bluuebunny/crossref_metadata_2025 huggingface dataset:
The care and keeping of clinicians in quality improvement
Authors: Shaikh Ulfat , Lachman Peter , Padovani Andrew J , McCarthy SiobhÁn E
Published: June 2020

Objective

Although frontline clinicians are crucial in implementing and spreading innovations, their engagement in quality improvement remains suboptimal. Our goal was to identify facilitators and barriers to the development and engagement of clinicians in quality improvement.

Design

A 25-item questionnaire informed by theoretical frameworks was developed, tested and disseminated by email.

Settings

Members and fellows of the International Society for Quality in Healthcare.

Participants

1010 eligible participants (380 fellows and 647 members).

Interventions

None.

Main Outcome Measures

Self-efficacy and effectiveness in conducting and leading quality improvement activities.

Results

We received 212 responses from 50 countries, a response rate of 21%. Dedicated time for quality improvement, mentorship and coaching and a professional quality improvement network were significantly related to higher self-efficacy. Factors enhancing effectiveness were dedicated time for quality improvement, multidisciplinary improvement teams, professional development in quality improvement, ability to select areas for improvement and organizational values and culture. Inadequate time, mentorship, organizational support and access to professional development resources were key barriers. Personal strengths contributing to effectiveness were the ability to identify problems that need to be fixed, reflecting on and learning from experiences and facilitating sharing of ideas. Key quality improvement implementation challenges were adopting new payment models, demonstrating the business case for quality and safety and building a culture of accountability and transparency.

Conclusions

Our findings highlight areas that organizations and professional development programs should focus on to promote clinician development and engagement in quality improvement. Barriers related to training, time, mentorship, organizational support and implementation must be concurrently addressed to augment the effectiveness of other approaches.
Diversity, abundance, and life histories of littoral chydorids (Cladocera: Chydoridae) in a subarctic European lake
Authors: Klemetsen Anders , Aase Berit M , Amundsen Per-Arne
Published: June 2020

Littoral chydorids were sampled with a bottom sledge in Takvatn, a 15 km2 north Norwegian oligotrophic lake with poor vegetation. Three out of eight recorded species of chydorids were common, with abundance minima in late summer and maxima in autumn. Eurycercus lamellatus (O.F. Müller, 1776) and Acroperus harpae (Baird, 1835) were monocyclic, whereas Chydorus sphaericus (O.F. Müller, 1776) was seemingly acyclic. Females of E. lamellatus appeared in early June and grew to maximum sizes of 2–2.5 mm in early August. Parthenogenesis started in late July and two summer generations could be distinguished by size distributions. Gamogenesis took place in September. Acroperus harpae females appeared in early June and grew to maximum sizes of around 0.7 mm in early August. Parthenogenesis started in early July and gamogenesis took place in September and October. Parthenogenetic females of C. sphaericus appeared already at ice-break and had constant sizes of around 0.4 mm through the entire season. Males or ephippial females were not observed. The acyclic life history may be an adaptation to the challenging environment of this subarctic lake. Summer generations could not be distinguished in the two small-sized species, but both populations reached high abundances in autumn. The abundance of E. lamellatus increased from August, but then decreased, possibly as a result of fish predation. We argue that the present results are typical for large oligotrophic lakes in subarctic Europe.
Poets of Promotion: Corporate Personality and Crowd Psychology in Guy Thorne and Leo Custance’s Sharks (1904)
Authors: Nielsen Jakob Gaardbo
Published: June 2020

This article deals with the relationship between fin-de-siècle crowd psychology and joint-stock companies in late Victorian and early Edwardian financial novels, most notably Guy Thorne and Leo Custance’s Sharks (1904). This satirical novel is not only an anatomy of the turn-of-the-century joint-stock economy, but also a critical examination of the legal principle of corporate personality and the ontology of the financial corporation. Tracing the launch and life of a ridiculously speculative joint-stock company, and employing a central metaphor of emergent corporative agency drawn from contemporary crowd psychologists such as Gustave Le Bon, the novel applies the formal logic of incorporation as a narrative principle and constructs a dystopic, farcical vision of the possibilities inherent in joint-stock companies for organizing, ordering, and connecting individuals. The article argues that, by positing the corporate person as a beheaded Leviathan, the novel portrays joint-stock business, and particularly the promotion of new companies, as an eminently imaginative kind of work, involving not simply the dissemination of financial information, but also an affective preconditioning of the investing public by means of an excessive production of texts across the period’s booming print industries.
Swimming-Induced Pulmonary Edema in an Active-Duty Female Triathlete
Authors: Haran James B , Donaldson Chase , Kicker Patrick W
Published: June 2020

Swimming-induced pulmonary edema (SIPE) is a noncardiogenic form of acute pulmonary edema infrequently described in the general military literature. Its pathophysiology is poorly understood. Treatment is supportive. Knowledge of SIPE is important for the military physician and should remain a top differential for any patient presenting with acute pulmonary edema following a water sport. This is the case of a patient with SIPE occurring during the swim portion of a Half Ironman Triathlon.
Exploring Theta Burst Stimulation for Post-traumatic Stress Disorder in Australian Veterans—A Pilot Study
Authors: Nursey Jane , Sbisa Alyssa , Knight Holly , Ralph Naomi , Cowlishaw Sean , Forbes David , O’Donnell Meaghan , Hinton Mark , Cooper John , Hopwood Malcolm , McFarlane Alexander , Herring Sally , Fitzgerald Paul
Published: June 2020

Introduction

Post-traumatic stress disorder (PTSD) is a severe and debilitating condition affecting a significant proportion of the veteran community. A substantial number of veterans with PTSD fail to benefit from trauma-focused psychological therapies or pharmacotherapy or are left with residual symptoms, and therefore, investigation of new and innovative treatment is required. Theta Burst Stimulation (TBS) is a novel form of Repetitive Transcranial Magnetic Stimulation, which has been shown to improve depression symptoms and associated cognitive deficits. The current pilot study aimed to explore the acceptability, safety, and tolerability of intermittent TBS (iTBS) as a treatment for PTSD in Australian veterans.

