bluuebunny/crossref_metadata_2025 huggingface dataset:
Long noncoding RNAs transcribed downstream of the human β-globin locus regulate β-globin gene expression
Authors: Higashi Miki , Ikehara Tsuyoshi , Nakagawa Takeya , Yoneda Mitsuhiro , Hattori Naoko , Ikeda Masaaki , Ito Takashi
Published: December 2021

The five β-like globin genes (ε, Gγ, Aγ, δ and β) at the human β-globin gene locus are known to be expressed at specific developmental stages, although details of the underlying mechanism remain to be uncovered. Here we used an in vitro transcription assay to clarify the mechanisms that control this gene expression. We first tested nuclear RNA from HeLa cells using RT-qPCR and discovered a long noncoding RNAs (lncRNAs) within a 5.2-kb region beginning 4.4 kb downstream of the β-globin gene coding region. We investigated nuclear RNA from K562 cells using a primer-extension assay and determined the transcription start sites (TSSs) of these lncRNAs. To clarify their functional role, we performed knockdown (KD) of these lncRNAs in K562 cells. Hydroxyurea (HU), which induces differentiation of K562 cells, increased haemoglobin peptide production, and the effect was enhanced by KD of these lncRNAs, which also enhanced upregulation of the γ-globin expression induced by HU. To confirm these results, we performed an in vitro transcription assay. Noncoding single-stranded RNAs inhibited β-globin expression, which was upregulated by GATA1. Furthermore, lncRNAs interacted with GATA1 without sequence specificity and inhibited its binding to its target DNA response element in vitro. Our results suggest that lncRNAs downstream of the β-globin gene locus are key factors regulating globin gene expression.
Combination of Three Different Negative Pressure Wound Therapy Applications and Free Flap for Open Elbow Joint Injury With Extensive Burns
Authors: Oshima Junya , Sasaki Kaoru , Aihara Yukiko , Sasaki Masahiro , Shibuya Yoichiro , Inoue Yoshiaki , Sekido Mitsuru
Published: December 2021

Negative pressure wound therapy (NPWT) for treating burns has a variety of therapeutic applications. Here, we present a case of a 53-year-old woman with self-inflicted burn injuries in whom NPWT was applied for three different purposes. The injured sites were the anterior neck, bilateral arms from the wrists upwards to the chest, and back. The left arm was deeply injured, and the elbow joint cavity was opened during treatment. First, NPWT was used for bridge to skin grafting on the entire upper left limb. Second, NPWT was used as a bolster dressing for the autograft after skin grafting was performed on the left arm except the open part of the joint. Third, NPWT over flap was used on the subsequent flap surgical site to address prolonged exudate from the flap margin. The exudate resolved after about a week. Good results were obtained using NPWT during the perioperative period of free flap transplantation for extensive open elbow joint burns. The use of NPWT is an effective option in the treatment of burns.
Screening Breast MRI and Gadolinium Deposition: Cause for Concern?
Authors: Neal Colleen H
Published: December 2021

Gadolinium-based contrast agents (GBCAs) have been used worldwide for over 30 years and have enabled lifesaving diagnoses. Contrast-enhanced breast MRI is frequently used as supplemental screening for women with an elevated lifetime risk of breast cancer. Data have emerged that indicate a fractional amount of administered gadolinium is retained in the bone, skin, solid organs, and brain tissues of patients with normal renal function, although there are currently no reliable data regarding the clinical or biological significance of this retention. Linear GBCAs are associated with a higher risk of gadolinium retention than macrocyclic agents. Over the course of their lives, screened women may receive high cumulative doses of GBCA. Therefore, as breast MRI screening utilization increases, thoughtful use of GBCA is indicated in this patient population.
At Which Mean Glandular Dose Does the Benefit of Breast Cancer Deaths Averted Equal the Risk of Lives Lost to Screening From Radiation-induced Malignancy for Mammography With and Without Tomosynthesis?
Authors: Covington Matthew F , Mrose Helen E , Brown Matthew
Published: December 2021

Objective

To estimate benefit-to-radiation-risk mean glandular dose (MGD) equivalence values for screening mammography, defined as the yearly MGD (over a 10-year period) at which the estimated benefit of mammography in terms of deaths averted equals the estimated risk of lives lost to screening due to radiation exposure (a benefit-to-risk ratio of 1).

Methods

Benefit-to-risk ratios were calculated as the ratio of breast cancer deaths averted and lives lost to screening over 10-year intervals starting at age 40 for mammography and tomosynthesis using previously published methodology. The MGD values at which estimated benefit equals risk were tabulated.

Results

The MGD values at which benefit-to-risk equivalence points were met for digital screening mammography are 63 milligray (mGy) (ages 40–49), 88 mGy (ages 50–59), 176 mGy (ages 60–69), and 336 mGy (ages 70–79). The MGD values that met benefit-to-risk equivalence for screening tomosynthesis plus digital mammography or synthetic mammography are 80 mGy (ages 40–49), 111 mGy (ages 50–59), 224 mGy (ages 60–69), and 427 mGy (ages 70–79).

