolio of ‘pump-priming’ research projects in the UK. We find these projects are sites of capability development in three ways: through convening cognitive capabilities required for academic practice; cultivating informal tacit capabilities; and maintaining often unacknowledged backstage capabilities over durations that extend beyond the lifetime of individual projects. Directing greater attention to these different modes of capability development in transdisciplinary research programmes may be useful formatively in identifying areas for ongoing project support, and also in steering research system capacity towards societal needs.
Effect of positioning error on the Hilgenreiner epiphyseal angle and the head-shaft angle compared to the femoral neck-shaft angle in children with cerebral palsy
Authors: Sullivan Emily S. , Jones Carly , Miller Stacey D. , Min Lee Kyoung , Seok Park Moon , Wilson David R. , Mulpuri Kishore , d’Entremont Agnes G.
Published: November 2021

Children with cerebral palsy (CP) often have changes in proximal femoral geometry. Neck-shaft angle (NSA), Hilgenreiner epiphyseal angle (HEA) and head-shaft angle (HSA) are used to measure these changes. The impact of femoral rotation on HEA/HSA and of ab/adduction on HEA/HSA/NSA is not well known. This study aimed to determine and compare the effect of rotation, ab/adduction and flexion/extension on HEA/HSA/NSA. Radiographic measurements from 384 patients with Gross Motor Function Classification System (GMFCS) levels I–V were utilized. NSA/HSA for affected hips were used with femoral anteversion averages to create three-dimensional models of 694 hips in children with CP. Each hip was rotated, ab/adducted and flexed/extended to simulate malpositioning. HEA/HSA/NSA of each model were measured in each joint position, and differences from correct positioning were determined. Mean HEA error at 20° of internal/external rotations were −0.60°/3.17°, respectively, with the NSA error of −6.56°/9.94° and the HSA error of −3.69°/1.21°. Each degree of ab/adduction added 1° of the HEA error, with no NSA/HSA error. NSA was most sensitive to flexion. Error for all measures increased with increasing GMFCS level. HEA/HSA were minimally impacted by rotation. NSA error was much higher than HEA/HSA in internal rotation and flexion whereas HEA was sensitive to changes in ab/adduction. Given abduction is more easily detectable on imaging than rotation, HEA may be less affected by positioning errors that are common with children with CP than NSA. HSA was least affected by position changes. HEA/HSA could be robust, complementary measures of hip deformities in children with CP.
Publication Rates of Abstracts Presented at Pediatric Orthopaedic Society of North America Meetings Between 2013 and 2016
Authors: Rawicki Nathaniel L. , Fasani-Feldberg Gregory B. , Agarwalla Avinesh , Sethuraman Saranya A. , Pammal Rajkumar S. , Lapow Justin , Cristofaro Robert
Published: November 2021

Background:

Academic conferences such as the annual Pediatric Orthopaedic Society of North America (POSNA) meeting provide opportunities to present up-to-date scientific work that can influence clinical decision making. This study reviewed 4 years of abstracts presented at POSNA to assess trends in poster and podium presentation publication rates and associated metrics and the impact of academic presentations on the pediatric orthopaedic literature.

Methods:

All abstracts presented at POSNA annual meetings from 2013 to 2016 were analyzed for presentation type, subspeciality, level of evidence, study design, peer-reviewed publication within 4 years of presentation, 1-year publication rates, journal impact factors, number of authors, and citations of the final publication. χ2, analysis of variance, and t tests were conducted to measure independence of variables. Statistical significance was indicated at P<0.05.

Results:

A total of 1135 abstracts were included with 676 published in peer-reviewed journals by August 2020 and 38 excluded because of publication before presentation. The number of accepted abstracts increased yearly. Total of 58.2% of POSNA abstracts were published and 42.5% had the same first author on the final manuscript. Average journal impact factor was 2.60±1.30 with a mean 14.3±16.0 citations. Podium presentations were significantly more likely to be published than poster presentations (63.1% vs. 51.2%, P<0.001) and in higher-impact factor journals. Level I evidence abstracts were published in journals with an average 1.663 higher impact factor than level V evidence abstracts, with no significant difference between overall publication rate and study type (P=0.69) or level of evidence (P=0.95) for podium presentations. The Journal of Pediatric Orthopaedics accepted the most abstracts, 38.4% overall, with 64.1% of acceptances resulting from podium presentations and no difference in time to publication based on subspecialty.

