bluuebunny/crossref_metadata_2025 huggingface dataset:
Lessons From the Wrong Isolation Policy Violating Human Rights for Leprosy in Japan
Authors: Horikoshi Yuho , Toizumi Michiko
Published: March 2023

Leprosy, caused by
Mycobacterium leprae
, is one of the so-called “neglected tropical diseases” and is found today mainly in Africa, Asia and South America. Although oral antibiotics capable of curing leprosy are now available, the disease is still misunderstood and feared by the public because of the unsightly deformities that it may cause. In Japan, leprosy has been present since the 8th century and was regarded as a hereditary disease; people avoided marrying into a family with a member affected by leprosy. At the beginning of the 20th century, the Japanese government instituted a policy of lifetime quarantine of individuals with leprosy to eradicate the disease, thereby purposely disseminating negative and inaccurate perceptions of the disease as deadly and highly contagious and fostering a long-lasting prejudice among the general public towards those affected. Even after effective treatments became available, the government continued quarantining patients until 1996. The government has since then apologized to the patients for violating their constitutionally guaranteed human rights. Children with leprosy and children born to parents with leprosy were also victims of the policy and prejudice created. We describe herein the history of leprosy-related policies in Japan to emphasize the importance of balancing public health policy with human rights.
Boosting of Voriconazole Levels With Omeprazole, A CYP450 2C19 Inhibitor
Authors: Hsu Alice J. , Lee Carlton K. K. , McAteer John , Zhang Sean X. , Tamma Pranita D.
Published: March 2023

Children metabolize voriconazole faster than adults and require higher weight-based doses and more frequent administration to achieve therapeutic troughs. We report a case of a 4-year-old girl with disseminated fusariosis with persistently undetectable voriconazole troughs. Omeprazole was added as a CYP2C19-inhibitor to increase voriconazole concentrations. This case highlights the role of omeprazole for voriconazole boosting in a child.
Decreased Hepatic Steatosis in South African Adolescents With Perinatal HIV Switching to Dolutegravir-containing Regimens
Authors: Rose Penelope C. , De la Rey Nel Etienne , Cotton Mark F. , Otwombe Kennedy , Browne Sara H. , Frigati Lisa J. , Rabie Helena , Innes Steve
Published: March 2023

Background:

Although dolutegravir (DTG) has a favorable metabolic profile, it has been linked to excess weight gain. We evaluated changes in hepatic steatosis in adolescents with perinatally acquired HIV switching to DTG-containing antiretroviral therapy (ART).

Methods:

Virologically suppressed adolescents switched to dolutegravir for a minimum of 4 months or on unchanged ART (84% protease inhibitor) were assessed prospectively with anthropometry, transient elastography with controlled attenuation parameter (CAP) and fasting metabolic profiles. ART regimens were determined independently of the study.

Results:

In total 68 adolescents [baseline median age 13.5 years [interquartile range (IQR): 12.5–14.4 years]; 42 (62%) female] were recruited. However, 38 remained on the same regimen and were followed for a median of 98 weeks (IQR: 48–108 weeks), and 30 switched to DTG and were followed for a median of 52 weeks (IQR: 49–101). There was no baseline difference in CAP between groups. There was no significant change in body mass index z-score in either group, but the median CAP in the DTG group decreased by −40dB/m (IQR: −51 to −31 dB/m) after a median of 44 weeks (IQR: 28–50 weeks) on DTG, compared to +1dB/m (IQR: −29 to +14 dB/m) in adolescents not switched (P < 0.01). Cholesterol and triglycerides were lower in those switched. Whereas hepatic steatosis prevalence decreased from 17% to 3% in adolescents who switched to dolutegravir, its prevalence doubled from 8% to 16% in those not switched (P = 0.1).

Conclusions:

In this exploratory study, adolescents switched to DTG-containing regimens had reduced hepatic steatosis, cholesterol and triglycerides with no excess weight gain compared to those on unchanged ART.
Development of the Anaerobic Microbiome in the Infant Gut
Authors: Faden Howard
Published: March 2023

Ninety-five percent of gut microbiota are anaerobes and vary according to age and diet. Complex carbohydrates in human milk enhance the growth ofBifidobacteriumandBacteroidesin the first year. Complex carbohydrates in solid foods enhance the growth ofBacteroidesandClostridiumin the second year. Short-chain fatty acids produced byAkkermansiaandFaecalibacteriummay reduce obesity, diabetes and IBD.
Factors Related to Multidimensional Frailty Among Hispanic People Living With HIV Aged 50 Years and Above: A Cross-sectional Study
Authors: Iriarte Evelyn , Cianelli Rosina , De Santis Joseph P. , Alamian Arsham , Castro Jose Guillermo , Matsuda Yui , Araya Alejandra-Ximena
Published: March 2023

