bluuebunny/crossref_metadata_2025 huggingface dataset:
Performance comparison of the solar-driven supercritical organic Rankine cycle coupled with the vapour-compression refrigeration cycle
Authors: Khan Yunis , Mishra Radhey Shyam
Published: September 2021

In this study, a parametric analysis was performed of a supercritical organic Rankine cycle driven by solar parabolic trough collectors (PTCs) coupled with a vapour-compression refrigeration cycle simultaneously for cooling and power production. Thermal efficiency, exergy efficiency, exergy destruction and the coefficient of performance of the cogeneration system were considered to be performance parameters. A computer program was developed in engineering equation-solver software for analysis. Influences of the PTC design parameters (solar irradiation, solar-beam incidence angle and velocity of the heat-transfer fluid in the absorber tube), turbine inlet pressure, condenser and evaporator temperature on system performance were discussed. Furthermore, the performance of the cogeneration system was also compared with and without PTCs. It was concluded that it was necessary to design the PTCs carefully in order to achieve better cogeneration performance. The highest values of exergy efficiency, thermal efficiency and exergy destruction of the cogeneration system were 92.9%, 51.13% and 1437 kW, respectively, at 0.95 kW/m2 of solar irradiation based on working fluid R227ea, but the highest coefficient of performance was found to be 2.278 on the basis of working fluid R134a. It was also obtained from the results that PTCs accounted for 76.32% of the total exergy destruction of the overall system and the cogeneration system performed well without considering solar performance.
Zero-emission public transit could be a catalyst for decarbonization of the transportation and power sectors
Authors: Ku Anthony Y , de Souza Andrew , McRobie Jordan , Li Jimmy X , Levin Jaimie
Published: September 2021

Reaching carbon neutrality will require investment on an unprecedented scale. Here we suggest that there is an underappreciated opportunity to leverage public funds to mobilize private capital in support of these aims. We illustrate the point using examples from public transit. Although the fuelling energy requirements of public fleets represent a small fraction of the eventual total demand across the transportation sector, the predictable and long-term nature of the refuelling profiles can reduce the financing risk. With appropriate coordination across the energy supply chain, near-term investments can be used to support scale-up of wider efforts to decarbonize the transportation sector and electric grid. We present two examples from California—one related to overnight power for battery electric bus charging and the other related to medium-scale supply chains for zero-carbon hydrogen production—to illustrate how this might be achieved.
Economic Contributions from Conserved Forests: Four Case Studies of the USDA Forest Service Forest Legacy Program
Authors: Murray Helena , Catanzaro Paul , Markowski-Lindsay Marla , Butler Brett J , Eichman Henry
Published: September 2021

Privately-owned forests provide important environmental, economic, and cultural benefits to the general public. Resulting impacts from landownership changes and conversion of working forests to other land uses threaten these benefits. The USDA Forest Service Forest Legacy Program (FLP) permanently protects threatened private forests that are of environmental, cultural, and economic importance to the greater public while keeping land ownership and forest management at the private or local level. FLP provides grants to state agencies to purchase conservation easements on private forestlands or, less frequently, acquisition by public agencies. We employed IMPLAN’s input-output model of the 2016 economy to estimate how land protected by FLP in four regions of the United States contributes to the economy. FLP land adds tens of millions of dollars of value annually and supports thousands of jobs in the four study areas and, due to the permanent protection of these lands, they will continue to do so in perpetuity. Nonfederal partners contributed 34%–60% of total project costs, highlighting the importance of land conservation to multiple stakeholders and the ability to leverage federal resources. The permanent nature of FLP protection provides long-term security for the economic and cultural benefits these lands provide.
Childhood Socioeconomic Status and Cardiometabolic Health: A Test of the John Henryism Hypothesis in African American Older Adults
Authors: Zilioli Samuele , Gómez Jennifer M , Jiang Yanping , Rodriguez-Stanley Jacqueline
Published: September 2021

Background

John Henryism (JH) is a form of active high-effort coping. Low-socioeconomic status (SES) African Americans adopting JH to deal with structural racism and other chronic stressors might be more likely to display cardiovascular disease risk factors. Previous tests of this hypothesis have mostly focused on the moderating role of current SES and hypertension as the outcome variable. Furthermore, most of the previous work has been conducted among young and middle-aged adults. This study aimed at extending work on the JH hypothesis by testing the combined effect of JH and childhood SES on metabolic syndrome and systemic inflammation among African American older adults.

Methods

One hundred seventy urban African American older adults (Mage = 67.64 years, 75.9% female) were recruited. Participants completed questionnaires assessing JH, childhood SES, and other variables used as covariates (ie, demographic information, chronic conditions, medication use, and health behaviors). Blood pressure, waist circumference, and blood were also collected. Triglycerides, high-density lipoprotein cholesterol, hemoglobin A1C, and C-reactive protein levels were measured from the blood samples.

Results

JH was positively associated with metabolic syndrome symptoms among participants reporting low childhood SES levels, but not among those reporting high childhood SES levels. The same pattern did not emerge when we considered current SES. Similar patterns of results did not emerge as far as systemic inflammation was concerned.