Materials and Methods

This study employed a case series, repeated-measures design. Eight Australian Defence Force veterans with PTSD received 20 bilateral iTBS treatments (1 session per day, 5 days per week over a 4-week period) and were assessed on a range of mental health and neuropsychological measures, including the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and Hamilton Depression Rating Scale (HAM-D), at pretreatment, post-treatment, and a 3-month follow-up.

Results

Treatment was generally welltolerated, with reported side-effects including mild to moderate site-specific cranial pain and headaches during stimulation, which were relieved with the use of low dose analgesics. No serious side effects or adverse events were reported. Participants exhibited reductions in both PTSD and depression symptom severity (the repeated-measures effect size [dRM] for the CAPS-5 was −1.78, and the HAM-D was −1.16 post-treatment), as well as improvements in working memory and processing speed. Although significance cannot be inferred, these preliminary estimates of effect size indicate change over time.

Conclusions

Bilateral iTBS appears to be welltolerated by Australian veterans. Within this repeated-measures case series, iTBS treatment shows promise in reducing both PTSD and mood symptoms, as well as improving cognitive difficulties associated with these disorders. Large-scale randomized controlled trials of this promising treatment are warranted.
SMOOTH, NONSYMPLECTIC EMBEDDINGS OF RATIONAL BALLS IN THE COMPLEX PROJECTIVE PLANE
Authors: Owens Brendan
Published: June 2020

We exhibit an infinite family of rational homology balls, which embed smoothly but not symplectically in the complex projective plane. We also obtain a new lattice embedding obstruction from Donaldson’s diagonalization theorem and use this to show that no two of our examples may be embedded disjointly.
Introduction to Interdisciplinary Roles in a Nursing Leadership Course
Authors: Yordy Morgan , Lambert Ann , Parker Francine
Published: June 2020

Active learning experiences for undergraduate nursing students build upon their understanding of concepts that transfer to new learning skills throughout the curriculum. Faculty implemented a leadership simulation in the classroom focusing on communication skills as a nurse leader to better understand the role of the nurse in the interdisciplinary team. The classroom setting is an ideal platform to teach interdisciplinary collaboration when opportunities do not present in the clinical setting. Scaffolding simulation experiences throughout the curriculum helps bridge the knowledge and skills gap between classroom and clinical experiences.
A National, Qualitative Study of the Motivators and Outcomes of Nurse Educator Certification
Authors: Lindell Deborah F. , Hagler Debra , Poindexter Kathleen
Published: June 2020

AIM

This qualitative study sought to describe motivators and outcomes of academic nurse education certification.

BACKGROUND

Several studies have explored perceptions of the value of nurse educator certification (CNE). However, there is a gap in understanding motivators and outcomes of certification as a nurse educator.

METHOD

As part of a larger, web-based, mixed-method study, a national sample of certified and noncertified nursing educator administrators and faculty responded to nine open-ended questions. The inductive content analysis approach was used to identify constructs and themes.

RESULTS

From an overall sample of 721 participants, three constructs and associated themes emerged.

CONCLUSION

Motivators for pursing CNE align with previously reported intrinsic values. Participants seek extrinsic rewards as well. Educator outcomes include enhanced teaching and expanded roles. Student outcomes were less clear. Further study of outcomes of CNE is recommended to promote recognition of academic nursing education as an advanced nursing specialty.
Exploring the Contributions of Combined Model Regional Medical Education Campuses to the Physician Workforce
Authors: Bates Joanna , Grand’Maison Paul , Banner Sandra R. , Lovato Chris Y. , Eva Kevin W.
Published: June 2020

Purpose

Physician shortages and maldistribution, particularly within family medicine, have led many medical schools worldwide to create regional medical campuses (RMCs) for clerkship training. However, Canadian medical schools have developed a number of RMCs in which all years of training (i.e., a combined model that includes both preclerkship and clinical training) are provided geographically separate from the main campus. This study addresses the question: Are combined model RMC graduates more likely to enter postgraduate training in family medicine and rural-focused programs relative to main campus graduates?

Method

The authors used a quasi-experimental research design and analyzed 2006–2016 data from the Canadian Resident Matching Service (CaRMS). Graduating students (N = 26,525) from 16 Canadian medical schools who applied for the CaRMS match in their year of medical school graduation were eligible for inclusion. The proportions of graduates who matched to postgraduate training in (1) family medicine and (2) rural-focused programs were compared for combined model RMCs and main campuses.