Among Hispanics, frailty has been extensively studied as a physical syndrome associated with an increased risk for adverse outcomes. Because of additional barriers to accessing care, the impact of frailty may be even more significant for people living with HIV (PLWH). Multidimensional frailty among Hispanic PLWH has not been studied. This study aimed to examine the factors related to multidimensional frailty among Hispanic PLWH aged 50 years and above. A cross-sectional design with 120 participants was used. Hypothesized factors related to multidimensional frailty were sociodemographic and psychosocial variables. Multidimensional frailty was measured with the Tilburg Frailty Indicator. We found that 45.83% of the participants were frail (n = 55), and multidimensional frailty was significantly associated with higher depressive symptoms (b = .26, p < .001) and a higher number of comorbidities (b = .71, p < .001). This study identified factors that clinicians should be aware of when caring for Hispanic PLWH to prevent or manage frailty-related complications.
A Turkish Study to Identify the Discharge Learning Needs of Spinal Surgery Patients
Authors: Boran Omer , Kose Gulsah
Published: March 2023

PURPOSE: The aim of this study was to identify the learning needs of spinal surgery patients before hospital discharge. METHODS: This cross-sectional study consisted of 117 spinal surgery patients admitted to the neurosurgery department between October 2019 and March 2020. Data were collected using a descriptive information form, visual analog scale, and the Patient Learning Needs Scale. Data were analyzed using descriptive statistics, Mann-Whitney U and Kruskal-Wallis tests, and Spearman correlation analysis. RESULTS: The mean age of the participants was 54 years, 54.7% were male, and 59% underwent surgery because of spinal disc herniation. The mean Patient Learning Needs Scale score was 188.74. The primary learning needs of the patients were related to the dimensions of activities of living, medication, treatment, and complications, whereas the feelings related to condition were the least-demanded dimension of learning needs. Sex and occupation were the primary factors influencing learning needs. CONCLUSION: The level of learning needs in spinal surgery patients was relatively high. Therefore, discharge education may be planned in line with the learning needs and priorities of these patients, and sex and occupation may be considered while planning discharge education.
On the Frontlines in Shanghai
Authors: Xu Zhimin , Liu Xia , Ghisi Gabriela Lima de Melo , Cui Lixian , Grace Sherry L.
Published: March 2023

Background

COVID-19 (COronaVIrus Disease-19) control measure stringency, including testing, has been among the highest globally in China. Psychosocial impact on pandemic workers in Shanghai and their pandemic-related attitudes were investigated.

Methods

Participants in this cross-sectional study were health care providers (HCPs) and other pandemic workers. A Mandarin online survey was administered between April and June 2022 during the omicron-wave lockdown. The Perceived Stress Scale and Maslach Burnout Inventory were administered.

Results

Eight hundred eighty-seven workers participated, of which 691 (77.9%) were HCPs. They were working 6.25 ± 1.24 days per week for 9.77 ± 4.28 hours per day. Most participants were burned out, with 143 (16.1%) moderately and 98 (11.0%) seriously. The Perceived Stress Scale score was 26.85 ± 9.92 of 56, with 353 participants (39.8%) having elevated stress. Many workers perceived benefits: cohesive relationships (n = 581 [65.5%]), resilience (n = 693 [78.1%]), and honor (n = 747 [84.2%]). In adjusted analyses, those perceiving benefits showed significantly less burnout (odds ratio, 0.573; 95% confidence interval, 0.411 to 0.799), among other correlates.

Conclusions

Pandemic work, including among non-HCPs, is highly stressful, but some can derive benefits.
Multidisciplinary Stroke Pathway for Children Supported With Ventricular Assist Devices
Authors: Lee Sarah , Ryan Kathleen R. , Murray Jenna , Chen Sharon , Grant Gerald A. , Wilkins Sarah , Yarlagadda Vamsi V. , Wintermark Max , Dodd Robert , Rosenthal David , Teuteburg Jeffrey , Navaratnam Manchula , Lee Joanne , Jordan Lori C. , Almond Christopher S.
Published: March 2023

Mechanical circulatory support (MCS), including ventricular assist device (VAD) support, is a leading cause of stroke in children; however, existing pediatric stroke recommendations do not apply to many pediatric VAD patients. We sought to develop a multidisciplinary pathway to improve timely and effective acute stroke care and examine the early performance of the pathway in expediting stroke care. Stakeholders from pediatric heart failure, cardiac intensive care, neurology, interventional radiology, neuroradiology, neurosurgery, pharmacy, and adult VAD care convened at Stanford University in August 2017 to discuss the challenges of providing high-quality acute stroke care to children on VAD support, and to develop multidisciplinary acute stroke pathways. Stakeholders identified multiple barriers to providing timely acute stroke care to pediatric VAD patients. These include delayed recognition of stroke, and lack of clarity related to the optimal imaging technique, when to emergently reverse antithrombotic therapy (AT), pediatric indications for thrombectomy and cranial decompression, and strategies to avoid unnecessary serial CTS. Four stroke pathways were created including evaluation and management of the pediatric patient with (1) an acute neurologic change before an imaging diagnosis; (2) an arterial ischemic stroke (AIS); (3) an intracerebral hemorrhage (ICH); and (4) a subdural hematoma (SDH). With the implementation of the stroke pathway, the median time-to-first-CT image decreased by 43 minutes from 66 to 23 minutes (P < 0.001) while the proportion with a CT within 30 minutes increased from 0% to 67% (P < 0.001). Despite a variety of challenges, multidisciplinary consensus can be achieved on a rapid stroke management pathway for children on VAD support that addresses important barriers to timely stroke care. Although too few stoke events occurred to differentiate clinical outcomes, the time-to-first-CT image was significantly shorter after pathway implementation.
Diagnosis of invasive respiratory mycoses in the immunocompromised host
Authors: Houston Hamish , Wilson Andrew J. , Stone Neil
Published: March 2023

Purpose of review

The burden of invasive fungal infection is increasing worldwide, largely due to a growing population at-risk. Most serious human fungal pathogens enter the host via the respiratory tract. Early identification and treatment of invasive fungal respiratory infections (IFRIs) in the immunocompromised host saves lives. However, their accurate diagnosis is a difficult challenge for clinicians and mortality remains high.

