bluuebunny/crossref_metadata_2025 huggingface dataset:
A statistical study of the optical spectral variability in gamma-ray blazars
Authors: Otero-Santos J , Acosta-Pulido J A , Becerra González J , Luashvili A , Castro Segura N , González-Martín O , Raiteri C M , Carnerero M I
Published: February 2022

Blazars optical emission is generally dominated by relativistic jets, although the host galaxy, accretion disc, and broad-line region (BLR) may also contribute significantly. Disentangling their contributions has been challenging for years due to the dominance of the jet. To quantify the contributions to the spectral variability, we use the statistical technique for dimensionality reduction non-negative matrix factorization on a spectroscopic data set of 26 γ-ray blazars. This technique allows to model large numbers of spectra in terms of a reduced number of components. We use a priori knowledge to obtain components associated with meaningful physical processes. The sources are classified according to their optical spectrum as host-galaxy dominated BL Lac objects (BL Lacs), BL Lacs, or flat spectrum radio quasars (FSRQs). Host-galaxy sources show less variability, as expected, and bluer-when-brighter (BWB) trends, as the other BL Lacs. For FSRQs, more complicated colour-flux behaviours are observed: redder-when-brighter for low states saturating above a certain level and, in some cases, turning to BWB. We are able to reproduce the variability observed during 10 yr using only two to four components, depending on the type. The simplest scenario corresponds to host-galaxy blazars, whose spectra are reconstructed using the stellar population and a power law (PL) for the jet. BL Lac spectra are reproduced using from two to four PLs. Different components can be associated with acceleration/cooling processes taking place in the jet. The reconstruction of FSRQs also incorporates a QSO-like component to account for the BLR, plus a very steep PL, associated with the accretion disc.
Structure and kinematics of tidally limited satellite galaxies in LCDM
Authors: Errani Raphaël , Navarro Julio F , Ibata Rodrigo , Peñarrubia Jorge
Published: February 2022

We use N-body simulations to model the tidal evolution of dark matter-dominated dwarf spheroidal galaxies embedded in cuspy Navarro-Frenk-White subhaloes. Tides gradually peel off stars and dark matter from a subhalo, trimming it down according to their initial binding energy. This process strips preferentially particles with long orbital times, and comes to an end when the remaining bound particles have crossing times shorter than a fraction of the orbital time at pericentre. The properties of the final stellar remnant thus depend on the energy distribution of stars in the progenitor subhalo, which in turn depends on the initial density profile and radial segregation of the initial stellar component. The stellar component may be completely dispersed if its energy distribution does not extend all the way to the subhalo potential minimum, although a bound dark remnant may remain. These results imply that ‘tidally limited’ galaxies, defined as systems whose stellar components have undergone substantial tidal mass-loss, neither converge to a unique structure nor follow a single tidal track. On the other hand, tidally limited dwarfs do have characteristic sizes and velocity dispersions that trace directly the characteristic radius (rmx) and circular velocity (Vmx) of the subhalo remnant. This result places strong upper limits on the size of satellites whose unusually low velocity dispersions are often ascribed to tidal effects. In particular, the large size of kinematically cold ‘feeble giant’ satellites like Crater 2 or Antlia 2 cannot be explained as due to tidal effects alone in the Lambda Cold Dark Matter scenario.
Using artificial intelligence and real galaxy images to constrain parameters in galaxy formation simulations
Authors: Macciò Andrea V , Ali-Dib Mohamad , Vulanovic Pavle , Al Noori Hind , Walter Fabian , Krieger Nico , Buck Tobias
Published: February 2022

Cosmological galaxy formation simulations are still limited by their spatial/mass resolution and cannot model from first principles some of the processes, like star formation, that are key in driving galaxy evolution. As a consequence they still rely on a set of ’effective parameters’ that try to capture the scales and the physical processes that cannot be directly resolved in the simulation. In this study, we show that it is possible to use Machine Learning techniques applied to real and simulated images of galaxies to discriminate between different values of these parameters by making use of the full information content of an astronomical image instead of collapsing it into a limited set of values like size, or stellar/ gas masses. In this work, we apply our method to the NIHAO simulations and the THINGS and VLA-ANGST observations of H i maps in nearby galaxies to test the ability of different values of the star formation density threshold n to reproduce observed H i maps. We show that observations indicate the need for a high value of n ≳ 80 cm−3 (although the numerical value is model-dependent), which has important consequences for the dark matter distribution in galaxies. Our study shows that with innovative methods it is possible to take full advantage of the information content of galaxy images and compare simulations and observations in an interpretable, non-parametric, and quantitative manner.
Quantifying the Population-Level Effect of the COVID-19 Mass Vaccination Campaign in Israel: A Modeling Study
Authors: Somekh Ido , KhudaBukhsh Wasiur R , Root Elisabeth Dowling , Boker Lital Keinan , Rempala Grzegorz , Simões Eric A F , Somekh Eli
Published: February 2022

Background

Estimating real-world vaccine effectiveness is challenging as a variety of population factors can impact vaccine effectiveness. We aimed to assess the population-level reduction in cumulative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cases, hospitalizations, and mortality due to the BNT162b2 mRNA coronavirus disease 2019 (COVID-19) vaccination campaign in Israel during January–February 2021.

Methods

A susceptible-infected-recovered/removed (SIR) model and a Dynamic Survival Analysis (DSA) statistical approach were used. Daily counts of individuals who tested positive and of vaccine doses administered, obtained from the Israeli Ministry of Health, were used to calibrate the model. The model was parameterized using values derived from a previous phase of the pandemic during which similar lockdown and other preventive measures were implemented in order to take into account the effect of these prevention measures on COVID-19 spread.