Conclusions

Our findings highlight the importance of considering the joint impact of objective conditions early in life and individual psychological proclivities in explaining increased risk for cardiovascular disease risk in this population.
Simulating rhizodeposition patterns around growing and exuding root systems
Authors: Landl Magdalena , Haupenthal Adrian , Leitner Daniel , Kroener Eva , Vetterlein Doris , Bol Roland , Vereecken Harry , Vanderborght Jan , Schnepf Andrea
Published: September 2021

In this study, we developed a novel model approach to compute the spatio-temporal distribution patterns of rhizodeposits around growing root systems in three dimensions. This model approach allows us to study the evolution of rhizodeposition patterns around complex three-dimensional root systems. Root systems were generated using the root architecture model CPlantBox. The concentration of rhizodeposits at a given location in the soil domain was computed analytically. To simulate the spread of rhizodeposits in the soil, we considered rhizodeposit release from the roots, rhizodeposit diffusion into the soil, rhizodeposit sorption to soil particles and rhizodeposit degradation by microorganisms. To demonstrate the capabilities of our new model approach, we performed simulations for the two example rhizodeposits mucilage and citrate and the example root system Vicia faba. The rhizodeposition model was parameterized using values from the literature. Our simulations showed that the rhizosphere soil volume with rhizodeposit concentrations above a defined threshold value (i.e. the rhizodeposit hotspot volume) exhibited a maximum at intermediate root growth rates. Root branching allowed the rhizospheres of individual roots to overlap, resulting in a greater volume of rhizodeposit hotspots. This was particularly important in the case of citrate, where overlap of rhizodeposition zones accounted for more than half of the total rhizodeposit hotspot volumes. Coupling a root architecture model with a rhizodeposition model allowed us to get a better understanding of the influence of root architecture as well as rhizodeposit properties on the evolution of the spatio-temporal distribution patterns of rhizodeposits around growing root systems.
A Decision Tree Analysis on the Impact of a Technology-Based Program on Symptom Distress
Authors: Im Eun-Ok , Yi Jee-Seon , Chee Wonshik
Published: September 2021

Using a decision tree analysis, this study aimed to identify the characteristics of the groups within Asian American breast cancer survivors whose symptom distress scores were effectively improved by a technology-based program. This was a secondary analysis of the data from an ongoing randomized controlled trial among 115 Asian American breast cancer survivors. The instruments were questions on background factors; the Memorial Symptom Assessment Scale-Short Form; the Cancer Behavior Inventory; the Questions on Attitudes, Subjective Norm, Perceived Behavioral Control, and Behavioral Intention; and the Supportive Care Needs Survey-Short Form 34. The data were analyzed using chi-square tests, t tests, repeated measurement analyses, and decision tree analyses. The decrease in the global distress index scores was the largest (1.253 points) among those with high psychological support needs. The decrease in the physical symptom distress scale scores was the largest (1.133 points) among those with high physical and daily living support needs who had a short US residence period and who were young. The decrease in the psychological symptom distress scores was the largest (1.511) among those with high psychological support needs. The findings suggest several characteristics of the groups within Asian American breast cancer survivors whose symptom distress could be highly improved by a technology-based intervention.
Web-Based Training and Telephone Follow-up of Patients With Heart Failure
Authors: İlaslan Emine , Özer Zeynep
Published: September 2021

This study was carried out to determine the effect of Web-based training and telephone follow-up on symptom burden and health status in patients with heart failure. Patient training and postdischarge follow-up are necessary to improve symptom management and quality of life in patients with heart failure. In Turkey, Web-based education and phone monitoring are not very common yet. In this parallel randomized controlled trial, patients were allocated to a control group (n = 32) or an intervention group (n = 32). The control group received routine care, and the intervention group was administered the following interventions in addition to routine care: Web-based training, four-session telephone follow-up, and one text message weekly. All results regarding symptom management and quality of life were assessed beginning and at the 12th week. The Consolidated Standards of Reporting Trials checklist was used. In the 12th week after discharge, patients in the intervention group showed a significant improvement in terms of symptom burden and health status compared with the control group.
The potential of using artificial intelligence to improve skin cancer diagnoses in Hawai‘i’s multiethnic population
Authors: Willingham Mark Lee , Spencer Shane Y.P.K. , Lum Christopher A. , Navarro Sanchez Janira M. , Burnett Terrilea , Shepherd John , Cassel Kevin
Published: September 2021

Skin cancer remains the most commonly diagnosed cancer in the USA with more than 1 million new cases each year. Melanomas account for about 1% of all skin cancers and most skin cancer deaths. Multiethnic individuals whose skin is pigmented underestimate their risk for skin cancers and melanomas and may delay seeking a diagnosis. The use of artificial intelligence may help improve the diagnostic precision of dermatologists/physicians to identify malignant lesions. To validate our artificial intelligence’s efficiency in distinguishing between images, we utilized 50 images obtained from our International Skin Imaging Collaboration dataset (n = 25) and pathologically confirmed lesions (n = 25). We compared the ability of our artificial intelligence to visually diagnose these 50 skin cancer lesions with a panel of three dermatologists. The artificial intelligence model better differentiated between melanoma vs. nonmelanoma with an area under the curve of 0.948. The three-panel member dermatologists correctly diagnosed a similar number of images (n = 35) as the artificial intelligence program (n = 34). Fleiss’ kappa (ĸ) score for the raters and artificial intelligence indicated fair (0.247) agreement. However, the combined result of the dermatologists panel with the artificial intelligence assessments correctly identified 100% of the images from the test data set. Our artificial intelligence platform was able to utilize visual images to discriminate melanoma from nonmelanoma, using de-identified images. The combined results of the artificial intelligence with those of the dermatologists support the use of artificial intelligence as an efficient lesion assessment strategy to reduce time and expense in diagnoses to reduce delays in treatment.
Ultra-high-frequency ultrasound monitoring of melanomas arising in congenital melanocytic nevi: a case series
Authors: Janowska Agata , Oranges Teresa , Iannone Michela , Davini Giula , Suraci Simona , Fidanzi Cristian , Granieri Giammarco , Romanelli Marco , Dini Valentina
Published: September 2021