Results

Of RMC graduates, 48.4% matched to family medicine (95% confidence interval [CI] = 46.1–50.7) compared with 37.1% of main campus graduates (95% CI = 36.5–37.7; P < .001). Of RMC graduates, 23.9% matched to rural-focused training programs (95% CI = 21.8–25.9) compared with 10.4% of main campus graduates (95% CI = 10.0–10.8; P < .001). Subanalyses ruled out a variety of potentially confounding variables.

Conclusions

Combined model RMCs, in which all years of training take place away from the medical school’s main campus, are associated with greater proportions of medical students entering family medicine postgraduate training and rural-focused training programs. These findings should encourage policymakers, health services agencies, and medical schools to continue seeking complements to academic medical center-based medical education.
Growth Disturbance Following Intra-articular Distal Radius Fractures in the Skeletally Immature Patient
Authors: Kallini Jennifer R. , Fu Eric C. , Shah Apurva S. , Waters Peter M. , Bae Donald S.
Published: June 2020

Introduction:

The purpose of this study was to characterize the incidence of growth disturbance following intra-articular distal radius fractures in skeletally immature patients and to assess early radiographic and functional outcomes.

Methods:

A retrospective investigation of pediatric patients with intra-articular distal radius fractures between 1997 and 2012 at a single institution was performed. Pathologic fractures and fractures in patients with closed physes were excluded. In total, 28 patients (24 males, 4 females), with a mean age of 13.8 years and mean follow-up of 31.7 months, met inclusion criteria. Fractures were categorized according to the Salter-Harris classification, and all radiographs were assessed for evidence of physeal disturbance. Information regarding treatment and early clinical results were obtained from a medical record review. Functional outcomes using the Disabilities of the Arm, Shoulder, and Hand (DASH) and Modified Mayo Wrist Score (MMWS) were collected. Fisher exact test was used to compare the incidence of physeal arrest in the study population to previously published rates of physeal arrest in extra-articular fractures involving the distal radius. Because the data were not parametrically distributed, the Mann-Whitney-Wilcoxon test was used to compare those who did and did not develop physeal arrest.

Results:

Of the 28 patients, 9 (32%) sustained Salter-Harris III fractures and 19 (68%) sustained Salter-Harris IV fractures. Growth disturbance occurred in 12 (43%) patients, comprised of 3 Salter-Harris III fractures and 9 Salter-Harris IV fractures; 7 of these patients underwent surgical intervention to address deformity. All 4 children age 10 years or younger had growth arrests that underwent subsequent procedures for a skeletal rebalancing of the wrist. No significant differences in DASH or MMWS were seen in the short term between patients who did or did not have physeal arrest.

Conclusions:

Intra-articular distal radius fractures in skeletally immature patients have a considerably higher rate of physeal growth arrest than extra-articular physeal fractures. Following acute management aimed at restoring and preserving anatomic physeal and articular alignment, follow-up radiographs should be obtained to evaluate for physeal arrest in skeletally immature children. Patients and families should be counseled regarding the high rate of growth disturbance and the potential need for deformity correction in the future, particularly in younger children.

Level of Evidence:

IV—case series.
Percutaneous Radiofrequency Ablation of the Posterior and Anterior Interosseous Nerves for Chronic Wrist Pain: A Novel Technique
Authors: Smeraglia Francesco , Berritto Daniela , Basso Morena A. , Mosillo Giuseppe , Grassi Roberto , Mariconda Massimo
Published: June 2020

The treatment of chronic wrist pain, due to posttraumatic, degenerative, or inflammatory arthritis, is challenging to adequately manage. The ideal surgical procedure should preserve wrist mobility and provide long-lasting pain relief. In this regard, denervation aims to decrease wrist pain by interrupting sensory innervation, without impairing motor function, and avoids the need for postoperative immobilization to decrease the risk of stiffness. For these reasons, denervation is particularly attractive as a possible treatment for chronic wrist pain. Our aim was to describe our novel technique for partial percutaneous wrist denervation, performed by radiofrequency ablation of the posterior and anterior interosseous nerves, and to report on the prospective outcomes over a 1-year follow-up for 3 patients (4 wrists) treated as of March 2019. The technique is performed on an outpatient basis and does not require postprocedure wrist immobilization or restriction in activities of daily living or work. Findings at the 1-year follow-up indicate that partial denervation improved grip strength, provided pain relief, maintained wrist motion, and improved subjective report of disabilities of the arm, shoulder, and hand. One patient did not report a benefit of the procedures, with other patients being very satisfied. Our percutaneous procedure is an evolution of the traditional partial denervation technique, providing advantages of being less invasive, not requiring restriction of movement or activities in the postoperative phase, can be performed on an out-patient basis, and does not preclude the subsequent use of invasive surgical procedures, as needed.
Assessment and management of low anterior resection syndrome after sphincter preserving surgery for rectal cancer
Authors: Sakr Ahmad , Sauri Fozan , Alessa Mohammed , Zakarnah Eman , Alawfi Homoud , Torky Radwan , Kim Ho Seung , Yang Seung Yoon , Kim Nam Kyu
Published: June 2020