Results

Our model predicted for the total population a reduction of 648 585 SARS-CoV-2 cases (75% confidence interval [CI], 25 877–1 396 963) during the first 2 months of the vaccination campaign. The number of averted hospitalizations for moderate to severe conditions was 16 101 (75% CI, 2010–33 035), and reduction of death was estimated at 5123 (75% CI, 388–10 815) fatalities. Among children aged 0–19 years, we estimated a reduction of 163 436 (75% CI, 0–433 233) SARS-CoV-2 cases, which we consider to be an indirect effect of the vaccine.

Conclusions

Our results suggest that the rapid vaccination campaign prevented hundreds of thousands of new cases as well as thousands of hospitalizations and fatalities and has probably averted a major health care crisis.
Circulating Biomarkers for Therapeutic Monitoring of Anti-cancer Agents
Authors: Janse van Rensburg Helena J , Spiliopoulou Pavlina , Siu Lillian L
Published: February 2022

Circulating biomarkers have emerged as valuable surrogates for evaluating disease states in solid malignancies. Their relative ease of access and rapid turnover has bolstered clinical applications in monitoring treatment efficacy and cancer progression. In this review, the roles of various circulating biomarkers in monitoring treatment response are described. Non-specific markers of disease burden, tumor markers (eg CA 125, CEA, PSA, etc.), circulating tumor cells, nucleic acids, exosomes, and metabolomic arrays are highlighted. Specifically, the discovery of each of these markers is reviewed, with examples illustrating their use in influencing treatment decisions, and barriers to their application noted where these exist. Finally, opportunities for future work using these circulating biomarkers are discussed.
Survival and Incidence Patterns of Pancreatic Neuroendocrine Tumors Over the Last 2 Decades: A SEER Database Analysis
Authors: Sonbol Mohamad Bassam , Mazza Gina L , Mi Lanyu , Oliver Thomas , Starr Jason , Gudmundsdottir Hallbera , Cleary Sean P , Hobday Timothy , Halfdanarson Thorvardur R
Published: February 2022

Background

Pancreatic neuroendocrine tumors (pNETs) are rare cancers with outcomes determined by multiple factors including grade, stage, and clinical presentation. In this study, we aimed to determine the prognosis of patients with pNETs using a large population-based database.

Materials and Methods

In this population-based study, we identified patients with pNETs from the SEER 18 registry (2000-2016) using a combination of ICD-O-3 and histology codes. We calculated age-adjusted incidence rates using SEER*Stat 8.3.5. In addition, we analyzed overall survival (OS) using the Kaplan-Meier method, and investigated prognostic factors using a multivariable Cox proportional hazards model.

Results

A total of 8944 pNETs patients were identified. Annual incidence rates increased from 0.27 to 1.00 per 100 000. This was largely explained by an increase in number of patients diagnosed with localized disease in more recent years (2012-2016). Median OS was 68 months (95% CI [64, 73]) and 5-year OS rates in localized, regional, and metastatic disease were 83%, 67%, and 28%, respectively. There was a significant improvement in OS for patients diagnosed between 2009 and 2016 (median OS 85 months) compared with those diagnosed between 2000 and 2008 (median OS 46 months) (HR 0.66; 95% CI [0.62, 0.70]). This improvement in OS was consistent across all stages.

Conclusions and Relevance

This study shows a steady increase pNETs incidence with notable stage migration to earlier stages in recent years. This increase in incidence is accompanied by a significant improvement in survival across different disease stages.
The Unavoidability of Low Inflation–Low Output Traps
Authors: Kocherlakota Narayana R
Published: February 2022

Since the collapse of the Bretton Woods monetary system, the monies of the developed world have been unbacked by any formal promise of convertibility. Yet, inflation has typically undershot, not overshot, central bank targets over the past couple decades. The low, while generally positive, inflation rate has (more arguably) been associated with low output and low growth. In this article, I consider these observations through the lens of a class of representative agent rational expectations models with nominal (price-setting) frictions and the possibility of firm entry/exit. I show that for any level of nominal frictions (no matter how small) and for any monetary policy rule that satisfies a set of weak restrictions, there is a large set of equilibria that exhibit permanently low inflation, low output, and low nominal interest rates. These equilibria can only exhibit positive long-run inflation if growth is low and the specification of nominal frictions (i.e. the Phillips curve) takes an unconventional but nonetheless empirically plausible form.
Risk Price Variation: The Missing Half of Empirical Asset Pricing
Authors: Patton Andrew J , Weller Brian M
Published: February 2022

Equal compensation across assets for the same risk exposures is a bedrock of asset pricing theory and empirics. Yet real-world frictions can violate this equality and create apparently high Sharpe ratio opportunities. We develop new methods for asset pricing with cross-sectional heterogeneity in compensation for risk. We extend k-means clustering to group assets by risk prices and introduce a formal test for whether differences in risk premiums across market segments are too large to occur by chance. We find significant evidence of cross-sectional variation in risk prices for almost all combinations of test assets, factor models, and time periods considered.
Competitive binding of transcription factors underlies flexibility of T peripheral helper cells and T follicular helper cells in SLE
Authors: Jiang Qinglian , Wang Jiakai , Jiang Hongkun , Li Wei , Sun Yini , Shan Yu , Wei Tong , Chi Xuyang , Yu Shihan , Ma Xiaoxue
Published: February 2022

Objective

Peripheral helper T (Tph) cells interact with B cells and promote immune responses at sites of ectopic lymphoid structures (ELSs). To assess the characteristics of Tph cells, we investigated the phenotype of T helper (Th) cells in patients with SLE and the underlying competitive binding mechanisms using cytokine-mediated signal transducer and activator of transcription (STAT) factors.

