bluuebunny/crossref_metadata_2025 huggingface dataset:
What Is Death?
Authors: Graham Mackenzie
Published: October 2021

This chapter discusses how the line between life and death has been blurred by advances in science and technology. For much of human history, determining death was a straightforward process. When illness or injury caused the irreversible loss of heart, lung, or brain function, their mutual interdependence meant that the other vital functions would inevitably cease within a matter of minutes. A physician could declare a patient dead simply by showing the absence of a heartbeat, breathing, or reaction of the eye to light. The introduction of new medical procedures in the 1950s, including mechanical ventilation and cardiopulmonary resuscitation (CPR), meant that a person whose heart had stopped beating, or lungs had stopped breathing, could be kept alive. These patients presented a problem for the traditional understanding of death because they had irreversibly lost some vital functions, but not others. To understand the nature of human death, one must begin by defining the concept: what is it for any living thing to die? Having answered this metaphysical question, one can move to an epistemological one: what is the appropriate standard for judging that something has met the definition of death? Finally, one requires criteria and tests to affirm that the epistemological standard has been met: when can we confidently say that someone is dead?
Exploring the Relationships Among Social Support, Patient Activation, and Pain-Related Outcomes
Authors: Matthias Marianne S , Hirsh Adam T , Ofner Susan , Daggy Joanne
Published: October 2021

Objective

Social support has been linked to more effective pain adaptation. The relationship between social support and other relevant constructs is less well understood. Chief among these is patient activation, which has robust links to effective self-management, yet has not been well studied in chronic pain. We sought to better understand these relationships in an effort to inform future intervention strategies for patients with chronic pain.

Methods

Using baseline data from a clinical trial with patients with chronic pain (N = 213), we analyzed the relationships among perceived social support and patient activation, depression, anxiety, general health perceptions, pain centrality, pain catastrophizing, and pain intensity and interference. Multiple linear regression was used to examine the effect of social support on outcomes. Patient activation was explored as a mediator of the effect of social support on outcomes.

Results

Social support was significantly associated with all outcomes except pain. Social support explained the greatest variance in patient activation (squared semi-partial correlation = 0.081), followed by depression (0.073) and general health perceptions (0.072). Patient activation was not found to be a significant mediator of the effect of social support on pain-related outcomes.

Conclusions

These findings provide insight into the roles of patient activation and social support in chronic pain management. Although patient activation did not mediate the relationship between social support and outcomes, this study is an important step toward gaining a more complete understanding of constructs thought to be related to pain self-management and points to the need to advance theory in this area to guide future research. Such work is needed to optimize interventions for patients with chronic pain.
Hypnosis for Chronic Neuropathic Pain: A Scoping Review
Authors: McKittrick Melissa L , Connors Erin L , McKernan Lindsey C
Published: October 2021

Objective

Neuropathic pain is complex and often refractory. Clinical hypnosis has emerged as a viable treatment for pain. This scoping review is the first comprehensive review of hypnosis for chronic neuropathic pain. It critically assesses available evidence noting practice implications, literature gaps, and future research opportunities.

Subjects

Individuals with chronic neuropathic pain treated with hypnosis.

Methods

Following PRISMA guidelines, we searched PubMed, CINAHL, Embase, and PsycInfo for studies for which the intervention and primary outcome(s) were associated with hypnosis and neuropathic pain, respectively. Included studies were empirical, in English, and published from January 1996 to August 2021.

Results

Nine articles with 301 total participants were reviewed. Neuropathic pain included, for example, complex regional pain syndrome (CRPS), brachial neuralgia, and spinal cord injury. Hypnosis dose varied with administration and format. Six studies used comparators. Every trial demonstrated pain and quality-of-life benefits, with several controlled trials indicating hypnosis as superior to active comparator or standard of care. CRPS-specific studies showed notable improvements but had significant study limitations. Methodological weaknesses involved trial design, endpoints, and recruitment strategies.

Conclusions

The evidence is weak because of poor study design, yet encouraging both for analgesia and functional restoration in hard-to-treat chronic neuropathic pain conditions. We highlight and discuss key knowledge gaps and identify particular diagnoses with promising outcomes after hypnosis treatment. This review illustrates the need for further empirical controlled research regarding hypnosis for chronic neuropathic pain and provides suggestions for future studies.
Policing a Pandemic in New York City: How Do Community Features Matter in the Location of Social Distancing Violations?
Authors: Gibbons Joseph , Chanin Joshua , Yang Tse-Chuan
Published: October 2021

This study assesses the contextual role that race/ethnicity play in predicting the enforcement of COVID-19 precautions during the early stages of the pandemic. We draw upon 311 police service calls pertaining to social distancing violations in New York City to investigate whether Black and Hispanic communities are less likely to call in social distancing violations as well as whether racial/ethnic composition influences law enforcement response. We conduct negative binomial models estimating spatial effects and controlling for the number of COVID-19 cases, police behavior (arrests, stop and frisks, community complaints), community social networks, and other demographic characteristics. We find the racial/ethnic disparities in law enforcement response and intervention in social distancing violations exist independently of local COVID-19 rates. There are fewer calls for social distancing violations in Black communities, but the likelihood of law enforcement intervening in COVID-19 violations, including arrests, is stronger in Black and Hispanic communities than in White communities.
Ozone Responsive Gene Expression as a Model for Describing Repeat Exposure Response Trajectories and Interindividual Toxicodynamic Variability In Vitro
Authors: Bowers Emma C , Martin Elizabeth M , Jarabek Annie M , Morgan David S , Smith Hannah J , Dailey Lisa A , Aungst Emily R , Diaz-Sanchez David , McCullough Shaun D
Published: October 2021