Conclusion

Cutoff MGD values at which the estimated benefit from screening equals the estimated risk are well above standard screening MGD exposures. Care is necessary to ensure that threshold values are not exceeded during a screening exam, particularly for women ages 40–49 years old when using digital mammography plus tomosynthesis (due to an approximate doubling of dose per exam that will more readily exceed cutoff MGD values) and when many additional views are obtained.
Managing Challenging Patient Interactions in Breast Imaging
Authors: Soo Mary Scott , Lowell Dorothy A , Destounis Stamatia V
Published: December 2021

Managing challenging patient interactions can be a daily stressor for breast imaging radiologists, leading to burnout. This article offers communication and behavioral practices for radiologists that help reduce radiologists’ stress during these encounters. Patient scenarios viewed as difficult can vary among radiologists. Radiologists’ awareness of their own physical, mental, and emotional states, along with skillful communications, can be cultivated to navigate these interactions and enhance resiliency. Understanding underlying causes of patients’ emotional reactions, denial, and anger helps foster empathy and compassion during discussions. When exposed to extremely disruptive, angry, or racially abusive patients, having pre-existing institutional policies to address these behaviors helps direct appropriate responses and guide subsequent actions. These extreme behaviors may catch breast imaging radiologists off guard yet have potentially significant consequences. Rehearsing scripted responses before encounters can help breast imaging radiologists maintain composure in the moment, responding in a calm, nonjudgmental manner, and most effectively contributing to service recovery. However, when challenging patient encounters do trigger difficult emotions in breast imaging radiologists, debriefing with colleagues afterwards and naming the emotion can help the radiologists process their feelings to regain focus for performing clinical duties.
The 100 most cited articles on pancreatic neuroendocrine tumors from 2000 to 2020: a bibliometric analysis
Authors: Shi Hao , Chen Hao , Qian Baolin , Huang Zhiwei , Tan Peng , Peng Yan , Tang Xiaowei , Ye Mingxin
Published: December 2021

Purpose

The present study attempted to identify 100 most cited articles on pancreatic neuroendocrine tumors and characterize them via bibliometric analysis whereby it would provide an insight into the progress and trend in this field.

Methods

Records regarding pancreatic neuroendocrine tumors and published between 2000 and 2020 were retrieved in 2021 through the Web of Science to identify the 100 most cited articles.

Results

The 100 articles were screened in 17 434 records. The number of citations of the top-cited articles ranged from 151 to 1867. These articles were published in 47 journals among which the Journal of Clinical Oncology produced the most articles (n = 10). The USA contributed most of the articles (n = 44). Articles enrolled came from 58 institutions; the University of California System of the USA came to the top (n = 7). More than half of the articles were clinical studies (n = 55), basic science research reports accounting for a quarter. In clinical topics (n = 73), treatment issues were the most concerned (n = 21), in which more articles focused on targeted inhibitors. Articles about gene mutation were cited most frequently in basic science topics (n = 27).

Conclusions

This bibliometric analysis reflected the brief the progress and highlighted current trend in pancreatic neuroendocrine tumor research, providing references for further study.
Evaluation of Pyriproxyfen Effects on Aedes aegypti and Predatory Mosquito Toxorhynchites rutilus (Diptera: Culicidae)
Authors: Alomar Abdullah A , Alto Barry W
Published: December 2021

Control of mosquito vectors of pathogens remains heavily dependent on the application of conventional insecticides. Pyriproxyfen (PPF) is a novel insecticide that has been proposed for use in autodissemination techniques to control mosquito vectors. The use of PPF can inhibit adult emergence but does not inhibit larval development. This feature is favorable for controlling Aedes aegypti because PPF has the potential to work in combination with natural sources of mortality (competition, predation) during the immature stages, and other control methods, including biocontrol agents that further suppress recruitment of adult mosquitoes. However, the PPF effects on life-history traits of Ae. aegypti in comparison to predatory mosquito Toxorhynchites rutilus, a source of mortality, are not fully understood. Here, we show that larval exposure to PPF concentrations that inhibit 50–90% of adult emergence in Ae. aegypti had a negligible effect on adult emergence and lifespan of Tx. rutilus. Weights of adult Ae. aegypti and Tx. rutilus were not influenced by PPF. These findings suggest that the use of PPF to control mosquito vectors may have low effects on mosquito biocontrol agents. Our results extend and confirm earlier data showing that PPF has potential to implement with Tx. rutilus to suppress Ae. aegypti and provide an additional advantage of PPF use in autodissemination control strategies.
MicroRNA-155-5p Targets SKP2, Activates IKKβ, Increases Aβ Aggregation, and Aggravates a Mouse Alzheimer Disease Model
Authors: Wang Wei , Gu Xun-Hu , Li Min , Cheng Zhi-Juan , Tian Sheng , Liao Ying , Liu Xu
Published: December 2021

The nuclear factor kappa B (NF-κB) pathway and inhibitor of NF-κB kinase β (IKKβ) are involved in Alzheimer disease (AD) pathogenesis. This study explored the mechanisms underlying IKKβ-mediated Aβ aggregation and neuron regeneration in APP.PS1 mice. Adenoviral transduction particles were injected into the hippocampal CA1 region of the mice to knock down or inhibit target genes. Morris water maze was performed to evaluate the cognitive function of the mice. Aβ deposition was determined by histological examination. sh-IKKβ plasmids and microRNA (miR)-155-5p inhibitor were transfected into Aβ1-42-induced N2a cells. The expressions of AD-related proteins were detected by Western blot. The interaction between S-phase kinase-associated protein 2 (SKP2) and IKKβ was assessed by co-immunoprecipitation. IKKβ knockdown (KD) and miR-155-5p inhibition ameliorated cognitive impairment, improved neuron regeneration, and attenuated Aβ deposition in APP/PS1 mice. SKP2 KD aggravated cognitive impairment, inhibited neuron regeneration, and promoted Aβ deposition in the mice. SKP2 regulated the stability of IKKβ protein via ubiquitination. MiR-155-5p regulates Aβ deposition and the expression of Aβ generation-related proteins in N2a cells via targeting SKP2. These results indicate that the miR-155-5p/SKP2/IKKβ axis was critical for pathogenesis in this AD model and suggest the potential of miR-155-5p as a target for AD treatment.
Morphology of the Dentate Gyrus in a Large Cohort of Sudden Infant Deaths—Interrelation Between Features but Not Diagnosis
Authors: Machaalani Rita , Vivekanandarajah Arunnjah , Despotovski Vanessa , Rodriguez Michael , Waters Karen A
Published: December 2021