Methods

Peripheral blood mononuclear cells from SLE patients and healthy controls were analysed for phenotypic identification. Serum cytokine levels were detected using Luminex assays. In vitro culture was performed to assess cytokine-induced conversion of phenotypes and transcriptional regulation using flow cytometry and PCR. Chromatin immunoprecipitation was used to evaluate STAT binding and histone modifications.

Results

CXCR5−PD-1+Tph-like cells were increased in SLE patients and showed strong association with disease activity and renal involvement. Serum IFN-α levels were increased and associated with Tph frequency. IFN-α promoted the differentiation of IL-10-producing CXCR5−PD-1+Tph-like cells, increased the responsiveness of IL-2 and induced the conversion of Tfh-like cells to Tph-like cells. STAT5 gained a competitive advantage and bound to the BCL6 locus at the expense of STAT1, accompanied by suppression of H3K4me3. Finally, anti-IFNAR1 decreased the differentiation of Tph-like cells, thereby suppressing the generation of CD38highCD27highplasmablasts.

Conclusion

Tph cells might be crucial makers to effectively reflect disease activity level in SLE patients. The finding that synergy of IFN-α and IL-2 increases Tph cells through competitive transcriptional regulation could be one of the mechanisms responsible for pathological formation of ELSs and helpful for selection of individualized therapeutic approaches for SLE.
Kidney Organoids Are Capable of Forming Tumors, but Not Teratomas
Authors: Shankar Anusha S , Du Zhaoyu , Tejeda Mora Hector , Boers Ruben , Cao Wanlu , van den Bosch Thierry P P , Korevaar Sander S , Boers Joachim , van IJcken Wilfred F J , Bindels Eric M J , Eussen Bert , de Klein Annelies , Pan Qiuwei , Oudijk Lindsey , Clahsen-van Groningen Marian C , Hoorn Ewout J , Baan Carla C , Gribnau Joost , Hoogduijn Martin J
Published: February 2022

Induced pluripotent stem cell (iPSC)-derived kidney organoids are a potential tool for the regeneration of kidney tissue. They represent an early stage of nephrogenesis and have been shown to successfsully vascularize and mature further in vivo. However, there are concerns regarding the long-term safety and stability of iPSC derivatives. Specifically, the potential for tumorigenesis may impede the road to clinical application. To study safety and stability of kidney organoids, we analyzed their potential for malignant transformation in a teratoma assay and following long-term subcutaneous implantation in an immune-deficient mouse model. We did not detect fully functional residual iPSCs in the kidney organoids as analyzed by gene expression analysis, single-cell sequencing and immunohistochemistry. Accordingly, kidney organoids failed to form teratoma. Upon long-term subcutaneous implantation of whole organoids in immunodeficient IL2Ry−/−RAG2−/− mice, we observed tumor formation in 5 out of 103 implanted kidney organoids. These tumors were composed of WT1+CD56+ immature blastemal cells and showed histological resemblance with Wilms tumor. No genetic changes were identified that contributed to the occurrence of tumorigenic cells within the kidney organoids. However, assessment of epigenetic changes revealed a unique cluster of differentially methylated genes that were also present in undifferentiated iPSCs. We discovered that kidney organoids have the capacity to form tumors upon long-term implantation. The presence of epigenetic modifications combined with the lack of environmental cues may have caused an arrest in terminal differentiation. Our results indicate that the safe implementation of kidney organoids should exclude the presence of pro-tumorigenic methylation in kidney organoids.
Hip Prognosis in Patients With Congenital Diastasis of the Pubic Symphysis
Authors: Yamaguchi Ryosuke , Nakamura Tomoyuki , Yanagida Haruhisa , Yamaguchi Toru , Takamura Kazuyuki , Wada Akifusa , Nakashima Yasuharu
Published: February 2022

Background:

Congenital diastasis of the pubic symphysis (CDPS) is a rare musculoskeletal malformation in the exstrophy-epispadias complex that is potentially associated with the development of hip dysplasia. The purpose of this study was to investigate the incidence and prognostic factors of hip dysplasia in patients with CDPS.

Methods:

Fifty-four hips in 27 patients with CDPS initially evaluated between 1983 and 2016 were retrospectively reviewed. The mean age at the first visit was 2.3 (0 to 8) years. The mean follow-up duration was 10.5 (1 to 36) years. Patient characteristics at the first visit, the clinical course at the most recent follow-up, and radiologic parameters on pubic malformation and hip dysplasia during at least 2 time points (first visit or age 1, and either the most recent visit or before hip surgery) were evaluated. Prognostic factors associated with the development of hip dysplasia were analyzed using univariate/multivariate analysis. The Kaplan-Meier survival curves were generated and compared based on these factors.

Results:

Nine of 27 patients (33%) and 13 of 54 hip joints (24%) with CDPS developed hip dysplasia. Paraplegia (odds ratio, 10.0; 95% confidence interval, 1.7-76.6) and center-edge angle of <5 degrees at the first visit or age 1 (P<0.001) were independent predictors of the development of hip dysplasia. Patients with CDPS and either paraplegia or center-edge angle <5 degrees at the first visit or age 1 were significantly more likely to develop hip dysplasia than other patients (hazard ratio, 29.3; 95% confidence interval, 3.4-250).