Inhaled chemical/material exposures are a ubiquitous part of daily life around the world. There is a need to evaluate potential adverse effects of both single and repeat exposures for thousands of chemicals and an exponentially larger number of exposure scenarios (eg, repeated exposures). Meeting this challenge will require the development and use of in vitro new approach methodologies (NAMs); however, 2 major challenges face the deployment of NAMs in risk assessment are (1) characterizing what apical outcome(s) acute assays inform regarding the trajectory to long-term events, especially under repeated exposure conditions, and (2) capturing interindividual variability as it informs considerations of potentially susceptible and/or vulnerable populations. To address these questions, we used a primary human bronchial epithelial cell air-liquid interface model exposed to ozone (O3), a model oxidant and ubiquitous environmental chemical. Here we report that O3-induced proinflammatory gene induction is attenuated in repeated exposures thus demonstrating that single acute exposure outcomes do not reliably represent the trajectory of responses after repeated or chronic exposures. Further, we observed 10.1-, 10.3-, 14.2-, and 7-fold ranges of induction of interleukin (IL)-8, IL-6, heme oxygenase 1, and cyclooxygenase 2 transcripts, respectively, within in our population of 25 unique donors. Calculation of sample size estimates that indicated that 27, 24, 299, and 13 donors would be required to significantly power similar in vitro studies to identify a 2-fold change in IL-8, IL-6, HMOX1, and cyclooxygenase 2 transcript induction, respectively, to inform considerations of the uncertainty factors to reflect variability within the human population for in vitro studies.
Delineating the Effects of Passaging and Exposure in a Longitudinal Study of Arsenic-Induced Squamous Cell Carcinoma in a HaCaT Cell Line Model
Authors: Banerjee Mayukh , Al-Eryani Laila , Srivastava Sudhir , Rai Shesh N , Pan Jianmin , Kalbfleisch Theodore S , States J Christopher
Published: October 2021

Cutaneous squamous cell carcinoma (cSCC) is a major deleterious health effect of chronic arsenic (iAs) exposure. The molecular mechanism of arsenic-induced cSCC remains poorly understood. We recently demonstrated that chronic iAs exposure leads to temporally regulated genome-wide changes in profiles of differentially expressed mRNAs and miRNAs at each stage of carcinogenesis (7, 19, and 28 weeks) employing a well-established passage-matched HaCaT cell line model of arsenic-induced cSCC. Here, we performed longitudinal differential expression analysis (miRNA and mRNA) between the different time points (7 vs 19 weeks and 19 vs 28 weeks) within unexposed and exposed groups, coupled to expression pairing and pathway analyses to differentiate the relative effects of long-term passaging and chronic iAs exposure. Data showed that 66–105 miRNA [p < .05; log2(fold change) > I1I] and 2826–4079 mRNA [p < .001; log2(fold change) > I1I] molecules were differentially expressed depending on the longitudinal comparison. Several mRNA molecules differentially expressed as a function of time, independent of iAs exposure were being targeted by miRNA molecules which were also differentially expressed in a time-dependent manner. Distinct pathways were predicted to be modulated as a function of time or iAs exposure. Some pathways were also modulated both by time and exposure. Thus, the HaCaT model can distinguish between the effects of passaging and chronic iAs exposure individually and corroborate our previously published data on effects of iAs exposure compared with unexposed passage matched HaCaT cells. In addition, this work provides a template for cell line-based longitudinal chronic exposure studies to follow for optimal efficacy.
Dental polymorphisms inCrocidura(Soricomorpha: Soricidae) and evolutionary diversification of crocidurine shrew dentition
Authors: Voyta Leonid L , Abramov Alexei V , Lavrenchenko Leonid A , Nicolas Violaine , Petrova Ekaterina A , Kryuchkova Lyudmila Yu
Published: October 2021

The upper dentition of Crocidura exhibits polymorphic characters that were revealed for the first time in this study via high-resolution X-ray computed microtomography. Our analyses of 11 Crocidura species and selected Diplomesodon, Suncus and Sylvisorex species from different geographical regions and size groups revealed the most complex character states of upper dentition in the Ethiopian endemic species Crocidura yaldeni. A three-dimensionally based geometric morphometric analysis revealed the dependence of variation in skull muzzle shape on alterations in general upper dentition, such as a reduction in the number of antemolars. Principal components analysis revealed highly significant shape alterations and morphological trajectories in C. yaldeni (and more moderate ones in Suncus murinus) toward the Sorex-like morphotype in the outgroup, and less significant shape alterations in Crocidura obscurior, Crocidura phanluongi and Crocidura sapaensis with double-rooted third antemolar. Cladistic analysis based on a new data matrix for 20 species and 46 characters allowed us to determine the directions of the morphological trajectories: the apomorphic state of the most complex antemolars of C. yaldeni is associated with deviating skull muzzle shape changes, which we determined to be attributable to neomorphosis, and the less significant alterations in the shape of other Crocidura with complex antemolars are attributable to regional adaptation.
Expression of the Type III Secretion System Genes in Epiphytic Erwinia amylovora Cells on Apple Stigmas Benefits Endophytic Infection at the Hypanthium
Authors: Cui Zhouqi , Huntley Regan B. , Schultes Neil P , Kakar Kaleem U. , Yang Ching-Hong , Zeng Quan
Published: October 2021

