bluuebunny/crossref_metadata_2025 huggingface dataset:
18. Sexual Orientation, Gender Identity, and Human Rights
Authors: Keating Christine , Burack Cynthia
Published: October 2023

This chapter analyses the central human rights issues of LGBTIQ people by referencing sexual orientation and gender identity rights. It considers the power of human rights language and discourses with regard to addressing the discrimination, marginalization, and persecution of oppressed people. People are vulnerable to sexual orientation and gender identity (SOGI) rights violations as a result of the social and political processes which led to heteronormativity and homophobia. The chapter covers the features of SOGI human rights violations such as violence, being committed by states, and correlates these to human rights concerns. It also tackles the critiques on SOGI human rights activism from conservative and progressive perspectives.
19. Human Rights and Religion
Authors: Fazaeli Roja , Hanisek Joel
Published: October 2023

This chapter focuses on the correlation between human rights and religion. It explains how the oversimplification of both systems' complexity resulted in the reductive classification of religion and human rights as oppositional systems. Significant ideas of human rights theories overlap with doctrinal claims in religious traditions, while human rights language occasionally features liturgical, public worship, devotional, and public structures of religious traditions. Trends such as treatment of women, toleration, and authoritative interpretation tend to raise arguments on the compatibility between some expressions of religion and international human rights norms. The chapter then covers the interdependence of human rights by referencing the Masterpiece Cakeshop case and the Sahin case.
Surgical outcomes of thoracoscopic thymectomy via the single-port subxiphoid approach versus the unilateral intercostal approach
Authors: Lee Joonseok , Cho Sukki , Yoon Seung Hwan , Shih Beatrice Chia-Hui , Jung Woohyun , Jeon Jae Hyun , Kim Kwhanmien , Jheon Sanghoon
Published: October 2023

OBJECTIVES

The purpose of this study was to explore the safety and feasibility of video-assisted thoracic surgery (VATS) total thymectomy via the single-port subxiphoid approach compared with the intercostal approach

METHODS

From January 2018 to May 2022, patients who underwent VATS total thymectomy via the subxiphoid or unilateral intercostal approach and diagnosed with Masaoka–Koga stage I–II, non-myasthenic thymoma were included in this study. Perioperative outcomes, immediate and long-term pain evaluations were compared in a propensity score-matching analysis.

RESULTS

In total, 95 patients were included and underwent the subxiphoid approach (n = 37) and the intercostal approach (n = 58). Propensity score yielded 2 well-matched cohorts of 30 patients and there was no significant demographical imbalance between the 2 groups. Compared with the intercostal approach, the subxiphoid group demonstrated favourable perioperative outcomes including the intraoperative blood loss (P = 0.025) and the median duration of hospital stay (P = 0.083). The immediate and long-term pain evaluations revealed that the subxiphoid group reported lower visual analogue scales at postoperative 24 h and lower total doses of fentanyl bolus infusions during hospitalization (P = 0.004 and 0.018, respectively), along with lower long-term neuropathic pain scale scores (P = 0.005) than patients in the intercostal group.

CONCLUSIONS

VATS thymectomy via the single-port subxiphoid approach showed favourable perioperative outcomes compared to the intercostal approach. Moreover, the subxiphoid approach seemed both to cause minimal immediate postoperative pain and to have advantages in reducing long-term neuropathic pain compared with the intercostal approach.
Application of natural language processing to identify social needs from patient medical notes: development and assessment of a scalable, performant, and rule-based model in an integrated healthcare delivery system
Authors: Gray Geoffrey M , Zirikly Ayah , Ahumada Luis M , Rouhizadeh Masoud , Richards Thomas , Kitchen Christopher , Foroughmand Iman , Hatef Elham
Published: October 2023

Objectives

To develop and test a scalable, performant, and rule-based model for identifying 3 major domains of social needs (residential instability, food insecurity, and transportation issues) from the unstructured data in electronic health records (EHRs).

Materials and Methods

We included patients aged 18 years or older who received care at the Johns Hopkins Health System (JHHS) between July 2016 and June 2021 and had at least 1 unstructured (free-text) note in their EHR during the study period. We used a combination of manual lexicon curation and semiautomated lexicon creation for feature development. We developed an initial rules-based pipeline (Match Pipeline) using 2 keyword sets for each social needs domain. We performed rule-based keyword matching for distinct lexicons and tested the algorithm using an annotated dataset comprising 192 patients. Starting with a set of expert-identified keywords, we tested the adjustments by evaluating false positives and negatives identified in the labeled dataset. We assessed the performance of the algorithm using measures of precision, recall, and F1 score.