Morphological differences in the dentate gyrus (DG) have been reported in sudden unexpected deaths in infancy (SUDI), with the feature of focal granule cell (GC) bilamination (FGCB) reported as increased in unexplained SUDI, including sudden infant death syndrome (SIDS), compared with explained SUDI (eSUDI). However, it remains to be determined how these morphologies relate to each other and their extent along the anteroposterior length. This retrospective study evaluated the prevalence of FGCB, single or clustered ectopic GCs, granule cell dispersion (GCD), heterotopia, hyperconvolution, gaps, thinning, blood vessel dissection (BVD), and cuffing (BV cuffing), in an Australian SUDI cohort, and compared the prevalence of these features in eSUDI and unexplained SUDI. We analyzed 850 formalin-fixed paraffin-embedded serial and subserial sections of the hippocampus at the level of the lateral geniculate nucleus from 90 infants, and identified GCD in 97% of infants, single ectopic cells, hyperconvolution, thinning, and BVD in 60%-80%, heterotopia in 36%, gaps, clusters of ectopic cells and BV cuffing in 9%–15%, and FGCB in 18%. These features are clustered within 3–5 serial sections. The presence of FGCB correlated with single ectopic GCs and hyperconvolution. There were no differences in the prevalence of these features between unexplained SUDI (n = 74) and eSUDI (n = 16). Our findings highlight that DG morphological features are highly localized, extending 14–35 µm at their focal location(s) along the anteroposterior length. Consequently, multiple sections along the longitudinal extent are required to identify them. No feature differentiated SUDI from eSUDI in our cohort, thus we cannot conclude that any of these features are abnormal and it remains to be determined their functional significance.
Diffusion Tensor Orientation as a Microstructural MRI Marker of Mossy Fiber Sprouting After TBI in Rats
Authors: Hutchinson Elizabeth , Osting Susan , Rutecki Paul , Sutula Thomas
Published: December 2021

Diffusion tensor imaging (DTI) metrics are highly sensitive to microstructural brain alterations and are potentially useful imaging biomarkers for underlying neuropathologic changes after experimental and human traumatic brain injury (TBI). As potential imaging biomarkers require direct correlation with neuropathologic alterations for validation and interpretation, this study systematically examined neuropathologic abnormalities underlying alterations in DTI metrics in the hippocampus and cortex following controlled cortical impact (CCI) in rats. Ex vivo DTI metrics were directly compared with a comprehensive histologic battery for neurodegeneration, microgliosis, astrocytosis, and mossy fiber sprouting by Timm histochemistry at carefully matched locations immediately, 48 hours, and 4 weeks after injury. DTI abnormalities corresponded to spatially overlapping but temporally distinct neuropathologic alterations representing an aggregate measure of dynamic tissue damage and reorganization. Prominent DTI alterations of were observed for both the immediate and acute intervals after injury and associated with neurodegeneration and inflammation. In the chronic period, diffusion tensor orientation in the hilus of the dentate gyrus became prominently abnormal and was identified as a reliable structural biomarker for mossy fiber sprouting after CCI in rats, suggesting potential application as a biomarker to follow secondary progression in experimental and human TBI.
Attention Centrality and Audience Fragmentation: An Approach for Bridging the Gap Between Selective Exposure and Audience Overlap
Authors: Barnidge Matthew , Diehl Trevor , Sherrill Lindsey A , Zhang Jiehua
Published: December 2021

Scholarship on audience fragmentation typically takes one of two approaches: The micro-level analysis of individuals’ selective exposure to partisan news, or the macro-level analysis of audience overlap. To bridge the gap between these levels of analysis, we introduce the concept of attention centrality as a set of macro-to-micro measures that characterize how individual news media selection is situated within networks of public attention. Relying on an online panel survey conducted in the United States (N = 1,493), we examine the relationship between three indicators of respondents’ attention centrality (closeness, betweenness, and reach) and the partisan valence of their news selections. The study finds different patterns of results for the three indicators of attention centrality, indicating that partisan news media are not uniformly isolated to the periphery of public attention. Results are discussed in light of conversations about selective exposure and audience overlap in the United States and around the world.
Study on carbon nanotube/shape memory polymer composites and their applications in wireless worm actuator
Authors: Hsu Wei-Hsuan , Lin Chia-Wei , Chen Yi-Hung , Wu Shang-Ru , Tsai Hung-Yin
Published: December 2021