The aims of our study were to evaluate with ultra-high-frequency ultrasound (UHFUS) the ultrasound features of congenital melanocytic nevi (CMNs) and malignant melanomas (MMs) arising in CMNs and the correlation between ultrasonographic thickness and histological thickness in MMs. We evaluated 10 patients with small-medium CMNs and 10 patients with MMs arising in small-medium CMNs. We collected patient’s data, clinical and dermoscopic features. The UHFUS was performed using a 70 MHz frequency probe to study the ecostructure, shape and vascularization. Breslow thickness was compared with ultrasonographic thickness. In the MMs group the following dermoscopic features were described: hyperpigmentation (n = 9), regression area (n = 6), whitish-blue veil (n = 5), thickened network (n = 5), irregular globules (n = 3), inverse network (n = 2) and striae (n = 1). Hyperpigmentation (n = n = 9), thickened network (n = 7), irregular globules (n = 5), regression area (n = 5), striae (n = 1) and whitish-blue veil (n = 1) were found in the CMNs group. The multicomponent pattern was present in both MMs (n = 4) and in CMNs (n = 5). Moreover, the parameters indicative of suspected malignancy were variously combined in the two groups, without showing significant differences in the statistical analysis; with the exception of the blue veil that correlated with the diagnosis of MM. Ultrasonoghaphic vascularization was an ever-present parameter in MMs (100%), with high intensity of intratumoral signal, as opposed to CMNs. We also found a statistically significant correlation between ultrasound thickness and Breslow thickness. In the future, this technique could implement the diagnostic preoperative phase of MMs arising in CMNs in combination with standard clinical-dermatoscopic evaluation.
Geographical Variations of the Minimum Mortality Temperature at a Global Scale
Authors: Tobías Aurelio , Hashizume Masahiro , Honda Yasushi , Sera Francesco , Ng Chris Fook Sheng , Kim Yoonhee , Roye Dominic , Chung Yeonseung , Dang Tran Ngoc , Kim Ho , Lee Whanhee , Íñiguez Carmen , Vicedo-Cabrera Ana , Abrutzky Rosana , Guo Yuming , Tong Shilu , Coelho Micheline de Sousa Zanotti Stagliorio , Saldiva Paulo Hilario Nascimento , Lavigne Eric , Correa Patricia Matus , Ortega Nicolás Valdés , Kan Haidong , Osorio Samuel , Kyselý Jan , Urban Aleš , Orru Hans , Indermitte Ene , Jaakkola Jouni J. K. , Ryti Niilo R. I. , Pascal Mathilde , Huber Veronika , Schneider Alexandra , Katsouyanni Klea , Analitis Antonis , Entezari Alireza , Mayvaneh Fatemeh , Goodman Patrick , Zeka Ariana , Michelozzi Paola , de’Donato Francesca , Alahmad Barrak , Diaz Magali Hurtado , De la Cruz Valencia César , Overcenco Ala , Houthuijs Danny , Ameling Caroline , Rao Shilpa , Di Ruscio Francesco , Carrasco Gabriel , Seposo Xerxes , Nunes Baltazar , Madureira Joana , Holobaca Iulian-Horia , Scovronick Noah , Acquaotta Fiorella , Forsberg Bertil , Åström Christofer , Ragettli Martina S. , Guo Yue-Liang Leon , Chen Bing-Yu , Li Shanshan , Colistro Valentina , Zanobetti Antonella , Schwartz Joel , Dung Do Van , Armstrong Ben , Gasparrini Antonio
Published: September 2021

Background:

Minimum mortality temperature (MMT) is an important indicator to assess the temperature-mortality association, indicating long-term adaptation to local climate. Limited evidence about the geographical variability of the MMT is available at a global scale.

Methods:

We collected data from 658 communities in 43 countries under different climates. We estimated temperature-mortality associations to derive the MMT for each community using Poisson regression with distributed lag nonlinear models. We investigated the variation in MMT by climatic zone using a mixed-effects meta-analysis and explored the association with climatic and socioeconomic indicators.

Results:

The geographical distribution of MMTs varied considerably by country between 14.2 and 31.1 °C decreasing by latitude. For climatic zones, the MMTs increased from alpine (13.0 °C) to continental (19.3 °C), temperate (21.7 °C), arid (24.5 °C), and tropical (26.5 °C). The MMT percentiles (MMTPs) corresponding to the MMTs decreased from temperate (79.5th) to continental (75.4th), arid (68.0th), tropical (58.5th), and alpine (41.4th). The MMTs indreased by 0.8 °C for a 1 °C rise in a community’s annual mean temperature, and by 1 °C for a 1 °C rise in its SD. While the MMTP decreased by 0.3 centile points for a 1 °C rise in a community’s annual mean temperature and by 1.3 for a 1 °C rise in its SD.