Erwinia amylovora causes fire blight on rosaceous plants. One of the major entry points of E. amylovora into hosts is flowers, where E. amylovora proliferates epiphytically on stigmatic and hypanthium surfaces and, subsequently, causes endophytic infection at the hypanthium. The type III secretion system (T3SS) is an important virulence factor in E. amylovora. Although the role of T3SS during endophytic infection is well characterized, its expression during epiphytic colonization and role in the subsequent infection is less understood. Here, we investigated T3SS gene expression in epiphytic E. amylovora on stigma and hypanthium of apple flowers under different relative humidities (RH). On stigma surfaces, T3SS was expressed in a high percentage of E. amylovora cells, and its expression promoted epiphytic growth. On hypanthium surfaces, however, T3SS was expressed in fewer E. amylovora cells than on the stigma, and displayed no correlation with epiphytic growth, even though T3SS expression is essential for infection. E. amylovora cells grown on stigmatic surfaces and then flushed down to the hypanthium displayed a higher level of T3SS expression than cells grown on the hypanthium surface alone. Furthermore, E. amylovora cells precultured on stigma had a higher potential to infect flowers than E. amylovora cells precultured in a T3SS-repressive medium. This suggests that T3SS induction during the stigmatic epiphytic colonization may be beneficial for subsequent infection. Finally, epiphytic expression of T3SS was influenced by RH. Higher percentage of stigmatic E. amylovora cells expressed T3SS under high RH than under low RH.

[Formula: see text] Copyright © 2021 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
The Role of the Wheat Reduced height (Rht)-DELLA Mutants and Associated Hormones in Infection by Claviceps purpurea, the Causal Agent of Ergot
Authors: Tente Eleni , Carrera Esther , Gordon Anna , Boyd Lesley A.
Published: October 2021

Partial resistance to the biotrophic fungal pathogen Claviceps purpurea, causal agent of ergot, has been found that colocates with mutant alleles of the wheat Reduced height (Rht) loci on chromosomes 4B and 4D. These Rht loci represent the wheat orthologs of the Arabidopsis Della genes. To investigate the role of the Rht mutant DELLA proteins in ergot resistance, we assessed C. purpurea infection in wheat near-isogenic lines (NILs) carrying the gibberellic acid (GA)-insensitive semidwarf alleles Rht-B1b and Rht-D1b and the severe dwarf alleles Rht-B1c and Rht-D1c. NILs of the GA-sensitive alleles Rht8 (chromosome 2D) and Rht12 (chromosome 5A) were also included. A general trend toward increased resistance to C. purpurea, with smaller and lighter sclerotia, was observed on the NILs Rht-B1b, Rht-D1b, Rht-B1c, and Rht-D1c, and also on Rht8. Levels of the bioactive GA4 and the auxin indole-3-acetic acid increased after inoculation with C. purpurea, following similar patterns and implicating a potential auxin-mediated induction of GA biosynthesis. In contrast, jasmonic acid (JA) levels fell in the parental lines ‘Mercia’ and ‘Maris Huntsman’ after inoculation with C. purpurea, but increased in all the Rht-mutant NILs. Inoculation with C. purpurea did not show any informative changes in the levels of salicylic acid. Our results suggest that GA-mediated degradation of the DELLA proteins and down-regulation of JA-signaling pathways supports infection of wheat by C. purpurea. As these responses are generally associated with necrotrophic fungal pathogens, we propose that the biotroph C. purpurea may have a necrotrophic growth stage.
Opioid-induced Hyperalgesia in Patients With Chronic Pain
Authors: Guichard Leah , Hirve Axel , Demiri Migena , Martinez Valeria
Published: October 2021

Introduction:

Opioid-induced hyperalgesia (OIH) remains an issue in patients with chronic pain. Multiple cases of OIH in patients with chronic pain exposed to opioids have been reported worldwide. The objective of this systematic review was to summarize the evidence of OIH from clinical reports.

Methods:

We searched the PubMed, Cochrane, EMBASE, and LILACS databases for case reports and case series of OIH published up to December 2020, with the aim to summarize the evidence for OIH in patients with chronic pain from clinical reports and to discuss issues relevant to the clinical diagnosis and management of OIH.

Results:

We retrieved and reviewed 41 articles describing 72 cases. Clinical features of OIH were observed in patients of both sexes, all ages, and with various types of pain treated with different classes of opioids. OIH was reported at all doses, but most published studies reported a pattern of OIH following treatment with very high daily doses of opioids (median oral morphine equivalent dose of 850 mg). OIH was diagnosed clinically in all cases. Three different strategies for OIH management were described: opioid rotation, opioid cessation, and the use of adjuvant pharmacotherapies. All had statistically similar success rates for OIH treatment: 72%, 57%, and 79%, respectively. The decrease in pain was achieved rapidly (mean: 8 d; range: 1 to 28 d). Adjuvant therapies resulted in the largest decrease in dose. Ketamine and dexmedetomidine were the most widely used adjuvant drugs.