Conclusions:

The overall publication rate for POSNA abstracts has increased 8.7% from prior analysis. Podium presentations are more likely than poster presentations to be published, overall and in higher-impact journals, and are cited more frequently.

Level of Evidence:

Level IV—descriptive retrospective epidemiological study.
Frontline Nurse Feedback During the Development of a System to Track Cleaning of Portable Medical Equipment
Authors: Williams Marjory D. , Coppin John David , Martel JulieAnn , Stibich Mark , Simmons Sarah , Passey Deborah G. , Chatterjee Piyali , Choi Hosoon , Ramirez Hector , Crowley Patrick , Jinadatha Chetan
Published: November 2021

As part of the development and testing of an innovative technology for tracking disinfection of portable medical equipment, end-user feedback was obtained during an initial trial on two acute care hospital units. The disinfection tracking device was installed on the computers-on-wheels and vital signs machines. Each device had the capability of detecting a cleaning event, reporting the event to an online database, and displaying the time since last cleaning event on a visual display. End-user feedback regarding functionality, usefulness of information provided, and impact on workflow was obtained by survey and facilitated group discussions. Seventeen frontline nurses completed the anonymous survey, and 22 participated in the facilitated group discussions. End users found the system functionally easy to use and the information about time since last cleaning useful and reported minimum disruption of workflow. Functionality of the system was confirmed by consistency between recorded and self-reported cleaning patterns. Managers found the data on cleaning of portable medical equipment helpful in validating compliance with hospital equipment cleaning policy. Frontline staff expressed appreciation for technology that helps them and improves outcomes but also discussed concerns about the potential for technology that creates extra work and disruption in the busy frontline nursing care delivery environment. Nurses were appreciative of opportunities to provide feedback and input into efforts to develop and introduce technology. Recorded cleaning events coincided with self-reported equipment cleaning patterns and illustrated that the device efficiently collects information deemed useful by the end user.
School Readiness in Children Born <30 Weeks' Gestation at Risk for Developmental Coordination Disorder: A Prospective Cohort Study
Authors: Spittle Alicia J. , Olsen Joy E. , FitzGerald Tara L. , Cameron Kate L. , Albesher Reem A. , Mentiplay Benjamin F. , Treyvaud Karli , Burnett Alice , Lee Katherine J. , Pascoe Leona , Roberts Gehan , Doyle Lex W. , Anderson Peter , Cheong Jeanie L. Y.
Published: November 2021

Objective:

The objective of this study was to determine whether school readiness differs between children born <30 weeks' gestation who are classified as at risk for developmental coordination disorder (DCD) and those who are not.

Methods:

This study was a prospective cohort study of children born <30 weeks' gestation. Children were classified as at risk for DCD at a corrected age of 4 to 5 years if they scored <16th centile on the Movement Assessment Battery for Children–Second Edition (MABC-2), had a full scale IQ score of ≥80 on the Wechsler Preschool and Primary Scale of Intelligence–Fourth Edition (WPPSI-IV), and had no cerebral palsy. Children were assessed on 4 school readiness domains: (1) health/physical development [Physical Health domain of Pediatric Quality of Life Inventory (PedsQL), Pediatric Evaluation of Disability Inventory Computer Adaptive Test, and Little Developmental Coordination Disorder Questionnaire], (2) social-emotional development (Strengths and Difficulties Questionnaire and PedsQL psychosocial domains), (3) cognitive skills/general knowledge (WPPSI-IV), and (4) language skills (WPPSI-IV).

Results:

Of 123 children assessed, 16 were ineligible (IQ < 80 or cerebral palsy: n = 15; incomplete MABC-2: n = 1); 28 of 107 (26%) eligible children were at risk for DCD. Children at risk for DCD had poorer performance on all school readiness domains, with group differences of more than 0.4 SD in health/physical development, social-emotional development, and language skills and up to 0.8 SD for cognitive skills/general knowledge compared with those not at risk of DCD.