In this study, the surface of the carbon nanotubes was modified by chemical functionalization. The carbon nanotubes were placed in a mixed acid solution with a nitric acid-to-sulfuric acid volume ratio of 1:3. The results of the functionalization of the carbon nanotubes were investigated by controlling the reaction time. From the experimental results, the functionalized carbon nanotubes with a reaction time of 12 hours show good dispersibility. In the study of the essential characteristics of composite materials, it was observed that the tensile strength decreased with increase of carbon nanotube content. Compared with the result of the tensile strength test, it can be found that with increasing carbon nanotube content, the microwave heating and shape recovery speed are greatly improved. The experimental results show that the shape memory polymer composite with 4 wt% carbon nanotubes has the fastest microwave heating rate, so it takes only 2 minutes to achieve complete shape recovery. Finally, this study used shape memory polymer composites doped with 4 wt% carbon nanotubes as the driving end, combined with an elastic structure made of polyimide (PI) film using origami techniques to form a worm actuator. In the test, the system could move a distance of 6 mm forward during a microwave time of 1 minute. In addition, this research also constructed a physical model of shape memory polymer and explored the simple movement mechanism of the system.
Printing the Levellers: Clandestine Print, Radical Propaganda, and the New Model Army
Authors: Como David R
Published: December 2021

this article uses techniques of typographical analysis to identify the print houses that secretly produced the most important writings associated with the incipient ‘Leveller’ grouping as it took shape in 1646–47. It examines the key printers, Jane Coe and Thomas Paine, while illuminating the dynamics of the clandestine book trade of the 1640s. It then shows that these same printers acted as stationers of choice for the emergent New Model Army agitators, producing works such as the The Case of the Army Truly Stated and An Agreement of the People, among other titles. The resulting account sheds light on the origins and nature of the Leveller movement, and allows for discussion of the connections between the Levellers and the New Model Army. More broadly, this article highlights the centrality of printers as political protagonists and suggests that new modes of bibliographical analysis can address major problems in early-modern history.
Publications Produced by the Francis Galton Laboratory for National Eugenics
Authors: Cain Joe
Published: December 2021

In 1907, Karl Pearson created the Francis Galton Laboratory for National Eugenics at University College, University of London. His ambitions emphasised both discipline building and the assertion of primacy for university research in eugenics over political activism. An academic entrepreneur, Pearson operated the ‘Eugenics Laboratory’ as a publishing house or imprint. It published five series. Because titles in each series were printed as ad hoc private separates for much of their duration, current bibliographic records show considerable variation and error while historical studies of the Eugenics Laboratory tend toward fragmentation. This paper presents a comprehensive inventory for each series associated with the Eugenics Laboratory, and it offers brief analysis of emerging patterns. The series inventoried are: (1) Eugenics Laboratory Lectures, (2) Eugenics Laboratory Memoirs, (3) The Treasury of Human Inheritance, (4) Questions of the Day and of the Fray, and (5) Studies in National Deterioration.
An Odd End: Cambridge, Jesus College, MS Q.G.13, fol. 41a
Authors: Hanna Ralph
Published: December 2021

This note addresses a small obscurity in M. R. James's description of a manuscript at Jesus College, Cambridge. While the difficulty resolved is minor, it does gesture toward a persisting problem of manuscript production, how to conclude a book or similar smaller unit.
Nurse Leader Breaks Through Glass Ceiling: Making History as First Air Force Nurse Major General (1999-2005)
Authors: Hughes Vickie , Sistrunk Katherine , Hughes Hallmon
Published: December 2021

Introduction

There is a gap in the nursing literature about the significant contributions of executive military nurse leaders to the advancement of nursing as a profession and into interprofessional leadership roles. Many executive military nurse leaders have demonstrated the value of nursing leadership in non-traditional roles and paved the way to expand the leadership opportunities for nurses who would follow. The purpose of this study is to explore the personal stories, experiences, leadership strategies, and lessons learned through the eyes of the first nurse to achieve the rank of Major General in the U.S. Air Force.

Materials and Methods

The oral history method guided the exploration of participant memories and experiences. In compliance with the Oral History Association guidelines, the investigator obtained Institution Review Board permission, informed consent, and audiotaped interviews. An expert panel provided feedback on the appropriate language use in semi-structured interview questions with Air Force nurse executives. The oral history method provided a framework for the semi-structured interview and analysis. Active listening techniques such as exploration, clarifying, and paraphrasing helped foster deep listening. A graduate research assistant transcribed the 4-hour interview verbatim. The primary investigator emailed a copy of the transcript to the participant to verify accuracy and clarify content. Analysis involved examination and interpretation of the professional, military, nursing, and participant’s personal perspective to enhance historical understanding. Three independent coders extracted prevalent themes and subthemes during analysis.

Results

Repetitive major themes of courage, figuring it out, and winning others over emerged during data analysis. The major theme of courage has corresponding subthemes of tenacity, risk-taking, and re-writing the narrative. The major theme of figuring it out has subthemes of optimism, creativity, connectedness, learning, and managing change. Lastly, the winning others over theme has subthemes of emotional intelligence, teamwork, role-model/mentor, and moving from outsider to insider. The leadership strategies of taking calculated risks while remaining calm, being open to opportunities that she had never considered, and spending time learning new skills contributed to repeated advancement into higher leadership positions not previously held by a nurse within the U.S. Air Force.