Conclusion:

The key finding is that clinical symptoms of OIH can be resolved when this condition is diagnosed and managed.
A Systematic Review and Synthesis of Psychometric Properties of the Numeric Pain Rating Scale and the Visual Analog Scale for Use in People With Neck Pain
Authors: Modarresi Shirin , Lukacs Michael J. , Ghodrati Maryam , Salim Shahan , MacDermid Joy C. , Walton David M.
Published: October 2021

Objectives:

To conduct a systematic search and synthesis of evidence about the measurement properties of the Numeric Pain Rating Scale (NPRS) and the Visual Analog Scale (VAS) as patient-reported outcome measures in neck pain research.

Methods and Materials:

CINAHL, Embase, PsychInfo, and MedLine databases were searched to identify studies evaluating the psychometric properties of the NPRS and the VAS used in samples of which >50% of participants were people with neck pain. Quality and consistency of findings were synthesized to arrive at recommendations.

Results:

A total of 46 manuscripts were included. Syntheses indicated high-to-moderate-quality evidence of good-to-excellent (intraclass correlation coefficient 0.58 to 0.93) test-retest reliability over an interval of 7 hours to 4 weeks. Moderate evidence of a clinically important difference of 1.5 to 2.5 points was found, while minimum detectable change ranged from 2.6 to 4.1 points. Moderate evidence of a moderate association (r=0.48 to 0.54) between the NPRS or VAS and the Neck Disability Index. Findings from other patient-reported outcomes indicated stronger associations with ratings of physical function than emotional status. There is limited research addressing the extent that these measures reflect outcomes that are important to patients.

Discussion:

It is clear NPRS and the VAS ratings are feasible to implement, provide reliable scores and relate to multi-item patient-reported outcome measures. Responsiveness (meaningful change) of the scales and interpretation of change scores requires further refinement. The NPRS can be a useful single-item assessment complimenting more comprehensive multi-item patient-reported outcome measures in neck pain research and practice.
The Right to Pain Relief
Authors: Sullivan Mark D. , Ballantyne Jane C.
Published: October 2021

Objectives:

The claim of a right to pain relief was made in recent decades by pain professionals, courts, and patient advocacy groups and likely contributed to increased opioid prescribing, overdose deaths, and addictions, but the origins and nature of this right have not been investigated.

Materials and Methods:

Relevant clinical, ethical, and legal literature concerning patient rights to pain care was reviewed.

Results:

The record describes the effort to improve end-of-life and cancer pain care in the 1980s and 1990s, which simultaneously legitimated pain relief as an independent goal of medical care and opioids as a safe and effective means to achieve this relief. In 1997, the US Supreme Court denied the right to assisted suicide but affirmed a right to palliative care to prevent dying in overwhelming pain. Other guidelines and regulations extended this right to pain relief from end-of-life care to chronic pain care, along with the titrate-to-effect principle, which specified that the correct opioid dose was the dose that relieved pain.

Discussion:

The most important consequence of combining the right to pain relief with the titrate-to-effect principle was the idea that a high pain score must not be ignored. This extension of the right to pain relief neglected important differences between end-of-life care and chronic pain care including: time frame, clinical setting and context, target of titration, and nature of iatrogenic harms. To help end our current opioid epidemic and prevent a future epidemic, we need to demedicalize pain and reintegrate it with the rest of human suffering as an experience connected to other personal behaviors and meanings.
Did COVID-19 impact osteoarthritis – clinical perspective?
Authors: Alhassan Eaman , Siaton Bernadette C. , Hochberg Marc C.
Published: October 2021

Purpose of review

To assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on patients with osteoarthritis (OA).

Recent findings

The COVID-19 pandemic negatively affected patients with OA irrespective of them contracting the infection. Patients with OA had a disruption in access to the healthcare system, which resulted in delays in joint replacement surgeries from cancellations of elective surgical procedures. On the other hand, the pandemic accelerated the drive towards telemedicine and telerehabilitation, with many nonurgent services being delivered remotely whenever possible. Cross-sectional studies showed that the majority of patients with OA were willing to accept the increased risks of contracting the COVID-19 infection and proceed with elective joint replacement surgeries.

The American College of Rheumatology and the European League Against Rheumatism issued guidelines for managing immune-mediated rheumatic diseases during the pandemic. However, these guidelines did not include recommendations for patients with OA.

Healthcare providers, including physical therapists, should aim to schedule more frequent telemedicine follow-up appointments to maximize medical management while patients await elective joint procedures.
Playing High School Football Is Not Associated With an Increased Risk for Suicidality in Early Adulthood
Authors: Iverson Grant L. , Merz Zachary C. , Terry Douglas P.
Published: October 2021

Objective:

To determine if playing high school football is associated with suicide ideation between the ages of 24 and 32 years.

Design:

Data were analyzed from the National Longitudinal Study of Adolescent to Adult Health. This prospective cohort study sampled nationally representative US participants at 4 time points from 1994 to 2008.

Setting:

In-home assessment.

Participants:

There were 3147 boys (age: median = 14.9, SD = 1.8) who participated during adolescence in 1994 to 1995 (wave I), of whom 2353 were reinterviewed in 2008 (wave IV, age: median = 29.1, SD = 1.8).

