bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of myocardial perfusion and coronary calcium on medical management for coronary artery disease
Authors: Hijazi Waseem , Feng Yuanchao , Southern Danielle A , Chew Derek , Filipchuk Neil , Har Bryan , James Matthew , Wilton Stephen , Slomka Piotr J , Berman Daniel , Miller Robert J H
Published: October 2023

Aims

Single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) remains one of the most widely used imaging modalities for the diagnosis and prognostication of coronary artery disease (CAD). Despite the extensive prognostic information provided by MPI, little is known about how this influences the prescription of medical therapy for CAD. We evaluated the relationship between MPI with computed tomography (CT) attenuation correction and prescription of acetylsalicylic acid (ASA) and statins.

Methods and results

We performed a retrospective analysis of consecutive patients who underwent SPECT MPI at a single centre between 2015 and 2021. Myocardial perfusion abnormalities and coronary calcium burden were assessed, with attenuation correction imaging 77.8% of patients. Medication prescriptions before and within 180 days after the test were compared. Associations between abnormal perfusion and calcium burden with ASA and statin prescription were assessed using multivariable logistic regression. In total, 9908 patients were included, with a mean age 66.8 ± 11.7 years and 5337 (53.9%) males. The prescription of statins increased more in patients with abnormal perfusion (increase of 19.2 vs. 12.0%, P < 0.001). Similarly, the presence of extensive CAC led to a greater increase in statin prescription compared with no calcium (increase 12.1 vs. 7.8%, P < 0.001). In multivariable analyses, ischaemia and coronary artery calcium were independently associated with ASA and statin prescription.

Conclusion

Abnormal MPI testing was associated with significant changes in medical therapy. Both calcium burden and perfusion abnormalities were associated with increased prescriptions of medical therapy for CAD.
National trends in emergency coronary artery bypass grafting
Authors: Keeling William B , Binongo Jose , Wei Jane , Leshnower Bradley G , Farrington Woodrow , Halkos Michael E
Published: October 2023

OBJECTIVES

Emergency coronary artery bypass grafting (CABG) is often omitted from current research, and volumes as well as outcomes are unknown. The purpose of this research is to examine national trends in emergency CABG.

METHODS

The Society of Thoracic Surgeons national adult cardiac surgical database was queried from 2005 to 2017 for patients who underwent emergency and emergency salvage isolated CABG procedures, and 92 607 patients were included for analysis. Generalized linear mixed models were used to assess time trends, taking into account the clustering effect of region.

RESULTS

Over the study period, volumes of emergency and emergency salvage CABG declined from 7991 to 6916 cases/year. Emergency and emergency salvage cases accounted for ∼4.9% of all CABG procedures performed nationwide in 2005 and 4.1% in 2017. The predicted risk of mortality (PROM) declined in the entire patient cohort over time from 12% to 8% (P < 0.0001). Rates of important postoperative morbidities also declined including prolonged intubation, re-exploration for haemorrhage and postoperative pneumonia (P < 0.001). Observed-to-expected mortality rates rose over the study period from 0.81 to 1.06 as the overall PROM declined from 9.3% to 7.6%. Emergency salvage CABG rates also declined over the course of the study from 358 to 323 cases/year. The observed-to-expected ratios for mortality increased for emergency salvage CABG during the study from 1.16 to 1.66, and emergency salvage mortality rates averaged 46.5%.

CONCLUSIONS

The volume of patients undergoing emergency and emergency salvage CABG in the USA has declined. Increases in mortality are largely driven by emergency salvage cases, and the PROM algorithm may not accurately reflect the risk involved for these patients.
Philippine Politics and Government
Authors: Teehankee Julio
Published: October 2023

The study of politics and government in the Philippines was borne out of critical junctures in historical state-making and nation-building in the country. From colonialism to nationalism, modernization, authoritarianism, and democratization, the Philippines is an interesting case study since it reflects significant periods in its political history. The emergence of political science in the Philippines has contributed to the rise of several Philippine politics and government theories that frame the analysis of its political development. Despite the early influence of American political science on the study of Philippine politics and government, Philippine political science has avoided quantitative methods until recently. Nonetheless, the latest studies by Filipino political scientists present a dynamic and pluralist perspective. For the most part, the bulk of research publications has focused on democratic and state institutions that include executive, legislative, and judicial branches of government; the bureaucracy; local government and decentralization; policymaking in general; the military and police; elections; voting; election rules; and political parties. Philippine politics has been largely criticized for being corrupt, patronage-based, and lacking ideological grounding. However, political and social movements have mobilized ideology in contesting power in the country. Essentially, there have been four ideological traditions in the Philippines: nationalism, liberalism, radical Marxism, and socialism. Despite several attempts to articulate an ideologically based discourse, Philippine politics continue to revolve around candidate-centered alliances of provincial bosses, political machines, and local clans, grounded on clientelistic, parochial, and personal inducements rather than issues, ideologies, and party programs. Nonetheless, alternative theories have emerged to challenge this view of Philippine politics. In recent years, the strong institutionalist and statist approach of the discipline in the country has been receptive to alternative and multidisciplinary perspectives. The Philippines is also home to a broad range of voluntary associations, nongovernmental organizations (NGOs), and other manifestations of a relatively vibrant civil society and social movements. New ideological formations gravitating around postmodern, cultural, and identity-based issues have also emerged. Moreover, new challenges, such as democratic regression, authoritarian revival, and digital disinformation, necessitate looking at old problems with new academic lenses. In addition, domestic politics continue to impact how the country navigates its foreign policy, particularly in defense of its “national interest” in the rapidly shifting global arena.
Cross-Cultural Pragmatics
Authors: Gladkova Anna
Published: October 2023