Recent findings

This article reviews IFRIs, focussing on host susceptibility factors, clinical presentation, and mycological diagnosis. Several new diagnostic tools are coming of age including molecular diagnostics and point-of-care antigen tests. As diagnosis of IFRI relies heavily on invasive procedures like bronchoalveolar lavage and lung biopsy, several novel noninvasive diagnostic techniques are in development, such as metagenomics, ‘volatilomics’ and advanced imaging technologies.

Where IFRI cannot be proven, clinicians must employ a ‘weights-of-evidence’ approach to evaluate host factors, clinical and mycological data. Implementation studies are needed to understand how new diagnostic tools can be best applied within clinical pathways. Differentiating invasive infection from colonization and identifying antifungal resistance remain key challenges. As our diagnostic arsenal expands, centralized clinical mycology laboratories and efforts to ensure access to new diagnostics in low-resource settings will become increasingly important.
Climate change, air pollution, pollen allergy and extreme atmospheric events
Authors: D’Amato Gennaro , D’Amato Maria
Published: March 2023

Purpose of review

Respiratory allergy correlates strictly with air pollution and climate change. Due to climate change, the atmospheric content of trigger factors such as pollens and moulds increase and induce rhinitis and asthma in sensitized patients with IgE-mediated allergic reactions.

Pollen allergy is frequently used to evaluate the relationship between air pollution and allergic respiratory diseases. Pollen allergens trigger the release of immunomodulatory and pro-inflammatory mediators and accelerate the onset of sensitization to respiratory allergens in predisposed children and adults. Lightning storms during pollen seasons can exacerbate respiratory allergy and asthma not only in adults but also in children with pollinosis. In this study, we have focalized the trigger (chemical and biologic) factors of outdoor air pollution.

Recent findings

Environmental pollution and climate change have harmful effects on human health, particularly on respiratory system, with frequent impact on social systems.

Climate change is characterized by physic meteorological events inducing increase of production and emission of anthropogenic carbon dioxide (CO2) into the atmosphere. Allergenic plants produce more pollen as a response to high atmospheric levels of CO2. Climate change also affects extreme atmospheric events such as heat waves, droughts, thunderstorms, floods, cyclones and hurricanes. These climate events, in particular thunderstorms during pollen seasons, can increase the intensity of asthma attacks in pollinosis patients.

Climate change has important effects on the start and pathogenetic aspects of hypersensitivity of pollen allergy. Climate change causes an increase in the production of pollen and a change in the aspects increasing their allergenic properties. Through the effects of climate change, plant growth can be altered so that the new pollen produced are modified affecting more the human health. The need for public education and adoption of governmental measures to prevent environmental pollution and climate change are urgent. Efforts to reduce greenhouse gases, chemical and biologic contributors to air pollution are of critical importance. Extreme weather phenomena such as thunderstorms can trigger exacerbations of asthma attacks and need to be prevented with a correct information and therapy.
Daily Vitamin D Supplementation Improves Vitamin D Deficiency in Patients With Chronic Liver Disease
Authors: Mariano da Rocha Carolina Roos , Guaragna-Filho Guilherme , Kieling Carlos Oscar , Adami Marina Rossato , Guedes Renata Rostirola , Gonçalves Vieira Sandra Maria
Published: March 2023

Objective:

The objective of this article is to evaluate the response to 6000 IU oral cholecalciferol (OC) treatment in children with chronic liver disease (CLD) and 25(OH)D deficiency.

Methods:

This historical cohort included non-transplanted CLD patients younger than 18 years old, which were analyzed for serum 25(OH)D, liver function, bone metabolism, Child-Pugh classification, and anthropometry. Patients with 25(OH)D deficiency (defined as 25(OH)D < 20 ng/mL) who received 6000 IU/day of OC were analyzed pre- and post-intervention, and considered responders if 25(OH)D > 20 ng/mL after at least 60 days. We compared clinical and laboratory data from patients with and without 25(OH)D deficiency, responders and nonresponders.

Results:

We studied 96 patients, of which 57.2% had biliary atresia. The prevalence of 25(OH)D deficiency was 67.7% (65/96). These patients were younger (P < 0.001), had higher Child-Pugh scores (P < 0.001), higher levels of total bilirubin (TB) (P < 0.001), gamma-glutamyl transferase (P < 0.001), and alkaline phosphatase (P = 0.002), as well as lower levels of phosphorus (P = 0.009) compared with patients without 25(OH)D deficiency. The median treatment length was 126 days (70–307 days). At the end of treatment, we observed a higher median of 25(OH)D (P < 0.001), and lower median of parathyroid hormone (PTH) (P = 0.023). Nine patients (29%) restored 25(OH)D to normal range; they had lower Child-Pugh score (P = 0.001), lower TB levels (P = 0.001), and higher level of phosphorus (P = 0.003) after treatment.