Many patients develop a variety of bowel dysfunction after sphincter preserving surgeries (SPS) for rectal cancer. The bowel dysfunction usually manifests in the form of low anterior resection syndrome (LARS), which has a negative impact on the patients’ quality of life. This study reviewed the LARS after SPS, its mechanism, risk factors, diagnosis, prevention, and treatment based on previously published studies. Adequate history taking, physical examination of the patients, using validated questionnaires and other diagnostic tools are important for assessment of LARS severity. Treatment of LARS should be tailored to each patient. Multimodal therapy is usually needed for patients with major LARS with acceptable results. The treatment includes conservative management in the form of medical, pelvic floor rehabilitation and transanal irrigation and invasive procedures including neuromodulation. If this treatment failed, fecal diversion may be needed. In conclusion, Initial meticulous dissection with preservation of nerves and creation of a neorectal reservoir during anastomosis and proper Kegel exercise of the anal sphincter can minimize the occurrence of LARS. Pre-treatment counseling is an essential step for patients who have risk factors for developing LARS.
Small airway immunoglobulin A profile in emphysema-predominant chronic obstructive pulmonary disease
Authors: Liu Hu , Tang Huo-Yan , Xu Jian-Ying , Pang Zhi-Gang
Published: June 2020

Background

Due to airway remodeling and emphysematous destruction in the lung, the two classical clinical phenotypes of chronic obstructive pulmonary disease (COPD) are emphysema and bronchiolitis. The present study was designed to investigate the levels of small airway immunoglobulin A (IgA) in COPD with “emphysema phenotype.” The study also evaluated the associations between the small airway IgA levels and the severity of disease by the extent of emphysema versus airflow limitation.

Methods

Thirty patients (20 with COPD and ten healthy smokers) undergoing lung resection surgery for a solitary peripheral nodule were included. The study was conducted from January 2015 to December 2018 in the Shanxi Dayi Hospital. The presence of small airway IgA expression was determined in the lung by immunohistochemistry. In vivo, Wistar rats were exposed to silica by intratracheal instillation. Rats were sacrificed at 15 and 30 days after exposure of silica (n = 10 for each group). We also evaluated airway IgA from rats.

Results

Small airway secretory IgA (sIgA), dimeric IgA (dIgA), and dIgA/sIgA of Global Initiative for Chronic Obstructive Lung Disease grade 1–2 COPD patients showed no difference compared with smoking control subjects (5.15 ± 1.53 vs. 6.03 ± 0.85; 1.94 ± 0.66 vs. 1.67 ± 0.04; 41.69 ± 21.02 vs. 28.44 ± 9.45, all P > 0.05). dIgA/sIgA level in the lung of COPD patients with emphysema showed higher levels than that of COPD patients without emphysema (51.89 ± 24.81 vs. 31.49 ± 9.28, P = 0.03). The percentage of low-attenuation area below 950 Hounsfield units was positively correlated with dIgA/sIgA levels (r = 0.45, P = 0.047), but not associated with the severity of disease by spirometric measurements (forced expiratory volume in the first second %pred, P > 0.05). Likewise, in the rat study, significant differences in sIgA, dIgA, dIgA/sIgA, mean linear intercept, mean alveoli number, and mean airway thickness of bronchioles (VV airway, all P < 0.01) were only observed between control rats and those exposed for 30 days. However, in the group exposed for 15 days, although the VV airway was higher than that in normal rats (27.61 ± 2.26 vs. 20.39 ± 1.99, P < 0.01), there were no significant differences in IgA and emphysema parameters between the two groups (all P > 0.05).

Conclusion

Airway IgA concentrations in mild and moderate COPD patients are directly associated with the severity of COPD with “emphysema phenotype” preceding severe airway limitation. This finding suggests that small airway IgA might play an important role in the pathophysiology of COPD, especially emphysema phenotype.
A guide to human microbiome research: study design, sample collection, and bioinformatics analysis
Authors: Qian Xu-Bo , Chen Tong , Xu Yi-Ping , Chen Lei , Sun Fu-Xiang , Lu Mei-Ping , Liu Yong-Xin
Published: June 2020

The purpose of this review is to provide medical researchers, especially those without a bioinformatics background, with an easy-to-understand summary of the concepts and technologies used in microbiome research. First, we define primary concepts such as microbiota, microbiome, and metagenome. Then, we discuss study design schemes, the methods of sample size calculation, and the methods for improving the reliability of research. We emphasize the importance of negative and positive controls in this section. Next, we discuss statistical analysis methods used in microbiome research, focusing on problems with multiple comparisons and ways to compare β-diversity between groups. Finally, we provide step-by-step pipelines for bioinformatics analysis. In summary, the meticulous study design is a key step to obtaining meaningful results, and appropriate statistical methods are important for accurate interpretation of microbiome data. The step-by-step pipelines provide researchers with insights into newly developed bioinformatics analysis methods.
Zinc finger and BTB domain-containing protein 46 is essential for survival and proliferation of acute myeloid leukemia cell line but dispensable for normal hematopoiesis
Authors: Liu Yuan-Yuan , Xiao Fei-Fei , Yang Bi-Jie , Li Xi , Xu Shuang-Nian , Chen Zhi-Wei , Li Ping , Huang Yong-Xiu , Fu Xue-Mei , Huang Xing-Qin , Zheng Guang-Ling , Chen Jie-Ping , Hou Yu
Published: June 2020

Background

Zinc finger and BTB domain-containing protein 46 (Zbtb46) is a transcription factor identified in classical dendritic cells, and maintains dendritic cell quiescence in a steady state. Zbtb46 has been reported to be a negative indicator of acute myeloid leukemia (AML). We found that Zbtb46 was expressed at a relatively higher level in hematopoietic stem and progenitor cells (HSPCs) compared to mature cells, and higher in AML cells compared to normal bone marrow (BM) cells. However, the role of Zbtb46 in HSPCs and AML cells remains unclear. Therefore, we sought to elucidate the effect of Zbtb46 in normal hematopoiesis and AML cells.