Assessment of Risk Factors:

Football participation, history of psychological counseling, suicide ideation, and a suicide attempt in the past year during high school.

Main Outcome Measures:

Lifetime history of depression, suicide ideation within the past year, and feeling depressed in the past 7 days at wave IV.

Results:

Men who played high school football, compared with those who did not, reported similar rates of lifetime diagnosis of depression, suicide ideation in the past year, and feeling depressed in the past 7 days. Those who played football reported similar rates of suicide ideation in the past year when they were in their early 20s. Individuals who underwent psychological counseling during adolescence were more likely to report a lifetime history of depression and suicide ideation in the past year.

Conclusions:

Young men who played high school football are not at an increased risk for suicide ideation during both their early 20s and late 20s. By contrast, those who experienced mental health problems in high school were much more likely to experience suicide ideation during their 20s.
Delayed Facial Nerve Palsy Following Resection of Vestibular Schwannoma: Clinical and Surgical Characteristics
Authors: MacDonald Bridget V. , Ren Yin , Shahrvini Bita , Tawfik Kareem O. , Moshtaghi Omid , Schwartz Marc S. , Friedman Rick A.
Published: October 2021

Objective:

Analyze delayed facial nerve palsy (DFNP) following resection of vestibular schwannoma (VS) to describe distinct characteristics and facial nerve (FN) functional course.

Study Design:

Prospective cohort with retrospective review.

Setting:

Academic medical center.

Patients:

Consecutive patients undergoing VS resection 11/2017 to 08/2020. Exclusion criteria: preoperative House-Brackmann (HB) ≥ III, postoperative HB ≥ III without delayed palsy, <30 days follow-up.

Interventions:

VS resection with intraoperative electromyographic monitoring.

Main Outcome Measures:

FN outcomes utilizing the HB scale; comparison between patients with DFNP (deterioration greater than one HB grade 24 hours to 30 days postoperatively) vs. those with HBI–II throughout.

Results:

Two hundred eighty-eight patients met criteria: mean age 47.6 years, 36.1% male; 24.0% middle cranial fossa, 28.5% retrosigmoid, 47.6% translabyrinthine. DFNP occurred in 31 (10.8%) patients with average time to onset of 8.1 days. Of these, 22 (71.0%) recovered HBI–II and 3 (9.7%) recovered HBIII. Patients who experienced DFNP, on average, had larger maximum tumor diameter (23.4 vs. 18.7 mm, p = 0.014), lower rate of gross-total resection (54.8% vs. 75.5%, p = 0.014), and lower rate of ≥100 μV FN response to 0.05 mA stimulus intraoperatively (80.6% vs. 94.9%, p = 0.002). Compared to overall incidence of DFNP, translabyrinthine approach demonstrated higher incidence (15.3%, p = 0.017) while retrosigmoid lower (3.7%, p = 0.014). In multivariable logistic regression, patients with FN response ≥100 μV to 0.05 mA stimulus were 72.0% less likely to develop DFNP (p = 0.021).

Conclusions:

Intraoperative electromyographic facial nerve response, tumor size, surgical approach, and extent of resection may play a role in development of DFNP following resection of VS. Most patients who develop DFNP recover near-normal function.
Occupational exposures and sarcoidosis: current understanding and knowledge gaps
Authors: Lin Nancy W. , Maier Lisa A.
Published: October 2021

Purpose of review

Sarcoidosis is an idiopathic granulomatous disease that primarily affects the lungs. Several lines of evidence suggest that occupational exposures are associated with disease risk. This review critically evaluates studies using the Bradford Hill criteria for causation to determine if a causal relationship can be established between occupational exposure and sarcoidosis.

Recent findings

Large epidemiological studies have proposed multiple occupational exposures associated with sarcoidosis but lack consistency of results. Many convincing studies demonstrate an association between World Trade Center (WTC) dust and sarcoidosis, which illustrates a causal relationship based on the fulfillment of the Bradford Hill criteria. Studies describing an association between silica/metals and sarcoidosis are intriguing but fulfill a limited number of the Bradford Hill criteria and warrant further investigation before a causal relationship can be determined. Finally, we also discuss preliminary studies associating sarcoidosis phenotypes with specific occupational exposures.

Using the Bradford Hill criteria for causation, we demonstrate that WTC dust has a causative relationship with sarcoidosis, which reinforces the theory that sarcoidosis is an exposure-related disease. More research is needed to determine other specific occupational exposures causing disease.
A brave new world: the gastrointestinal lab during and after a pandemic
Authors: Subramaniam Sharmila , Al-Kandari Asma , Bhandari Pradeep
Published: October 2021

Purpose of review

The COVID-19 global pandemic resulted in a radical change in the provision and delivery of endoscopy services worldwide. As we emerge from this pandemic, various strategies were advocated to resume endoscopy whilst prioritizing the safety and wellbeing of patients and staff.

Recent findings

This review summarizes the main changes including infection control and prevention measures in endoscopy and explores the overarching impact of the pandemic on the gastrointestinal lab. Various solutions are outlined to enable the well tolerated resumption of endoscopy services including retention of certain infection control measures, use of personal protective equipment, testing and vaccination. Strategies to deal with the mounting backlog of cases are also discussed.