Conclusions:

The geographical distribution of the MMTs and MMTPs is driven mainly by the mean annual temperature, which seems to be a valuable indicator of overall adaptation across populations. Our results suggest that populations have adapted to the average temperature, although there is still more room for adaptation.
Environmental risk factors for reduced kidney function due to undetermined cause in India
Authors: Hamilton Sophie A. , Jarhyan Prashant , Fecht Daniela , Venkateshmurthy Nikhil Srinivasapura , Pearce Neil , Venkat Narayan Kabayam M. , Ali Mohammed K. , Mohan Viswanathan , Tandon Nikhil , Prabhakaran Dorairaj , Mohan Sailesh
Published: September 2021

Background:

An epidemic of chronic kidney disease is occurring in rural communities in low-income and middle-income countries that do not share common kidney disease risk factors such as diabetes and hypertension. This chronic kidney disease of unknown etiology occurs primarily in agricultural communities in Central America and South Asia. Consequently, environmental risk factors including heat stress, heavy metals exposure, and low altitude have been hypothesized as risk factors. We conducted an environmental epidemiological analysis investigating these exposures in India which reports the disease.

Methods:

We used a random sample population in rural and urban sites in Northern and Southern India in 2010, 2011, and 2014 (n = 11,119). We investigated associations of the heat index, altitude, and vicinity to cropland with estimated glomerular filtration rate (eGFR) using satellite-derived data assigned to residential coordinates. We modeled these exposures with eGFR using logistic regression to estimate the risk of low eGFR, and linear mixed models (LMMs) to analyze site-specific eGFR-environment associations.

Results:

Being over 55 years of age, male, and living in proximity to cropland was associated with increased risk of low eGFR [odds ratio (OR) (95% confidence interval (CI) = 2.24 (1.43, 3.56), 2.32 (1.39, 3.88), and 1.47 (1.16, 2.36)], respectively. In LMMs, vicinity to cropland was associated with low eGFR [−0.80 (−0.44, −0.14)]. No associations were observed with temperature or altitude.

Conclusions:

Older age, being male, and living in proximity to cropland were negatively associated with eGFR. These analyses are important in identifying subcommunities at higher risk and can help direct future environmental investigations.
miR-24 Alleviates MI/RI by Blocking the S100A8/TLR4/MyD88/NF-kB Pathway
Authors: Yang Jian , Xiang Zujin , Zhang Jing , Yang Jun , Zhai Yuhong , Fan Zhixing , Wang Huibo , Wu Jingyi , Huang Yifan , Xiong Mengting , Ma Cong
Published: September 2021

Although inflammation plays an important role in myocardial ischemia/reperfusion injury (MI/RI), an anti-inflammatory treatment with a single target has little clinical efficacy because of the multifactorial disorders involved in MI/RI. MicroRNAs (miR-24) can achieve multitarget regulation in several diseases, suggesting that this factor may have ideal effects on alleviation of MI/RI. In the present study, bioinformatics method was used to screen potential therapeutic targets of miR-24 associated with MI/RI. Three days before ischemia/reperfusion surgery, rats in the ischemia/reperfusion, miR-24, and adenovirus-negative control groups were injected with saline, miR-24, and adenovirus-negative control (0.1 mL of 5 × 109 PFU/mL), respectively. Myocardial enzymes, myocardial infarct size, cardiac function, and the possible molecular mechanism were subsequently analyzed. In contrast to the level of S100A8, the level of miR-24 in myocardial tissue was significantly reduced after 30 minutes of ischemia followed by reperfusion for 2 hours. Overexpression of miR-24 reduced the myocardial infarction area and improved the heart function of rats 3 days after MI/RI. Moreover, miR-24 inhibited infiltration of inflammatory cells in the peri-infarction area and decreased creatine kinase myocardial band and lactate dehydrogenase release. Interestingly, miR-24 upregulation reduced S100A8 expression, followed by inhibition of toll-like receptor 4/MyD-88/nuclear factor-k-gene binding signaling activation. In conclusion, miR-24 can alleviate MI/RI via inactivation of the S100A8/toll-like receptor 4/MyD-88/nuclear factor-k-gene binding signaling pathway.
Backward Estimation of Atmospheric Release of 137Cs and 131I Using Total Cumulative Deposition in Terrestrial Areas Following the Fukushima Daiichi Nuclear Power Plant Accident
Authors: Iijima Masashi , Takahara Shogo
Published: September 2021

The Fukushima Daiichi Nuclear Power Plant (FDNPP) accident caused a significant release of radionuclides into the environment. It is important to explore the timing and amount of radioactive release to terrestrial areas in order to clarify the consequences of the accident, including the dose received by the population living in the areas affected by the accident. In general, backward estimations are performed using air concentrations of radionuclides, but they are difficult to measure when radioactive plumes are passing through, and only spatially and temporally limited measurements are available. Therefore, a new method of backward estimation was developed based on the total cumulative deposition density, which can provide sufficient data in the environment by combining the atmospheric transport, dispersion, and deposition model calculations. Consequently, our estimations show that a major release of 137Cs and 131I occurred on 15, 20, 21, 22, 25, and 30 March 2011, after the accident. The amounts of release estimated by our new method for 137Cs and 131I were 4.9 × 1015 Bq and 120 × 1015 Bq, respectively. These results have no significant contradiction with the estimated results by the previous studies that were based on air concentrations and air dose rates that were measured in terrestrial areas. It was found that our new method is applicable for backward estimation oriented to the dose assessment for the people living in terrestrial areas.
Prognostic Impact of Prediabetes on Patient Outcomes After Coronary Artery Bypass Grafting: A Single-center Cohort Study
Authors: Fallahzadeh Aida , Sheikhy Ali , Hosseini Kaveh , Sadeghian Saeed , Vasheghani Farahani Ali , Salehi Omran Abbas , Pashang Mina , Masoudkabir Farzad , Shirzad Mahmoud , Bagheri Jamshid , Tavolinejad Hamed , Tajdini Masih
Published: September 2021