Conclusion:

Being at risk for DCD in children born <30 weeks' gestation is associated with challenges in multiple school readiness domains, not only the health/physical domain.
The role of trabeculectomy in the era of minimally invasive glaucoma surgery
Authors: Kalarn Sachin , Le Tinh , Rhee Douglas J.
Published: November 2021

Purpose of review

This review discusses recent findings in surgical management of glaucoma, focusing on trabeculectomy and minimally invasive glaucoma surgery (MIGS). We discuss how the role these procedures play in conjunction with phacoemulsification.

Recent findings

New findings of the Primary Trab Vs Tube study and findings regarding the Hydrus, Xen 45, Kahook dual blade, Ab-interno Canaloplasty and head-to-head MIGS studies are summarized.

Patients with glaucoma greatly benefit from combining cataract surgery with a MIGS procedure that can be tailored to disease severity and medication use. Certain MIGS combined with phacoemulsification in severe and refractory glaucoma can potentially delay incisional glaucoma, although trabeculectomy- mitomycin C (MMC) still remains the best option in certain patient populations. We provide an update in the MIGS treatment paradigm based on newer, stronger evidence.
Low-concentration povidone-iodine for the prevention of intraocular infections in ophthalmic surgery
Authors: Grzybowski Andrzej , Shimada Hiroyuki , Nakashizuka Hiroyuki , Koerner Jagger
Published: November 2021

Purpose of review

Endophthamitis following intraocular surgery is rare using current antiseptic techniques, such as single application of 5% povidone-iodine to the ocular surface and adjuvant topical or intracameral antibiotics. Challenges remain, however, including increased multidrug-resistant bacterial endophthalmitis, increased fungal endophthalmitis, and the low but nonzero endophthalmitis rate attributable to the typical bacteria that colonize the ocular surface.

Recent findings

Povidone-iodine has a wide spectrum of activity, including activity against novel pathogens, such as SARS-CoV-2. Povidone-iodine alternatives, such as hypochlorous acid can have significantly less efficacy in vitro against endophthalmitis isolates. Repetitive application of dilute povidone-iodine has an excellent safety profile and strong evidence base for efficacy.

Povidone-iodine is widely available, inexpensive, and commonly used by ophthalmologists. The repetitive application of dilute povidone-iodine is a well studied, well tolerated, and efficacious way to transiently sterilize the ocular surface during intraocular surgery. Additional benefits include activity against multidrug-resistant bacteria, fungi, and lack of inducible resistance.
Capsaicin-induced depolymerization of axonal microtubules mediates analgesia for trigeminal neuropathic pain
Authors: Arora Vipin , Li Tingting , Kumari Sinu , Wang Sheng , Asgar Jamila , Chung Man-Kyo
Published: November 2021

Capsaicin is a specific agonist of transient receptor potential vanilloid 1 (TRPV1), which is enriched in nociceptors. Capsaicin not only produces acute pain but also leads to long-lasting analgesia in patients with chronic pain. Although capsaicin-induced TRPV1 and Ca2+/calpain-dependent ablation of axonal terminals is necessary for long-lasting analgesia, the mechanisms underlying capsaicin-induced ablation of axonal terminals and its association with analgesia are not fully understood. Microtubules are composed of tubulin polymers and serve as a main axonal cytoskeleton maintaining axonal integrity. In this study, we hypothesized that capsaicin would increase the depolymerization of microtubules and lead to axonal ablation and analgesia for trigeminal neuropathic pain. Paclitaxel, a microtubule stabilizer, decreased capsaicin-induced ablation of axonal terminals in time-lapsed imaging in vitro. Capsaicin increases free tubulin in dissociated sensory neurons, which was inhibited by paclitaxel. Consistently, subcutaneous injection of paclitaxel prevented capsaicin-induced axonal ablation in the hind paw skin. Capsaicin administration to the facial skin produced analgesia for mechanical hyperalgesia in mice with chronic constriction injury of the infraorbital nerve, which was prevented by the coadministration of paclitaxel and capsaicin. Whole-mount staining of facial skin showed that paclitaxel reduced capsaicin-induced ablation of peptidergic afferent terminals. Despite the suggested involvement of TRPV1 Ser801 phosphorylation on microtubule integrity, capsaicin-induced analgesia was not affected in TRPV1 S801A knock-in mice. In conclusion, capsaicin-induced depolymerization of axonal microtubules determined capsaicin-induced ablation of nociceptive terminals and the extent of analgesia. Further understanding of TRPV1/Ca2+-dependent mechanisms of capsaicin-induced ablation and analgesia may help to improve the management of chronic pain.
Cognitive Function and the Relationship With Health Literacy and Secondary Prevention in Patients With Acute Coronary Syndrome at Early Discharge
Authors: Zhao Emma , Lowres Nicole , Naismith Sharon L. , Tofler Geoffrey , Bauman Adrian , Gallagher Robyn
Published: November 2021

