bluuebunny/crossref_metadata_2025 huggingface dataset:
Electrical effects on droplet behaviour
Authors: Airey M W , Harrison R G , Aplin K L , Pfrang C , McGinness B
Published: February 2024

The effect of charge on water droplets modulates various aspects of their behaviour. These include the droplet stability, evaporation, and lifetime. Microphysical models have been developed such that a reasonably good understanding of these processes has been achieved. However, the specific effects of charge deserve further scrutiny as they are an intrinsic component of the factors controlling droplet characteristics. Describing the effects of these requires an understanding of the electrostatic pressure present in the droplet and its surface tension. One way to test these effects and assess droplet response to charge is to take an experimental approach to make observations directly. In this study, individual droplets are levitated in an acoustic wave to allow isolated measurements to be taken. The droplets are monitored using a CCD camera with a microscope objective lens. In some cases, with sufficient charge present, effects on droplet stability can be observed as Rayleigh explosions, where a sudden drop in mass is seen superimposed on the evaporation profile. These events also allow the charge on the droplet to be calculated, which is then compared with the droplet evaporation. Another factor that plays a part in droplet behaviour is droplet composition. Different substances have different surface tension, and this is explored by performing some experiments on sulphuric acid droplets. Theory predicts that the more highly charged a droplet is, the more resistant to evaporation it becomes. Experimental data collected during this study agrees with this, with more highly charged droplets observed to have slower evaporation rates. However, highly charged drops were also observed to periodically become unstable during evaporation and undergo Rayleigh explosions. Each instability of a highly charged drop removes mass, reducing the overall droplet lifetime regardless of the slower evaporation rate. The sulphuric acid droplets were observed to be much more resistant to evaporation and no Rayleigh instabilities were observed.
Experimental study and numerical simulation of particles trajectories in a flexible-electrode-type electrostatic separator
Authors: Maammar Mohamed , Touhami Seddik , Rezoug Mohammed , Daioui Khaled , Dascalescu Lucian , Medles Karim
Published: February 2024

The novel device used in this study is a free fall electrostatic separator equipped with flexible electrodes. This special feature enabled the experimentation of different electric field configurations, avoiding as much as possible the impacts of particles on electrode walls, which is the major drawback of standard free-fall electrostatic separators. The present work was focused on the numerical modelling and simulating the trajectories of charged insulating particles. The study was aimed at contributing to a more in-depth understanding of the various physical phenomena that occur during electrostatic separation. An accurate numerical model of particle movement was developed. The results of the numerical simulations were validated using the experimental data obtained with an appropriate image acquisition tool.
Modelling an Ion Thruster for a Small Spacecraft in Very Low Earth Orbit
Authors: Gomez I , Aplin KL , Lawrie A , Toomer CA
Published: February 2024

A gridded ion thruster running on two different propellants (Xenon and Iodine) and sited within a 3U CubeSat satellite, is modelled in a Low-Earth-Orbit (altitude 400 km), using a Particle-in-Cell approach. Charged exchange collisions cause a plume backflow, which results in erosion or contamination of external spacecraft surfaces. In particular, this research is motivated by evaluating the risks to solar panel arrays from plume backflow. At low altitudes there is a wide range of ambient species able to interact electrostatically with the ion plume. In particular one must consider the plasma potential of the incoming particle flux at the solid boundaries as well as a sheath comparison and the temperature of the solar panel surfaces. This enables evaluation of the effect of temperature on the charged exchange region. A Particle-in-Cell is used, with a hybrid approach where electrons are treated as a fluid and the propellant as kinetic particles. Our results compare surface ablation for two propellants, focusing on solar panel arrays which are considered to be especially vulnerable to the backflow of ions from the plume expansion. It is found that the flux of incoming particles increases for lower satellite surface temperatures. Furthermore, Xenon results in having a lower overall effect on the sensitivity of the particle flux in comparison to Iodine.
On input and Langlands parameters for epipelagic representations
Authors: Romano Beth
Published: February 2024

A paper of Reeder–Yu [J. Amer. Math. Soc. 27 (2014), pp. 437–477] gives a construction of epipelagic supercuspidal representations of

p
p

-adic groups. The input for this construction is a pair

(
λ
,
χ
)

(\lambda , \chi )

where

λ
\lambda

is a stable vector in a certain representation coming from a Moy–Prasad filtration, and

χ
\chi

is a character of the additive group of the residue field. We say two such pairs are equivalent if the resulting supercuspidal representations are isomorphic. In this paper we describe the equivalence classes of such pairs. As an application, we give a classification of the simple supercuspidal representations for split adjoint groups. Finally, under an assumption about unramified base change, we describe properties of the Langlands parameters associated to these simple supercuspidals, showing that they have trivial L-functions and minimal Swan conductors, and showing that each of these simple supercuspidals lies in a singleton L-packet.
Analysis of the impact of COVID-19 on Scotland’s care-homes from March 2020 to October 2021: national linked data cohort analysis
Authors: Burton Jennifer Kirsty , McMinn Megan , Vaughan James E , Nightingale Glenna , Fleuriot Jacques , Guthrie Bruce
Published: February 2024

Background

The impact of the COVID-19 pandemic on long-term care residents remains of wide interest, but most analyses focus on the initial wave of infections.

Objective

To examine change over time in: (i) The size, duration, classification and pattern of care-home outbreaks of COVID-19 and associated mortality and (ii) characteristics associated with an outbreak.