Conclusion:

Despite an increase in 25(OH)D and decrease in PTH levels, 6000 IU/day of OC was not sufficient to restore 25(OH)D deficiency in most of the patients in this study.
Development and Validation of a Questionnaire to Measure ICU Nurses' Knowledge, Attitudes, and Practices Related to Central Line Bloodstream Infection Practices
Authors: Dang Fangping , Zhai Tiantian , Ding Nannan , Gao Jing , Li Rao , Li Huiju , Ran Xingwu
Published: March 2023

Background:

Currently, there is no instrument available to assess intensive care unit (ICU) nurses' knowledge, attitudes, and practices (KAP) of central line–associated bloodstream infection (CLABSI) prevention practices.

Purpose:

To develop and validate a CLABSI questionnaire to measure ICU nurses' KAP (CLABSI-KAP-Q).

Methods:

Data were collected from 255 nurses at 4 hospitals in Gansu Province, China. Questions on the CLABSI-KAP-Q were generated through a review of the literature, interviews with nurses, and multiple rounds of content validity evaluation by experts. The validity and reliability of the CLABSI-KAP-Q were assessed with exploratory factor analysis, confirmatory factor analysis, internal consistency, and correlation coefficients.

Results:

The final version of the CLABSI-KAP-Q consisted of 32 items. The reliability was represented by a Cronbach α of 0.946, while the test-retest reliability was 0.945. The overall content validity was 0.95.

Conclusions:

The CLABSI-KAP-Q is shown to be valid and reliable and recommended for use in clinical practice.
Upper Gastrointestinal Screening of Polyp Load in Children With Familial Adenomatous Polyposis: Is It Required?
Authors: Middleton Thomas , Sugarman Ian
Published: March 2023

Objectives and study:

Patients with familial adenomatous polyposis (FAP) have a propensity to form not only large bowel polyps but also upper gastrointestinal (GI) polyps with malignant potential. International guidance suggests that upper GI screening need not begin until patients are at least into their twenties. It is our experience that patients develop upper GI polyps long before this point which have the potential for malignant change.

Methods:

A prospective record of all upper GI endoscopies in children (aged 9 to 17) with FAP was kept across a 12-year period by 1 surgeon in our center. For each scope performed, we recorded the location, histology, and treatment of upper GI polyps.

Results:

Twent-eight patients aged 9 to 17 underwent a total of 48 esophagogastroduodenoscopies across a 12-year period. Thirty-eight esophagogastroduodenoscopies (79%) identified at least 1 gastric or duodenal polyp in 22 (79%) patients; 10 (36%) patients had gastric adenomas. Eight (29%) patients showed very high numbers of polyps. All 21 patients who had duodenal polyps had adenomas. None had yet developed malignancy, but 1 patient required extensive polyp excision and one is awaiting endoscopic mucosal resection.

Conclusion:

Our results demonstrate that young people with FAP are at the risk of developing upper GI polyps long before current guidance suggests screening the upper GI tract. We advocate for screening of the upper GI tract to start along with colonoscopy and happen at the same sitting for pediatric and young adult patients with FAP.
The Community Cost of Maintaining Gastrostomies in Pediatric Patients
Authors: Makker Jasmine , Pardy Caroline , Kelly Veronica , Yardley Iain
Published: March 2023

Background:

The use of gastrostomies in children is increasing and their need for long-term management following insertion presents a potentially significant financial and resource challenge to local healthcare systems.

Objectives:

The aim of this study was to determine the yearly cost of maintaining a gastrostomy in a pediatric patient.

Methods:

A retrospective, bottom-up cost-analysis was conducted in a cohort of 180 patients with gastrostomies aged 0–19 years. One in 5 patients were randomly selected for individual cost analysis (n = 36). Their electronic health record was interrogated from the period of March 1, 2019–March 1, 2020. Costs included in the analysis were staff contact time from the community nursing and nutrition teams, and equipment costs.

Results:

The mean cost of maintaining a pediatric gastrostomy across all ages was £709.87 (SD 403.18) per year. Mean annual cost varied by age, underlying diagnosis, and gastrostomy device, but this variation was only statistically significant for the type of device, with Mic-Key buttons having a mean annual cost of £834.66 (SD 307.85), Mini buttons £799.06 (SD 395.01), and percutaneous endoscopic gastrostomy tubes £279.34 (SD 297.45; P = 0.004).

Conclusion:

The mean cost of maintaining a gastrostomy in a pediatric patient is just over £700 per year. The cost is the highest as a child enters adulthood. Button devices have higher maintenance costs compared with percutaneous endoscopic gastrostomy tubes.
Care Bundle to Improve Oxygen Maintenance and Events
Authors: Shivananda Sandesh , Thomas Sumesh , Dutta Sourabh , Fusch Christoph , Williams Connie , Gautham Kanekal Suresh
Published: March 2023

Introduction:

Prolonged periods spent outside the target range of oxygen saturation (SpO2) in preterm infants, along with frequent desaturation events, predispose them to retinopathy of prematurity (ROP) and long-term neurodevelopmental impairment. The primary aim of this study was to increase the mean time spent within the target SpO2 range (WTR) by 10% and to reduce the frequency of desaturation events by 5 events per patient day, respectively, within 18 months of implementing a care bundle.