Cross-cultural pragmatics (CCP) is an area of linguistics that studies natural language use in a contrastive perspective accounting for cultural factors. “Natural language” here is interpreted in its relation to culture. By culture, people’s shared ways of living, thinking, feeling, doing things, and speaking are understood. CCP is a relatively recent field in linguistics, and it is not uniform either. It lies at the intersection of pragmatics, contrastive linguistics, and anthropological linguistics or ethnolinguistics, and its different realizations also intersect with cognitive studies and sociolinguistics. The approaches here stem from different areas of linguistic studies and emphasize different aspects of language use—pragmatics, on the one hand, and social, cultural, and anthropological approaches, on the other. At the same time, the possibility of providing a contrastive perspective in the analysis is crucial. Therefore, approaches to studying cross-cultural pragmatics can be broadly divided into two trends—linguo-philosophical and sociocultural or anthropological. The linguo-philosophical trend accepts the main postulates of pragmatics as a field and uses them as grids of comparison. Sociocultural approaches analyze language use in its close relation to culture and society. This article will consider the following approaches within each trend: Politeness Theory and Contrastive Pragmatics as the linguo-philosophical trend, and Ethnopragmatics, Intercultural Pragmatics, Pragmatic Act Theory, Cultural Linguistics, The Moscow School of Semantics and the Lublin School of Linguistic Worldview Studies, and Postcolonial Pragmatics as the sociocultural trend.
Robert Creeley
Authors: Gold Alexandra J.
Published: October 2023

Robert White Creeley (b. 1926–d. 2005) was born in Arlington, Massachusetts, to Genevieve and Oscar Creeley. Creeley’s early life was marked by tragedy, as the poet suffered both the loss of his left eye in an automobile accident and the loss of his father by age five, after which he was raised by his mother along with his sister, Helen. He would go on to matriculate at Harvard College before dropping out to serve as an ambulance driver with the American Field Service in World War II. On return, Creeley married his first wife, Ann McKinnon, with whom he had three children; the couple settled on a New Hampshire farm before venturing abroad to France and Spain. Throughout this period, in the 1950s, Creeley established himself as a serious writer, engaging in correspondence with influential poets like Denise Levertov and Charles Olson, publishing verse and fiction in little magazines, founding his own Divers Press, and teaching at the experimental Black Mountain College alongside other avant-garde luminaries. Following his Black Mountain stint and a divorce, Creeley moved to New Mexico, where he lived and worked throughout the 1960s as a poet, secondary school teacher, and later professor. There, he met his second wife, writer and artist Bobbie Louise Hawkins, with whom he shared two daughters and two stepdaughters. His first major poetic volume, For Love, also appeared in this period. Though he had previously published several small volumes and numerous essays and stories, it was For Love (1962) and the subsequent Words (1967) and Pieces (1968) that crystallized Creeley’s role as a significant postwar American poet and earned him greater acclaim. On the heels of these volumes, in the late 1960s, Creeley took up a teaching post at SUNY Buffalo, where he remained for over three decades and established a renowned poetics program. During this time, from the mid-to-late 1970s through the early 2000s, Creeley divorced Hawkins, met and married his third wife, Penelope Highton (with whom he had two more children), and enjoyed a prolific poetic career, publishing volumes like Hello (1976), Mirrors (1983), Echoes (1994), and Life & Death (1999), among myriad other collaborations, chapbooks, and projects. In 2003, Creeley joined the Brown University faculty where he taught until his 2005 death from pneumonia; his final collection, On Earth: Last Poems and an Essay (2006), was posthumously published.
Advanced Theory of Mind
Authors: Miller Scott A.
Published: October 2023