Methods

We generated Zbtb46
fl/fl and Zbtb46
fl/fl
Mx1-Cre mice. The deletion of Zbtb46 in Zbtb46
fl/fl
Mx1-Cre mice was induced by intraperitoneal injection of double-stranded poly (I). poly (C) (poly(I:C)), and referred as Zbtb46 cKO. After confirming the deletion of Zbtb46, the frequency and numbers of HSPCs and mature blood cells were analyzed by flow cytometry. Serial intraperitoneal injection of 5-fluorouracil was administrated to determine the repopulation ability of HSCs from Zbtb46
fl/fl and Zbtb46 cKO mice. The correlation between Zbtb46 expression and prognosis was analyzed using the data from the Cancer Genome Atlas. To investigate the role of Zbtb46 in AML cells, we knocked down the expression of Zbtb46 in THP-1 cells using lentiviral vectors expressing small hairpin RNAs targeting Zbtb46. Cell proliferation rate was determined by cell count assay. Cell apoptosis and bromodeoxyuridine incorporation were determined by flow cytometry.

Results

The percentages and absolute numbers of HSPCs and mature blood cells were comparable in Zbtb46 cKO mice and its Zbtb46
fl/fl littermates (Zbtb46
fl/fl
vs. Zbtb46 cKO, HPC: 801,310 ± 84,282 vs. 907,202 ± 97,403, t = 0.82, P = 0.46; LSK: 86,895 ± 7802 vs. 102,210 ± 5025, t = 1.65, P = 0.17; HSC: 19,753 ± 3116 vs. 17,608 ± 3508, t = 0.46, P = 0.67). The repopulation ability of HSCs from Zbtb46
fl/fl
Mx1-Cre mice was similar to those from Zbtb46
fl/fl control (P = 0.26). Zbtb46 had elevated expression in AML cells compared to total BM cells from normal control. Knockdown of Zbtb46 in THP-1 cells led to a significant increase in cell apoptosis and reduced cell growth and proliferation.

Conclusion

Collectively, our data indicate that Zbtb46 is essential for survival and proliferation of AML cells, but dispensable for normal hematopoiesis.
Survivors’ Perceptions of Quality of Colorectal Cancer Care by Sexual Orientation
Authors: Boehmer Ulrike , Clark Melissa A. , Ozonoff Al , Winter Michael , Potter Jennifer
Published: June 2020

Objective:

The objective of this study was to assess sexual minority and heterosexual survivors’ perceived quality of cancer care and identify demographic, clinical, and psychosocial characteristics associated with patient-centered quality of care.

Materials and Methods:

Four cancer registries provided data on 17,849 individuals who were diagnosed with stage I, II, or III colorectal cancer an average of 3 years prior and resided in predetermined diverse geographic areas. A questionnaire, which queried about sexual orientation and other eligibility criteria was mailed to all cancer survivors. Of these, 480 eligible survivors participated in a telephone survey. Quality of cancer care was defined by 3 measures of interpersonal care (physician communication, nursing care, and coordination of care) and by rating cancer care as excellent. We used generalized linear models and logistic regression with forward selection to obtain models that best explained each quality of care measure.

Results:

Sexual minority survivors rated physician communication, nursing care, and coordination of care similarly to heterosexual survivors, yet a significantly higher percentage of sexual minority survivors rated the overall quality of their cancer care as excellent (59% vs. 49%). Sexual minority survivors’ greater likelihood of reporting excellent care remained unchanged after adjusting for demographic, clinical, and psychosocial characteristics.

Conclusions:

Sexual minority survivors’ ratings of quality of colorectal cancer care were comparable or even higher than heterosexual survivors. Sexual minority survivors’ reports of excellent care were not explained by their interpersonal care experiences.
Extensive Scarring Alopecia Treated Through a Single Dense-Packing Follicular Unit Extraction Megasession
Authors: Zhu De-Cong , Liu Pei-Hua , Fan Zhe-Xiang , Hu Zhi-Qi , Miao Yong
Published: June 2020

BACKGROUND

Follicular unit extraction (FUE) is becoming more popular in hair restoration. However, its potential for treating extensive scarring alopecia is unknown.

METHODS

Patients with scarring alopecia larger than 100 cm2 were enrolled from 2015 to 2018. After assessing scar quality regarding vascularity, pliability, and thickness, dense-packing megasession (DPM)-FUE was performed on high-quality recipient sites. Patients were followed up at 1 week and 12 months postoperatively to evaluate complications, survival rates of grafts, and patient satisfactions. Cases of nonscarring alopecia were reviewed as controls.

RESULTS

Fifty-two scarring alopecia and 55 nonscarring alopecia patients were enrolled. The mean scar area was 120 cm2, and the procedure required an average of 8 operative hours, with no difference between groups (p > .05). Graft amount and postoperative complications were similar as well (p > .05). The survival rate in scarring alopecia was lower than that in the control but was still 85% (p < .05). Follow-up photographs showed effective scar camouflage after DPM-FUE. Most patients were very satisfied with the final results (p > .05).