Design

Retrospective observational cohort study using routinely-collected data.

Setting

All adult care-homes in Scotland (1,092 homes, 41,299 places).

Methods

Analysis was undertaken at care-home level, over three periods. Period (P)1 01/03/2020-31/08/2020; P2 01/09/2020-31/05/2021 and P3 01/06/2021–31/10/2021. Outcomes were the presence and characteristics of outbreaks and mortality within the care-home. Cluster analysis was used to compare the pattern of outbreaks. Logistic regression examined care-home characteristics associated with outbreaks.

Results

In total 296 (27.1%) care-homes had one outbreak, 220 (20.1%) had two, 91 (8.3%) had three, and 68 (6.2%) had four or more. There were 1,313 outbreaks involving residents: 431 outbreaks in P1, 559 in P2 and 323 in P3. The COVID-19 mortality rate per 1,000 beds fell from 45.8 in P1, to 29.3 in P2, and 3.5 in P3. Larger care-homes were much more likely to have an outbreak, but associations between size and outbreaks were weaker in later periods.

Conclusions

COVID-19 mitigation measures appear to have been beneficial, although the impact on residents remained severe until early 2021. Care-home residents, staff, relatives and providers are critical groups for consideration and involvement in future pandemic planning.
Characterization of T-/natural killer cell lymphoproliferative neoplasms associated with systemic, chronic, active Epstein-Barr virus in adults: A report of 5 cases in a Western population
Authors: Murga-Zamalloa Carlos , Stone Michael Brandon , Gutierrez Marc G , Hippalgaonkar Neha Rajendra , Tariq Hamza , Sadeh Morteza , Mehta Ankit , Khan Irum , Alkan Serhan , Inamdar Kedar V , Wilcox Ryan , Behdad Amir
Published: February 2024

Objectives

Because of its low frequency in adult populations and clinical and laboratory overlap with hemophagocytic lymphohistiocytosis and other T-cell lymphomas, T-cell/natural killer (NK) cell systemic, chronic, active Epstein-Barr virus (EBV) (T/NK sCAEBV) infection remains underdiagnosed, preventing critical, prompt therapeutic interventions.

Methods

We report a 5-case series that included 2 adult patients with T/NK sCAEBV and 3 additional adult patients with T/NK lymphomas with concomitant systemic EBV infection to review these entities’ overlapping diagnostic and clinical features.

Results

Approximately 95% of the world population has been infected with EBV during their lifetime, and infection is usually asymptomatic, with symptomatic cases eventually resolving spontaneously. A small subset of immunocompetent patients develops CAEBV, a life-threatening complication resulting from EBV-infected T-cell or NK cell neoplastic lymphocytes. The sites of end-organ damage in T/NK sCAEBV demonstrate pathologic findings such as reactive lymphoid proliferations, making the diagnosis difficult to establish, with the only curative option being an allogeneic hematopoietic stem cell transplant.

Conclusions

This diagnosis is most prevalent in Asia, with few cases reported in Western countries. Adult age is an independent risk factor for poor outcomes, and most cases are diagnosed in pediatric populations.
Characterizing the role of informal payments in the delivery of pathology and clinical laboratory services
Authors: Glynn Emily H , Amukele Timothy , Soge Olusegun , Baird Geoffrey , Vian Taryn
Published: February 2024

Objectives

Informal payments (IPs) are unofficial cash or in-kind payments for goods or services that should be covered by the health care system. They are a common but regressive method of financing health care in low- and lower-middle-income countries (LMICs). This study aims to characterize the prevalence and impact of IPs on pathology and laboratory medicine (PALM) services.

Methods

From September 2021 to September 2022, PALM staff were surveyed about the frequency, determinants, and impacts of IPs in their respective workplaces.

Results

In total, 268 responses were received, and 46.6% (125/268) reported experience with IPs. These 125 participants were more likely to work in the public sector and in LMICs. Approximately 65% reported accepting IPs to perform tests or release results. Obtaining faster results was the most commonly perceived reason for patients offering IPs. Overall, participants reported that IPs had more negative than positive impacts on their workplace.

Conclusions

This represents a first step in characterizing IPs within PALM and how this practice may affect access to these services in LMICs. Specifically, the fact that faster turnaround time was the most frequently perceived reason for offering IPs uncovers a potential barrier to improving PALM capacity in these regions.
VirGrapher: a graph-based viral identifier for long sequences from metagenomes
Authors: Miao Yan , Sun Zhenyuan , Ma Chenjing , Lin Chen , Wang Guohua , Yang Chunxue
Published: February 2024

Viruses are the most abundant biological entities on earth and are important components of microbial communities. A metagenome contains all microorganisms from an environmental sample. Correctly identifying viruses from these mixed sequences is critical in viral analyses. It is common to identify long viral sequences, which has already been passed thought pipelines of assembly and binning. Existing deep learning-based methods divide these long sequences into short subsequences and identify them separately. This makes the relationships between them be omitted, leading to poor performance on identifying long viral sequences. In this paper, VirGrapher is proposed to improve the identification performance of long viral sequences by constructing relationships among short subsequences from long ones. VirGrapher see a long sequence as a graph and uses a Graph Convolutional Network (GCN) model to learn multilayer connections between nodes from sequences after a GCN-based node embedding model. VirGrapher achieves a better AUC value and accuracy on validation set, which is better than three benchmark methods.
Mind the implementation gap: a systems analysis of the NHS Long Term Workforce Plan to increase the number of doctors trained in the UK raises many questions
Authors: Geary Una , McKee Martin , Petty-Saphon Katie
Published: February 2024

Background

The National Health Service (NHS) in England is facing a workforce crisis. A new Long Term Workforce Plan (LTWP) seeks to address this, setting out ambitious proposals to expand and reform domestic medical education and training in England. However, there are concerns about their feasibility.