Methods:

This study was completed in a 46-bed neonatal intensive care unit (NICU), involving 246 staff members and led by a quality improvement team. The change interventions included implementing new practice guidelines, reviewing daily summaries of SpO2 maintenance, daily infant wellness assessment, standardizing workflow, and responding to SpO2 alarms. In addition, we collected staff satisfaction and compliance with change interventions, resource use, and morbidity and mortality data at discharge.

Results:

The mean time spent WTR increased from 65.3% to 75.3%, and the frequency of desaturation events decreased from 25.1 to 16.5 events per patient day, respectively, with a higher magnitude of benefit in infants on days with supplemental oxygen. Postimplementation, the duration of high-frequency ventilation and supplemental oxygen were lower, but morbidity and mortality rates were similar. Staff satisfaction with training workshops, coaching, use of the infant wellness assessment tool, and SpO2 alarm management algorithms were 74%, 82%, 80%, and 74%, respectively.

Conclusion:

Implementing a care bundle to improve oxygen maintenance and reduce desaturation events increased the time spent WTR and reduced the frequency of desaturation events.
Reduced Computed Tomography for Appendicitis in Children after Implementation of Next-day Surgery Clinic Follow-up
Authors: Ryan Sydney , Dudley Nanette C. , Schunk Jeff E. , Weng Cindy , Skarda David E. , Glissmeyer Eric W.
Published: March 2023

Introduction:

The use of computed tomography (CT) in the emergency department (ED) evaluation of pediatric patients for suspected appendicitis can be safely reduced. However, published examples of reduced CT use also report increased MRI utilization, ED length of stay, hospitalization rates, and in-ED surgical consultation. In addition, previous studies recommended follow-up for undifferentiated abdominal pain, yet none with pediatric surgeons. Therefore, we implemented a diagnostic algorithm that includes an option for next-day surgery clinic follow-up in cases where uncertainty remains after appendix ultrasound (US) to reduce CT utilization without increasing hospital-based resources.

Methods:

We implemented a diagnostic algorithm in January 2014. We retrospectively identified 4,577 patients who underwent an evaluation for suspected appendicitis from January 2012 to September 2015. CT utilization was compared before and after implementation using Statistical Process Control. In addition, we evaluated secondary outcomes, including US utilization, hospital admission, surgery clinic follow-up, ED surgery consultation, ED return visits within 7 days, and ED length of stay.

Results:

Following the implementation of the algorithm, CT utilization decreased significantly from 13.8% to 6%. Forty-eight patients were evaluated the next day in the optional pediatric surgery clinic for 21 months after implementation. There was no significant change in US utilization, hospital admission, ED surgery consultation, ED return visits within 7 days, or ED length of stay.

Conclusion:

We achieved decreased CT utilization without an increase in the utilization of other hospital-based resources after implementing a pediatric appendicitis evaluation algorithm that includes the option for next-day pediatric surgery clinic follow-up.
Updates in Traumatic Lower Extremity Free Flap Reconstruction
Authors: Lee Z-Hye , Daar David A. , Yu Jason W. , Kaoutzanis Christodoulos , Saadeh Pierre B. , Thanik Vishal , Levine Jamie P.
Published: March 2023

What’s the latest in lower extremity traumatic free flap reconstruction?

Lower extremity reconstruction particularly in the setting of trauma remains one of the most challenging tasks for the plastic surgeon. While advances in wound management and microsurgical techniques in conjunction with long-term outcomes studies have expanded possibilities for limb salvage, much of our management choice has continued to rely on principles set forth many decades ago by Gustilo and Godina in the 1980s. The purpose of this article was to provide a comprehensive update on the various management aspects of traumatic lower extremity microvascular reconstruction based on the latest evidence with an examination of recent publications.
Blockchain, Information Security, Control, and Integrity – Who Is in Charge?
Authors: Barrera Janos A , Trotsyuk Artem A. , Henn Dominic , Sivaraj Dharshan , Chen Kellen , Mittal Smiti , Mermin-Bunnell Alana M. , Larson Madelyn R. , Padmanabhan Jagannath , Kinney Brian , Nachbar James , Sacks Justin , Terkonda Sarvam P , Jeffers Lynn , Gurtner Geoffrey C.
Published: March 2023

Blockchain technology has attracted significant interest in recent years, most notably for its effect on global economics through the advent of cryptocurrency. Within the healthcare domain, blockchain technology has actively been explored as a tool for improving personal health data management, medical device security, and clinical trial management. Despite a strong demand for innovation and cutting-edge technology in Plastic Surgery, integration of Blockchain technologies within our specialty is still in its infancy. Recent advances and mainstream adoption of blockchain are gaining​ momentum​ and have shown significant promise for improving patient care and information management. In this article, we explain what defines a blockchain, and we discuss its history and potential applications in the field of Plastic Surgery. Existing evidence suggests that Blockchain can enable patient-centered data management, improve privacy, and provide additional safeguards against human error. Integration of Blockchain technology into clinical practice requires further research and development to demonstrate its safety and efficacy for patients and providers.
Epidemiology of Anterior and Lateral Basilar Skull Fractures With CSF Leak: A National Trauma Data Bank Analysis
Authors: Fritz Christian , Harris Jacob , De Ravin Emma , Xu Katherine , Parhar Harman S. , Davis Lauren , Moreira Alvaro , Rajasekaran Karthik
Published: March 2023