Results

The algorithm for identifying residential instability had the best overall performance, with a weighted average for precision, recall, and F1 score of 0.92, 0.84, and 0.92 for identifying patients with homelessness and 0.84, 0.82, and 0.79 for identifying patients with housing insecurity. Metrics for the food insecurity algorithm were high but the transportation issues algorithm was the lowest overall performing metric.

Discussion

The NLP algorithm in identifying social needs at JHHS performed relatively well and would provide the opportunity for implementation in a healthcare system.

Conclusion

The NLP approach developed in this project could be adapted and potentially operationalized in the routine data processes of a healthcare system.
Temperature Fluctuations Modulate Molecular Mechanisms in Skeletal Muscle and Influence Growth Potential in Beef Steers
Authors: Smith Zachary K , Eckhardt Erika , Kim Won Seob , Menezes Ana Clara Baio , Rusche Warren C , Kim Jongkyoo
Published: October 2023

Our investigation elucidated the effects of severe temperature fluctuations on cellular and physiological responses in beef cattle. Eighteen Red Angus beef steers with an average body weight of 351 ± 24.5 kg were divided into three treatment groups: 1) Control (CON), exposed to a temperature-humidity index (THI) of 42 for 6 h without any temperature changes; 2) Transport (TP), subjected to a one-mile trailer trip with a THI of 42 for 6 h; and 3) Temperature swing (TS), exposed to a one-mile trailer trip with a THI shift from 42 to 72–75 for 3 h. Our findings indicate that TS can induce thermal stress in cattle, regardless of whether the overall temperature level is excessively high or not. Behavioral indications of extreme heat stress in the cattle were observed, including extended tongue protrusion, reduced appetite, excessive salivation, and increased respiratory rate. Furthermore, we observed a pronounced overexpression (P < 0.05) of heat shock proteins (HSPs) 20, 27, and 90 in response to the TS treatment in the longissimus muscle (LM). Alterations in signaling pathways associated with skeletal muscle growth were noted, including the upregulation (P < 0.01) of Pax7, Myf5, and myosin heavy chain (MHC) isoforms. In addition, an increase (P < 0.05) in transcription factors associated with adipogenesis was detected (P < 0.05), such as PPARγ, C/EBPα, FAS, and SCD in the TS group, suggesting the potential for adipose tissue accumulation due to temperature fluctuations. Our data illustrated the potential impacts of these temperature fluctuations on the growth of skeletal muscle and adipose tissue in beef cattle.
Field evaluation of organic and synthetic insecticides against the hala scale, Thysanococcus pandani (Hemiptera: Halimococcidae), on Maui, Hawaii
Authors: Russo Mason , Waisen Philip , Lutgen Hannah , Cheng Zhiqiang
Published: October 2023

The hala scale, Thysanococcus pandani Stickney, is an invasive insect that infests hala trees, Pandanus tectorius, and has recently arrived in the Hawaiian Islands of Maui, Oahu, and Molokai. Hala scale is native to Thailand, Indonesia, and Singapore and was accidentally introduced to Maui, with its first detection in Hana in 1995. The hala tree is a frequently planted ornamental plant throughout Hawaii’s urban landscape and is also a native tree found in coastal areas of ecological suitability throughout the state. These trees are integral to native Hawaiian weaving traditions, as the leaves were used to make items such as sails, hats, or mats. The spread of T. pandani threatens the continuation of these practices, as the plant material may not be sufficient for weaving. Hala trees infested with T. pandani can have negative effects such as deformation, discoloration, and early tree death. Experimental field trials were set up to evaluate the efficacy of organic and chemical insecticides as potential treatments to mitigate the damage of T. pandani infestations. This was done on the Island of Maui, where T. pandani is widespread. These trees were artificially inoculated with T. pandani and evaluated throughout the trials for changes in plant height, canopy width, scale removal, and visual infestation ratings. The results of 2 repeated field trials indicated that flupyradifurone and buprofezin were effective treatments in the reduction of the hala scale infestation and improving visual aspects related to plant health.
Diverse mechanisms of bioproduction heterogeneity in fermentation and their control strategies
Authors: Mu Xinyue , Zhang Fuzhong
Published: October 2023

Microbial bioproduction often faces challenges related to populational heterogeneity, where cells exhibit varying biosynthesis capabilities. Bioproduction heterogeneity can stem from genetic and non-genetic factors, resulting in decreased titer, yield, stability, and reproducibility. Consequently, understanding and controlling bioproduction heterogeneity are crucial for enhancing the economic competitiveness of large-scale biomanufacturing. In this review, we provide a comprehensive overview of current understandings of the various mechanisms underlying bioproduction heterogeneity. Additionally, we examine common strategies for controlling bioproduction heterogeneity based on these mechanisms. By implementing more robust measures to mitigate heterogeneity, we anticipate substantial enhancements in the scalability and stability of bioproduction processes.