The term theory of mind refers to beliefs about the mental world—to what people know or believe about beliefs, desires, emotions, and other mental states. Many basic forms of such understanding emerge early in development, and these early achievements have long been the most common focus of research on theory of mind. Development of theory of mind, however, is by no means complete by age five or six; rather, recent research documents a number of further developments that build on and extend the early forms of understanding. These further developments include understanding of second-order false belief (John thinks that Mary thinks . . . .), the capacity for higher-order recursive thinking (A thinks that B thinks that C thinks . . . .), understanding of interpretive diversity (two people may hold different beliefs about the same aspect of reality), understanding of opacity (the truth of some utterances depends on the utterance and not on the reality), the ability to interpret nonliteral utterances (e.g., lies, jokes, irony, sarcasm), and the ability to perceive the true emotion in instances of hidden or multiple emotions. Mastery of such knowledge typically extends across late childhood and adolescence, and, in some instances, even adults fall short of ceiling in their performance. Individual differences in understanding are, therefore, considerably more marked than is true in early childhood, and such differences have been shown to contribute to a number of other developments in both the cognitive and the social domains. This point holds true for typically occurring development, and it is often especially the case in clinical syndromes, most notably autism spectrum disorder or ASD. Theory of mind, including advanced theory of mind, is therefore of considerable pragmatic importance. Theory of mind also presents a number of important theoretical challenges, challenges that relate to central issues in developmental psychology. What is the nature of the underlying cognitive system that makes advanced theory-of-mind mastery possible? How does this system differ from the forms of knowledge available to the young child? And what are processes by which the initial system transforms into the advanced one? The sections to come will address these and other issues in the study of advanced theory of mind. In most instances the answers offered will be partial ones, and, therefore, needed directions for future research will be a continuing theme.
Team Performance
Authors: Fernandez Castillo Gabi , Khalid Maha , Salas Eduardo
Published: October 2023

The last twenty years of team research have seen a bloom in the publishing of team performance methods, frameworks, theories, and more. This bibliography offers research that is both novel and foundational, focusing on the last three decades of research (starting in 1996) to highlight recent findings while still providing the reader with a basic understanding of concepts surrounding team performance. In this bibliography, a “team” is defined as a group of two or more people working together to accomplish a common goal. Furthermore, we conceptualize team performance not as the output of a team, but instead as the actions and factors that comprise it. Team scientists conceptualize team performance as a dynamic process primarily composed of task and teamwork behaviors. Task behaviors can be defined as team members’ interactions with different factors, such as tools or systems to carry out the team’s goal. On the other hand, teamwork behaviors comprise everything the team does in order to achieve that goal, such as communicating or coordinating with team members. However, team performance is simultaneously a multilevel process involving individual-level inputs, team-level inputs, and organizational inputs in both of these categories. Lastly, team effectiveness can be understood as the caliber of performance outcomes, which will ultimately vary depending on the goal at hand. In this bibliography, we summarize key reference sources (such as journals) and present research that underlies and explores the foundations of task and teamwork behaviors, also looking at how leadership affects team performance, and how performance can be improved via measurement and team training. We take findings from a variety of fields and contexts, aiming to provide an interdisciplinary overview. The bibliography’s sections aim to provide general overviews of the materials provided. Additionally, under each item’s description, we highlight why each source might be useful, trying to describe the nature of the methods, if applicable, and the general findings of the research at hand. Each subsection is organized in alphabetical order. If applicable, we describe if the article is more practitioner-based. This aside, team performance research is always adapting and growing, and we look forward to updating the bibliography as new advancements are made.
Social Media Analytics
Authors: Zhao Bo
Published: October 2023

Social media analytics is the process of collecting, analyzing, and visualizing data from platforms like Twitter, Instagram, Weibo, and TikTok to gain insights into how people behave in the real world or virtual spaces. The data is a collection of digital records people create while interacting with social media platforms. Each record often contains textual or multimedia descriptions of the user’s input, a unique identifier, a geotag indicating the interaction’s location, and a timestamp indicating when the interaction occurs. In practice, social media data is collected in large quantities via front-end scraping or an Application Programming Interface (API). Once collected, the data can be examined using content analysis, spatial-temporal analysis, and geovisual analysis, although these analyses are often mutually inclusive. Content Analysis involves examining the metadata, text, images, or videos in social media posts to extract insights. This can be done using keyword matching, machine learning, or topic modeling. Spatial-Temporal Analysis examines the location and timing of social media posts, and can be used to identify event patterns, predict future occurrences, find geographical clusters, assess spatial-temporal correlations, examine patterns in social networks, and determine spatial-temporal variation in hotspots of activity. Geovisual Analytics involves creating maps or other visual representations of social media data to help understand patterns and trends. These analyses can be combined to provide a comprehensive understanding of the phenomena depicted in the data. However, it’s important to note that using social media data raises social and ethical concerns when such data is presented, curated, or commodified. Some identified issues include data bias, privacy leaks, and location spoofing.
GIS, Geospatial Technology, and Spatial Thinking in Geography Education
Authors: Sinton Diana
Published: October 2023