Sources of data

In September 2023, over 60 individuals representing medical education and training in the UK participated in an exercise run by UK Medical Schools Council by using systems theory to identify risks.

Areas of agreement

The UK does need more ‘home grown’ doctors, but the LTWP has important gaps, including lack of attention to postgraduate training, absence of reference to the need for more educators and capital investment and risk of inadequate clinical placement capacity, particularly in primary care settings.

Areas of controversy

There are unresolved differences in the understanding of a proposed medical apprenticeship model and no scheme has, as yet, been approved by the General Medical Council. Participants were unable to determine who the beneficiaries of this scheme will be (apart from the apprentices themselves).

Growing points

While the LTWP represents a welcome, although overdue, commitment to address the NHS workforce crisis, we identified significant gaps that must be resolved.

Areas timely for developing research

First, the development of the LTWP provides a case study that adds to literature on policymaking in the UK. Second, while we only examined the expansion of medical training, the method could be applied to other parts of the LTWP. Third, a prospective evaluation of its implementation is necessary.
Graphs and the idiographic brain
Authors: Elmalem Michael S , Nachev Parashkev , Jha Ashwani
Published: February 2024

This scientific commentary refers to ‘Integrating direct electrical brain stimulation with the human connectome’ by Coletta et al. (https://doi.org/10.1093/brain/awad402).
Predicting brain age using partition modeling strategy and atlas-based attentional enhancement in the Chinese population
Authors: Wu Yingtong , Chen Yingqian , Yang Yang , Lin Chuxuan , Su Shu , Zhao Jing , Wu Songxiong , Wu Guangyao , Liu Heng , Liu Xia , Yang Zhiyun , Zhang Jian , Huang Bingsheng
Published: February 2024

As a biomarker of human brain health during development, brain age is estimated based on subtle differences in brain structure from those under typical developmental. Magnetic resonance imaging (MRI) is a routine diagnostic method in neuroimaging. Brain age prediction based on MRI has been widely studied. However, few studies based on Chinese population have been reported. This study aimed to construct a brain age predictive model for the Chinese population across its lifespan. We developed a partition prediction method based on transfer learning and atlas attention enhancement. The participants were separated into four age groups, and a deep learning model was trained for each group to identify the brain regions most critical for brain age prediction. The Atlas attention-enhancement method was also used to help the models focus only on critical brain regions. The proposed method was validated using 354 participants from domestic datasets. For prediction performance in the testing sets, the mean absolute error was 2.218 ± 1.801 years, and the Pearson correlation coefficient (r) was 0.969, exceeding previous results for wide-range brain age prediction. In conclusion, the proposed method could provide brain age estimation to assist in assessing the status of brain health.
The weak genetic structure of Melolontha melolontha (L.) and Melolontha hippocastani (Fabr.), two important forest pests, indicates their large population sizes and effective gene flow
Authors: Niemczyk Marzena , Tereba Anna , Skrzecz Iwona , Kajtoch Łukasz
Published: February 2024

Cockchafers Melolontha spp. are polyphagous root pests and outbreak species of considerable economic importance to forestry in Europe. Knowledge of genetic diversity within and between cockchafer populations is largely unexplored but could lead to more effective monitoring and management strategies of these pests. In this study, we fill several gaps in the knowledge of the genetic population structure of Melolontha melolontha and Melolontha hippocastani. Using microsatellite loci and over 200 individuals per species, we examined the genetic structure of Melolontha spp. populations collected from three primary outbreak areas in central and southeastern Poland. We demonstrated that our focal species share some common genetic patterns, such as considerable genetic diversity within subpopulations (within sampling sites) with minor effects of past bottlenecks possibly masked by current population sizes. The estimates of effective population sizes, although subject to wide credibility intervals, indicated a large number of individuals contributing to further generations of the population. The migration rates exceed the threshold of one per generation required for gene flow and maintenance of population equilibrium, indicating limited impact from forest management practices on either cockchafer species. While genetic differentiation was observed in M. melolontha populations, supported by various indices (fixation index, principal coordinate analysis, assignment tests), the M. hippocastani populations were genetically similar. This disparity may hint at the potential historical divergence between these species. In this aspect, more detailed phylogeographic and population genetic studies covering a large area of the Palaearctic distributions of both species are required. Our findings constitute one of the initial efforts aimed at delineating the genetic diversity, differentiation, population structure, gene flow, and migration patterns within Melolontha spp. This exploration is especially significant for M. hippocastani, given its completely unexplored genetic population structure.
Determining the effective diffusivity coefficient and activation energy in thin-layer drying of Haj Kazemi peach slices and modeling drying kinetics using ANFIS
Authors: Barforoosh Majid Yazdani , Borghaee Ali Mohammad , Rafiee Shahin , Minaei Saeid , Beheshti Babak
Published: February 2024