One-sentence summary

This review summarizes current understandings of different mechanisms of bioproduction heterogeneity and common control strategies based on these mechanisms.
Resisting policing in higher education: wilful White ignorance in the campus safety debate
Authors: Taylor Rebecca M , Perez-Mugg Martha
Published: October 2023

Activists have challenged the reach of the carceral state into higher education. Whether calling out the exclusion of currently and formerly incarcerated people from higher education or the ways campus police perpetuate the racial and economic biases that plague the US criminal legal system, these voices offer insights that higher education leaders should take seriously. Yet, these challenges are often met with appeals to safety, which purport to override concerns about the harms produced by extension of the criminal legal system into educational contexts. Campus safety debates offer an opportunity to examine the role of wilful ignorance in the perpetuation of systemic injustices on college and university campuses, highlighting tensions between the testimony of those challenging these systems and practices and prevailing narratives around safety. In analysing the operation of wilful ignorance in this context, we will focus on campus policing as a manifestation of carcerality in higher education. We argue that the perpetuation of policing in higher education in the USA reflects wilful White ignorance that represents both an epistemic and moral failing on the part of higher education leaders.
Outbreak of Invasive Group A Streptococcus in Children—Colorado, October 2022–April 2023
Authors: Ho Erin C , Cataldi Jessica R , Silveira Lori J , Birkholz Meghan , Loi Michele M , Osborne Christina M , Dominguez Samuel R
Published: October 2023

Background

In the fall of 2022, we observed a sharp rise in pediatric Invasive Group A Streptococcus (iGAS) hospitalizations in Colorado. We compared the epidemiology, clinical features, and patient outcomes in this outbreak to prior years.

Methods

Between October 2022 and April 2023, we prospectively identified and reviewed iGAS cases in hospitalized pediatric patients at Children’s Hospital Colorado. Using laboratory specimen records, we also retrospectively compared the number of patients with sterile site GAS-positive cultures across three time periods: pre-COVID-19 (January 2015–March 2020), height of COVID-19 pandemic (April 2020–September 2022), and outbreak (October 2022–April 2023).

Results

Among 96 prospectively identified iGAS cases, median age was 5.7 years old; 66% were male, 70% previously healthy, 39% required critical care, and four patients died. Almost 60% had associated respiratory viral symptoms, 10% had toxic shock syndrome, and 4% had necrotizing fasciitis. Leukopenia, bandemia, and higher C-reactive protein values were laboratory findings associated with need for critical care. There were significantly more cases during the outbreak (9.9/month outbreak vs 3.9/month pre-pandemic vs 1.3/month pandemic), including more cases with pneumonia (28% outbreak vs 15% pre-pandemic vs 0% pandemic) and multifocal disease (17% outbreak vs 3% pre-pandemic vs 0% pandemic), P < .001 for all.

Conclusions

Outbreak case numbers were almost triple the pre-pandemic baseline. The high percentage of cases with associated viral symptoms suggests a link to coinciding surges in respiratory viruses during this time. Invasive GAS can be severe and evolve rapidly; clinical and laboratory features may help in earlier identification of critically ill children.
Abacavir Drug Exposures in African Children Under 14 kg Using Pediatric Solid Fixed Dose Combinations According to World Health Organization Weight Bands
Authors: Chupradit Suthunya , Wamalwa Dalton C , Maleche-Obimbo Elizabeth , Kekitiinwa Adeodata R , Mwanga-Amumpaire Juliet , Bukusi Elizabeth A , Nyandiko Winstone M , Mbuthia Joseph K , Swanson Alistair ,   DNDi Clinical Team, Cressey Tim R , Punyawudho Baralee , Musiime Victor
Published: October 2023

Background

The pharmacokinetics of abacavir (ABC) in African children living with HIV (CLHIV) weighing <14 kg and receiving pediatric fixed dose combinations (FDC) according to WHO weight bands dosing are limited. An ABC population pharmacokinetic model was developed to evaluate ABC exposure across different World Health Organization (WHO) weight bands.

Methods

Children enrolled in the LIVING study in Kenya and Uganda receiving ABC/lamivudine (3TC) dispersible tablets (60/30 mg) according to WHO weight bands. A population approach was used to determine the pharmacokinetic parameters. Monte Carlo simulations were conducted using an in silico population with demographic characteristics associated with African CLHIV. ABC exposures (AUC0–24) of 6.4–50.4 mg h/L were used as targets.