Geospatial technologies, including the use of geographic information systems (GIS) and web-based maps, are slowly being integrated into geography education. By 2023, these practices had become common in higher education but continued to be less so in secondary education and were still rare in primary education. For decades, proponents of the technologies have made compelling arguments for the potential benefits of the applications, pointing to outcomes such as improvements in applying spatial analytical solutions problems, or to increased engagement with the subject. The first phases of technology adoption, however, were fraught with frustration and abandoned efforts, largely the result of poor alignment between instructional logistics, available standards-based curricula, and teacher’s reluctant wariness. Since the early 2010s, many of these obstacles have been reduced or even removed, particularly thanks to the availability of online mapping technologies. At the university level, a geography department or program without some type of GIS opportunity is uncommon, and larger institutions have students and faculty from dozens of different instructional units outside of geography regularly using the technologies in their research and educational workflows. However, in school-level geography, the word “despite” has been persistent in published observations and conclusions. Despite the easier access to mapping platforms, despite the availability of lessons and data designed for direct alignment with educational standards, despite increased school administrator support, and despite numerous professional development opportunities, there is still significantly less uptake than would have been expected by now. Arguably, the most substantial efforts have aimed to ameliorate the how of usage without adequate or convincing attention on the why. That is, despite the small but steady number of research-based conclusions that GIS usage can often have diverse and positive benefits on learning outcomes, those reasons are not always sufficient or adequate motivations for a teacher, a district, a state, or a country to begin the practices. The long-term linking of “GIS” and “spatial thinking” has been a complicated one. Spatial “skills”—such as the ability to mentally rotate an abstract three-dimensional object—are key indicators for success in engineering, architecture, and dentistry, but perhaps not so essential for those focusing on human geography; plus, improving the speed and accuracy at such skills is not an automatic outcome achieved via GIS. Important attention is now being paid to better understand the types and scales of spatial thinking that GIS may evoke, and how and why such GIS experiences may impact geography education.
Geocomputation in Geography Education
Authors: Bowlick Forrest
Published: October 2023

Geocomputation refers broadly to various work using geographic data combined with computational technologies and methodologies. A dynamic area of research, geocomputation work covers many areas of application seeking to leverage the affordances of computing, especially high-performance computing, for solving spatial problems and working with geographic data. Embracing the rapid advances in computational capacity while engaging with long established problems in understanding geographic and spatial relationships results in an area of scholarship inviting a range of expertise to contribute. The difficulties of exploring the boundaries of what is or is not geocomputation reveal themselves especially in earlier work outlining the area, and concepts like geographic information systems/science (both referred to here as GIS) receive variant embrasure. New ideas for analysis and new names for what that analysis might be, emerging from/through and within/without geocomputation, prove successful in maintaining a dynamic and energetic area of practice. At the same time, this range of knowledge, skills, and experience provides a difficult landscape for educational efforts. Teaching and learning (taken together here as “education”) along the broad and deep interface between geocomputation and geography requires difficult choices, learning pathways, and execution in curriculum and instruction. Grappling with the balance and inclusion of computational components in geography education remains an open opportunity for investigation. Whether computing education includes geography is a different discussion.
Early Modern European Engravings and Etchings, 1400–1700
Authors: Silver Larry
Published: October 2023

Making multiple images from a print matrix basically began in tandem with the the use of the printing press during the later 15th century; however, a different press had to be developed to print ink from grooves produced on a metal matrix rather than from an inked surface ridge, as with printed letters or woodblock lines in relief. In whatever way that linework is produced in the metal (usually copper), the general name of this kind of printmaking is intaglio, and the plate surface is wiped. In engraving, produced with a gouging instrument called a burin, the resulting printed lines produce a slightly raised surface of dried ink. In etching, finer but also more maneuverable lines are achieved by scratching onto a waxlike prepared surface called a ground, so that when the plate is submerged in an acid bath, the ground resists biting and only the scratches produce lines on the plate once the ground has been removed to expose the surface. An etched ground also permits covering up some lines and rebiting others in a process called ”stopping out,” which reinforces the exposed lines so that darker tones can be produced from the further action of the acid. Engravings completely dominated the production of intaglio prints from their origins in the mid-15th century, but the manual skill required to use a burin for lines in metal usually required the same extended apprentice training as for a goldsmith. However, once safe and replicable etching techniques had emerged, early in the 16th century, artists without such specialized craft skills could begin to make intaglio prints in the newer method. By the 17th century, while some trained engraving specialists still produced virtuoso prints, often emphasizing the calligraphic beauty of their linework, the dominant medium for intaglio prints clearly shifted to etching. Another important development, first in Italy (especially Rome) but later highly developed in the Netherlands (especially Antwerp) as well, found specialist, professional printmakers, often doubling as print publishers, taking drawn designs by nonspecialist artists and converting them into engravings. Large printmaking firms, akin to book publishers, provided an alternative way for painters (including Titian, Bruegel, and Rubens, among others) to circulate their images as engraved reproductions. Finally, the advent of color printing through the use of multiple plates for each tone first emerged for multiblock woodcuts during the 16th century, a time when intaglio prints were hand-colored by well-paid specialist painters (called Briefmaler in Germany). But later centuries brought more technical innovations for intaglio plates to simulate the effects of drawings. Those new techniques, particularly aquatint and mezzotint during the 18th century, mark a major expansion of printmaking effects, so this transitional moment marks the effective end of this study of early intaglios, from the mid-15th century through the 17th century. Given the limitations of the Oxford Online Bibliography series, this list must necessarily remain selective.
An affirming approach to caring for transgender and gender-diverse youth
Authors: Vandermorris Ashley , Metzger Daniel L
Published: October 2023