This study investigated the moisture changes in Haj Kazemi peach slices during drying in a thin-layer dryer at five temperature levels (40, 50, 60, 70, and 80°C), three levels of inlet air velocity (1, 1.5, and 2 m/s), and three slice thicknesses (2, 4, and 6 mm). The relative moisture content during drying was calculated, and an adaptive neuro fuzzy inference system (ANFIS) was used to predict the drying process of peach slices. The results indicated that slice thickness had a greater impact on drying time than air velocity. Moreover, an almost direct relationship was observed between changes in slice thickness and drying time. The effective moisture diffusivity coefficient in peach slices increased with an increase in slice thickness, temperature, and air velocity and ranged from 9.57 × 10^-10 to 4.33 × 10^-9 m^2/s under different experimental conditions. The calculated activation energy for drying peach slices under experimental conditions ranged from 16.74 to 20.48 kJ/mol. The designed model for simulating the drying conditions was based on an adaptive neuro fuzzy inference system (ANFIS) with input and output membership functions of triangular and linear shapes and a hybrid learning algorithm. The model could simulate the drying process with a correlation coefficient of 0.979.
Innovative cinque rib-roughened stimulators on performance improvement in triangular channel solar air heater
Authors: Stalin P Michael Joseph , Lokanadham R , Naveen Gaddam , Singh Bharat , Tayyab Shaik Abdul , Panchal Hitesh , Kumar Abhinav , Siddiqui Md Irfanul Haque , Natrayan L , Shah Mohd Asif
Published: February 2024

Present study investigates application of cinque-faced rib roughening to improve the efficiency of solar air heaters (SAHs). Research focuses on a novel design, the cinque-faced rib-roughened triangular channel SAH (CFRTCSAH), which incorporates five-faced wire ribs on the absorber plate’s underside. By breaking down the laminar sublayer and enhancing flow separation and reattachment, - ribs significantly enhance heat transfer. It establishes a comprehensive theoretical model to analyze the thermal and hydraulic performance of the CFRTCSAH. The study considers the influence of parameters such as relative roughness pitch (P/e) and relative roughness height (e/Dh) on thermal efficiency and heat removal factor. The results demonstrate that the CFRTCSAH achieves remarkable thermal efficiency, reaching up to 80.7% under optimal roughness parameters (P/e = 12, e/Dh = 0.05). It is found that an increase in mass flow rates positively impacts thermal efficiency but should not exceed 0.09 kg/s for maximum effective efficiency. Additionally, it has observed that the CFRTCSAH performs most effectively when the relative roughness pitch ratio (P/e) is set to 12. A higher relative roughness height (e/Dh) promotes convective heat transfer, enhancing thermal performance, especially at lower mass flow rates. Conclusion presents a novel approach to improving the thermal performance of SAHs by introducing cinque-faced rib roughening. The CFRTCSAH design exhibits significant potential for achieving high thermal efficiency and can contribute to more efficient solar energy utilization in various applications. These findings offer valuable insights for the development of SAHs, promoting sustainable and energy-efficient technologies.
The impact of nuance DAX ambient listening AI documentation: a cohort study
Authors: Haberle Tyler , Cleveland Courtney , Snow Greg L , Barber Chris , Stookey Nikki , Thornock Cari , Younger Laurie , Mullahkhel Buzzy , Ize-Ludlow Diego
Published: February 2024

Objective

To assess the impact of the use of an ambient listening/digital scribing solution (Nuance Dragon Ambient eXperience (DAX)) on caregiver engagement, time spent on Electronic Health Record (EHR) including time after hours, productivity, attributed panel size for value-based care providers, documentation timeliness, and Current Procedural Terminology (CPT) submissions.

Materials and Methods

We performed a peer-matched controlled cohort study from March to September 2022 to evaluate the impact of DAX in outpatient clinics in an integrated healthcare system. Primary outcome measurements included provider engagement survey results, reported patient safety events related to DAX use, patients’ Likelihood to Recommend score, number of patients opting out of ambient listening, change in work relative values units, attributed value-based primary care panel size, documentation completion and CPT code submission deficiency rates, and note turnaround time.

Results

A total of 99 providers representing 12 specialties enrolled in the study; 76 matched control group providers were included for analysis. Median utilization of DAX was 47% among active participants. We found positive trends in provider engagement, while non-participants saw worsening engagement and no practical change in productivity. There was a statistically significant worsening of after-hours EHR. There was no quantifiable effect on patient safety.

Discussion

Nuance DAX use showed positive trends in provider engagement at no risk to patient safety, experience, or clinical documentation. There were no significant benefits to patient experience, documentation, or measures of provider productivity.

Conclusion

Our results highlight the potential of ambient dictation as a tool for improving the provider experience. Head-to-head comparisons of EHR documentation efficiency training are needed.
Pharmacological evidence that the inhibitory effects of prostaglandin E2 are mediated by the EP2 and EP4 receptors in human neutrophils
Authors: Lavoie Jean-Philippe C , Simard Mélissa , Kalkan Hilal , Rakotoarivelo Volatiana , Huot Sandrine , Di Marzo Vincenzo , Côté Andréanne , Pouliot Marc , Flamand Nicolas
Published: February 2024