Results

Plasma samples were obtained from 387 children. A 1-compartment model with allometric scaling of clearance (CL/F) and volume of distribution (V/F) according to body weight best characterized the pharmacokinetic data of ABC. The maturation of ABC CL/F was characterized using a sigmoidal Emax model dependent on postnatal age (50% of adult CL/F reached by 0.48 years of age). Exposures to ABC were within the target range for children weighing 6.0–24.9 kg, but children weighing 3–5.9 kg were predicted to be overexposed.

Conclusions

Lowering the ABC dosage to 30 mg twice daily or 60 mg once daily for children weighing 3–5.9 kg increased the proportion of children within the target and provided comparable exposures. Further clinical study is required to investigate clinical implications and safety of the proposed alternative ABC doses.
In search of founding era registers: automatic modeling of registers from the corpus of Founding Era American English
Authors: Repo Liina , Hashimoto Brett , Laippala Veronika
Published: October 2023

Registers are situationally defined text varieties, such as letters, essays, or news articles, that are considered to be one of the most important predictors of linguistic variation. Often historical databases of language lack register information, which could greatly enhance their usability (e.g. Early English Books Online). This article examines register variation in Late Modern English and automatic register identification in historical corpora. We model register variation in the corpus of Founding Era American English (COFEA) and develop machine-learning methods for automatic register identification in COFEA. We also extract and analyze the most significant grammatical characteristics estimated by the classifier for the best-predicted registers and found that letters and journals in the 1700s were characterized by informational density. The chosen method enables us to learn more about registers in the Founding Era. We show that some registers can be reliably identified from COFEA, the best overall performance achieved by the deep learning model Bidirectional Encoder Representations from Transformers with an F1-score of 97 per cent. This suggests that deep learning models could be utilized in other studies concerned with historical language and its automatic classification.
Locomotive syndrome and depressive symptoms: A cross-sectional study in middle-aged women
Authors: Kato Michitaka , Ozaki Etsuko , Matsui Daisuke , Nakano Wataru , Nakano Satoko , Ono Sintaro , Kito Kazuya , Koyama Teruhide
Published: October 2023

Objective

Evidence for an association between locomotive syndrome (LS) and depression is lacking in middle-aged women. This study aimed to investigate the relationship between LS severity and depressive symptoms in community-dwelling middle-aged women.

Methods

This cross-sectional study included 1520 middle-aged women (mean age 52 ± 6 years). LS severity was evaluated using the 25-question Geriatric Locomotive Function Scale questionnaire and motor function test. Depressive symptoms were assessed using the Zung self-rating depression scale. Multiple logistic regression analyses were performed to determine the association between depressive symptoms and LS severity, adjusting for potential confounding factors.

Results

LS severity, as evaluated through both questionnaires and motor function tests, was significantly associated with depressive symptoms (self-rating depression scale  ≥ 40 points) in middle-aged women. The relationship between LS and depressive symptoms was only significant when assessed through the 25-question Geriatric Locomotive Function Scale questionnaire rather than the motor function tests. Additionally, a stepwise association was observed between pain severity, as assessed by the 25-question Geriatric Locomotive Function Scale, and the prevalence of depressive symptoms.

Conclusions

LS severity is significantly associated with depressive symptoms in community-dwelling middle-aged women, suggesting the need for additional mental status assessment in participants with LS and concurrent pain.
Dietary biomarkers—an update on their validity and applicability in epidemiological studies
Authors: Landberg Rikard , Karra Prasoona , Hoobler Rachel , Loftfield Erikka , Huybrechts Inge , Rattner Jodi I , Noerman Stefania , Claeys Liesel , Neveu Vanessa , Vidkjaer Nanna Hjort , Savolainen Otto , Playdon Mary C , Scalbert Augustin
Published: October 2023