Increasing numbers of youth identify as transgender or gender-diverse (TGD). Many paediatricians and primary care providers (PCPs) will encounter this population in their practice, either for gender-related care or general health needs. This statement is intended as a resource to guide paediatricians and PCPs in implementing an affirming approach to routine health care provision for all youth. Furthermore, it presents information to assist providers in responding to requests for counselling from TGD youth and their families around potential options for medical transition, and in making referrals to specialized services, if desired and relevant. Finally, as demand for gender-affirming care is anticipated to continue to increase, some health care providers (HCPs) may wish to develop the knowledge and skills required to initiate adolescents on hormone-blocking agents and gender-affirming hormones. This document is not intended to be a clinical practice guideline, but will provide foundational information regarding these potential components of gender-affirming care, recognizing that the needs and goals of individual adolescents may or may not include such interventions. Additional resources relevant to developing the expertise required to provide gender-affirming interventions will also be identified.
Human wild‐type andD76Nβ2‐microglobulin variants are significant proteotoxic and metabolic stressors for transgenicC. elegans
Authors: Raimondi Sara , Faravelli Giulia , Nocerino Paola , Mondani Valentina , Baruffaldi Alma , Marchese Loredana , Mimmi Maria Chiara , Canetti Diana , Verona Guglielmo , Caterino Marianna , Ruoppolo Margherita , Mangione P. Patrizia , Bellotti Vittorio , Lavatelli Francesca , Giorgetti Sofia
Published: October 2023

β2‐microglobulin (β2‐m) is a plasma protein derived from physiological shedding of the class I major histocompatibility complex (MHCI), causing human systemic amyloidosis either due to persistently high concentrations of the wild‐type (WT) protein in hemodialyzed patients, or in presence of mutations, such as D76N β2‐m, which favor protein deposition in the adulthood, despite normal plasma levels. Here we describe a new transgenic Caenorhabditis elegans (C. elegans) strain expressing human WT β2‐m at high concentrations, mimicking the condition that underlies dialysis‐related amyloidosis (DRA) and we compare it to a previously established strain expressing the highly amyloidogenic D76N β2‐m at lower concentrations. Both strains exhibit behavioral defects, the severity of which correlates with β2‐m levels rather than with the presence of mutations, being more pronounced in WT β2‐m worms. β2‐m expression also has a deep impact on the nematodes' proteomic and metabolic profiles. Most significantly affected processes include protein degradation and stress response, amino acids metabolism, and bioenergetics. Molecular alterations are more pronounced in worms expressing WT β2‐m at high concentration compared to D76N β2‐m worms. Altogether, these data show that β2‐m is a proteotoxic protein in vivo also in its wild‐type form, and that concentration plays a key role in modulating pathogenicity. Our transgenic nematodes recapitulate the distinctive features subtending DRA compared to hereditary β2‐m amyloidosis (high levels of non‐mutated β2‐m vs. normal levels of variant β2‐m) and provide important clues on the molecular bases of these human diseases.
Better Mobility Is Associated With Higher Incomes and Longer Working Years Among Older Adults
Authors: Pu Alex , Paul Subrata , Luke Brian , Bhattacharyya Timothy
Published: October 2023

Background

Robust physical mobility is the key to healthy independent aging. Although the association between socioeconomic status and health is well documented, it is unclear whether there is a relationship between mobility and income, because income data are not readily available.

Questions/purposes

(1) Do individuals with better mobility have higher incomes? (2) Does maintaining mobility over time allow individuals to keep working? (3) Is exercise associated with higher mobility over time?

Methods

We obtained longitudinal income and health data from the nationally representative Health and Retirement Study. Three cohorts were used. First, we studied the relationship between household income and mobility (on a 6-point index of walking impairment) in 19,430 adults who were assessed in 2016 (representing 93% of the 20,805-person total cohort). We measured the association of mobility and household income in a multivariate linear regression analysis of age, gender, health conditions, and education. We then identified a second group of 1094 individuals with unrestricted mobility in the year 2000 and compared differences in income and working rates between those who maintained mobility and those who lost mobility after 10 years. Finally, we identified a third group of 7063 individuals who were 60 to 80 years old in 2012, divided the group by how often they engaged in exercise, and observed differences in mobility after 4 years.

Results

After adjusting for covariates, a drop of one level of mobility was associated with a USD 3410 reduction in annual household income (95% CI USD 2890 to USD 3920; p < 0.001). After 10 years, individuals who maintained their mobility had incomes that were USD 6500 higher than that of individuals who were not working (95% CI USD 2300 to USD 10,300; p < 0.001) and were more likely to be working (40% versus 34.5%; p < 0.001). Exercising at least once per week was associated with better mobility 4 years later (mobility score 4.46 ± 0.08 versus 3.66 ± 0.08; p < 0.001).