Prostaglandin E2 (PGE2) is a recognized inhibitor of granulocyte functions. However, most of the data supporting this was obtained when available pharmacological tools mainly targeted the EP2 receptor. Herein, we revisited the inhibitory effect of PGE2 on reactive oxygen species production, leukotriene biosynthesis, and migration in human neutrophils. Our data confirm the inhibitory effect of PGE2 on these functions and unravel that the effect of PGE2 on human neutrophils is obtained by the combined action of EP2 and EP4 agonism. Accordingly, we also demonstrate that the inhibitory effect of PGE2 is fully prevented only by the combination of EP2 and EP4 receptor antagonists, underscoring the importance of targeting both receptors in the effect of PGE2. Conversely, we also show that the inhibition of ROS production by human eosinophils only involves the EP4 receptor, despite the fact that they also express the EP2 receptor.
Chlamydial Proctitis Mimicking Inflammatory Bowel Disease in a Young Active Duty Sailor With Undiagnosed Human Immunodeficiency Virus Infection: A Case Report
Authors: Oliver Logan , Pak Kevin , Maier Adam , Sadowski Brett
Published: February 2024

Proctitis is an inflammation of the lining of the rectum that can be either acute or chronic in presentation. Symptoms include rectal bleeding, constipation, rectal discharge, rectal pain, and tenesmus. It is commonly associated with inflammatory bowel diseases (IBDs) such as ulcerative colitis and Crohn’s disease. However, it is important to consider the infectious causes of proctitis such as the sexually transmitted infections (STIs), especially Chlamydia trachomatis and Neisseria gonorrhoeae, as these can mimic the symptoms and pathology of IBD. We present the case of a young male sailor with subacute rectal bleeding who was hospitalized with initial concern for an index presentation of IBD. Endoscopic evaluation revealed proctitis although findings were atypical for inflammation related to IBD. Acquisition of additional history revealed that he had both receptive and insertive anal intercourse with both male and female partners. A full STI screening, including HIV was performed. Results were positive for both rectal C. trachomatis and HIV antigen and antibody serology, which were confirmed as HIV-1 on confirmatory testing. He was treated with doxycycline for his chlamydial proctitis with symptom resolution and was also initiated on antiretroviral therapy for his HIV infection. This case highlights the importance of obtaining a sexual history and considering STIs as a cause of proctitis, as this will ensure proper screenings and prompt subsequent treatment and potentially avoid unnecessary endoscopic and medical evaluation, which could potentially worsen the underlying process.
GPR97 deficiency suppresses Wnt/β‐catenin signaling in hypertensive nephropathy
Authors: Gao Ping , Zhu Jinghan , Xiangyun Guo , Li Jing , Wu Jichao
Published: February 2024

Accumulating evidence shows that renal fibrosis plays a key role in the development of hypertensive nephropathy (HTN). Therefore, a better understanding of the underlying mechanism of renal fibrosis regulation in HTN would be critical for designing rational strategies for therapeutic interventions. In this study, we revealed that GPR97, a novel identified adhesion G coupled receptor, plays an important role in the regulation of Wnt/β‐catenin signaling, which is the crucial driver of renal fibrosis in HTN. First, we identified that the expression of GPR97 correlated with the β‐catenin expression in renal biopsy from patients with HTN. Moreover, we found that GPR97 deficiency inhibited Wnt/β‐catenin signaling in mice with HTN, as evidenced by the reduction of β‐catenin expression and downstream target proteins, including MMP7 and Fibronectin. Mechanistically, we found that GPR97 could directly bind with Wnt1 in cultured tubular cells and TGF‐β1 treatment enhanced the binding ability of GPR97 and Wnt1. In addition, the gene silencing of GPR97 could decrease the Wnt1‐induced fibrotic phenotype of tubular cells and inflammatory responses, suggesting that the binding of GPR97 and Wnt1 promoted Wnt/β‐catenin signaling. Collectively, our studies reveal that GPR97 is a regulator of Wnt/β‐catenin signaling in HTN, and targeting GPR97 may be a novel therapeutic strategy for HTN treatment.
A Suprapatellar approach, when compared to an Infrapatellar approach, yields less Anterior Knee Pain and better patellofemoral joint Function, for intramedullary nailing of diaphyseal tibial fractures. Results of a Randomised Controlled Trial.
Authors: van de Pol Gerrit J , Axelrod Daniel E , Conyard Christopher , Tetsworth Kevin D
Published: February 2024

OBJECTIVES:

To assess if a suprapatellar (SP) approach, when compared to an infrapatellar (IP) approach, yielded less patient reported anterior knee pain and higher patellofemoral joint function at 6 weeks and 12 months post operatively, when treating tibial fractures with intramedullary nailing

METHODS:

Design:

Prospective, parallel group randomized control trial

Setting:

Tertiary level one trauma care centre, Brisbane, Australia

Patients Selection Criteria:

Skeletally mature patients with an acute diaphyseal tibial fracture (AO/OTA 41A2/3, 42 A1- 43A3) amenable to an IMN were included. Exclusion criteria were peri-prosthetic fractures, nonunions, and presence of a contralateral injury that would restrict weightbearing.

Outcome Measures and Comparisons:

Anterior knee pain, through the visual analogue scale (VAS) and patellofemoral function using the Kujala scale at 6-weeks and 12-months were compared between those treated with a SP and IP approach.

Results:

95 tibia fractures were included in the randomized trial, with complete follow-up data for 44 and 46 tibia fractures in the SP and IP groups, respectively. The SP cohort exhibited better patella-femoral knee function at both 6 weeks post operatively (Kajula 53.0 for SP vs 43.2 for IP, p<0.01)) and 12 months (Kujala 92.0 for SP vs 81.3 for IP (p<0.01)), and a reduction in anterior knee pain at 12-months post-operatively (VAS 0.7 SP vs 2.9 IP, p<0.01).