Objective:

Cerebrospinal fluid (CSF) leaks are a complication from dural violations that can occur in the setting of skull base fractures. No prior study provides a nationwide epidemiological analysis of traumatic CSF leaks. The objective of this report is to characterize patient demographics, injury-related variables, and operative management.

Methods:

The national trauma data bank was queried for both anterior and lateral skull base fracture cases between 2008 and 2016. Clinical data were extracted.

Results:

A total of 242 skull base fractures with CSF leak were identified. Most patients were male (84.3%), and the median patient age was 39.7±17.6 years old. Glasgow Coma Scale was 14.0 [interquartile range (IQR): 6.5–10.6] for lateral fractures, 13.0 (IQR: 3.0–10.0) for anterior fractures, and severe range for combined fractures at 7.0 (IQR: 5.0–9.0) (analysis of variance, P=0.122). Common mechanisms of injury were motor vehicle accidents (107, 44.2%), followed by falls and firearms (65, 26.9% and 20, 8.3%, respectively). The median length of stay was 2 weeks, with a median of 14 days (IQR: 10–25) for the anterior fractures and 10 days (IQR 5–19) among the lateral fractures (P=0.592). Patients were most commonly discharged home in both the anterior (43.8%) and lateral (49.2%) groups.

Conclusions:

The prototypical patient tends to be a young adult male presenting with moderate-to-severe range neurological dysfunction after a vehicular accident. The overall prognosis of skull base fractures with CSF leak remains encouraging, with nearly half of these patients being discharged home within 2 weeks.
Melatonin Protects Bone Microarchitecture against Deterioration due to High-Fat Diet-Induced Obesity
Authors: Kim Bukyung , Kim Yeon Ji , Kim Jae Hyun , Park Kwangkuk , Ku Hyungjune , Choi Young-Sik
Published: March 2023

Background: We evaluated the protective effects of melatonin against high-fat diet (HFD)-induced deterioration of bone microarchitecture using high-resolution peripheral quantitative computed tomography (HR-pQCT).Methods: Four-week-old male C57BL/6 mice were divided into control (chow diet group), HFD, and HFD + melatonin-administered groups. Mice were sacrificed after 14 weeks, and the right femur was extracted. The microskeletal structure of the femur was analyzed using SkyScan1173 (version 1.6). A 3-dimensional image was reconstructed using the Nrecon (version 1.7.0.4) program.Results: Bone volume (BV) was significantly increased in the HFD group compared with that in the normal diet group, and that of the melatonin group also increased significantly compared with BV of the normal diet group (p<0.05). Percent BV/total volume [TV] and bone surface/BV were significantly higher in both the HFD and melatonin groups than in the normal diet group (p<0.05), and the melatonin group had the highest BV/total volume (TV). BMD was lower in the HFD than in the normal diet group and was the highest in the melatonin group.Conclusions: This study shows that melatonin inhibited the deterioration of microarchitecture induced by a HFD. A better understanding of the protective effect of melatonin on bone microarchitecture and mechanisms could provide fracture prevention for people who are obese.
Different Pattern of T-Score Discordance between Patients with Atypical Femoral Fracture and Femur Neck Fracture
Authors: Yoon Byung-Ho , Park Jang-Won , Lee Chan Woo , Koh Young Do
Published: March 2023

Background: Our study evaluated the prevalence and pattern of T-score discordance between the spine and hip in Korean patients with atypical femoral fracture (AFF) and femur neck fracture (FNF).Methods: A total of 49 patients (all women) who were treated for AFF and 1:3 matched 147 female patients with FNF were included from January 2012 to August 2022. A discordance of more than 1.5 between lumbar spine and femur neck bone mineral density (BMD) was defined as a difference and divided into 3 groups: lumbar low (LL; lumbar BMD is less than femur neck BMD), no discordance (ND), and femur neck low (FL; femur neck BMD is less than lumbar BMD). We compared the prevalence and pattern of discordance between 2 groups, and the associated risk factors of T-score discordance among the subjects were evaluated using regression analysis.Results: The prevalence of discordance was significantly higher in patients with AFF (51%) than in those with FNF (25.2%; p<0.001). LL discordance was found in 46.9% of the patients with AFF but only 4.8% in those with FNF. Conversely, FL discordance was found in 4.1% of the patients with AFF and 20.4% in those with FNF, respectively. No specific risk factor was found as T-score discordance in the 2 groups.Conclusions: Clinicians should be aware that the pattern of T-score discordance can vary depending on the location of osteoporotic fractures. In addition, a longitudinal study would be necessary to verify the pattern of T-score discordance related to the osteoporotic fracture location.
Expansion of modern humans over the world: The origin when considering non-linearity
Authors: Cenac Zarus
Published: March 2023