Conclusions:

Approximately one third of patients with CDPS develop hip dysplasia. Paraplegia and center-edge angle of <5 degrees at the first visit are independent risk factors.

Level of Evidence:

Level III.
Dynamic Supination in Congenital Clubfoot: A Modified Delphi Panel Approach to Standardizing Definitions and Indications for Treatment
Authors: Baskar Danika , Hosseinzadeh Pooya , Mosca Vincent , Bouchard Maryse , Aroojis Alaric , Arkader Alexandre , Cidambi Emily , Denning Jaime , Eastwood Deborah , Gantsoudes George , Kelly Derek M. , Kishta Waleed , Masquijo Javier , May Collin , Milbrandt Todd , Nichols Louise R. , Frick Steven
Published: February 2022

Background:

Dynamic supination is a well-recognized cause of congenital clubfoot deformity relapse. However, there is no consensus on how to diagnose it and there are varied approaches in its management. This study aims to define dynamic supination and indications for treatment by presenting consensus from an international panel of experts using a modified Delphi panel approach.

Methods:

An international panel of 15 pediatric orthopaedic surgeons with clinical and research expertise in childhood foot disorders participated in a modified Delphi panel on dynamic supination in congenital clubfoot. Panelists voted on 51 statements using a 4-point Likert scale on dynamic supination, clinical indications for treatment, operative techniques, and postoperative casting and bracing. All panelists participated in 2 voting rounds with an interim meeting for discussion. Responses were classified as unanimous consensus (100%), consensus (80% or above), near-consensus (70% to 79%), and indeterminate (69% or less).

Results:

Consensus was achieved for 34 of 51 statements. Panelists agreed dynamic supination is present when the forefoot is supinated during swing phase of gait with initial contact on the lateral border of the foot. There was also agreement that dynamic supination results from muscle imbalance between the tibialis anterior and the peroneus longus and brevis. There was no consensus on observation of hindfoot varus in dynamic supination, operative indications for posterior release of the ankle joint, or incisional approach for tibialis anterior tendon transfer. Reference to the calcaneopedal unit concept, planes of movement, and phases of gait were deemed important factors for consideration when evaluating dynamic supination.

Conclusions:

Consensus statements from the Delphi panel can guide diagnosis and treatment of dynamic supination in clubfoot deformity relapse, including clinical decision making regarding preoperative casting, surgical approach, and postoperative immobilization. Near-consensus and indeterminate statements may be used to direct future areas of investigation.

Level of Evidence:

Level V.
The Rise and Fall of Bone Morphogenetic Protein 2 Throughout the United States
Authors: Beschloss Alexander M. , DiCindio Christina M. , Lombardi Joseph S. , Shillingford Jamal N. , Laratta Joseph L. , Holderread Brendan , Louie Phillip , Pugely Andrew J. , Sardar Zeeshan , Khalsa Amrit S. , Arlet Vincent M. , Saifi Comron
Published: February 2022

Study Design:

Retrospective Database Study.

Objective:

Investigate utilization of bone morphogenetic protein (BMP-2) between 2004 and 2014.

Summary of Background Data:

The utilization, particularly off-label utilization, of BMP-2 has been controversial and debated in the literature. Given the concerns regarding cancer and potential complications, the risk benefit profile of BMP must be weighed with each surgical case. The debate regarding the costs and potential side effects of BMP-2 compared with autologous iliac crest bone harvest has continued.

Methods:

The National Inpatient Sample (NIS) database was queried for the use of BMP-2 (ICD-9-CM 84.52) between 2004 and 2014 across 44 states. The NIS database represents a 20% sample of discharges, weighted to provide national estimates. BMP-2 utilization rates in spine surgery fusion procedures were calculated as a fraction of the total number of thoracic, lumbar, and sacral spinal fusion surgeries performed each year.

Results:

Between 2004 and 2014, BMP-2 was utilized in 927,275 spinal fusion surgeries. In 2004, BMP-2 was utilized in 28.3% of all cases (N=48,613). The relative use of BMP-2 in spine fusion surgeries peaked in 2008 at 47.0% (N=112,180). Since then, it has continued to steadily decline with an endpoint of 23.6% of cases in 2014 (N=60,863).

Conclusions:

Throughout the United States, the utilization of BMP-2 in thoracolumbar fusion surgeries increased from 28.3% to 47.0% between 2004 and 2008. However, from 2008 to 2014, the utilization of BMP-2 in thoracolumbar spine fusion surgeries decreased significantly from 47.0% to 23.4%. While this study provides information on the utilization of BMP-2 for the entire United States over an 11-year period, further research is needed to the determine the factors affecting these trends.
Effect of Inconsistent Optical Coherence Tomography Scan Location on Glaucoma Progression Analysis
Authors: Hwang Young Hoon , Song Mi Yeon
Published: February 2022

Précis:

Circumpapillary retinal nerve fiber layer (RNFL) thickness change induced by optical coherence tomography (OCT) scan circle location displacement was not completely compensated despite the use of Guided Progression Analysis (GPA), especially when the “R1” registration method was applied.

Purpose:

The purpose of this study was to evaluate the effect of inconsistent OCT scan location on glaucoma progression detection using GPA.