Conclusions:

This randomized trial demonstrated clinically meaningful differences in patellofemoral function, for a suprapatellar versus infrapatellar approach, with a greater than 10 point discrepancy in Kujala score at both 6 weeks and 12 months. Additionally, there was a clinically important difference in VAS knee pain scores for patients at 12 months, but not at 6 weeks, post operatively. These results contribute to the growing body of evidence demonstrating the functional and clinical benefits of the suprapatellar approach.
Impact of Skin Pigmentation on Cerebral Regional Saturation of Oxygen Using Near-Infrared Spectroscopy: A Systematic Review
Authors: Patel Nikunj A. , Bhattal Harvir S. , Griesdale Donald E. , Hoiland Ryan L. , Sekhon Mypinder S.
Published: February 2024

OBJECTIVES:

Near-infrared spectroscopy (NIRS) is used in critical care settings to measure regional cerebral tissue oxygenation (rSo
2). However, the accuracy of such measurements has been questioned in darker-skinned individuals due to the confounding effects of light absorption by melanin. In this systematic review, we aim to synthesize the available evidence on the effect of skin pigmentation on rSo
2 readings.

DATA SOURCES:

We systematically searched MEDLINE, Cochrane Database of Systematic Reviews, Embase, and Google Scholar from inception to July 1, 2023.

STUDY SELECTION:

In compliance with our PROSPERO registration (CRD42022347548), we selected articles comparing rSo
2 measurements in adults either between racial groups or at different levels of skin pigmentation. Two independent reviewers conducted full-text reviews of all potentially relevant articles.

DATA EXTRACTION:

We extracted data on self-reported race or level of skin pigmentation and mean rSo
2 values.

DATA SYNTHESIS:

Of the 11,495 unique records screened, two studies (n = 7,549) met our inclusion criteria for systematic review. Sun et al (2015) yielded significantly lower rSo
2 values for African Americans compared with Caucasians, whereas Stannard et al (2021) found little difference between self-reported racial groups. This discrepancy is likely because Stannard et al (2021) used a NIRS platform which specifically purports to control for the effects of melanin. Several other studies that did not meet our inclusion criteria corroborated the notion that skin pigmentation results in lower rSo
2 readings.

CONCLUSIONS:

Skin pigmentation likely results in attenuated rSo
2 readings. However, the magnitude of this effect may depend on the specific NIRS platform used.
Results of a Pilot Virtual Microsurgery Course for Plastic Surgeons in LMICs
Authors: Davis Greta L. , Abebe Metasebia W. , Vyas Raj M. , Rohde Christine H. , Coriddi Michelle R. , Pusic Andrea L. , Gosman Amanda A.
Published: February 2024

Background:

The Plastic Surgery Foundation’s Surgeons in Humanitarian Alliance for Reconstruction, Research and Education (SHARE) program seeks to expand surgical capacity worldwide through mentorship and training for local plastic surgeons. This study aims to define the need for microsurgery training among SHARE global fellows and describe results of a pilot course.

Methods:

Ten participants of the SHARE Virtual Microsurgical Skills Course were asked to complete an anonymous survey. Pre- and post-course response rates were 100% and 50.0%, respectively.

Results:

There was a high incidence of microsurgical problems encountered in the clinical setting. Resource availability was varied, with high access to loupes (100%), yet limited access to microsurgery instruments (50%), medications (40%), operating microscope (20%), skilled nursing (0%) and appropriate peri-operative care settings (0%). Participants identified vessel preparation, instrument selection, and suture handling as priority learning objectives for a microsurgery skills course. Post-course satisfaction with learning objectives was high (60% “very good,” 40% “excellent”). Participants reported high levels of improvement in suture handling (Likert 4.60±0.55), end-to-end anastomosis (4.40±0.55), instrument selection (4.20±0.45), vessel preparation (4.20±0.45), and economy of motion (4.20±0.45).

Conclusions:

This study demonstrates a high frequency of reconstructive problems encountered by global fellows yet low access to appropriate resources to perform microsurgical procedures. Initial results from a pilot virtual microsurgery course demonstrate very high satisfaction and high self-rated improvement in key microsurgical skills. The virtual course is an effective and accessible format for training surgeons in basic microsurgery skills and can be augmented by providing longitudinal opportunities for remote feedback.
Tamoxifen Upregulates Collagenase Gene Expression in Human Dermal Fibroblasts
Authors: Wang Joanne , Lee Raphael C.
Published: February 2024

Background:

Tamoxifen is a known inhibitor of fibroblast transforming growth factor beta biosynthesis and wound scar formation. Tamoxifen is also known to be an estrogen antagonist and protein kinase C (PKC) inhibitor. Cells treated with tamoxifen and other PKC/calmodulin inhibitors depolymerize their membrane focal adhesion complexes and cytoskeletal protein structures. These effects result in substrate detachment, cell shape rounding, and upregulation of collagenase synthesis and extracellular matrix degradation. The purpose of our study was to test the hypothesis that tamoxifen treatment of human foreskin fibroblasts results in alteration of cytoskeletal protein organization, cell detachment and rounding, and increased collagenase synthesis similar to known PKC/calmodulin inhibitors such as H-7.