Conclusion

Better mobility was associated with more than USD 3000 in annual income. Regular exercise and other interventions that improve mobility may have meaningful returns on investment.

Clinical Relevance

Because greater mobility is strongly associated with higher income, orthopaedic interventions may be undervalued.
The Impact of Prolonged Operative Time Associated with Minimally Invasive Colorectal Surgery: A Report from the Surgical Care Outcomes Assessment Program
Authors: Unruh Kenley R. , Bastawrous Amir L. , Kanneganti Shalini , Kaplan Jennifer A. , Moonka Ravi , Rashidi Laila , Sillah Arthur , Simianu Vlad V.
Published: October 2023

BACKGROUND:

Increased operative time in colorectal surgery is associated with worse surgical outcomes. Laparoscopic and robotic operations have improved outcomes, despite longer operative times. Further, the definition of “prolonged” operative time has not been consistently defined.

OBJECTIVE:

The first objective was to define prolonged operative time across multiple colorectal operations and surgical approaches. The second was to describe the impact of prolonged operative time on length of stay and short-term outcomes.

DESIGN:

Retrospective-cohort study.

SETTING:

Forty-two hospitals in the Surgical Care Outcomes Assessment Program from 2011-2019

PATIENTS:

There were a total of 23,098 adult patients (age 18 years and older), undergoing 6 common, elective colorectal operations: right colectomy, left/sigmoid colectomy, total colectomy, low anterior resection, ileal-pouch anal anastomosis, or abdominoperineal resection.

MAIN OUTCOME MEASURES:

Prolonged operative time defined as the 75th quartile of operative times for each operation and approach. Outcomes were length of stay, discharge home, and complications. Adjusted models were used to account for factors that could impact both operative time and outcomes across the strata of open and minimally invasive approaches.

RESULTS:

Prolonged operative time was associated with longer median length of stay (7 vs. 5 days open, 5 vs. 4 days laparoscopic, 4 vs. 3 days robotic), more frequent complications (42% vs. 28% open, 24% vs. 17% laparoscopic, 27% vs. 13% robotic), but similar discharge home (86% vs. 87% open, 94% vs. 94% laparoscopic, 93% vs. 96% robotic). After adjustment, each additional hour of operative time above the median for a given operation was associated with 1.08 (1.06, 1.09) relative risk of longer length of stay for open operations and 1.07 (1.06, 1.09) relative risk for minimally invasive operations.

LIMITATIONS:

Our study was limited by being retrospective, resulting in selection bias, possible confounders for prolonged operative time, and lack of statistical power for subgroup analyses.

CONCLUSIONS:

Operative time has consistent overlap across surgical approaches. Prolonged operative time is associated with longer length of stay and higher probability of complications, but this negative effect is diminished with minimally invasive approaches..
Surveillance and Management of Pouch Neoplasia in Familial Adenomatous Polyposis: A Systematic Review
Authors: Gilad Ophir , Tulchinsky Hagit , Kariv Revital
Published: October 2023

BACKGROUND:

Patients with familial adenomatous polyposis often require prophylactic colectomy with ileal pouch-anal anastomosis to treat and/or reduce to risk of colorectal neoplasia. However, after surgery, patients are still at some risk of developing pouch polyps and even cancer in both handsewn or stapled anastomoses. Management relies mainly on endoscopic or surgical interventions, while chemopreventive agents have a limited role in the management and prevention of pouch neoplasia. Novel endoscopic techniques are evolving and may gradually overtake surgical intervention in selected cases. Since familial adenomatous polyposis is relatively rare, there is scarcity of data regarding the natural history of pouch polyps and cancer in this population.

OBJECTIVE:

This systematic literature review aims to describe the evolution, characteristics, various treatment modalities and their outcomes as well as recommended surveillance strategies of pouch neoplasia.

DATA SOURCES:

PubMed and Cochrane databases, the international pouch consortium (for expert opinion).

STUDY SELECTION:

Studies between 1990 and 2023, in English were included. Studies reporting neoplastic outcomes of inflammatory bowel disease pouch patients only were excluded.

MAIN OUTCOME MEASURES:

Incidence of pouch neoplasia and its outcomes (successful resections, surgical complications, mortality).

RESULTS:

Thirty-five studies were included.

LIMITATIONS:

Most studies focus on inflammatory bowel diseases pouch patients, there is scarce data regarding polyposis patients only. Most cohorts are small and retrospective. Data on interventions is mainly descriptive and no randomized controlled trials are available.