Background:

Prediabetes, as a precursor stage, has an important role in development of overt diabetes as well as coronary artery disease (CAD). The aim of this study is to evaluate the association between prediabetes and adverse outcomes (major adverse cardiovascular and cerebrovascular events [MACCE] and all-cause mortality) in patients who underwent coronary artery bypass grafting (CABG).

Methods:

In this prospective study, we included 3754 patients with CAD who underwent elective isolated CABG between January 2016 to January 2020. Patients were categorized based on their glycemic status at the time of CABG as follows: diabetics (n = 2707), prediabetics (n = 471), and nondiabetics (n = 576). Primary endpoints were occurrence of all-cause mortality and MACCE.

Results:

We studied 3754 patients for a median of 32.25 months after CABG. MACCE occurred in 474 (12.6%) patients. After adjusting for potential confounders, diabetic patients had a higher risk of MACCE (hazard ratio [HR] 1.69; 95% confidence intervals [CI], 1.24-2.29) and death (HR 2.33, 95% CI, 1.45-3.7) compared with nondiabetic and prediabetic ones. However, patients with prediabetes had lower HR of MACCE, but the association was nonsignificant (HR 1.02; 95% CI, 0.67-1.56).

Conclusions:

Diabetes is significantly associated with higher risk of mortality and MACCE; however, prediabetes did not show a prognostic impact in terms of overall and MACCE-free survival.
Research Letter: Concussion Knowledge Is Difficult to Predict From Self-Reported Exposure, Sports Participation, and Education
Authors: Kinmond Sally , Sullivan Karen A. , Jaganathan Kannan Singaravelu
Published: September 2021

Objectives:

Increasing concussion knowledge could contribute to improving injury outcomes. Understanding the predictors of concussion knowledge could determine the areas of educational need. This study examined whether individual factors, prior brain injury, prior concussion education, and contact-sports participation predicted concussion knowledge.

Design and Setting:

Cross-sectional study with recruitment of community volunteers.

Participants:

An online survey was completed by 525 adults, 443 of whom provided useable responses.

Main Measures:

The respondents provided background information and completed the Concussion Knowledge Index from the Rosenbaum Concussion Knowledge and Attitudes Survey (RoCKAS).

Results:

On average, the participants answered 19.8 out of 25 items correctly. A multiple regression model with demographic, injury, and sport-related variables did not significantly predict concussion knowledge.

Conclusion:

This community sample had higher than expected concussion knowledge (restricted range), but some important misconceptions were still present. The model reflecting a combination of self-reported factors did not predict concussion knowledge. The implications for concussion education are discussed, including the need for targeted education to address specific misconceptions.
Effect of Repeated Topical Povidone-Iodine and Antibiotic Applications on Meibomian Glands and Ocular Surface Parameters in Patients With Repeated Intravitreal Injections
Authors: Polat Osman A. , Çetinkaya Zekeriya , Evereklioğlu Cem , Karaca Çağatay , Erkiliç Kuddusi
Published: September 2021

Objectives:

To assess whether meibomian glands and ocular surface parameters are affected by repeated topical povidone-iodine and antibiotic applications in patients with repeated intravitreal injections.

Methods:

Forty-five patients with at least three previous intravitreal injections and 28 healthy controls were included in the study. In the injection group, 21 patients had age-related macular degeneration and 24 patients had diabetic macular edema. For each participant, infrared meibography for the upper and lower eyelids and noninvasive tear break-up time calculation were performed with a corneal topographer. Fluorescein tear break-up time and ocular surface disease index (OSDI) scores were also obtained. Noninvasive tear break-up time, fluorescein tear break-up time, and OSDI scores were recorded for each participant and compared between the injection and control groups. These parameters were also compared as a subgroup analysis between patients with age-related macular degeneration (AMD) and diabetic macular edema (DME).

Results:

Upper lid meibomian gland loss, lower lid meibomian gland loss ratios, and OSDI scores were significantly higher in the intravitreal injection group compared with the control group (P=0.004, P<0.001, P<0.001, respectively). Fluorescein tear break-up time and noninvasive tear break-up time were significantly lower in the intravitreal injection group compared with the control group (P<0.001, P<0.001). There was no significant difference between the AMD and DME groups for these parameters.

Conclusion:

This study showed for the first time that meibomian gland losses were significantly increased by repeated povidone-iodine and antibiotic applications in patients with repeated intravitreal injections. Ocular surface parameters were altered with higher ocular surface symptoms in those patients.
Troponin Elevation Following Percutaneous Coronary Intervention in Acute Coronary Syndrome
Authors: Miner Daniel G. , Parcetich Kevin , Smith Kellen
Published: September 2021

Background:

Recent advances in revascularization procedures have improved survival rates for individuals with acute coronary syndrome (ACS). However, evidence to guide clinical decision-making for early mobility following percutaneous coronary intervention (PCI) is extremely limited.