Background

Cognitive impairment (CI) may contribute to difficulties in understanding and implementing secondary prevention behavior change after acute coronary syndrome (ACS), but the association is poorly understood.

Objectives

The aim of this study was to explore the prevalence of CI in patients 4 weeks post ACS and the association with health literacy and secondary prevention.

Methods

Patients with ACS who were free from visual deficits, auditory impairment, and dementia diagnoses were recruited and assessed 4 weeks post discharge for cognitive function (Montreal Cognitive Assessment and Hopkins Verbal Learning Test), health literacy (Newest Vital Sign), depression (Patient Health Questionnaire), physical activity (Fitbit Activity Tracker and Physical Activity Scale for the Elderly), and medication knowledge and adherence.

Results

Participants (n = 45) had an average age of 65 ± 11 years, 82% were male, 64% were married/partnered, and 82% had high school education or higher. Overall CI was identified in 28.9% (n = 13/45) of the patients 4 weeks after discharge, which was composed of patients detected on both the Montreal Cognitive Assessment and Hopkins Verbal Learning Test (n = 3), patients detected on Montreal Cognitive Assessment alone (n = 6), and patients detected on Hopkins Verbal Learning Test alone (n = 4). Fewer patients with CI had adequate health literacy (61.4%) than patients with normal cognition (90.3%, P = .024). Significant correlations were found between Hopkins Verbal Learning Test scores and medication knowledge (0.4, P = .008) and adherence (0.33, P = .029).

Conclusions

In this exploratory study, 30% of patients with ACS demonstrated CI at 4 weeks post discharge. Two screening instruments were required to identify all cases. Cognitive impairment was significantly associated with health literacy and worth further investigation.
Cold snare polypectomy vs. hot snare polypectomy vs. argon plasma coagulation for small (5–9mm) left-sided colorectal polyps: a prospective randomized trial
Authors: Varytimiadis Lazaros , Viazis Nikos , Gkolfakis Paraskevas , Tribonias Georgios , Tziatzios Georgios , Kyriakopoulos Georgios , Argyrakos Theodore , Pontas Christos , Papastergiou Vasilios , Arkadopoulos Nikolaos , Smyrniotis Vasilios , Mantzaris Gerassimos J. , Papanikolaou Ioannis S.
Published: November 2021

Objective

To compare recurrence rates among three endoscopic treatment modalities for 5–9 mm left-sided colorectal polyps.

Methods

Consecutive adults referred for elective colonoscopy (1/2015–1/2018) with at least one polyp of eligible size (5–9 mm) located distally to the splenic flexure were randomly assigned (1:1:1) to one of three treatment modalities: (1) cold snare polypectomy (CSP), (2) hot snare polypectomy (HSP) and (3) argon plasma coagulation (APC) ablation (50–60 W, flow: 2 l/min). The polyp site was marked with an endoscopic tattoo, and a follow-up colonoscopy with scar biopsies was performed >6 months after the index procedure. Outcomes were polyp recurrence rate and occurrence of complications.

Results

One hundred nineteen patients were enrolled, of whom 112 (62.5% males, mean age 61.1 ± 9.9 years) with 121 polyps (CSP, 39; HSP, 45; APC, 37) returned for follow-up colonoscopy. Mean polyp size was 6.7 ± 0.91 mm, 58% were located in the sigmoid, 33% in the rectum and 8% in the descending colon. The majority of polyps resected by CSP or HSP were neoplastic (tubular adenomas: 25.9%, tubulovillous adenomas: 11.1% and sessile serrate adenomas/polyps: 17.5%). No cases of delayed bleeding or perforation occurred. Scar biopsies at follow-up colonoscopy (performed after a mean interval of 13.4 ± 3.8 months) revealed 7 (5.8%) cases of polyp recurrence, showing no significant difference among the three treatment groups [CSP, 3/39 (7.7%); HSP, 1/45 (2.2%); APC, 2/37 (5.4%); P = 0.51).