The aim of this literature review was to identify and provide a summary update on the validity and applicability of the most promising dietary biomarkers reflecting the intake of important foods in the Western diet for application in epidemiological studies. Many dietary biomarker candidates, reflecting intake of common foods and their specific constituents, have been discovered from intervention and observational studies in humans, but few have been validated. The literature search was targeted for biomarker candidates previously reported to reflect intakes of specific food groups or components that are of major importance in health and disease. Their validity was evaluated according to 8 predefined validation criteria and adapted to epidemiological studies; we summarized the findings and listed the most promising food intake biomarkers based on the evaluation. Biomarker candidates for alcohol, cereals, coffee, dairy, fats and oils, fruits, legumes, meat, seafood, sugar, tea, and vegetables were identified. Top candidates for all categories are specific to certain foods, have defined parent compounds, and their concentrations are unaffected by nonfood determinants. The correlations of candidate dietary biomarkers with habitual food intake were moderate to strong and their reproducibility over time ranged from low to high. For many biomarker candidates, critical information regarding dose response, correlation with habitual food intake, and reproducibility over time is yet unknown. The nutritional epidemiology field will benefit from the development of novel methods to combine single biomarkers to generate biomarker panels in combination with self-reported data. The most promising dietary biomarker candidates that reflect commonly consumed foods and food components for application in epidemiological studies were identified, and research required for their full validation was summarized.
Transcription factor NAC1 activates expression of peptidase-encoding AtCEPs in roots to limit root hair growth
Authors: Rodríguez-García Diana R , Rondón Guerrero Yossmayer del Carmen , Ferrero Lucía , Rossi Andrés Hugo , Miglietta Esteban A , Aptekmann Ariel A , Marzol Eliana , Martínez Pacheco Javier , Carignani Mariana , Berdion Gabarain Victoria , Lopez Leonel E , Díaz Dominguez Gabriela , Borassi Cecilia , Sánchez-Serrano José Juan , Xu Lin , Nadra Alejandro D , Rojo Enrique , Ariel Federico , Estevez José M
Published: October 2023

Plant genomes encode a unique group of papain-type Cysteine EndoPeptidases (CysEPs) containing a KDEL endoplasmic reticulum (ER) retention signal (KDEL-CysEPs or CEPs). CEPs process the cell-wall scaffolding EXTENSIN (EXT) proteins that regulate de novo cell-wall formation and cell expansion. Since CEPs cleave EXTs and EXT-related proteins, acting as cell-wall-weakening agents, they may play a role in cell elongation. The Arabidopsis (Arabidopsis thaliana) genome encodes 3 CEPs (AtCPE1-AtCEP3). Here, we report that the genes encoding these 3 Arabidopsis CEPs are highly expressed in root-hair (RH) cell files. Single mutants have no evident abnormal RH phenotype, but atcep1-3 atcep3-2 and atcep1-3 atcep2-2 double mutants have longer RHs than wild-type (Wt) plants, suggesting that expression of AtCEPs in root trichoblasts restrains polar elongation of the RH. We provide evidence that the transcription factor NAC1 (petunia NAM and Arabidopsis ATAF1, ATAF2, and CUC2) activates AtCEPs expression in roots to limit RH growth. Chromatin immunoprecipitation indicates that NAC1 binds to the promoter of AtCEP1, AtCEP2, and, to a lower extent, AtCEP3 and may directly regulate their expression. Inducible NAC1 overexpression increases AtCEP1 and AtCEP2 transcript levels in roots and leads to reduced RH growth while the loss of function nac1-2 mutation reduces AtCEP1-AtCEP3 gene expression and enhances RH growth. Likewise, expression of a dominant chimeric NAC1-SRDX repressor construct leads to increased RH length. Finally, we show that RH cell walls in the atcep1-3 atcep3-2 double mutant have reduced levels of EXT deposition, suggesting that the defects in RH elongation are linked to alterations in EXT processing and accumulation. Our results support the involvement of AtCEPs in controlling RH polar growth through EXT processing and insolubilization at the cell wall.
Linear algebra in engineering: a study of specialized knowledge of Chilean and Brazilian teachers
Authors: Bianchini Barbara Lutaif , Gomes Eloiza , González Marcela Parraguez , Lima de Gabriel Loureiro
Published: October 2023

The objective of this paper is to establish comparisons between the Linear Algebra (LA) approach practiced in Engineering courses offered by Chilean and Brazilian Higher Education Institutions and, for that, teachers from both countries were interviewed. From a methodological point of view, the research consists of two case studies. For the analysis of the interviews, we used the precepts of Content Analysis. The data were qualitatively analyzed considering the MTSK theoretical model. In this analysis, we sought to identify what specialized knowledge these teachers have regarding AL and about its teaching and learning. The results have shown that, in relation to the Mathematical Knowledge (MK) domain, which refers to content knowledge, the Knowledge of Topics subdomain (KoT), linked to the way that teachers know the topics they teach, is the most present among interviewees. In the Pedagogical Content Knowledge (PCK) domain, covering specific pedagogical knowledge linked to Mathematics, the Knowledge of Mathematics Teaching (KMT), regarding strategies, teaching theories, resources and materials, and Knowledge of Mathematics Learning Standards (KMLS) subdomains, concerning the curricular specifications and the moments in which the student must or can learn certain content and with what level of depth prevail.
Agreement Between Self-reports and Urine Toxicology Measures of Illicit Methamphetamine and Cocaine Use During Early Pregnancy
Authors: Sujan Ayesha C. , Alexeeff Stacey E. , Slama Natalie E. , Goler Nancy , Avalos Lyndsay A. , Adams Sara R. , Conway Amy , Ansley Deborah , Pal Anish , Gunn Rachel L. , Micalizzi Lauren , Young-Wolff Kelly C.
Published: October 2023

Objective

This study aimed to assess agreement between self-report and urine toxicology measures assessing use of 2 illicit simulants (methamphetamine and cocaine) during early pregnancy.