Purpose:

The purpose of this clinical perspective and literature review is to provide context for the clinical interpretation of cardiac troponin (cTn) levels in individuals with ACS following revascularization via PCI and present an evidence-supported clinical decision-making algorithm to guide clinicians in the appropriate timing of initiation of early mobility for individuals with ACS.

Methods:

A literature review on cTn values is presented to guide the clinical interpretation of laboratory values for clinical decision-making. A comparison of consensus-based guidelines for early mobility is presented as the basis for proposing a novel algorithm for clinical decision-making in individuals with ACS following PCI.

Conclusion:

The clinical value and utility of postprocedural cTn levels in individuals with ACS following PCI is to help understand prognosis and mortality but does not provide sufficient information about the safety of initiating early mobility following PCI. Decisions for initiation of early mobility in this population using the proposed evidence-supported algorithm may help avoid unnecessary prolongation of bed rest.
What Does It Mean to Be Breastfed? A Concept Analysis in the Context of Healthcare Research, Clinical Practice, and the Parent Perspective
Authors: Elgersma Kristin M. , Sommerness Samantha A.
Published: September 2021

Over the past 3 decades, there have been attempts to define breastfeeding for scientific research. However, a lack of clarity remains, with concurrent ambiguity in clinical practice and insufficient inclusion of the parent perspective. Furthermore, previous concept analyses of “breastfeeding” may not fully represent what it means for an infant to be breastfed. Therefore, this concept analysis sought to define “breastfed” in the context of Western healthcare research, clinical practice, and the parent perspective. Informed by Rodgers' evolutionary method, a literature search resulted in 16 representative articles, with related terms, attributes, antecedents, and consequences identified. Analysis of the literature resulted in a theoretical definition of breastfed as a valuable process, experience, or characteristic that involves human milk consumption by an infant through a variety of delivery methods. To be breastfed relies on the existence of lactation, whether from a parent or another source, and depends upon the intentional decision of a birthing person, caregiver, or provider. It is recommended that healthcare providers and institutions adopt this inclusive definition, committing to a linguistic and conceptual distinction between a breastfed infant and direct breastfeeding. Increased clarity may improve comparability between studies, reporting to government agencies, provider communication, and supportive, family-centered care.
Ambient temperature and infarct size, microvascular obstruction, left ventricular function and clinical outcomes after ST-segment elevation myocardial infarction
Authors: Redfors Björn , Simonato Matheus , Chen Shmuel , Vincent Flavien , Zhang Zixuan , Thiele Holger , Eitel Ingo , Patel Manesh R. , Ohman E. Magnus , Maehara Akiko , Ben-Yehuda Ori , Stone Gregg W.
Published: September 2021

Objectives

Incidence and prognosis of ST-segment elevation myocardial infarction (STEMI) vary according to ambient temperature and season. We sought to assess whether season and temperature on the day of STEMI are associated with infarct size, microvascular obstruction (MVO), left ventricular ejection fraction (LVEF) and clinical outcomes after primary percutaneous coronary intervention (PCI).

Methods

Individual patient data from 1598 patients undergoing primary PCI in six randomized clinical trials were pooled. Infarct size was evaluated by cardiac magnetic resonance within 30 days in all trials. Patients were categorized either by whether they presented on a day of temperature extremes (minimum temperature <0 °C or maximum temperature >25 °C) or according to season.

Results

A total of 558/1598 (34.9%) patients presented with STEMI on a day of temperature extremes, and 395 (24.7%), 374 (23.4%), 481 (30.1%) and 348 (21.8%) presented in the spring, summer, fall and winter. After multivariable adjustment, temperature extremes were independently associated with larger infarct size (adjusted difference 2.8%; 95% CI, 1.3–4.3; P < 0.001) and smaller LVEF (adjusted difference −2.3%; 95% CI, −3.5 to −1.1; P = 0.0002) but not with MVO (adjusted P = 0.12). In contrast, infarct size, MVO and LVEF were unrelated to season (adjusted P = 0.67; P = 0.36 and P = 0.95, respectively). Neither temperature extremes nor season were independently associated with 1-year risk of death or heart failure hospitalization (adjusted P = 0.79 and P = 0.90, respectively).

Conclusion

STEMI presentation during temperature extremes was independently associated with larger infarct size and lower LVEF but not with MVO after primary PCI, whereas season was unrelated to infarct severity.
Site-based performance of 131I-MIBG imaging and 99mTc-HYNIC-TOC scintigraphy in the detection of nonmetastatic extra-adrenal paraganglioma
Authors: Hou Guozhu , Jiang Yuanyuan , Li Fang , Zhu Zhaohui , Jing Hongli
Published: September 2021

Objectives

This study aimed to evaluate the performance of 131I-metaiodobenzylguanidine (MIBG) imaging to detect nonmetastatic extra-adrenal paragangliomas at their respective sites (abdominal vs. thoracic vs. head and neck vs. urinary bladder), and compare it with that of 99mTc-hydrazinonicotinyl-tyr3-octreotide (HYNIC-TOC) scintigraphy.