The COVID-19 pandemic wreaked havoc on healthcare systems worldwide and affected the provision and delivery of gastrointestinal diagnostic services, such as endoscopy necessitating a new way of working and an emphasis on infection control and better use of technology that are likely to be here to stay in the post pandemic era.
Cui Bono? Identifying Patient Groups That May Benefit From Granulocyte Transfusions in Pediatric Hematology and Oncology
Authors: Johann Pascal D. , Wuchter Patrick , Trojanova Lenka , Sturm Dominik , Lu Kevin Hai-Ning , Kulozik Andreas E. , Kunz Joachim B.
Published: October 2021

Introduction:

Granulocyte transfusions have long been used to bridge the time to neutrophil recovery in patients with neutropenia and severe infection. Recent randomized controlled trials did not prove a beneficial effect of granulocyte transfusions, but were likely underpowered and suffered from very heterogeneous study populations.

Methods:

We retrospectively reviewed data of all patients treated with granulocyte transfusions at our pediatric center from 2004 to 2019. To identify parameters that predict the success of granulocyte transfusions, we stratified patients in 3 groups. Patients in group 1 cleared their infection, whereas patients in group 2 succumbed to an infection in neutropenia despite granulocyte transfusions. A third group included all patients who died of causes that were not related to infection.

Results:

We demonstrate that patients without respiratory or cardiocirculatory insufficiency are enriched in group 1 and more likely to benefit from granulocyte transfusions than patients who already require these intensive care measures. The effect of granulocyte transfusions correlates with the cell dose per body weight applied per time. With our standard twice weekly dosing, patients with a body weight below 40 kg are more likely to achieve a sufficient leukocyte increment and clear their infection in comparison to patients with a higher body weight.

Discussion/Conclusions:

We suggest that future studies on the benefits of granulocyte transfusions stratify patients according to clinical risk factors that include the need for respiratory or cardiocirculatory support and strive for a sufficient dose density of granulocyte transfusions.
Indwelling Pleural Catheters for Malignant Pleural Effusion
Authors: Vrtis Mary C. , DeCesare Eileen , Day Rebecca S.
Published: October 2021

Malignant pleural effusion (MPE) resulting from metastatic spread to the pleura frequently occurs in patients with primary lung, breast, hematological, gastrointestinal, and gynecological cancers. These effusions tend to reaccumulate quickly, and the patient requires increasingly frequent thoracentesis. An indwelling pleural catheter allows for dramatic improvement in quality of life as the patient has the power to ease her/his own suffering by draining the effusion at home when shortness of breath and/or chest pain intensifies. Patients with MPE need home healthcare support to address symptom management related to complications of advanced metastatic cancer and antineoplasm treatment regimens. The financial obstacles for the home healthcare agency are explored by using agency supply costs, per visit costs, and the patient-driven groupings reimbursement mode grouper to estimate reimbursement. Care for a home healthcare patient with MPE costs Medicare approximately $64.50 per day, markedly less than costs for hospitalization and outpatient thoracentesis. Unfortunately, agencies must absorb the cost of vacuum drainage bottles. Whereas a small positive balance of $291 was estimated for the first 30-day posthospital episode, losses were estimated at $1,185 to $1,633 for subsequent 30-day episodes. Absorbing these costs has become extremely difficult as home healthcare agencies are experiencing unprecedented COVID-19 infection control and staffing-related costs.
Congenital Myotonic Dystrophy with Combined Heterozygous ATP8B1/ABCB4 Mutation Leading to Progressive Cholestasis and Liver Failure
Authors: Chiou Fang Kuan , Rizvi Hina , Quinlivan Ros , Gupte Girish L.
Published: October 2021

Myotonic dystrophy (MyoD) is an inherited genetic disorder caused by the expansion of a CTG trinucleotide repeat in the dystrophia myotonica protein kinase gene. It manifests as a multisystem disease affecting not only skeletal muscles, but also heart, lung, eye, gastrointestinal tract, central nervous system, and endocrine system. However, MyoD is rarely associated with a progressive liver disorder. We report a case of congenital MyoD with combined heterozygous ATP8B1/ABCB4 mutation who developed chronic, progressive low gamma-glutamyltransferase cholestatic liver disease at early infancy, and eventually underwent successful liver transplantation.
Aesthetic Design of Expanded Bilateral Superficial Temporal Vascular Fascial Pedicled Flap for Repairing Maxillocervical Scars
Authors: Cao Zilong , Liu Liqiang , Fan Jincai , Tian Jia , Gan Cheng , Jiao Hu , Yang Zengjie
Published: October 2021

Background

Large-scale maxillocervical scars impair face and neck function and damage appearance. The forehead expanded bilateral superficial temporal pedicled flap is a good treatment strategy for this area; however, the traditional cutaneous pedicled flap damages the temporal hair area. This impairs aesthetics and causes alopecia; furthermore, requires an additional pedicle-cut operation.

Methods

A retrospective study was performed on 7 patients with large-scale maxillocervical scars from January 2014 to August 2018. Forehead expanders were implanted in the first-stage operation for all patients. After the injection and rest period, patients were treated using the forehead expanded bilateral superficial temporal vascular fascial pedicled flap. Superficial temporal vascular fascia pedicles were carefully harvested. The use of an intralesional or hidden retrotragus incision was determined by the presence of a preauricular scar. Patient satisfaction with postoperative neck activity and the incision scar was evaluated.