Methods

This cross-sectional study of 203,053 pregnancies from 169,709 individuals receiving prenatal care at Kaiser Permanente Northern California between January 1, 2011, and December 31, 2019, assessed agreement (κ, sensitivity, and specificity) between self-reported frequency and urine toxicology measures of methamphetamine and cocaine early in pregnancy.

Results

Prenatal use of the illicit stimulants was rare according to toxicology (n = 244 [0.12%]) and self-report measures (n = 294 [0.14%]). Agreement between these measures was low (κ < 0.20). Of the 498 positive pregnancies, 40 (8.03%) screened positive on both measures, 204 (40.96%) screened positive on toxicology tests only, and 254 (51.00%) screened positive by self-report only. Relative to toxicology tests, sensitivity of any self-reported use was poor with 16.39% (95% confidence interval [CI], 11.75%–21.04%) of pregnancies with a positive toxicology test self-reporting any use in pregnancy. Relative to self-report, sensitivity of toxicology tests was also poor with 13.61% (95% CI, 9.69%–17.52%) of pregnancies who self-reported any use having positive urine toxicology tests. The sensitivity improved slightly at higher frequencies of self-reported use: daily, 17.50% (95% CI, 5.72%–29.29%); weekly, 25.00% (95% CI, 11.58%–38.42%); and monthly or less, 11.06% (95% CI, 6.89%–15.23%). Specificity was high (>99%), reflecting the high negative rate of use.

Conclusions

Findings suggest that using self-report and toxicology measures in combination likely provides the most accurate information on methamphetamine and cocaine use in early pregnancy. Findings also highlight the need to provide supportive nonstigmatizing environments in which pregnant individuals feel comfortable disclosing substance use without fear of punishment.
Comparison of Gait and Functional Outcomes Between Open and Arthroscopic Treatment of Adolescent and Young Adult Femoroacetabular Impingement
Authors: Morris William Z. , Loewen Alex , Ulman Sophia , Johnson Ben , Sucato Daniel J. , Podeszwa David A. , Ellis Henry B.
Published: October 2023

Background:

Management of femoroacetabular impingement (FAI) through an arthroscopic or surgical hip dislocation (SHD) approach has been shown to have similar clinical success and patient-reported outcomes. However, there are limited data comparing functional outcomes. The purpose of this study was to compare gait and functional outcomes of adolescent/young adult patients with FAI treated by either an arthroscopic or open SHD approach.

Methods:

We identified prospectively enrolled adolescent/young adult patients (≤20 years old) who underwent surgical treatment for FAI through an SHD or arthroscopic approach. Participants were evaluated in a movement science lab preoperatively and postoperatively (minimum 8 months postoperatively) with barefoot walking and a 30-second single-limb balance trial on the affected side. Participants also completed the Harris Hip Score at the same timepoints. Differences from preoperative to postoperative were determined using a paired-samples t test for each surgical technique, and differences between the SHD and arthroscopic groups were determined using an independent samples t test (α=0.05).

Results:

Fifty-five participants (42F, 16.2±1.4 y) were tested and grouped by surgical intervention. The SHD and arthroscopy groups consisted of 28 and 27 participants, respectively, with no significant difference between the SHD and arthroscopic cohorts in age (16.4±1.2 vs. 15.9±1.5 y, respectively, P=0.218) or sex distribution (78.6% vs. 74.1% females, respectively, P=0.75). Each group demonstrated significant postoperative improvement in Harris Hip Score (SHD: 64.8±16.4 to 81.8±17.8; arthroscopy: 57.0±16.7 to 84.7±19.7; preoperatively to postoperatively, respectively, both P<0.001). During gait, increased maximum hip flexion was observed following surgical intervention for the SHD group (32.3±5.7 vs. 36.1±5.2, P=0.003). No other clinically significant changes were detected in the SHD or arthroscopic groups preoperatively to postoperatively in trunk, pelvis, or hip kinematics in the coronal plane. During the balance task, neither cohort demonstrated markers of clinically significant abductor dysfunction. However, post operatively, the arthroscopy group was able to balance longer than the SHD group (18.8±7.8 vs. 14.2±2.7 s, respectively, P=0.008), although no differences were detected in trunk or pelvis position in the coronal plane during balance.