Conclusions

CSP, HSP and APC-ablation are effective and well-tolerated treatment modalities for 5–9 mm left-sided colorectal polyps. The present randomized study did not detect any difference in polyp recurrence rate among the three endoscopic techniques.
Fungi
Authors: Alookaran Jane , Liu Yuying , Auchtung Thomas A. , Tahanan Amirali , Hessabi Manouchehr , Asgarisabet Parisa , Rahbar Mohammad H. , Fatheree Nicole Y. , Pearson Deborah A. , Mansour Rosleen , Van Arsdall Melissa R. , Navarro Fernando , Rhoads J. Marc
Published: November 2021

Gastrointestinal (GI) symptoms often affect children with autism spectrum disorders (ASD) and GI symptoms have been associated with an abnormal fecal microbiome. There is limited evidence of Candida species being more prevalent in children with ASD. We enrolled 20 children with ASD and GI symptoms (ASD + GI), 10 children with ASD but no GI symptoms (ASD − GI), and 20 from typically developing (TD) children in this pilot study. Fecal mycobiome taxa were analyzed by Internal Transcribed Spacer sequencing. GI symptoms (GI Severity Index [GSI]), behavioral symptoms (Social Responsiveness Scale ‐2 [SRS‐2]), inflammation and fungal immunity (fecal calprotectin and serum dectin‐1 [ELISA]) were evaluated. We observed no changes in the abundance of total fungal species (alpha diversity) between groups. Samples with identifiable Candida spp. were present in 4 of 19 (21%) ASD + GI, in 5 of 9 (56%) ASD − GI, and in 4 of 16 (25%) TD children (overall P = 0.18). The presence of Candida spp. did not correlate with behavioral or GI symptoms (P = 0.38, P = 0.5, respectively). Fecal calprotectin was normal in all but one child. Finally, there was no significance in serum dectin‐1 levels, suggesting no increased fungal immunity in children with ASD. Our data suggest that fungi are present at normal levels in the stool of children with ASD and are not associated with gut inflammation.
Florid Lymphoid Hyperplasia or Lymphoma-like Lesion of the Lower Genital Tract: A 35-Year Literature Review in View of the New WHO Classification
Authors: Laville David , Martin Laurent , Chauleur Celine , Mehdi Ahmed , Peoc’h Michel , Karpathiou Georgia
Published: November 2021

Florid lymphoid hyperplasias of the lower female genital tract, also known as pseudolymphoma or lymphoma-like lesions, are benign lesions displaying histologic features which mimic aggressive B-cell lymphomas. Initially described by Young and colleagues in 1985, fewer than 100 cases have been published, making this lesion rather uncommon and subject to misdiagnoses. However, given that this entity has now been included in the World Health Organization’s most recent classification, greater clarity would be beneficial for pathologists and physicians. Thus, our report aims to review these entities and provide all available data. We reviewed the available literature according to PRISMA guidelines. We found that lymphoma-like lesions, regardless of their localization, display numerous superficial lymphoid B cells admixed with a polymorphic small lymphocytic and plasmocytic background and, sometimes, superficial ulceration. Large lymphoid cells show prominent nucleoli and mitotic figures. Immunohistochemistry can usually exclude large cell lymphomas, such as high-grade follicular lymphoma and Burkitt lymphoma, when a starry sky pattern is found, as well as Hodgkin Lymphoma; however, the exclusion of diffuse large B-cell lymphoma or marginal zone lymphoma is more difficult. Explorations seeking infectious agents may show Epstein-Barr virus or, rarely, Borrelia burgdorferi involvement. Molecular study occasionally finds a monoclonal B-cell population, but without the subsequent follow-up which would otherwise be worrisome. Despite its somewhat aggressive histologic features, the benignity of this entity must be highlighted to avoid misdiagnosis and complications due to overtreating.