Methods:

Eighty-four glaucomatous eyes with at least 4 serial OCT tests were included. To evaluate the ability of OCT GPA to adjust the OCT scan location, an analysis was performed without manipulation (control set), and after the OCT scan of the latest test was intentionally moved inferotemporally (test set). The eyes were classified into the adjustment and nonadjustment groups based on the superior or inferior quadrant RNFL thickness agreement between the control and test sets.

Results:

When the OCT GPA parameters between the control and test sets were compared, the test set showed a greater superior RNFL thickness and lesser inferior RNFL thickness compared with the control set (P<0.05). The eyes in the nonadjustment group (n=21, 25%) had a lower chance of applying the eye-tracking function (P=0.003) and a higher frequency of the “R1” registration method of OCT GPA (P<0.001) than the adjustment group (n=63, 75%); all eyes with the “R1” method were in the nonadjustment group and all eyes with the “R2” method were in the adjustment group.

Conclusions:

Inconsistent OCT scan location induced changes in RNFL thickness that were not completely compensated despite the use of OCT GPA, especially when the “R1” registration method was applied. These findings indicates a potential for misidentified glaucoma progression.
Placebo Response Rates in Acupuncture Therapy Trials for Functional Dyspepsia
Authors: Liu Jie , Song Gengqing , Huang Yizhou , Lv Chaolan , Wang Ying , Wu Dandan , Sun Chenyu , Jing Meng , Yu Yue
Published: February 2022

Background:

Functional dyspepsia (FD) is a functional digestive disease with limited management selection. Previous studies revealed that acupuncture therapy is effective for FD. However, because sham controls were not implemented in most clinical trials following acupuncture therapy, it is difficult to differentiate overall treatment responses from placebo. This study aims to quantify placebo responses in clinical trials in which FD patients received sham manual acupuncture (MA) and sham electroacupuncture (EA).

Materials and Methods:

Randomized controlled trials of MA and EA for FD patients were searched in PubMed, Web of Science, Cochrane Library, and Embase databases, as well as 4 Chinese language databases from inception to January 2021. RevMan 5.20 software was used for pooled analysis of symptom scores and quality of life. The symptom scores were combined using standard mean difference (SMD) or weighted mean difference (WMD) with a 95% confidence interval (CI). The quality of included studies was tested using modified Jadad scale and Standards for Reporting Interventions in Controlled Trials of Acupuncture (STRICTA) checklist. Egger’s test, Begg’s test, and sensitivity analyses were conducted using Stata 11.0 statistical software. The protocol of this study is registered in PROSPERO as CRD42021233858.

Results:

After screening, the current systematic review included 13 randomized controlled trials, of which 8 studies were used in the meta-analysis. Regarding subjective outcomes, the combined effect of sham MA on FD symptoms was [SMD=−0.42, 95% CI (−0.72, −0.12);P=0.005], whereas sham EA treatment was [SMD=−0.54, 95% CI (−0.81, −0.27);P<0.001]. The combined effect on FD quality of life of post-sham MA group was [SMD=−0.32, 95% CI (−0.52, −0.12);P=0.002]. With regard to objective outcomes, the combined effect of sham EA on dominant frequency was [WMD=−0.11, 95% CI (−0.30, −0.08);P=0.24], while the combined effect of sham EA on dominant power was [WMD=−3.35, 95% CI (−8.04, 1.35);P=0.16].

Conclusions:

Sham MA and sham EA remarkably improve symptoms and quality of life scores of FD without influencing objective outcomes, highlighting the significance of sham controls in acupuncture therapy clinical trials.
Addressing Occupational Fatigue in Nurses
Authors: Steege Linsey M. , Arsenault Knudsen Élise N. , Brzozowski Sarah , Cho Hyeonmi
Published: February 2022

OBJECTIVE

To understand hospital nurses' current fatigue risk management (FRM), identify design goals and principles, and obtain feedback on FRM design concepts.

BACKGROUND

FRM systems can address fatigue and associated risks, yet they are not widely implemented in hospital nursing. This may be due to a lack of contextually appropriate FRM tools.

METHODS

A user-centered design approach was used, including interviews with 21 hospital nursing stakeholders.

FINDINGS

Nurses described integrated fatigue monitoring and management activities to pursue balance between work demands and capacity to meet those demands as individual nurses, within the unit, across the hospital, and over time. Seven principles were identified and applied to 2 initial design concepts for tools to support FRM. Participants' feedback on designs was positive.

CONCLUSIONS

This study advances the science and practice for FRM in nursing. The design principles and concepts from this study can be used to facilitate implementation of FRM systems in hospitals.
Chameleon TFE3-translocation RCC and How Gene Partners Can Change Morphology: Accurate Diagnosis Using Contemporary Modalities
Authors: Tretiakova Maria S.
Published: February 2022

Translocation renal cell carcinoma (tRCC) with TFE3 gene rearrangements has been born as a distinct entity 20 years ago. These relatively rare tumors were notable among other RCC subtypes because of their disproportionally high incidence among children and young adults. Initial reports were focused on describing unifying morphologic criteria and typical clinical presentation. Follow-up studies of ancillary immunohistochemical and hybridization techniques provided additional diagnostic tools allowing recognition of tRCC tumors in practice. However, a growing body of literature also expanded the clinicomorphologic spectrum of tRCCs, to include a significant morphologic overlap with other RCC variants thus blurring the diagnostic clarity of this entity. More recent molecular studies utilizing next-generation sequencing technology accelerated recognition of numerous novel gene partners fusing at different breakpoints with the TFE3 gene. Accumulating data indicates that morphologic and clinical heterogeneity of tRCC could be explained by fusion subtypes, and knowledge of TFE3 partnering genes may be important in predicting tumor behavior. Herein we provided a comprehensive analysis of ∼400 tRCC cases with known TFE3 fusion partners, estimated their relative incidence and summarized clinicomorphologic features associated with most common fusion subtypes. Our data was based on an extensive literature review and had a special focus on comparing immunohistochemistry, fluorescent in situ hybridization and contemporary molecular studies for the accurate diagnosis of tRCC.
Updates and Proposed Diagnostic Approach to Psoriasiform Dermatoses
Authors: Shakshouk Hadir , Erickson Lori A. , Johnson Emma F. , Lehman Julia S.
Published: February 2022