Results

Intralesional and retrovagus incisions were used in 4 and 3 cases, respectively. One flap developed hematoma, which recovered completely after conservative treatment; all other cases had no complications. All flaps healed well. The neck mobility of the patients was significantly improved with no visible scar in the temporal region. Six cases reported being “very satisfied” and one was “relatively satisfied” with their improvement in neck mobility. All cases reported being “very satisfied” with frontotemporal morphology.

Conclusions

The forehead expanded bilateral superficial temporal vascular fascial pedicled flap is a good choice for patients with large-scale maxillocervical scars. This technique can maintain the aesthetics of temporal hair and reduce patients extra surgical injury.
Whole Blood for Resuscitation of Traumatic Hemorrhagic Shock in Adults
Authors: Jones Allison R. , Miller Justin L. , Jansen Jan O. , Wang Henry E.
Published: October 2021

Injured patients with traumatic hemorrhagic shock often require resuscitation with transfusion of red blood cells, plasma, and platelets. Resuscitation with whole blood (WB) has been used in military settings, and its use is increasingly common in civilian practice. We provide an overview of the benefits and challenges, guidelines, and unanswered questions related to the use of WB in the treatment of civilian trauma-related hemorrhage. Implications for advanced practice nurses and nursing staff are also discussed.
Best Practices Identified in an Academic Hospital Emergency Department to Reduce Transmission of COVID-19
Authors: Ponsford Lisa R. , Weaver Michelle A. , Potter Mindy
Published: October 2021

Emergency departments (EDs) are the point of entry for infectious diseases, making it necessary to reevaluate current practices and make adjustments to decrease transmission when presented with a novel viral infection. This article discusses strategies implemented in the ED to prevent transmission of coronavirus disease-2019 (COVID-19) while identifying areas of needed change in creating a safe environment for patients, health care workers, and ancillary staff. A team approach is ultimately necessary for success; therefore, development of interprofessional teams was formed to mitigate any obstacles. Dissemination of the most current information regarding proper personal protective equipment use, triaging, patient flow, and treatment areas were implemented with weekly emails, videoconferencing, and daily huddles. Developing an efficient triage screening process, redesigning patient flow, and cohorting of patients and staff to a geographical location are essential to minimize transmission. Constant reevaluation of processes is necessary to meet all the needs of patients and health care staff to prevent the spread of COVID-19.
The Impact of Amyloid PET Disclosure on Quality of Life in Patients With Young Onset Dementia
Authors: van der Doelen Daniël M. , Handels Ron L.H. , Zwan Marissa D. , van Kuijk Sander M.J. , Pelkmans Wiesje , Bouwman Femke H. , Scheltens Philip , Dirksen Carmen D. , Verhey Frans R.J.
Published: October 2021

Introduction:

The impact of amyloid positron emission tomography (PET) imaging on patient health outcomes for individuals with dementia is unknown. In the present study, we explored the association between diagnostic outcome and clinician’s level of certainty with quality of life (QoL) after [18F]flutemetamol PET results were disclosed in young onset dementia patients in a memory clinic cohort.

Methods:

In 154 patients suspected of dementia, QoL was measured before and after [18F]flutemetamol PET results were disclosed. Multiple regression analyses were conducted with (changed) general and disease-specific QoL measures as dependent factors [QoL-Alzheimer disease (AD) and EQ-5D Dutch tariff] and etiological diagnosis and clinician’s certainty as independent factors.

Results:

(Change in) diagnosis of AD was associated to QOL in 2 of the 4 analyses (utility-based QoL β=0.15, P=0.010; disease-specific QoL β=2.0, P=0.037). Diagnostic certainty was associated to QOL in 1 of the 4 analyses (generic QoL β=0.002, P=0.028).

Discussion:

The diverse results in this explorative analysis do not reflect a univocal association between diagnosis, certainty, and QoL. Nevertheless, this result could be interpreted as a possible potential for advanced diagnostic technologies for AD, which requires confirmation in future research.
Assessment of Functional Near-infrared Spectroscopy by Comparing Prefrontal Cortex Activity
Authors: Baik Ji Soo , Ko Myoung-Hwan , Ko Sung-Hwa , Min Ji Hong , Choi Jong Kwan , Baek Ji Yeong , Kim Tae Hun , Jung Na-Yeon , Jo Yunju , Lee Tae Young , Shin Yong-Il
Published: October 2021

Many studies have suggested the possibility of using functional near-infrared spectroscopy (fNIRS) devices as neuroimaging tools in various patients. We aimed to evaluate whether fNIRS to measure the prefrontal cortex (PFC fNIRS) is suitable as a screening tool for cognitive impairments. Sixty participants, divided into normal, mild cognitive impairment, and dementia groups, were instructed to wear an fNIRS device during cognitive assessments to assess whether there is a significant difference in the PFC activity between the groups. A significant difference in PFC activity between the groups was observed during the verbal fluency test. Moreover, the PFC activity during the verbal fluency test significantly correlated with the existing cognitive screening tool score. These results suggested that PFC fNIRS can be used as a cognitive impairment screening tool for mild cognitive impairment and dementia. A larger sample size is needed to validate the potential of PFC fNIRS as a cognitive impairment screening tool.
Creating underwater vision through wavy whiskers: a review of the flow-sensing mechanisms and biomimetic potential of seal whiskers
Authors: Zheng Xingwen , Kamat Amar M. , Cao Ming , Kottapalli Ajay Giri Prakash
Published: October 2021