Conclusions:

Both open SHD and arthroscopic treatment of FAI resulted in improved clinical outcomes with no clinically significant abductor dysfunction 1 year post operatively. However, further study is needed to determine whether more dynamic tasks can potentially elicit subtle differences between the groups.

Levels of Evidence:

Level II—prospective study.
Recovery of Gait in Children and Adolescents After Pediatric Femoral Shaft Fracture Treated With Intramedullary Nail Fixation: A Longitudinal Prospective Study
Authors: Flinck Marianne , Riad Jacques
Published: October 2023

Background:

Femoral shaft fractures in school-aged children are commonly treated with intramedullary nail fixation. Outcomes such as time to healing, alignment and non-union, leg length discrepancy, and refractures, and other complications are often reported based on radiographic findings. There are limited reports on physical function, including objective quantitative measures. The aim was to study the progress and recovery of gait after femoral shaft fracture in children and adolescents.

Methods:

Inclusion criteria were individuals 6 to 16 years of age with a femoral shaft fracture treated with intramedullary nails. Exclusion criteria were pathologic fractures and other physical impairments or injuries that influenced gait.

At 6 and 12 weeks, assessments of mobilization and weight bearing were performed at clinical hospital follow-ups.

At 3, 6, 9, and 12 months, physical examinations of passive range of motion, stair walking, and three-dimensional gait analysis, including temporospatial, movement (kinematics), and force (kinetics) data, were performed.

Results:

Seventeen participants, with a median of 9.2 (interquartile range 6.5 to 11.3) years of age were included. At 6 weeks, 14 of 16 (88%) used walking aids and at twelve weeks, 25% did. Sixty-nine percent could walk up and down stairs at 6 weeks and 100% at 12 weeks. At 3 months, 3 participants walked with a speed below 100 cm/second and had clear deviations in gait pattern compared with the control group. Three participants had no deviations in gait patterns at 3 months. Gait patterns had normalized in most participants at 6 months. Hip and knee extension moments were decreased up to 6 months compared with the control group. Hip extensor muscle work was increased on the fractured side compared with the control group.

Conclusions:

Early recovery, between 6 and 12 weeks postoperatively, was noted in basic performance tests after femoral shaft fractures in children and adolescents. Three-dimensional gait analysis revealed normalization of gait patterns at 6 months. Information on the expected time and degree of recovery of physical function could guide the rehabilitation process.

Level of Evidence:

Level III.
Comprehensive Grading System of Inflammatory Features of the Lumbar Facet Joints on Magnetic Resonance Imaging
Authors: Acosta José I. , Ermann Joerg , Isaac Zacharia , DeFilipp Miriam , Gottreich Julia R. , Andrew Michael N. , Chang Yuchiao , Zampini Jay M. , Katz Jeffrey N. , Mandell Jacob C.
Published: October 2023

Study design.

Retrospective.

Objective.

We aimed to describe a magnetic resonance imaging (MRI)-based grading system of inflammatory features of the lumbar facet joints using an atlas and assess its reliability.

Summary of Background Data.

Chronic low back pain is often caused by facet joint arthropathy. Inflammatory features are often evident on MRI. While several grading systems of facet arthropathy have been described, there is scant data on the reliability of these systems, and none focus exclusively on inflammatory features.

Methods.

We describe a grading system that assesses facet joint effusion, bone marrow edema, and soft tissue edema. Each feature was graded from 0-3 (facet edema) or 0-2 (bone marrow edema intensity and extent, soft tissue edema intensity and extent). Four spine experts graded MRIs of 50 subjects at the bilateral L3/4, L4/5, and L5/S1 levels. All subjects had symptomatic facet arthropathy and received therapeutic facet joint injections. We assessed the intra- and inter-reader reliability of each feature at each joint and summarized across all six joints.

Results.

The mean age of subjects was 56 years (SD = 17), and 48% were female. The injections occurred at the L3/4 level in 12% of cases, at L4/5 in 88%, and at L5/S1 in 80% of cases. The intra-reader reliability kappa’s for each feature ranged from 0.42 to 0.81. In contrast, the inter-reader reliability kappa values for each feature ranged from 0.37 to 0.54.

Conclusion.