Psoriasiform dermatoses represent a wide array of skin diseases commonly encountered by clinicians and pathologists. While they may present a diagnostic challenge, thorough observation coupled with proper interpretation of subtle additional clinical or histopathologic features provide clues to the correct diagnosis. In this review, we provide updates on emerging entities and develop a systemic approach to establish the pathologic diagnosis, with emphasis on the importance of clinicopathologic correlation.
Peripheral IV Administration of Hypertonic Saline: Single-Center Retrospective PICU Study*
Authors: Pohl Charles E. , Harvey Helen , Foley Jennifer , Lee Euyhyun , Xu Ronghui , O’Brien Nicole F. , Coufal Nicole G.
Published: February 2022

OBJECTIVES:

To determine the frequency and characteristics of complications of peripherally administered hypertonic saline (HTS) through assessment of infiltration and extravasation.

DESIGN:

Retrospective cross-sectional study.

SETTING:

Freestanding tertiary care pediatric hospital.

PATIENTS:

Children who received HTS through a peripheral IV catheter (PIVC).

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

We conducted a single-center retrospective review from January 2012 to 2019. A total of 526 patients with 1,020 unique administrations of HTS through a PIVC met inclusion criteria. The primary endpoint was PIVC failure due to infiltration or extravasation. The indication for the administration of HTS infusion was collected. Catheter data was captured, including the setting of catheter placement, anatomical location on the patient, gauge size, length of time from catheter insertion to HTS infusion, in situ duration of catheter lifespan, and removal rationale. The administration data for HTS was reviewed and included volume of administration, bolus versus continuous infusion, infusion rate, infusion duration, and vesicant medications administered through the PIVC. There were 843 bolus infusions of HTS and 172 continuous infusions. Of the bolus administrations, there were eight infiltrations (0.9%). The continuous infusion group had 13 infiltrations (7.6%). There were no extravasations in either group, and no patients required medical therapy or intervention by the wound care or plastic surgery teams. There was no significant morbidity attributed to HTS administration in either group.

CONCLUSIONS:

HTS administered through a PIVC infrequently infiltrates in critically ill pediatric patients. The infiltration rate was low when HTS is administered as a bolus but higher when given as a continuous infusion. However, no patient suffered an extravasation injury or long-term morbidity from any infiltration.
Are Opioids Out? Assessing Prescription Patterns in Plastic Surgery Using Medicare Part D Beneficiary Data
Authors: Maisner Rose S. , Song Amy , Zhou Benjamin , Srinivasan Nivetha , Thepmankorn Parisorn , Siniakowicz Claudia , Ayyala Haripriya S.
Published: February 2022

Introduction

Since 1999, nearly 841,000 individuals have died from overdoses, 29% involving prescription opioids. Use of opioids for postoperative pain lacks evidence-based guidelines, and despite studies showing the efficacy of nonopioid agents in reducing postoperative morbidity, opioids are still routinely prescribed. However, multiple states are adopting prescription drug monitoring programs and prescription drug laws. The authors sought to investigate recent opioid prescription patterns among plastic surgeons.

Methods

This cross-sectional study used “Medicare Provider Utilization and Payment Data: Part D Prescriber” provided by the Centers for Medicare & Medicaid Services from 2016 to 2018. Entries were filtered to include plastic surgeons. Demographic variables included surgeon sex, geographic region and state, board certification status, and length of experience. The surgeon's practice was designated as academic, private, or both. Outcomes included total opioid claims, opioid prescriber rate, and days per claim. Kruskal-Wallis tests were used for statistical comparison (α = .05).

Results

From 2016 to 2018, plastic surgeons wrote 289,525 opioid prescriptions for 1,729,523 days (6.0 days per prescription), totaling $3,346,979.39. In 2018, 62.2% of plastic surgeons prescribed 0 to 10 opioids, 36.5% prescribed 11 to 50 opioids, and 1.3% prescribed more than 50. Furthermore, 99.5% of plastic surgeons prescribing opioids are practicing in metropolitan areas (rural-urban commuting area codes 1–3). Plastic surgeons who were male or were board certified had significantly lower opioid prescriber rates (P < 0.001). There were no significant variations in outcomes by length of surgeon experience. Geographic region was significantly associated with opioid prescription rates and days per claim, with Southern plastic surgeons having lower rates (P < 0.001) and those Northeastern ones prescribing shorter courses (P = 0.004). The number of opioid claims, days per claim, and opioid prescriber rates were all significantly lower in 2018 than in 2017 and 2016 (P < 0.001).