Conclusion

The interview is packed full of leadership lessons that are just as relative today as 20 years ago. This presentation will conclude with a discussion of the most effective leadership strategies, the lasting impact of the leadership accomplishments, and current implications for nurse leaders today.
Improved Adherence to Best Practice Ventilation Management After Implementation of Clinical Practice Guideline (CPG) for United States Military Critical Care Air Transport Teams (CCATTs)
Authors: Maddry Joseph K , Mora Alejandra G , Perez Crystal A , Arana Allyson A , Medellin Kimberly L , Paciocco Joni A , Ng Patrick C , Davis William T , Hunninghake John C , Bebarta Vikhyat S
Published: December 2021

Background

Critical Care Air Transport Teams (CCATTs) play a vital role in the transport and care of critically ill and injured patients in the combat theater to include mechanically ventilated patients. Previous research has demonstrated improved morbidity and mortality when lung protective ventilation strategies are used. Our previous study of CCATT trauma patients demonstrated frequent non-adherence to the Acute Respiratory Distress Syndrome Network (ARDSNet) protocol and a corresponding association with increased mortality. The goals of our study were to examine CCATT adherence with ARDSNet guidelines in non-trauma patients, compare the findings to our previous publication of CCATT trauma patients, and evaluate adherence before and after the publication of the CCATT Ventilator Management Clinical Practice Guideline (CPG).

Methods

We performed a retrospective chart review of ventilated non-trauma patients who were evacuated out of theater by Critical Care Air Transport Teams (CCATT) between January 2007 and April 2015. Data abstractors collected flight information, oxygenation status, ventilator settings, procedures, and in-flight assessments. We calculated descriptive statistics to determine the frequency of compliance with the ARDSNet protocol before and after the CCATT Ventilator CPG publication and the association between ARDSNet protocol adherence and in-flight events.

Results

We reviewed the charts of 124 mechanically ventilated patients transported out of theater via CCATT on volume control settings. Seventy percent (n = 87/124) of records were determined to be Non-Adherent to ARDSNet recommendations predominately due to excessive tidal volume settings and/or high FiO2 settings relative to the patient’s positive end-expiratory pressure setting. The Non-Adherent group had a higher proportion of in-flight respiratory events. Compared to our previous study of ventilation guideline adherence in the trauma population, the Non-Trauma population had a higher rate of non-adherence to tidal volume and ARDSNet table recommendations (75.6% vs. 61.5%). After the CPG was rolled out, adherence improved from 24% to 41% (P = 0.0496).

Conclusions

CCATTs had low adherence with the ARDSNet guidelines in non-trauma patients transported out of the combat theater, but implementation of a Ventilator Management CPG was associated with improved adherence.
Prevention of Alcohol-related Incidents in the U.S. Air Force: Results From a Cluster Randomized Trial
Authors: Little Melissa A , Klesges Robert C , Mallawaarachchi Indika , McMurry Timothy , Pebley Kinsey , McDevitt-Murphy Meghan , Murphy James , Wayne Talcott G
Published: December 2021

Background

Alcohol misuse poses significant public health concerns in the U.S. Military. An Alcohol Misconduct Prevention Program (AMPP), which includes a brief alcohol intervention (BAI) session, plus random breathalyzer program, has been shown to reduce alcohol-related incidents (ARIs) among Airmen undergoing training.

Purpose

The current study sought to examine whether a booster BAI administered at the end of Airmen’s training reduced ARIs out to a 1-year follow-up.

Methods

Participants were 26,231 U.S. Air Force Technical Trainees recruited between March 2016 and July 2018. Participants were cluster randomized by cohort to two conditions: AMPP + BAI Booster or AMPP + Bystander Intervention. The primary analysis was a comparison of the interventions’ efficacies in preventing Article 15 ARIs at a 1-year follow-up, conducted using a generalized estimating equations logistic regression model controlling for covariates.

Results

There was no significant difference by condition in Article 15 ARIs at the 1-year follow-up (P = .912).

Conclusions

Findings suggest that a booster may not be necessary to produce maximum effects beyond the initial AMPP intervention. It is also possible that alcohol behaviors changed as a result of the intervention but were not captured by our outcome measures. Future research should consider alternative outcomes or participant-tracking measures to determine whether a different or more intensive BAI booster is effective. The majority of Article 15 ARIs were for underage drinking; therefore, developing an intervention focused on this problem behavior could lead to large reductions in training costs in the military.
An Assessment of Physician Well-Being and Burnout Among Army Obstetricians and Gynecologists
Authors: Walther Devin M , Kraus Mark E , Beeken Kelly E , Pier Bruce D
Published: December 2021

Introduction

Physician burnout is associated with unsafe patient care and poor patient satisfaction. Civilian studies show burnout rates of 46% among obstetricians/gynecologists (OB/GYNs). Army Active Duty (A-AD) physician burnout rates range from 7.7% to 26% across specialties, but no studies have assessed A-AD OB/GYN burnout. The objective of this study was to quantify well-being of A-AD OB/GYNs by determining rates of professional fulfillment (wellness) and burnout and detect factors of potential protective or risk for wellness and burnout.

Methods

A cross-sectional survey-based study was designed to determine well-being of A-AD OB/GYNs. This Institutional Review Board–approved study used the validated Professional Fulfillment Index. The survey was shared anonymously via email to 197 A-AD OB/GYNs. Additional questions asked as possible risk factors for burnout include location, training status, fellowship training, and remaining active duty service obligation (ADSO). Wellness and burnout rates were determined using published scales. Mean rates of wellness and burnout were reported, and chi-square tests detected associations between wellness/burnout and other variables.