Types of diversity have been known to decline linearly with the rise of geographical distance from Africa. Declines have helped to suggest the area in Africa which holds the origin for the global expansion of modern humans. Research has, at times, explored if there is a non-linear relationship between diversity and distance from Africa. A previous suggestion was that non-linearity could affect where the expansion appears to have originated. Linear analysis with Y-chromosomal microsatellite heterozygosity has been contrary to the expansion from Africa, instead indicating an origin involving Asia; could this be attributable to non-linearity? The present study looked into whether there are non-linear relationships between distance and diversities, and approximated where the expansion began. This study used diversities from previous research – genetic (autosomal, X-chromosomal, Y-chromosomal, and mitochondrial) and cranial shape. The Bayesian information criterion was the statistic for comparing linear and non-linear (quadratic) models to indicate if there is a non-linear relationship. This criterion was also used to estimate where the expansion launched from. Autosomal microsatellite heterozygosity favoured a non-linear relationship. This may be due to South American populations. Mitochondrial diversity suggested non-linearity too, but not when minimum temperature was controlled for. Whilst non-linear relationships indicated that the expansion had its start in Africa, for autosomal microsatellite heterozygosity, the area of origin appeared to be rather affected by the type of model (linear or non-linear). Other diversities (e.g., Y-chromosomal) supported linear relationships. Therefore, non-linearity does not seem to explain Y-chromosomal microsatellite heterozygosity being unexpressive of the global expansion.
Predictive reward-prediction errors of climbing fiber inputs integrate modular reinforcement learning with supervised learning
Authors: Hoang Huu , Tsutsumi Shinichiro , Matsuzaki Masanori , Kano Masanobu , Toyama Keisuke , Kitamura Kazuo , Kawato Mitsuo
Published: March 2023

Although the cerebellum is typically linked to supervised learning algorithms, it also exhibits extensive involvement in reward processing. In this study, we investigated the cerebellum’s role in executing reinforcement learning algorithms, with a particular emphasis on essential reward-prediction errors. We employed the Q-learning model to accurately reproduce the licking responses of mice in a Go/No-go auditory-discrimination task. This method enabled the calculation of reinforcement learning variables, such as reward, predicted reward, and reward-prediction errors in each learning trial. By tensor component analysis of two-photon Ca2+imaging data from more than 6,000 Purkinje cells, we found that climbing fiber inputs of the two distinct components, which were specifically activated during Go and No-go cues in the learning process, showed an inverse relationship with predictive reward-prediction errors. By assuming bidirectional parallel-fiber Purkinje-cell synaptic plasticity, we constructed a cerebellar neural-network model with 5,000 spiking neurons of granule cells, Purkinje cells, cerebellar nuclei neurons, and inferior olive neurons. The network model qualitatively reproduced distinct changes in licking behaviors, climbing-fiber firing rates and their synchronization during discrimination learning separately for Go/No-go conditions. We found that Purkinje cells in the two components could develop specific motor commands for their respective auditory cues, guided by the predictive reward-prediction errors from their climbing fiber inputs. These results indicate a possible role of context-specific actors in modular reinforcement learning, integrating with cerebellar supervised learning capabilities.
Integration of IoT into e-government
Authors: Shao Deo , Ishengoma Fredrick R. , Alexopoulos Charalampos , Saxena Stuti , Nikiforova Anastasija , Matheus Ricardo
Published: March 2023

Purpose

The purpose of this paper is to highlight the drivers, barriers, benefits and risks affecting the integration of Internet of Things (IoT) into the e-government and to provide a future research agenda.

Design/methodology/approach

Existing literature examining the relationships between e-government and IoT is scanned and evaluated by conceptualizing the IoT concept in the e-government perspective.

Findings

The study shows that there are drivers to integrate IoT in e-government, such as ensuring the economy, efficiency and effectiveness of government operations, which would largely establish a relationship between the government and the citizens. Furthermore, there are barriers to such integration, given the lack of political will, the appropriate information technology infrastructure, the training of the stakeholders with a focus on the employee and the like.

Originality/value

The integration of IoT in e-government is a novel and weakly explored concept, particularly in the light of new advances such as blockchain in the e-government, which requires further exploration and conceptualization, thereby achieving a shared/common vision and body of knowledge for its further successful and sustainable adoption – to the best of the authors’ knowledge, the current study is one of these initial attempts.
Career development in management accounting: empirical evidence
Authors: Thaller Johannes , Duller Christine , Feldbauer-Durstmüller Birgit , Gärtner Bernhard
Published: March 2023

Purpose

Due to globalization and digitalization, the world of work is undergoing comprehensive change. These trends are challenging management accounting (MA) and pressuring individuals and organizations to change. The literature postulates a replacement of traditional organizational careers by “new” career models characterized by dynamism and flexibility. However, the state of the art on careers in MA lacks empirical evidence and has disparate research interests.

Design/methodology/approach

In this study, the authors investigate the status quo of careers in MA, key influencing factors and assumed change in such careers. To do so, the authors conducted a quantitative empirical study, based primarily on the careers of 83 graduates of a department offering a MA major at a German-speaking university. Nine qualitative empirical interviews supplement the quantitative findings.