Conclusions

Prescriptions written by plastic surgeons may have contributed to the opioid epidemic, but 2018 data suggest opioids are becoming less routine in postoperative pain control. Further studies are warranted to assess factors related to reduced and shorter opioid prescriptions by plastic surgeons in the South and Northeast, respectively. Such insight, if adopted into law and implemented into clinical practice, may help reduce the burden of the opioid epidemic.
Minimizing Postoperative Pain in Autologous Breast Reconstruction With the Omental Fat–Augmented Free Flap
Authors: Deptula Peter , Zak Yulia , Dua Monica , Wapnir Irene , Nguyen Dung
Published: February 2022

Introduction

The omental fat–augmented free flap (O-FAFF) is a recently developed technique for autologous breast reconstruction. Our aim of the study is to evaluate the outcomes of our early case series. We assess the O-FAFF donor site morbidity in terms of postoperative pain, narcotic, and antiemetic use.

Methods

A retrospective analysis of patients undergoing O-FAFF from 2019 to 2021 was performed. Patients were evaluated for demographic data, operative time, hospital course, and complications. Mean pain scores (1–10 scale) and narcotic pain medication use in oral morphine equivalents and doses of antiemetic medications during their hospital course were analyzed. We compared outcomes of our O-FAFF group with those of a control group of patients who underwent breast reconstruction with traditional free abdominal tissue transfer.

Results

A total of 14 patients underwent O-FAFF breast reconstruction, representing 23 breasts. Patients had an average age of 48.5 years (±2.3 years) and body mass index of 22.6 kg/m2 (±1.09 kg/m2). Average follow-up was 232 days (±51 days). Average mastectomy weight was 245.6 g (±30.2 g) and average O-FAFF weight was 271 g (±31.7 g). Average pain scores on postoperative day 1 (POD1), POD2, and POD3 were 3.1 (±0.28), 2.8 (±0.21), and 2.1 (±0.35), respectively. The average narcotic use by patients in oral morphine equivalents on POD1, POD2, and POD3 are 24.3 (±5.5), 21.9 (±4.6), and 6.2 (±2.4), respectively. Total narcotic use during hospital stay was 79.4 mg (±11.1 mg). Average pain scores and narcotic use are significantly lower when compared with a previously published cohort of patients who underwent autologous breast reconstruction with free abdominal tissue transfer (P < 0.05). Average antiemetic use was lower in the O-FAFF group compared with the control group: 3.5 versus 4.8 doses (P = 0.6). Hospital length of stay was 3.0 days (±0.0 days). No complications were noted (0%). Patients were universally satisfied with their reconstructive outcome (100%).

Conclusions

The O-FAFF is proven to be a viable method of autologous breast reconstruction. Early series of patients undergoing O-FAFF reconstruction suggest a lower donor site morbidity as demonstrated by lower postoperative pain scores and lower consumptions of narcotic pain medications.
Implementation of Telehealth in a Pediatric Plastic Surgery Clinic: A Single Center's Response to COVID-19
Authors: Kim Erinn N. , Tyrell Richard , Moss Whitney D. , Siddiqi Faizi A.
Published: February 2022

Background

With limitation of in-person clinical visits due to the COVID-19 pandemic, telehealth has emerged as an important platform to deliver healthcare. Satisfaction with telehealth has been examined previously in the adult plastic surgery population. However, studies examining its use and satisfaction in the pediatric plastic surgery population are limited. In this study, we explore patient/caregiver satisfaction with the rapid institution of telehealth in our pediatric plastic surgery clinic and factors affecting satisfaction scores.

Methods

From March 2020 to February 2021, families of pediatric patients seen via video telehealth in the pediatric plastic surgery clinic at our center were invited to participate in a posttelehealth session survey. Telehealth visits encompassed both preliminary consultations as well as follow-up visits. After appropriate consent was obtained, patients' families completed a posttelehealth survey conveying demographics and satisfaction with telehealth via a 5-point Likert scale.

Results

Seventy eight of 131 eligible families elected to participate. Visit types included the following: initial consultations (23.1%), preoperative visits (10.3%), postoperative visits (29.5%), and follow-up visits (37.1%). A total of 80.3% of the respondents were overall satisfied with their telehealth experience. A total of 85.3% of the respondents agreed that telehealth made it easier for them to see their doctor, and 96.7% of the respondents felt using telehealth saved them time in traveling to the clinic. A total of 89.5% of the respondents felt it important for the state of Utah to have a telehealth program available to pediatric patients.

Conclusions

Video telehealth is a useful adjunct in the care of pediatric plastic surgery patients with high caregiver satisfaction.
Early Postoperative Sequelae After Open Sky Access in Nasal Osteotomy
Authors: Zaher Mahmoud M. , Elfeki Bassem , Ismail Khalid A. , Ismail Taha A. , Hegazy Safwat A.
Published: February 2022

Introduction

Nasal osteotomy is a powerful cornerstone step in almost all rhinoplasty procedures and is a major cause of postoperative periorbital ecchymosis and edema after rhinoplasty. Different accesses for osteotomy have been described, the most popular of which is the external perforating and the internal continuous methods. These accesses are blind maneuvers and have some drawbacks such as possible visible scar formation in the percutaneous access or high rate of mucosal tear in the endonasal access. Open sky access osteotomy after wide subperiosteal dissection had been described to overcome those disadvantages. Early postoperative sequelae have not been assessed in the literature after using this access. In the present study, we aim to assess early postoperative sequelae after using this technique in comparison with percutaneous perforating osteotomy.

Materials and Methods

The study was conducted between November 2017 and January 2021. Forty patients were randomly assigned into 2 equal groups. Group A was subjected to lateral osteotomy by percutaneous perforating method, whereas group B underwent lateral osteotomy by the open sky access technique using a 2-mm curved osteotome. Early postoperative periorbital sequelae were assessed on the second and seventh postoperative days, using the grading system suggested by Kara et al (Plast Reconstr Surg. 1999;104:2213–2218). Mucosal tear was assessed on the second postoperative day using nasal endoscopy after removal of nasal packs.