Results

Eighty-three A-AD OB/GYNs responded to the survey (42%), with 73 available for full analysis. 26.5% had positive wellness, and 50% reported burnout. Completing fellowship training and shorter ADSO (of 0-2 years compared to >5 years) had higher rates of wellness. There were no differences in burnout among groups.

Conclusions

Burnout rates in A-AD OB/GYNs appear higher than A-AD physicians of other specialties but are similar to civilian OB/GYNs. Fellowship training may confer higher rates of wellness. Further research is needed regarding improvements in A-AD OB/GYN well-being and burnout.
Occupational Injuries in Musicians: A Literature Review
Authors: Elam Trevor , Mowen Steven , Jonas Christopher
Published: December 2021

Introduction

The U.S. Department of Defense employs more musicians than any other organization in the USA with over 6,000 musicians employed. Musculoskeletal pathologies, behavioral health disorders, hearing loss, and dystonias account for the majority of reasons a musician seek medical care. The aim of this study is to review recent medical literature documenting occupational hazards in musicians.

Materials and Methods

Authors performed a literature review of publications related to musician performance-related musculoskeletal disorders (PRMDs) and performance-related pain (PRP), behavioral health disorders, dystonias, and hearing loss, published from 2004 to 2019 PubMed.

Results

The search returned 174 possible articles which, after review and exclusion, yielded 88 articles.

Conclusions

Medical literature suggests several risk factors for multiple disease categories. Practice time and history of PRMD/PRP were both associated with development of PRMD/PRP and focal dystonia. A history of behavioral health disorder was associated with development of focal dystonia. Clinicians should counsel their musician patients on strategies to minimize risks, and additional research is needed to identify specific causes of illnesses in musician populations.
Lower Extremity Splinting: A Head-to-Head Comparison of A Novel One-Step Spray-on Splint Versus Standard Splinting
Authors: Webb Tyler , Lynch Daniel , Lin James , Groth Adam , Ly Thuan , Martin Kevin D
Published: December 2021

Introduction

Splinting is an essential component of treating many lower extremity musculoskeletal injuries; however, little development has been made in splinting technology. The purpose of this study is to evaluate the efficacy of current immobilization equipment for lower extremity fractures by testing a novel one-step spray-on foam splint (Fast Cast) against structural aluminum malleable (SAM) lower extremity musculoskeletal injuries and 6-inch ACE (3M Corp., Minneapolis, MN, USA) bandage splints.

Materials and Methods

Six orthopedic surgical residents and two medical students participated in a prospective analysis of austere splinting techniques and equipment that utilized a cadaveric model with a distal third tibia-fibula shaft fracture. Each participant was observed and scored by three fellowship trained attending orthopedic surgeons. All scoring was independent using a 5-point Likert scale based on 10 splinting criteria (50 total points possible), including quality of radiographic reduction, time to completion, safety, and sustain longitudinal traction. The Likert scale is a set of questions that reflects the respondent’s degree of agreement or disagreement with a statement. Each of the 10 questions has a range of 1-5. A score of 50 means the splint performed perfectly. The lowest possible score is a 10. The participants utilized standard equipment that included SAM splints and 6-inch ACE wraps (3M Corp., Minneapolis, MN, USA) in their first attempt. A second immobilization attempt was done with a one-step spray-on foam splint (Fast Cast). After each splinting attempt, the reduction was verified with radiographic imaging. Data analysis was performed using standard descriptive statistics, Student’s t-tests, and inter-rater reliability was calculated using Cronbach’s alpha scores. This project is Institutional Review Board (IRB) exempt.

Results

The one-step spray-on foam splinting technique was superior (P < .05) in all parameters of the Likert scale, yielding a mean overall score of 45.1 points (±3.8), safety 4.7 points, longitudinal traction 4.5 points, and time 136 seconds (±23). The SAM resulted in a mean overall score of 33.8 points (±7.3), safety 2.8 points, longitudinal traction 4.1 points, and time 170 seconds (±52). Radiographic rating was 4.1 points (±0.7) for the SAM splint and 4.5 (±0.6) for Fast Cast. The differences in time to completion and radiograph rating did not reach statistical significance (P = .12 and P = .07, respectively).

Conclusion

A one-step spray-on foam splinting technique demonstrated consistent superiority in reducing fracture motion, potential soft-tissue damage, and sustained longitudinal traction as compared to the standard technique.
Using Catchment Population to Estimate Sporadic Creutzfeldt–Jakob Disease Incidence
Authors: Neeley Brandon C , Niazi Faraze A , Ebbert Michael A , Forman Alex G , Hobbs Gerald R , Riggs Jack E
Published: December 2021

Introduction

Catchment populations have several uses. A method using catchment population to estimate the incidence of sporadic Creutzfeldt–Jakob disease (sCJD) is described.

Materials and Methods

A cohort of nine consecutive patients diagnosed with sCJD, symptom onset spanning 26 months, were observed at a rural tertiary university medical center that has approximately 40,000 hospital discharges annually. An effective catchment population was determined using surrounding county utilization frequency that captured all nine sCJD patients and accounted for over 87% of discharges.

Results

The effective sCJD hospital catchment population was 1.266 million, implying an annual sCJD incidence rate of 3.39 per million (95% CIs, 1.55-6.43), assuming a Poisson distribution for sCJD occurrence.