Seals are known to use their highly sensitive whiskers to precisely follow the hydrodynamic trail left behind by prey. Studies estimate that a seal can track a herring that is swimming as far as 180 m away, indicating an incredible detection apparatus on a par with the echolocation system of dolphins and porpoises. This remarkable sensing capability is enabled by the unique undulating structural morphology of the whisker that suppresses vortex-induced vibrations (VIVs) and thus increases the signal-to-noise ratio of the flow-sensing whiskers. In other words, the whiskers vibrate minimally owing to the seal's swimming motion, eliminating most of the self-induced noise and making them ultrasensitive to the vortices in the wake of escaping prey. Because of this impressive ability, the seal whisker has attracted much attention in the scientific community, encompassing multiple fields of sensory biology, fluid mechanics, biomimetic flow sensing and soft robotics. This article presents a comprehensive review of the seal whisker literature, covering the behavioural experiments on real seals, VIV suppression capabilities enabled by the undulating geometry, wake vortex-sensing mechanisms, morphology and material properties and finally engineering applications inspired by the shape and functionality of seal whiskers. Promising directions for future research are proposed.
Dehydration-induced mechanical instabilities in active elastic spherical shells
Authors: Curatolo M. , Napoli G. , Nardinocchi P. , Turzi S.
Published: October 2021

Active elastic instabilities are common phenomena in the natural world, where they have the character of sudden mechanical morphings. Frequently, the driving force of the instability mechanisms has a chemo-mechanical nature, which makes the instabilities very different from the standard elastic instabilities. In this paper, we describe and study the active elastic instability occurring in a swollen spherical closed shell, confining a water-filled cavity, during a dehydration process. We set up a few numerical experiments based on a stress-diffusion model to give an insight into the phenomenon. Then, we present a study that looks at the chemo-mechanical problem and, through a few simplifying assumptions, allows us to derive a semi-analytical model of the phenomenon. It takes into account both the stress state and the water concentration in the walls of the shell at the onset of the instability. Moreover, it considers the invariance of the cavity volume at the onset of instability, which is due to the impossibility of instantaneously changing the cavity volume filled with water. Eventually, it is shown that the semi-analytic model matches very well the outcomes of the numerical experiments far from the initial regime; the ranges of validity of the approximated analytical model are also discussed.
The Dynamic Codon Biaser: calculating prokaryotic codon usage biases
Authors: Dehlinger Brian , Jurss Jared , Lychuk Karson , Putonti Catherine
Published: October 2021

Bacterial genomes often reflect a bias in the usage of codons. These biases are often most notable within highly expressed genes. While deviations in codon usage can be attributed to selection or mutational biases, they can also be functional, for example controlling gene expression or guiding protein structure. Several different metrics have been developed to identify biases in codon usage. Previously we released a database, CBDB: The Codon Bias Database, in which users could retrieve precalculated codon bias data for bacterial RefSeq genomes. With the increase of bacterial genome sequence data since its release a new tool was needed. Here we present the Dynamic Codon Biaser (DCB) tool, a web application that dynamically calculates the codon usage bias statistics of prokaryotic genomes. DCB bases these calculations on 40 different highly expressed genes (HEGs) that are highly conserved across different prokaryotic species. A user can either specify an NCBI accession number or upload their own sequence. DCB returns both the bias statistics and the genome’s HEG sequences. These calculations have several downstream applications, such as evolutionary studies and phage–host predictions. The source code is freely available, and the website is hosted at www.cbdb.info.
Adaptive single-channel EEG artifact removal with applications to clinical monitoring
Authors: Dora Matteo , Holcman David
Published: October 2021

Objective

Electroencephalography (EEG) has become very common in clinical practice due to its relatively low cost, ease of installation, non-invasiveness, and good temporal resolution. Portable EEG devices are increasingly popular in clinical monitoring applications such as sleep scoring or anesthesia monitoring. In these situations, for reasons of speed and simplicity only few electrodes are used and contamination of the EEG signal by artifacts is inevitable. Visual inspection and manual removal of artifacts is often not possible, especially in real-time applications. Our goal is to develop a flexible technique to remove EEG artifacts in these contexts with minimal supervision.

Methods

We propose here a new wavelet-based method which allows to remove artifacts from single-channel EEGs. The method is based on a data-driven renormalization of the wavelet components and is capable of adaptively attenuate artifacts of different nature. We benchmark our method against alternative artifact removal techniques.

Results

We assessed the performance of the proposed method on publicly available datasets comprising ocular, muscular, and movement artifacts. The proposed method shows superior performances on different kinds of artifacts and signal-to-noise levels. Finally, we present an application of our method to the monitoring of general anesthesia.

Conclusions

We show that our method can successfully attenuate various types of artifacts in single-channel EEG.

Significance

Thanks to its data-driven approach and low computational cost, the proposed method provides a valuable tool to remove artifacts in real-time EEG applications with few electrodes, such as monitoring in special care units.