Results

There was a statistically nonsignificant difference between the studied groups regarding ecchymosis and edema occurring on the second or seventh days. Meanwhile, mucosal tear was significantly less in the open sky access osteotomy group.

Conclusions

Open sky access osteotomy is a safe method for lateral nasal osteotomy with direct visualization of the surgical field. It does not require a skin incision that could lead to a scar formation. It produces less mucosal tear than percutaneous perforating osteotomy. No statistically significant difference is found between both techniques regarding postoperative periorbital ecchymosis and edema on the second and seventh postoperative days.
Quantity of Acellular Dermal Matrix in Immediate Breast Reconstruction and Outcomes
Authors: Driscoll Cassandra R. , Prabhu Shamit S. , Davidson Amelia L. , Katz Adam J.
Published: February 2022

Purpose

This study aimed to determine the impact of the quantity of acellular dermal matrix (ADM), “ADM burden,” used in implant-based breast reconstruction on infection, drain duration, and seroma formation.

Methods

A single-institution, retrospective review from 2015 to 2020 was conducted for patients who underwent immediate, implant-based breast reconstruction after mastectomy. Three cohorts were generated based on the amount of ADM used: (1) total ADM, (2) sling ADM, and (3) no ADM.

Results

In total, there were 374 patients who satisfied the inclusion criteria yielding 641 breasts with 143, 432, and 66 breasts in the total ADM, sling ADM, and no-ADM groups, respectively. The no-ADM group had higher mastectomy weights (788.4 g) than the sling (654.2 g) and total ADM (503.4 g) groups (F = 10.8, P < 0.001). Total ADM had higher rates of explantation secondary to infection compared with no ADM (P < 0.001). Linear regression analysis for drain duration was significant for body mass index (P < 0.0001) but not for ADM quantity (P = 0.52). Logistic regression analysis demonstrated a higher risk of infection in the total ADM group (odds ratio [OR], 5.4; P < 0.0001). Diabetes mellitus was a risk factor for both infection (OR, 3.6; P = 0.05) and seroma formation (OR, 0.04; P = 0.04).

Conclusions

Higher ADM burden is associated with an increased risk of infections and device explantation secondary to those infections. Although ADM has created new avenues in breast reconstruction, these findings indicate a need to evolve the technique to minimize the ADM burden. By doing so, patients can minimize their risk of postoperative complications while reducing the financial impact on institutions.
Enterococcus alishanensis sp. nov., a novel lactic acid bacterium isolated from fresh coffee beans
Authors: Chung Jen-hao , Otoguro Misa , Yanagida Fujitoshi , Wu Hui-chung , Chang Yu-chung , Lee Yun-Shien , Chen Yi-sheng
Published: February 2022

A coccus-shaped organism, designated ALS3T, was isolated from fresh coffee cherries collected at a farm located in the Ali Mountain region of Taiwan. Sequence analysis of its 16S rRNA gene indicated that strain ALS3T belongs to the genus

Enterococcus

and has more than 98.5 % sequence similarity to

Enterococcus pallens

and

Enterococcus hermanniensis

. When comparing the ALS3T genome with these two type strains, the average nucleotide identity values and digital DNA–DNA hybridization values were 72.6–73.3 and 19.2 %, respectively. The G+C content of the genomic DNA from strain ALS3T was 35.6 mol%. Results of sequence analysis, together with enzymatic activities and characteristics of carbohydrate metabolism, indicated that strain ALS3T is distinct and represents a novel species, for which the name Enterococcus alishanensis sp. nov. is proposed. The type strain is ALS3T (=NBRC 109593T=BCRC 80605T).
CPC-containing oral rinses inactivate SARS-CoV-2 variants and are active in the presence of human saliva
Authors: Anderson Enyia R. , Patterson Edward I. , Richards Siobhan , Pitol Ana K. , Edwards Thomas , Wooding Dominic , Buist Kate , Green Alison , Mukherjee Sayandip , Hoptroff Michael , Hughes Grant L.
Published: February 2022

Introduction. The importance of human saliva in aerosol-based transmission of SARS-CoV-2 is now widely recognized. However, little is known about the efficacy of virucidal mouthwash formulations against emergent SARS-CoV-2 variants of concern and in the presence of saliva.

Hypothesis. Mouthwashes containing virucidal actives will have similar inactivation effects against multiple SARS-CoV-2 variants of concern and will retain efficacy in the presence of human saliva.

Aim. To examine in vitro efficacy of mouthwash formulations to inactivate SARS-CoV-2 variants.

Methodology. Inactivation of SARS-CoV-2 variants by mouthwash formulations in the presence or absence of human saliva was assayed using ASTM International Standard E1052-20 methodology.

Results. Appropriately formulated mouthwashes containing 0.07 % cetylpyridinium chloride but not 0.2 % chlorhexidine completely inactivated SARS-CoV-2 (USA-WA1/2020, Alpha, Beta, Gamma, Delta) up to the limit of detection in suspension assays. Tests using USA-WA1/2020 indicates that efficacy is maintained in the presence of human saliva.

Conclusions. Together these data suggest cetylpyridinium chloride-based mouthwashes are effective at inactivating SARS-CoV-2 variants. This indicates potential to reduce viral load in the oral cavity and mitigate transmission via salivary aerosols.