Conclusions

This annual incidence rate suggests that many sCJD patients are unrecognized and unreported. An advantage of this catchment population method is independence from death certificate accuracy, important in rare diseases that are both rapidly and invariably fatal. The relative absence of significant healthcare systems competition in this rural population enhances the reliability of this finding. The most likely explanation for the high sCJD incidence rate suggested by this study is enhanced clinical suspicion and improved diagnostic accuracy.
An Analysis of Ketamine Doses Administrated to Nonintubated Casualties Prehospital
Authors: Bebarta Grace E , Bebarta Vikhyat S , Fisher Andrew D , April Michael D , Atkinson Andrew J , McGhee Laura L , Schauer Steven G
Published: December 2021

Introduction

Previous studies demonstrate that a significant proportion of casualties do not receive pain medication prehospital after traumatic injuries. To address possible reasons, the U.S. Military has sought to develop novel delivery methods to aid in administration of pain medications prehospital. We sought to describe the dose and route of ketamine administered prehospital to help inform materiel solutions.

Materials and Methods

This is a secondary analysis of a previously described dataset focused on prehospital data within the Department of Defense Trauma Registry from 2007 to 2020. We isolated encounters in which ketamine was administered along with the amount dosed and the route of administration in nonintubated patients.

Results

Within our dataset, 862 casualties met inclusion for this analysis. The median age was 28 and nearly all (98%) were male. Most were battle injuries (88%) caused by explosives (54%). The median injury severity score was 10 with the extremities accounting to the most frequent seriously injured body region (38%). The mean dose via intravenous route was 50.4 mg (n = 743, 95% CI 46.5-54.3), intramuscular was 66.7 mg (n = 234, 95% CI 60.3-73.1), intranasal was 56.5 mg (n = 10, 39.1-73.8), and intraosseous was 83.3 mg (n = 34, 66.3-100.4). Most had a medic or CLS in their chain of care (87%) with air evacuation as the primary mechanism of evacuation (86%).

Conclusions

The average doses administered were generally larger than the doses recommended by Tactical Combat Casualty Care guidelines. Currently, guidelines may underdose analgesia. Our data will help inform materiel solutions based on end-user requirements.
Kagoshima galactic object survey with the Nobeyama 45-metre telescope by mapping in ammonia lines (KAGONMA): star formation feedback on dense molecular gas in the W33 complex
Authors: Murase Takeru , Handa Toshihiro , Hirata Yushi , Omodaka Toshihiro , Nakano Makoto , Sunada Kazuyoshi , Shimajiri Yoshito , Nishi Junya
Published: December 2021

We present the results of NH3 (1,1), (2,2), and (3,3) and H2O maser simultaneous mapping observations toward the high-mass star-forming region W33 with the Nobeyama 45-m radio telescope. W33 has six dust clumps, one of which, W33 Main, is associated with a compact H ii region. To investigate star-forming activity feedback on its surroundings, the spatial distribution of the physical parameters was established. The distribution of the rotational temperature shows a systematic change from west to east in our observed region. The high-temperature region obtained in the region near W33 Main is consistent with interaction between the compact H ii region and the peripheral molecular gas. The size of the interaction area is estimated to be approximately 1.25 pc. NH3 absorption features are detected toward the centre of the H ii region. Interestingly, the absorption features were detected only in the NH3 (1,1) and (2,2) transitions, with no absorption feature seen in the (3,3) transition. These complex profiles in NH3 are difficult to explain by a simple model and may suggest that the gas distribution around the H ii region is highly complicated.
The peculiar behaviour of burst oscillations in the accreting millisecond X-ray pulsar XTE J1814−338
Authors: Cavecchi Yuri , Patruno Alessandro
Published: December 2021

Accreting millisecond X-ray pulsars (AMXPs) show burst oscillations during thermonuclear explosions of the accreted plasma that are markedly different from those observed in non-pulsating low-mass X-ray binaries. The AMXP XTE J1814−338 is known for having burst oscillations that are phase locked (constant phase difference) and coincident with the accretion-powered pulsations during all its thermonuclear bursts but the last one. In this work, we use a coherent timing analysis to investigate this phenomenon in more detail and with higher time resolution than was done in the past. We confirm that the burst oscillation phases are, on average, phase locked to the accretion-powered pulsations. However, they also display moderate (≲0.1 cycles) drifts during each individual burst, showing a repeating pattern that is consistently observed according to the thermonuclear burst phase (rise, peak, tail). Despite the existence of these drifting patterns, the burst oscillation phases somehow are able to average out at almost the exact position of the accretion-powered pulsations. We provide a kinematic description of the phenomenon and review the existing models in the literature. The phenomenon remains without a clear explanation, but we can place important constraints on the thermonuclear burst mechanism. In particular, the observations imply that the ignition point of the thermonuclear burst occurs close to the foot of the accretion column. We speculate that the burning fluid expands in a backward tilted accretion column trapped by the magnetic field, while at the same time the burning flame covers the surface.
Rheumatoid arthritis is a risk factor for refracture in patients with fragility fractures
Authors: Ishizu Hotaka , Shimizu Hirokazu , Shimizu Tomohiro , Ebata Taku , Ogawa Yuki , Miyano Masahiro , Arita Kosuke , Ohashi Yusuke , Iwasaki Norimasa
Published: December 2021

Objectives

To determine whether patients with rheumatoid arthritis (RA) who have had fragility fractures are at an increased risk of refractures.