CONCLUSION

DPM-FUE is a safe and effective treatment for extensive scarring alopecia.
Mechanical Strain of the Trilobed Transposition Flap in Artificial Skin Models: Pivotal Restraint Decreases With Decreasing Rotational Angles
Authors: Gibbons Mitchell S. , Gruber Paul J. , Syed Sana , Sell Scott A. , Carroll Chris J. , Maher Ian A.
Published: June 2020

BACKGROUND

In transposition flaps, thicker tissue and higher degrees of rotation are associated with increased pivotal restraint; however, limited experimental data exist quantifying the degree to which these affect flap biomechanics. The use of artificial skin models in conjunction with digital image correlation technology allows for investigation into biomechanical properties of skin flaps.

OBJECTIVE

To quantify the effects of tissue thickness and rotational angles on pivotal restraint within transposition flaps using artificial skin models.

METHODS

Ninety degree bilobed and trilobed flaps were used to close defects in artificial skin models of increasing thicknesses. Digital image correlation was used to quantify strain. Quantitative and qualitative differences in strain were assessed in increasing flap thicknesses and between flap designs.

RESULTS

Increasing flap thickness was associated with decreasing strain. In the bilobed flap, increasing thickness was associated with displacement of the flap pivot point away from the distal flap edge. Comparatively, lower angles of rotation in the trilobed flap were not associated with migration of the flap pivot point.

CONCLUSION

Increased pivotal restraint observed in higher degrees of rotation is due to migration of the flap pivot point. This model supports the common practice of decreasing flap angles to compensate for pivotal restraint.
Case Series of Stickler Syndrome Presenting With Acute Angle Closure
Authors: Walters Alexander , Lambert Nathan , Bricel Seth , Hwang Thomas , Ing Eliesa , Tehrani Shandiz
Published: June 2020

Purpose:

Stickler syndrome is associated with open-angle glaucoma, but no reports exist of adults presenting with acute angle closure. Here, we report the clinical associations and short-term outcomes in 2 patients with Stickler syndrome who presented with acute angle closure at a single tertiary referral center.

Observations:

A 36-year-old female with Stickler syndrome presented with acute onset of red and painful left eye with cloudy vision. Initial intraocular pressure (IOP) was measured to be 54 mm Hg. Gonioscopy revealed no angle structures or peripheral anterior synechiae in the left eye. Two laser peripheral iridotomies were created 5 days apart without adequate IOP lowering. Left eye cataract extraction with intraocular lens implantation and Ahmed glaucoma drainage device implantation were performed with resolution of ocular hypertension.

A 35-year-old male with Stickler syndrome presented with intermittent right eye pain and blurry vision. IOP was 42 mm Hg and gonioscopy revealed 270 degrees of angle closure in the right eye. The patient underwent laser peripheral iridotomy in the right eye with resolution of ocular hypertension by the next day.

Conclusions:

Recognizing angle closure as a potential feature of Stickler syndrome can help providers adequately screen and manage patients with Stickler syndrome presenting with acutely elevated IOP.
Health Professionals' Perspectives on the Efficacy of Using Comprehensive Care to Improve Outcomes in Patients With Traumatic Injury
Authors: LU Hsing-Ju , HUANG Hsiu-Mei , HSIAO Tsai-Yun , HUNG Chang-Chiao , LIN Wei-Ting , LEE Bih-O
Published: June 2020

Background

Barriers related to comprehensive posttrauma care and health outcome monitoring exist. The insights and perspectives of health professionals on this issue may help integrate care experiences to provide continuous care to patients with traumatic injury.

Purpose

The purpose of this study was to explore the perspectives of health professionals with regard to comprehensive care to improve the outcomes of patients with traumatic injury.

Methods

Data were collected at two teaching hospitals in Taiwan. In total, 28 health professionals across various disciplines were interviewed in five focus groups.

Results

Six themes were delineated, including “wound care is a primary concern for patients,” “ineffective health education during the hospital stay,” “patients and families worry about postinjury conditions,” “current continuity of care is not effective,” “lack of standards for discharge planning,” and “incorporation of interdisciplinary care to improve patient outcomes.”

Conclusions

The experiences of health professionals are useful to the establishment of a foundation for trauma case management and interdisciplinary care for hospitals.
Novel Strategies for Predicting Healthcare-Associated Infections at Admission
Authors: Zachariah Philip , Sanabria Elioth , Liu Jianfang , Cohen Bevin , Yao David , Larson Elaine
Published: June 2020

Background

Accurate, real-time models to predict hospital adverse events could facilitate timely and targeted interventions to improve patient outcomes. Advances in computing enable the use of supervised machine learning (SML) techniques to predict hospital-onset infections.

Objectives

The purpose of this study was to trial SML methods to predict urinary tract infections (UTIs) during inpatient hospitalization at the time of admission.

Methods

In a large cohort of adult hospitalizations in three New York City acute care facilities (N = 897,344), we used two SML methods—neural networks and decision trees—to predict having a hospital-onset UTI using data available and accessible on the first day of admission at healthcare facilities in the United States.

Results

Performance for both neural network and decision tree models were superior compared to logistic regression methods. The decision tree model had a higher sensitivity compared to neural network, but a lower specificity.