CONCLUSIONS:

Pouch adenoma are common and well managed by endoscopic resections, as advanced-endoscopic techniques are becoming more available. Additional data are required for defining updated recommendations for either endoscopic or surgical intervention. Pouch cancer is a very rare event and may arise despite surveillance. Continued endoscopic surveillance is key in cancer prevention and early detection. Outcome of cancer cases is poor and management in a referral center should be advised with tumor board discussions.
Effects of Mindfulness-Based Interventions on Cardiometabolic-Related Adverse Pregnancy Outcomes
Authors: Root Andrea L. , Crossley Nicole P. , Heck Jennifer L. , McCage Shondra , Proulx Jeffrey , Jones Emily J.
Published: October 2023

Background

Growing evidence suggests maternal stress contributes to the development of adverse pregnancy outcomes that are associated with cardiovascular and cardiometabolic risk in birthing persons. Mindfulness-based interventions may positively affect psychological stress in pregnancy and, in turn, reduce stress. However, few study authors have examined the effects of mindfulness-based interventions on adverse pregnancy outcomes that heighten cardiovascular risk.

Objective

The aim of this study was to appraise available literature examining the effects of mindfulness-based interventions delivered during pregnancy on adverse pregnancy outcomes associated with future cardiovascular and cardiometabolic disease risk.

Methods

In this systematic review, multiple electronic databases were searched using major keywords, including “mindfulness-based intervention,” “pregnancy,” “preterm delivery,” “gestational diabetes,” “small for gestational age,” “preeclampsia,” and “hypertension in pregnancy” during February 2023.

Results

Six studies using mindfulness-based interventions during pregnancy were included. The review indicated that these interventions were largely effective at reducing prenatal stress; however, the overall effects of interventions were mixed concerning their impact on pregnancy complications. Study authors examining the effects on gestational diabetes–related outcomes reported significant improvements in blood glucose levels, hemoglobin A1c, and oral glucose tolerance. Outcomes were mixed or inconclusive related to the effects of interventions on the incidence of preterm birth, birth of a small-for-gestational-age newborn, and preeclampsia.

Conclusions

Mitigating cardiovascular and cardiometabolic risk-associated adverse pregnancy outcomes through mindfulness-based approaches may represent an emerging field of study. The few studies and limited, mixed findings synthesized in this review indicate that high-validity studies are warranted to examine the effects of mindfulness-based interventions on pregnancy complications that contribute to cardiovascular-related maternal morbidity and suboptimal life course health for diverse birthing persons.
Physician Assistant Gender Differences in Research, Professional Goals, and Perceptions of Support
Authors: Lolar Sara , Welch Robert D. , Garino Alexandria
Published: October 2023

Purpose

The majority of Physician assistant (PA) educators are women, yet men proportionately publish more and advance further in academic rank. This study examined if research interest, promotion goals, and perceptions of institutional support differed between PA educators with different gender identities.

Methods

This is a subset analysis of a previously published cross-sectional study. PA programs were stratified by region and Carnegie classification and were sampled by a stratified random sampling method. PA faculty from selected programs were invited to participate in an anonymous survey. Data were analyzed to account for the stratified sample design. Means and proportions with associated 95% confidence intervals are described.

Results

There was a 51% response rate (N = 110). Sixty-three percent of respondents identified as female and 36% as male. Men had a mean of 5.67 (0.17, 11.16) career research articles and women had 1.56 (0.68, 2.44) articles. Fifteen percent (3.7%, 26.3%) of men were full professor compared to 4.3% (0, 9.1%) of women. When transitioning to a faculty role, 72.5% (58.4%, 86.6%) of men and 52.9% (41%, 64.7%) of women felt supported by their institution. Both genders valued promotion, but 80% (67.6%, 92.4%) of men reported having clear 5-year goals compared to 58.8% (46.6%, 71%) of women (P = .034).

Conclusion

There was no statistical difference in publications between men and women in this study. Women felt less supported when transitioning to a faculty role compared to men. Both men and women valued promotion equally, but men reported working towards that goal more intentionally. This study found few consistent differences in the attitudes and behaviors towards scholarship between men and women.
Oral Health Care Strategies in Rural Communities: A Case Study
Authors: McCarthy Maren , Van Hook Maureen , Dereczyk Amy , Shaw-Gallagher Marlene
Published: October 2023

Dental caries affect 97% of the world’s population during their lifetime. Early childhood caries are the number one chronic disease affecting young children, and it disproportionately affects children of low-income families. American Academy of Pediatrics recommends fluoridated toothpaste to all children starting at tooth eruption, regardless of caries risk. In addition, fluoride varnish is recommended in all children every 3 to 6 months from tooth emergence until they have an established dental home. The health disparities that are most apparent in the rural communities are inadequate prenatal care, low birth weight, cancer, chronic respiratory disease, heart disease, unintentional injury, and stroke. When it comes to oral health, water fluoridation is one of the most cost-effective strategies in preventing dental caries. The need for oral health education in physician assistant/associate (PA) programs is well documented. Implementation has largely been performed using interprofessional education. This article describes an interprofessional education program that teaches PA students to apply fluoride varnish so that they are practice-ready when they graduate and practice medicine.
Esophageal Carcinoma in Children: Report of 2 Cases and a Review of the Literature
Authors: Coşkun Çağri , Kurucu Nilgun , Kutluk Tezer , Oguz Berna , Orhan Diclehan , Cengiz Mustafa , Ekinci Saniye
Published: October 2023