Methods

Patients with fragility fractures who were treated surgically at 10 hospitals from 2008 to 2017 and who underwent follow-up for >24 months were either categorized into a group comprising patients with RA or a group comprising patients without RA (controls). The groups were matched 1:1 by propensity score matching. Accordingly, 240 matched participants were included in this study. The primary outcome was the refracture rate in patients with RA as compared to in the controls. Multivariable analyses were also conducted on patients with RA to evaluate the odds ratios (ORs) for the refracture rates.

Results

Patients with RA were significantly associated with increased rates of refractures during the first 24 months (OR: 2.714, 95% confidence interval [95% CI]: 1.015–7.255; p = 0.040). Multivariable analyses revealed a significant association between increased refracture rates and long-term RA (OR: 6.308, 95% CI: 1.195–33.292; p = 0.030).

Conclusions

Patients with RA who have experienced fragility fractures are at an increased risk of refractures. Long-term RA is a substantial risk factor for refractures.
Central sensitization in axial spondyloarthritis: An explorative study with quantitative sensory testing and clinical scales
Authors: Yücel Feyza Nur , Duruöz Mehmet Tuncay
Published: December 2021

Objectives

To evaluate the central sensitization (CS) and the related parameters in patients with axial spondyloarthritis (axSpA).

Methods

Quantitative sensory testing (QST) which consists of pressure pain threshold (PPT), temporal summation (TS), and conditioned pain modulation (CPM) were applied to the participants. Disease activity, functional status, sleep quality, pain, depression, and fatigue were assessed. Patients were divided as the ones with and without CS according to the central sensitization inventory (CSI) and the results were compared.

Results

One hundred patients and 50 controls were recruited. Sixty axSpA patients had CS. When QST results were compared between the patient and control groups, all PPT scores were found lower (p < 0.05) in patients. Regarding the comparison of the patients with and without CS, sacroiliac, and trapezius PPT scores were found lower in the patients with CS (p < 0.05). There was no significant difference between groups in TS values (p > 0.05). All investigated comorbidities were found to be significantly more frequent (p < 0.001) in the patients with CS.

Conclusions

CS and related comorbidities were found to be increased in axSpA patients. This increase should be taken into consideration in the management of these patients.
Efficacy of local oxygen–ozone therapy for the treatment of digital ulcer refractory to medical therapy in systemic sclerosis: A randomized controlled study
Authors: Kaymaz Serdar , Karasu Uğur , Alkan Hakan , Ulutaş Firdevs , Albayrak Yaşar Canan , Dündar Ök Zeynep , Çobankara Veli , Yiğit Murat , Yıldız Necmettin , Ardıç Füsun
Published: December 2021

Background

This study aimed to investigate the efficacy of local oxygen–ozone therapy in systemic sclerosis (SSc) patients with digital ulcers (DUs) who were resistant to medical therapy and had impairment in activities of daily living.

Methods

Participants’ demographic data, and clinical parameters were recorded. Twenty-five SSc patients with DUs were randomized to the ozone group (I) (n = 13) to receive medical treatment plus local oxygen–ozone therapy and the control group (II) (n = 12) to receive medical treatment only. Hand functions were assessed using the Health Assessment Questionnaire (HAQ) and the Modified Hand Mobility in Scleroderma (HAMISm) test. Clinical parameters, HAQ, and mHAMIS scores were re-evaluated in participants 4 weeks after the initiation of treatment.

Results

Demographic and clinical characteristics of the two groups showed no significant differences. At 4 weeks after the initial treatment, the efficacy rate was significantly higher in the ozone group than that in the control group (92% versus 42% P = 0.010). Clinical parameters, HAQ, and HAMISm scores were significantly improved in the treatment group compared to those in the control group (P < 0.05).

Conclusion

Local oxygen–ozone therapy was effective in the treatment of SSc patients with resistant DUs and improved clinical parameters and functional disability.
Periodontitis severity affects the clinical response to biological disease-modifying antirheumatic drugs in rheumatoid arthritis: A 1-year follow-up study
Authors: Kobayashi Tetsuo , Ito Satoshi , Murasawa Akira , Ishikawa Hajime , Tabeta Koichi
Published: December 2021

Objectives

To assess whether periodontitis severity affects the clinical response to biological disease-modifying antirheumatic drugs (bDMARDs) for 1 year in rheumatoid arthritis (RA) patients.

Methods

Data were collected from 50 RA patients who had received corticosteroids, conventional synthetic DMARDs, or non-steroidal anti-inflammatory drugs before (baseline) and after 1 year of bDMARD therapy in a retrospective study. Rheumatologic conditions were compared between the two periodontitis severity groups according to the periodontal inflamed surface area (PISA) or Centers for Disease Control and Prevention (CDC)/American Academy of Periodontology (AAP) case definitions

Results

Twenty-eight patients with no or mild periodontitis showed significantly greater decreases in changes in Clinical Disease Activity Index (CDAI) and tender and swollen joint count in comparison to 22 patients with moderate and severe periodontitis (p = .02, p = .01, and p = .03). Both bivariate and multivariate analyses revealed a significantly positive association between the baseline CDC/AAP definitions and CDAI changes (p = .005 and p = .0038). However, rheumatologic conditions were comparable between 25 patients each in the low and high PISA groups.

Conclusions

Baseline periodontitis severity according to the CDC/AAP definitions is associated with the clinical response to bDMARDs for 1 year in RA patients.