Findings

The authors’ findings indicate that while MA careers are changing, the characteristics of the profession are continuing to concur with the traditional organizational understanding of careers. Accumulated professional experience is the key factor to achieving a management position although management accountants tend to become more dynamic in terms of career paths and career understanding. Thus, employment in various functional areas opens new career paths in MA.

Research limitations/implications

The methodology of analysing quantitative and empirical cross-sectional data and the resulting final sample size is too small to guarantee robust statistical inference. Moreover, further interviews would lead to greater data saturation.

Practical implications

The study sheds light on the under-researched question of how careers in MA proceed and develop. This could be of interest for practitioners working with management accountants such as personnel consultants.

Originality/value

This study contributes to the field through its comprehensive consideration of careers in MA in this changed context, thus providing new insights for academia and business practice.
Affective memories and perceived value: motivators and inhibitors of the data search-access process
Authors: Li Qiao , Liu Chunfeng , Hou Jingrui , Wang Ping
Published: March 2023

Purpose

As an emerging tool for data discovery, data retrieval systems fail to effectively support users' cognitive processes during data search and access. To uncover the relationship between data search and access and the cognitive mechanisms underlying this relationship, this paper examines the associations between affective memories, perceived value, search effort and the intention to access data during users' interactions with data retrieval systems.

Design/methodology/approach

This study conducted a user experiment for which 48 doctoral students from different disciplines were recruited. The authors collected search logs, screen recordings, questionnaires and eye movement data during the interactive data search. Multiple linear regression was used to test the hypotheses.

Findings

The results indicate that positive affective memories positively affect perceived value, while the effects of negative affective memories on perceived value are nonsignificant. Utility value positively affects search effort, while attainment value negatively affects search effort. Moreover, search effort partially positively affects the intention to access data, and it serves a full mediating role in the effects of utility value and attainment value on the intention to access data.

Originality/value

Through the comparison between the findings of this study and relevant findings in information search studies, this paper reveals the specificity of behaviour and cognitive processes during data search and access and the special characteristics of data discovery tasks. It sheds light on the inhibiting effect of attainment value and the motivating effect of utility value on data search and the intention to access data. Moreover, this paper provides new insights into the role of memory bias in the relationships between affective memories and data searchers' perceived value.
An analysis of stock markets integration and dynamics of volatility spillover in emerging nations
Authors: Khan Imran
Published: March 2023

Purpose

BRICS (Brazil, Russia, India, China, and South Africa) a group of five emerging nations that are expected to lead the global economy by the year 2050. The growth potential of these nations attracts investors from all over the world who are in search of maximizing the return on their investments and limiting the losses to the lowest possible level. The purpose of this research study is to determine whether or not Indian stock market investors can diversify their stock market portfolios into other BRICS economies.

Design/methodology/approach

A daily frequency of stock market closing data for the BRICS nations over a period of 2013–2021 has been considered and several econometric techniques have been applied. Starting with the Granger causality test for checking the direction of causality. The VAR technique is applied to find out whether the movement in the Indian stock market is influenced by its own past values or the past values of the other BRICS nations, and lastly, the DCC-MGARCH technique is applied to check the degree of integration or the volatility spillover from the Indian stock market to the stock markets of other BRICS nations.

Findings

The results of the study indicated that in both the short term and long term, stock market volatility is spilling over from the Indian stock market to the stock markets of other BRICS nations. Hence, the study suggests that BRICS nations cannot be a destination for portfolio diversification for Indian stock market investors.

Originality/value

The stock markets of emerging nations experience high volatility, which creates confusion for investors as to whether to invest or to abstain from portfolio diversification. At present, there is a gap in the existing literature to capture the stock market volatility of BRICS nations. This research study fills this research gap and confirms that BRICS nations cannot be a destination for portfolio diversification. Moreover, equity market experts, portfolio managers and researchers can all take advantage of this study.
Halal tourism beyond 2020: concepts, opportunities and future research directions
Authors: Ekka Punit Moris
Published: March 2023

Purpose

The current research work investigates the concept of halal tourism through research articles published during the COVID-19 pandemic. The purpose of this paper is to contribute to the understanding of what halal tourism means, while traveling following the Islamic law. This study also contributes to the discussion on its definition and the shared understanding, as it is extremely important toward the sustainable development of this niche tourism section.

Design/methodology/approach

A systematic literature review of total 47 number of existing literature, extracted from two major databases, namely, Scopus and Web of Science, was conducted. For data collection, the time frame from January 2020 to January 2023 was chosen, which represents the pandemic times during which those articles were published.

Findings

Although being a growing segment, halal tourism is still at a nascent stage in business research. It is potentially an attractive and niche segment of tourism. Current research work highlights the major contents related to halal tourism, dominant theories used in literature, publishing authors, journals and research gaps for further research. In this line, future research directions are also proposed toward the end of this paper.

Originality/value

This study highlights the conceptual development and discusses the opportunities and implementation of halal tourism in post-pandemic world. Current research work presents interesting contextual data and presents insightful knowledge in a new context. This paper offers a systematic analysis and provides both an academic as well as the managerial implications.