Discussion

SML methods show potential for automated accurate UTI risk stratification using electronic data routinely available at admission; this could relieve nurses from the burden of having to complete and document additional risk assessment forms in the electronic medical record. Future studies should pilot and test interventions linked to the risk stratification results, such as short nursing educational modules or alerts triggered for high-risk patients.
Evaluation of Antegonial Angle and Antegonial Depth to Estimate Sex in a Prepubertal Turkish Population
Authors: Apaydin Burak Kerem , Ozbey Hilal
Published: June 2020

This retrospective study aimed to measure the antegonial angle (AGA) and antegonial depth (AGD) on panoramic radiographs in a Turkish subpopulation and to determine how those measurements relate to sex before puberty. A total of 600 patients were divided into 3 age groups (5, 6, or 7 years), and each group consists of 100 boys and 100 girls. For each patient, AGA and AGD indices in panoramic radiograph were measured by an oral radiologist and pediatric dentist. To our knowledge, this is the first study measuring AGA and AGD parameters on prepubertal subjects and identifying sex differences in these parameters. The data were analyzed by independent t test, Mann-Whitney U test, Spearman correlation analysis, and intraclass correlation coefficient for interobserver compliance using the SPSS software program. In all age groups, a statistically significant difference was found between the prepubertal boys and girls in both AGA and AGD parameters (P < 0.05). Our findings support the conclusion that, in addition to adults, AGA and AGD indices can be used to determine the sex of prepubertal Turkish children. These parameters can be used to determine the sex in forensic investigations of victims in whose age or pubertal condition are not known.
Association of Lung Function With HIV-Related Quality of Life and Health Care Utilization in a High-Risk Cohort
Authors: Raju Sarath , McCormack Meredith C. , Drummond Michael Bradley , Ramamurthi Hema C. , Merlo Christian A. , Wise Robert A. , Mehta Shruti H. , Brown Robert H. , Kirk Gregory D.
Published: June 2020

Background:

Chronic respiratory disease represents an important comorbidity for persons living with HIV (PLWH). HIV itself is associated with greater impairment in lung function. We aimed to determine the association between declining lung function and both quality of life (QOL) and health care utilization for PLWH.

Methods:

Using longitudinal data from the Study of HIV Infection in the Etiology of Lung Disease 2009–2017, we studied the association between changes in lung function and both QOL and acute care events (emergency department visit or hospitalization). The Medical Outcomes Studies-HIV Questionnaire provided QOL domains. Multivariable regression models were performed with generalized estimating equations accounting for 1499 participants, 485 with HIV, contributing 10,825 spirometry visits.

Results:

Among PLWH, decreased FEV1 was associated with worse physical health for those with higher viral load [β: −1.66, 95% confidence interval (CI): −3.11 to −0.39] compared to those with viral suppression (β: −0.58, 95% CI: −1.06 to −0.162), even in those without airflow obstruction. Lower FEV1 was also associated with increased odds of both emergency department (odds ratio: 1.21, 95% CI: 1.09 to 1.34) and inpatient (odds ratio: 1.26, 95% CI: 1.12 to 1.42) hospitalizations for PLWH. Lung function was not associated with increased odds of acute care events for HIV-uninfected participants.

Conclusions:

FEV1 declines represent an independent predictor of QOL and acute care events among PLWH. Although the generalizability of these results may be limited, because of the high-risk population included, findings suggest that care for PLWH should involve monitoring FEV1 over time, especially in those with poor virologic control, with emphasis on the development and implementation of interventions to mitigate lung function decline.
Nasal Cracking Leading to Septal Hematoma
Authors: Ali Aleeza , Gerth David , Thaller Seth Ray
Published: June 2020

Nasal cracking is the habit of applying pressure to one's nose until hearing a popping noise or feeling a release of pressure. Clinicians are mostly unaware of it as it is a lesser known habit that has been popularized on social media. Most often it is harmless, however sometimes it can lead to adverse consequences such as pain, bruising, bleeding, and/or breathing problems. In this case study, a patient is evaluated and treated for nasal cracking that led to a septal hematoma.
Beare-Stevenson Syndrome With Blepharoptosis as a Complication of Front-Orbital Advancement and Remodeling
Authors: Platt Alexander , Budden Curtis , Badilla Jaime , Pollock Natashka , Louie Gorman , Mehta Vivek
Published: June 2020

Beare-Stevenson syndrome (BSS) is an extremely rare genetic disorder characterized by a broad range of congenital malformations including craniosynostosis, cutis gyrata, facial deformities, and abnormal genitalia. The authors report a case of a 7 month old female who developed a mechanical ptosis secondary to dermatochalasis as a complication of fronto-orbital advancement and remodeling (FOAR) surgery which subsequently required multiple lid surgeries to reverse ptosis. This is the first report of blepharoptosis correction in a child with BSS as a complication of FOAR.
Delayed Supratentorial Intracerebral Hemorrhage After Posterior Fossa Acoustic Neuroma Surgery
Authors: Abuzayed Bashar , Alawneh Khaled , Qawasmeh Majdi Al , Abdalla Khalid , Al-Ali Mai , Raffee Liqaa
Published: June 2020