Methods:

We characterized the effects of PKC/calmodulin inhibitors tamoxifen and H-7 on human dermal fibroblast morphology, cytoskeletal protein organization, and collagenase gene expression in monolayer culture and within collagen gels.

Results:

We found that fibroblasts responded to tamoxifen by initiation of actin filament depolymerization followed by alteration from spindle to spheroidal shapes. This change in cell shape led to increased collagenase synthesis in cells treated with either tamoxifen or H-7 compared with controls. There was also a 23% increase of hydroxyproline release from tamoxifen-treated fibroblast-populated collagen matrices.

Conclusions:

Tamoxifen may reduce scarring by inhibiting fibroblast PKC/calmodulin activity, which down-regulates pro-fibrotic transforming growth factor beta signaling and upregulates collagenase production. These effects mimic those of the known PKC/calmodulin inhibitor H-7. Overall, these findings suggest that tamoxifen and its analogues are promising agents for clinical investigation as small molecule regulators of fibrosis and scarring disorders.
How social networks influence the local implementation of initiatives developed in quality improvement collaboratives in health care
Authors: Gillner Sandra , Wild Eva-Maria
Published: February 2024

Background

Quality improvement collaboratives (QICs) have facilitated cross-organizational knowledge exchange in health care. However, the local implementation of many quality improvement (QI) initiatives continues to fail, signaling a need to better understand the contributing factors. Organizational context, particularly the role of social networks in facilitating or hindering implementation within organizations, remains a potentially critical yet underexplored area to addressing this gap.

Purpose

We took a dynamic process perspective to understand how QI project managers’ social networks influence the local implementation of QI initiatives developed through QICs.

Methodology

We explored the case of a QIC by triangulating data from an online survey, semistructured interviews, and archival documents from 10 organizations. We divided implementation into four stages and employed qualitative text analysis to examine the relationship between three characteristics of network structure (degree centrality, network density, and betweenness centrality) and the progress of each QI initiative.

Results

The progress of QI initiatives varied considerably among organizations. The transition between stages was influenced by all three network characteristics to varying degrees, depending on the stage. Project managers whose QI initiatives progressed to advanced stages of implementation had formed ad hoc clusters of colleagues passionate about the initiatives.

Conclusion

Implementing QI initiatives appears to be facilitated by the formation of clusters of supportive individuals within organizations; this formation requires high betweenness centrality and high network density.

Practice Implications

Flexibly modifying specific network characteristics depending on the stage of implementation may help project managers advance their QI initiatives, achieving more uniform results from QICs.
Retinal vein occlusions before and during the COVID-19 pandemic. Visual outcomes and treatment patterns in a country with no mandatory lockdown.
Authors: Farrell Anna Cullhed , Epstein David
Published: February 2024

Purpose:

To investigate the incidence, treatment patterns and visual outcomes in patients with branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO) before and during the COVID-19 pandemic in a country with no mandatory lockdown.

Methods:

This retrospective study included 788 patients presenting with a retinal vein occlusion (RVO) during 2019–2022 at St. Erik Eye Hospital. The control group and study groups consisted of patients presenting before and during the pandemic respectively.

Results:

The incidence of diagnosed RVO cases decreased from 281 patients before the pandemic to 236 patients during the first year of the pandemic (p<0.05). In BRVO patients at the end of follow-up, the best-corrected visual acuity (BCVA) improved 10.3 letters (95% CI 7.6-12.9) in the control group compared to 14.3 letters (95% CI 12.6-16.0) in the study groups (p<0.05). In CRVO patients the BCVA improved 6.3 letters (95% CI 2.7-10.0) in the control group compared to 8.6 letters (95% CI 5.7-11.4) in the study groups (p=NS). Overall, the number of intravitreal anti-vascular endothelial growth factor (VEGF) injections increased from 7.0 (95% CI 6.6-7.3) in the control group to 7.6 (95% CI 7.4-7.8) in the study groups (p<0.05).

Conclusion:

Good visual and anatomical outcomes were sustained, and the number of intravitreal anti-VEGF injections increased significantly in RVO patients during the COVID-19 pandemic.
Morphological Biomarkers Predicting Exudative Conversion in Type 1 Nonexudative Macular Neovascularization Using OCT Angiography
Authors: Bae Su Ho , Bae Kunho , Yoon Chang Ki , Park Un Chul , Park Kyu Hyung , Lee Eun Kyoung
Published: February 2024

Purpose:

To investigate the incidence and morphological biomarkers to predict the exudative conversion in eyes with type 1 nonexudative macular neovascularization (MNV) using swept-source optical coherence tomography angiography (SS-OCTA).

Methods:

MNVs were detected using the retinal pigment epithelium (RPE)-to-RPE-fit slab of SS-OCTA scan. Depending on whether exudation developed within a year, the eyes were divided into two groups: active and silent. Qualitative and quantitative OCTA parameters of the two groups were evaluated to discriminate the biomarkers associated with exudative conversion.

Results:

Of the 40 eyes, nine developed exudation within one year (incidence rate 22.5%). The active group exhibited significantly higher "anastomosis and loops" pattern, greater "vessel density," increased "junction density," fewer “number of endpoints,” and lower "lacunarity" compared to silent group. "Anastomosis and loops" and higher "vessel density" were correlated with the active group in multivariate analyses. A predictive model combining these biomarkers achieved 95% accuracy in predicting exudative conversion.