Methods

We retrospectively analyzed 235 patients with nonmetastatic extra-adrenal paragangliomas who underwent preoperative 131I-MIBG imaging or 99mTc-HYNIC-TOC scintigraphy. Of all 235 patients, 145 patients underwent both imaging procedures, 16 patients 131I-MIBG imaging only and 74 patients 99mTc-HYNIC-TOC scintigraphy only.

Results

The overall sensitivity of 131I-MIBG and 99mTc-HYNIC-TOC imaging to detect extra-adrenal paragangliomas regardless of tumor sites was 75.8% (122/161) and 67.6% (148/219), respectively (P = 0.082). However, when stratified by tumor sites, 131I-MIBG imaging showed a significant improvement in the detection of extra-adrenal abdominal paragangliomas with a sensitivity of 90.3% (103/114), which was significantly higher than that of 99mTc-HYNIC-TOC scintigraphy (67.6% (96/142); P = 0.000). In addition, the intensity of tracer uptake in the extra-adrenal abdominal paragangliomas with 131I-MIBG imaging was evidently higher than with 99mTc-HYNIC-TOC scintigraphy. The sensitivity of 131I-MIBG imaging and 99mTc-HYNIC-TOC scintigraphy to detect urinary bladder, head and neck, and thoracic paragangliomas were 18.7 vs. 18.5% (P = 1.000); 17.4% vs. 84.6% (P = 0.000) and 60% vs. 94.4% (P = 0.030), respectively.

Conclusions

131I-MIBG imaging could become the first-line investigation modality in patients with extra-adrenal abdominal paragangliomas. However, 99mTc-HYNIC-TOC scintigraphy has high sensitivity and is superior to 131I-MIBG imaging for detecting head & neck and thoracic paraganglioma. Both 131I-MIBG imaging and 99mTc-HYNIC-TOC scintigraphy have poor performance for detecting urinary bladder paragangliomas.
Gait parameters assessed with inertial measurement unit during 6-minute walk test in people after stroke
Authors: Pollet Joel , Buraschi Riccardo , Villafañe Jorge Hugo , Piovanelli Barbara , Negrini Stefano
Published: September 2021

Gait impairments are among the main issues for stroke survivors as they are often linked with a lack of endurance capacity, balance impairments and functional limitations. These conditions can be carefully assessed by combining an endurance capacity test, the 6-minute walk test (6MWT), with the analysis of gait performed by an inertial measurement unit (IMU). We investigated the evolution of gait spatiotemporal and kinematic parameters during the 6MWT and compared it with age-matched healthy subjects. Moreover, gait parameters and 6MWT distance were associated with clinical outcome scales. In a postacute rehabilitation general hospital, we performed an observational study. Subjects with a single cortical stroke were recruited into the stroke group (SG). An age-matched healthy group (HG) was also recruited. All participants performed a 6MWT while wearing an IMU. The outcomes considered were 6MWT distance, gait spatiotemporal and kinematic parameters, and symmetry. Before the test at each subject, in the SG was administered Berg balance scale, Canadian neurological stroke scale and motricity index. 32 subjects were recruited into the SG, and 12 into the HG. Between the paretic and nonparetic limbs of the SG, there were differences in the stance phase and single support phase (P < 0.05). SG gait speed and stride length strongly correlated with balance, strength and disability scales. The SG walked fewer meters than the HG (Δ = −260.90 m; P < 0.001). Adopting an IMU during a 6mwt resulted valuable and effective in providing meaningful information regarding both the disability and functional capabilities of SG subjects.
Effect of Water Exposure on Contact Lens Storage Case Contamination in Soft Lens Wearers
Authors: Arshad Memoona , Carnt Nicole , Tan Jacqueline , Stapleton Fiona
Published: September 2021

SIGNIFICANCE

Water exposure during contact lens wear can transfer pathogenic microorganisms to the eye, causing ocular complications. This study determined that water exposure is prevalent among lens wearers and is independently associated with higher case contamination. Contact lens compliance education to minimize water exposure should be reenforced by contact lens organizations and practitioners.

PURPOSE

Given the increasing association between water exposure and contact lens disease, this study aimed to explore the effect of water exposure and storage case contamination in soft contact lens users.

METHODS

A total of 165 daily soft lens wearers completed a self-administered questionnaire on contact lens hygiene. Lens cases were collected, and microbial analysis was conducted using an adenosine triphosphate assay (for overall microbial bioburden) and limulus amebocyte lysate assay (for endotoxin levels). The lens hygiene (excellent, >35; moderate, 28 to 35; poor, <28) and water contact (≤1, good; >1, poor) scores measured the compliance and water exposure during lens wear, respectively. Multiple regression determined the association between water behaviors and case contamination.

RESULTS

The average (standard deviation) age of participants was 28 (13.5) years (18 to 78 years), and 65% were female. The average overall microbial bioburden of storage cases was 3.10 (0.98) log colony-forming unit/mL (1.09 to 5.94 log colony-forming unit/mL). Forty-five percent of participants reported showering, 49.7% reported swimming while wearing lenses (65.4% of whom swam without goggles), 27.8% used wet hands to handle lenses, and 17.5% used tap water to rinse storage cases. Showering with lenses significantly increased the risk of higher storage case bioburden (P = .001), whereas using wet hands (P = .01) doubled the risk of higher case endotoxin levels (odds ratio, 2.41; confidence interval 1.19 to 4.86).