A 72-year-old female patient was complaining from gradual loss of hearing in the left ear, left facial palsy with gait imbalance. Neuroimaging showed left cerebellopontine angle extra-axial mass and was diagnosed as acoustic neuroma. She was operated with left retromastoid suboccipital and gross total excision of the tumor was achieved. Early postoperative period was uneventful and brain computed tomographic (CT) scan in the postoperative day 1 showed gross total resection of the tumor without complications, and patient was discharged at the postoperative day 4. In the postoperative day 7, the patient showed decrease level of consciousness and brain CT scan showed a small hematoma in the anterior part of the left temporal lobe, which was evolved to large intraparanchymal hemorrhage with midline shift in postoperative day 9.
Vertical Distraction for the Treatment of Congenital Syngnathia
Authors: Zhu Wansheng , Choi Katherine J. , Wolfswinkel Erik M. , Goel Pedram , Hammoudeh Jeffrey
Published: June 2020

Congenital syngnathia is a very rare condition that presents with several unique challenges. There is no consensus on the best operative approach to manage this condition. Readhesion of surgically separated tissues is a relatively common occurrence. The authors propose that the use of a vertical distraction technique helps maintain adequate separation to prevent relapse of the bony fusion. Long-term follow-up will be required to follow mandibular growth and implications of this treatment option.
Endoscopic Forehead Approach for Minimally Invasive Frontal Osteoma Excision
Authors: Raponi Ingrid , Giovannetti Filippo , Cacciatore Federica , Di Carlo Daniele , Valentini Valentino
Published: June 2020

Benign osseous tumors of the frontal bone can be treated with endoscopic surgery, minimizing postoperative complications associated with the coronal approach and guaranteeing more functional and aesthetic results. The authors describe a case of a patient who had endoscopic removal of osteoma of the forehead using two 1 cm incisions behind the hairline. No complications such as hematoma and edema were detected. Endoscopic technique offered both good illumination and excellent magnification; it permitted safe anatomic dissection, minimum bleeding, avoiding visible scars. The outcome achieved with endoscopic technique could be the first-line surgical treatment of benign bone tumors of the frontal area, offering more advantages and better results than the conventional surgical approaches.
It's in the loop: shared sub-surface foot kinematics in birds and other dinosaurs shed light on a new dimension of fossil track diversity
Authors: Turner Morgan L. , Falkingham Peter L. , Gatesy Stephen M.
Published: June 2020

The feet of ground-dwelling birds retain many features of their dinosaurian ancestry. Experiments with living species offer insights into the complex interplay among anatomy, kinematics and substrate during the formation of Mesozoic footprints. However, a key aspect of the track-making process, sub-surface foot movement, is hindered by substrate opacity. Here, we use biplanar X-rays to image guineafowl walking through radiolucent substrates of different consistency (solid, dry granular, firm to semi-liquid muds). Despite substantial kinematic variation, the foot consistently moves in a looping pattern below ground. As the foot sinks and then withdraws, the claws of the three main toes create entry and exit paths in different locations. Sampling these paths at incremental horizons captures two-dimensional features just as fossil tracks do, allowing depth-based zones to be characterized by the presence and relative position of digit impressions. Examination of deep, penetrative tracks from the Early Jurassic confirms that bipeds had an equivalent looping response to soft substrates approximately 200 Ma. Our integration of extant and extinct evidence demonstrates the influence of substrate properties on sinking depth and sub-surface foot motion, both of which are significant sources of track variation in the fossil record of dinosaurs.
Beyond the limits: identifying the high-frequency detectors in the anuran ear
Authors: Cobo-Cuan Ariadna , Grafe T. Ulmar , Narins Peter M.
Published: June 2020

Despite the predominance of low-frequency hearing in anuran amphibians, a few frog species have evolved high-frequency communication within certain environmental contexts.
Huia cavitympanum
is the most remarkable anuran with regard to upper frequency limits; it is the first frog species known to emit exclusively ultrasonic signals. Characteristics of the Distortion Product Otoacoustic Emissions from the amphibian papilla and the basilar papilla were analysed to gain insight into the structures responsible for high-frequency/ultrasound sensitivity. Our results confirm the matching of vocalization spectra and inner ear tuning in this species. Compared to most anurans,
H. cavitympanum
has a hyperextended hearing range spanning from audible to ultrasonic frequencies, far above the previously established ‘spectral limits’ for the amphibian ear. The exceptional high-frequency sensitivity in the inner ear of
H. cavitympanum
illustrates the remarkable plasticity of the auditory system and the extent to which evolution can modify a sensory system to adapt it to its environment.
Comparative analysis of metabolic and transcriptomic features of
Nothobranchius furzeri
Authors: Fumagalli Maria Rita , Font-Clos Francesc , Milan Simone , Zapperi Stefano , La Porta Caterina A. M.
Published: June 2020

Some species have a longer lifespan than others, but usually lifespan is correlated with typical body weight. Here, we study the lifetime evolution of the metabolic behaviour of
Nothobranchius furzeri
, a killifish with an extremely short lifespan with respect to other fishes, even when taking into account rescaling by body weight. Comparison of the gene expression patterns of
N. furzeri
with those of zebrafish
Danio rerio
and mouse (
Mus musculus
) shows that a broad set of metabolic genes and pathways are affected in
N. furzeri
during ageing in a way that is consistent with a global deregulation of chromatin. Computational analysis of the glycolysis pathway for the three species highlights a rapid increase in the metabolic activity during the lifetime of
N. furzeri
with respect to the other species. Our results highlight that the unusually short lifespan of
N. furzeri
is associated with peculiar patterns in the metabolic activities and in chromatin dynamics.