Conclusion:

At 12 months, the risk of exudation was 22.5%, and "anastomosis and loops" and "vessel density" were useful OCTA biomarkers for predicting exudative conversion in eyes with type 1 nonexudative MNV. For eyes with a high risk of exudative conversion, more frequent follow-up is recommended.
Double-Blind Comparison of Eyelash Epilation Techniques for the Purpose of Demodex folliculorum Mite Retrieval
Authors: Bitton Etty , Wittich Walter
Published: February 2024

Objective:

Demodex folliculorum blepharitis is typically confirmed with lash epilation and microscopic identification of mites. However, mite counts may vary with the epilation technique. As there is no gold standard to epilating lashes for the purposes of mite counts, the aim of this study was to compare three epilation techniques.

Method:

A prospective randomized double-blind study compared three epilation techniques on lashes with cylindrical dandruff. Techniques included (A) direct pulling of the lash; (B) rotating the lash before epilation; and (C) sliding the cylindrical dandruff away, lash rotation, and epilation. Mean mite counts were analyzed using a repeated-measures analysis of variance.

Results:

Forty (n=40) participants (20 M: 20 F, mean age of 62.3±17.1 years) revealed similar mite counts between right (1.43±1.74) and left (1.35±1.59) eyes (P=0.63). A significant difference (P=0.03) in mite count was noted (technique A: 1.05 ± 1.60; technique B 1.76 ± 1.80; and technique C 1.36 ± 1.54) with technique B yielding the highest mite count (P=0.04).

Conclusion:

Demodex mite count is a key parameter in establishing infestation or to determine treatment efficacy. This study revealed that rotating the lash before epilation yielded the highest mite count. Future studies should report the epilation technique used to allow for study comparisons.
Factors associated with the malnutrition inflammation score (MIS) among hemodialysis patients in Dhaka city: a cross-sectional study in tertiary care hospitals
Authors: Bint Harun Khanum UN Homaira , Kawser Mahbuba , Nabi Mohammad Hayatun , Mitra Dipak Kumar
Published: February 2024

Background:

Chronic kidney disease (CKD) is a progressive disease that leads to end-stage renal disease (ESRD). Malnutrition increases the risk of mortality among patients with ESRD. This study aimed to determine malnutrition prevalence and associated factors among twice-weekly (n = 94/120) and thrice-weekly (n = 26/120) hemodialysis patients/HDP.

Method:

A cross-sectional study was conducted at two tertiary-level public hospitals in Dhaka city using a consecutive sampling technique from April to June 2021. Nutritional status was assessed by Malnutrition Inflammation Score (MIS). Multivariable ordinal logistic regression was performed to determine which socioeconomic, clinical, anthropometric, biochemical, and dietary factors are associated with MIS.

Results:

The prevalence of malnutrition was very high among HDP (severe 15.5%, mild/moderate 56.7%) with an average dialysis vintage of 28.7 months. Comorbidities (80.8%) and gastrointestinal symptoms/GIS (68.3%) were ubiquitous, and “dialysis frequencies” were not associated with MIS in bivariate analysis. Multivariable ordinal regression showed that anthropometric factors like mid-upper arm circumference/MUAC (adjusted odds ratio/AOR = 0.978), post-dialysis body mass index/BMI (AOR = 0.957), and biochemical parameters like albumin (AOR = 0.733) and TIBC/total iron binding capacity (AOR = 0.996) negatively (P < .05) associated with MIS. Moreover, having “no GIS” (AOR = 0.672, P < .001) was 33.0% less likely to be associated with MIS. Contrarily, as the month of dialysis increases, MIS increases by 22.0% (AOR = 1.22).

Conclusion:

Significant associations of clinical, anthropometric, and biochemical characteristics with MIS indicate the importance of routine screening of the nutritional status of patients with CKD to improve health status and prevent protein-energy wasting. The MIS could be a simple, noninvasive tool for testing nutritional status in patients with CKD.
Multimodal Analgesic Effectiveness on Acute Postoperative Pain Management After Adult Cardiac Surgery
Authors: Wynne Rochelle , Fredericks Suzanne , Hyde Emily K. , Matthews Stacey , Bowden Tracey , O'Keefe-McCarthy Sheila , Martorella Geraldine , Magboo Rosalie , Gjeilo Kari Hanne , Jedwab Rebecca Miriam , Keeping-Burke Lisa , Murfin Jo , Bruneau Jill , Lie Irene , Sanders Julie ,   On behalf of CONNECT: the Cardiac Surgery International Nursing & Allied Professional Research Network
Published: February 2024

Background

Many patients report moderate to severe pain in the acute postoperative period. Enhanced recovery protocols recommend multimodal analgesics, but the optimal combination of these is unknown.

Purpose

The aim of this study was to synthesize the best available evidence about effectiveness of multimodal analgesics on pain after adult cardiac surgery.

Methods

A systematic review to determine the effect of multimodal postoperative analgesics is proposed (International Prospective Register of Systematic Reviews Registration CRD42022355834). Multiple databases including the Cochrane Library, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, American Psychological Association, the Education Resources Information Centre, the Excerpta Medica database, the Medical Literature Analysis and Retrieval System Online, Scopus, Web of Science, and clinical trials databases will be searched. Screening in Covidence and quality assessment will be conducted by 2 authors. A grading of recommendations, assessment, development, and evaluation summary of findings will be presented if meta-analysis is possible.