CONCLUSIONS

Water contact behavior while wearing lenses is prevalent among soft lens wearers and is associated with higher case contamination. Practitioners may improve contact lens education to reduce water exposure and case contamination to reduce the risk of lens-related adverse events.
Association between Vision Impairment and Physical Quality of Life Assessed Using National Surveillance Data
Authors: VanNasdale Dean A. , Jones-Jordan Lisa A. , Hurley Megan S. , Shelton Erica R. , Robich Matthew L. , Crews John E.
Published: September 2021

SIGNIFICANCE

Physically unhealthy days assessments in national health surveillance datasets represent a useful metric for quantifying quality-of-life differences in those with and without vision impairment. Disproportionately poorer physical health in the visually impaired population provides further rationale for the inclusion of vision care in multidisciplinary approaches to chronic disease management.

PURPOSE

This study aimed to assess the association between vision impairment and health-related quality of life using data from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System.

METHODS

Data from each of the 50 states were extracted from the 2017 Behavioral Risk Factor Surveillance System data set. Self-report of difficulty seeing was used to categorize visually impaired versus nonvisually impaired populations. Self-report number of physically unhealthy days in the previous 30 days was used to quantify quality of life. The number of unhealthy days was calculated for the visually impaired and nonvisually impaired cohorts for each state. The ratio of the number of physically unhealthy days in the visually impaired versus nonvisually impaired population was calculated for each state and for different age cohorts.

RESULTS

Mean numbers of physically unhealthy days among persons with and without severe vision impairment across all states were 10.63 and 3.68 days, respectively, and demonstrated considerable geographic variability. Mean ratios of physically unhealthy healthy days in the visually impaired versus the nonvisually impaired population were 2.91 in the 18- to 39-year-old cohort, 2.87 in the 40- to 64-year-old cohort, and 2.16 in the ≥65-year-old cohort.

CONCLUSIONS

National surveillance data demonstrate a greater number of physically unhealthy days in the visually impaired population, indicating a need to improve our understanding of causes that lead to reduced physical health among those with vision impairment. Additional research is needed to better understand how individuals perceive vision as part of their overall health.
Did Emergency Department Visits in Infants and Young Children Increase in the Last Decade?
Authors: To Teresa , Terebessy Emilie , Zhu Jingqin , Fong Ivy , Liang Jocelyn , Zhang Kimball , McGihon Rachel
Published: September 2021

Objectives

The aims of the study were to measure overall trends and to identify leading causes for pediatric emergency department (ED) visits among children aged 0 to 4 years.

Methods

We conducted an 11-year population-based open cohort study using health administrative data from 2008 to 2018 in Ontario, Canada. All ED visits were extracted from the National Ambulatory Care Reporting System, along with the most responsible cause of each visit. Annual ED visit rates were calculated per 100 children in each year. Overall and disease-specific rates for all children were calculated and then stratified by sex and age groups. Relative percentage change in rates between 2008 and 2018 were calculated and compared using standardized differences (SDIFs). Statistical significance of time trends was tested using Poisson regression.

Results

This study included an average of 911,566 children from 2008 to 2018. All-cause ED visit rates increased by 28.2% from 2008 to 2018 (43.24–55.42 per 100, SDIF >0.1). Respiratory diseases were consistently the top cause of ED visits, and contributed to 1 in 3 ED visits in 2018. These respiratory conditions include asthma, asthma-related diseases (bronchiolitis, bronchitis, influenza, and pneumonia), and other respiratory diseases. Respiratory ED visit rates increased by 32.8% from 2008 to 2018 (11.51–15.28 per 100, SDIF <0.1), driven by a 46.4% (14.58–21.35 per 100, SDIF >0.1) increase among children younger than 1 year. There was a 78.0% increase in ED visits for bronchiolitis in infants (1.45–2.58 per 100, SDIF <0.1).

Conclusions

Respiratory diseases like bronchiolitis among infants were the consistent leading cause for ED visits. All-cause ED visit rates among young children increased by 28.17% from 2008 to 2018.
Efficacy of Apneic Oxygenation During Pediatric Endotracheal Intubation
Authors: Dancy Mark A.
Published: September 2021

Objective

Because of the abundance of complications associated with peri-intubation hypoxia, maintaining adequate oxygen saturation during endotracheal intubation (ETI) is of great concern. In addition to standard preoxygenation techniques, apneic oxygenation (AO), the continuous flow of passive oxygenation, is a potential tool that can be used to eliminate hypoxia during ETI. Although scarcely studied in the pediatric population, AO has proven effective in reducing the incidence of hypoxia in adult patients with minimal side effects. The objective of this study is to evaluate the use of apneic oxygenation in pediatric patients and to determine its efficacy in preventing or delaying oxygen desaturation during the apneic period of ETI.

Methods

This literature review examines 4 studies that evaluate the practice of AO in pediatric patients. A total of 712 patients across 3 randomized control trials and 1 observational study were assigned to either a control group that did not receive any form of AO, a group that did not receive 100% fraction of inspired oxygen (FiO2), or an intervention group where various methods of AO were delivered.

Results

Each AO method that provided 100% FiO2 saw a significantly longer time until initial desaturation when compared with those that did not receive any form of AO or those not receiving 100% FiO2.

Conclusions

The findings in this study confirm that the practice of AO is not only efficacious in increasing the time until initial desaturation but also reduces the overall incidence of hypoxia during laryngoscopy in children.