Esophageal carcinoma in children and adolescents is extremely rare. Here, we report 2 cases of pediatric esophageal carcinoma presenting with progressive dysphagia. There was not any underlying specific risk factor in our cases. The histopathological subtypes were adenocarcinoma in one and squamous cell carcinoma in another case. Response to combined modality treatment was good in the case of adenocarcinoma, while the patient with squamous cell carcinoma was unresponsive to treatment and died of the progressive disease. We reviewed the pediatric cases of esophageal carcinoma reported in the literature. Progressive dysphagia was observed in 89% of these cases. One third of pediatric cases had underlying risk factors. Squamous cell carcinoma is a more common type of childhood esophageal carcinoma. In contrast to adults, pediatric esophageal squamous cell carcinoma may distribute throughout the esophagus. Esophageal adenocarcinoma was seen in the distal esophagus in pediatric cases. Metastatic disease was found in 48% of pediatric patients at presentation, and the prognosis is poor. Collaborative efforts are needed for success in the treatment of esophageal carcinoma.
Psychosocial Issues in Sickle Cell Disease: A Review
Authors: Essien Emmanuel Aniekan , Winter-Eteng Blessing F. , Onukogu Chinyere Uchechi , Nkangha Dominic Dennis , Daniel Faithful
Published: October 2023

    

Abstract 

Sickle cell anaemia (SCA) is a severe sickle cell disease primarily affecting black populations and individuals in tropical countries. This condition causes significant morbidity and mortality and leads to various psychosocial challenges. Using a narrative review approach, this paper analysed 80 peer-reviewed articles published between 1989 and 2023 to understand these challenges comprehensively. Mental disorders, sleep disturbances, interpersonal relationship challenges, stigmatisation, and workplace discrimination significantly contributed to the psychosocial distress experienced by individuals with SCA and their families. Depression and anxiety were prevalent among individuals with SCA, leading to poor treatment adherence, increased pain, and disruptions in various aspects of life. Sleep disturbances, including sleep-disordered breathing and sleepwalking, were also significant contributors to poor sleep quality in SCA patients. Families of individuals with SCA also face challenges, including psychological stress, financial strain, and social disruption. Stigmatisation is common, leading to misconceptions and discrimination. Workplace discrimination is prevalent, with a high unemployment rate among adult SCA patients. Comprehensive care is crucial to address these psychosocial issues. Early identification and intervention, comprehensive support programs, patient and family education, enhanced pain management strategies, and integration of mental health into clinical care are recommended. School-based support, research and advocacy, and community support groups are also necessary. By addressing these challenges through comprehensive care and support, healthcare professionals, policymakers, and society can reduce psychosocial distress and improve the lives of individuals with Sickle cell anaemia.
MiR-155 promotes acute organ injury in LPS-induced endotoxemic mice by enhancing CCL-2 expression in macrophages
Authors: Wang Chun , Zheng Yuxuan , Fan Qingting , Li Zilüe , Qi Xin , Chen Fanyan , Xu Lei , Zhou Sha , Chen Xiaojun , Li Yalin , Zhu Jifeng , Su Chuan
Published: October 2023

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Macrophages play important roles in the inflammatory process of sepsis by secreting chemokines. Chemokine (CC-motif) ligand 2 (CCL-2) is one of the main pro-inflammatory chemokines secreted by macrophages that plays a critical role in the recruitment of more monocytes and macrophages to the sites of injury in sepsis, but the mechanisms that regulate CCL-2 expression in macrophages during sepsis are still unknown. In the present study, by using the lipopolysaccharide (LPS)-induced endotoxemia model, we found that LPS induced the expression of microRNA (miR)-155 and CCL-2 in endotoxemic mice and RAW264.7 cells. MiR-155 mimics or miR-155 inhibitor treatment experiment suggested that miR-155 was sufficient to increase LPS-induced CCL-2 expression in macrophages, but miR-155 was not the only factor promoting CCL-2 expression. We further demonstrated that miR-155-induced increase of CCL-2 promoted chemotaxis of additional macrophages, which subsequently enhanced lung injury in endotoxemic mice. Serum/glucocorticoid regulated kinase family member 3 (SGK3), a potential target of miR-155, was identified by RNA sequencing and predicted by TargetScan and miRDB. We further confirmed miR-155 regulated SGK3 to increase LPS-induced CCL-2 by using miR-155 mimics and SGK3 overexpression. Thus, our study demonstrates that miR-155 targets SGK3 to increase LPS-induced CCL-2 expression in macrophages, which promotes macrophage chemotaxis and enhances organs injury during endotoxemia. Our study contributed to a better understanding of the mechanisms underlying the inflammatory response during sepsis.