MRI inflammatory features of the lumbar facet joints are often noted in patients with low back pain. The proposed grading system is reliable and could serve as a research tool for studies assessing the clinical relevance and prognostic value of these features.
Progressive Necrotizing Ocular Surface Disease, Despite Immunosuppression
Authors: Mas-Castells Maria , Verity David H. , Timlin Hannah , Rose Geoffrey E.
Published: October 2023

A 60-year-old man was referred with 2 years of left conjunctivitis that persisted despite antibiotic and systemic corticosteroid therapy. The severity and extent of surface disease had increased slowly after prior dacryocystorhinostomy. Subsequent conjunctival biopsies demonstrated granulomas with patchy necrosis but no evidence of malignancy or organisms; systemic screening for sarcoidosis and tuberculosis was negative. A markedly thickened and inflamed left ocular surface was present on referral, with areas of conjunctival ischemia and patchy white slough on the tarsi. Further ocular surface biopsy did not reveal malignancy, and therefore mycobacterial infection was considered a possible cause. Mycobacterium tuberculosis was cultured, albeit only after repeated conjunctival swabs and biopsies. Appropriate treatment led to a very rapid resolution of ocular surface disease. Localized periocular tuberculosis is extremely rare outside developing nations, and its rarity may cause this differential diagnosis for persistent severe ocular surface disease to be overlooked in industrialized nations.
Proptosis Regression After Teprotumumab Treatment for Thyroid Eye Disease
Authors: Rosenblatt Tatiana R. , Chiou Carolina A. , Yoon Michael K. , Wolkow Natalie , Lee Nahyoung Grace , Freitag Suzanne K.
Published: October 2023

Purpose:

This study analyzed the degree and timing of proptosis regression after teprotumumab therapy.

Methods:

A retrospective study of all patients who completed 8 teprotumumab infusions at 1 institution from January 1, 2020 to December 31, 2022. Change in proptosis was assessed in millimeters and percentages compared with immediate post-treatment and pretreatment proptosis.

Results:

Of 119 patients with post-treatment data (mean follow-up 10.56 months, range: 3.05–25.08), 208 (87.39%) eyes of 110 patients had initial proptosis improvement. Of the 78 patients with multiple follow-up visits, 102 (65.38%) eyes of 59 patients had proptosis regression averaging 12.78% (range: 1.85–58.82%) compared with immediately post-treatment or 2.43 mm (0.5–10.0 mm). Eight (7.84%) eyes had initial documentation of regression more than 1 year after treatment, 40 (39.22%) between 6 months and 1 year, and 54 (52.94%) eyes within 6 months with 25 (46.30%) of these continuing to worsen at subsequent follow-up. Forty (25.64%) eyes of 24 patients had more proptosis at most recent follow-up than before teprotumumab, with an average regression of 1.53 mm (0.5–4.0 mm) or 7.74% (1.85–20.69%) of pretreatment proptosis. In comparison, 99 (63.46%) eyes of 54 patients maintained improvement, with reduction averaging 3.13 mm (0.5–11.0 mm) or 13.19% (1.92–41.67%) of pretreatment proptosis (p < 0.001).

Conclusions:

Two-thirds of eyes had regression despite initial teprotumumab response, typically within 1 year of treatment, with ongoing worsening over time. Most patients maintained some proptosis reduction compared with before treatment despite regression, although 25% were worse than pretreatment. The occurrence of regression was independent of the pretreatment duration of clinical thyroid eye disease. Overall, compared with preteprotumumab, there was a greater amount of improvement than regression at most recent follow-up.
Improvement of positive dysphotopsia with multifocal intraocular lenses by hormone replacement therapy
Authors: Komatsu Koji , Masuda Yoichiro , Hayashi Takaaki , Nakano Tadashi
Published: October 2023

Introduction:

The case of a patient with positive dysphotopsia (PD) affected by hormone replacement therapy (HRT) after multifocal intraocular lens (IOL) insertion is reported.

Patient and Clinical Findings:

A 66-year-old woman underwent bilateral cataract surgery and multifocal IOL implantation. Postoperatively, the uncorrected distance and near visual acuity improved bilaterally. The patient experienced mild PD symptoms in the left eye. She had been using an estradiol patch for menopausal disorders. 6 months postoperatively, the use of an estradiol patch was discontinued because of dermatitis and she noticed a marked worsening of her PD.

Diagnosis, Intervention, and Outcomes:

With the patient's cooperation, full-field electroretinography (ERG) and contrast sensitivity tests were performed before and after estradiol discontinuation. After the discontinuation, the amplitude of both rod and cone ERGs decreased, contrast sensitivity decreased, and PD deteriorated. There were no changes in anterior-segment condition and retinal shape.

Conclusions:

PD symptoms worsened after the discontinuation of estrogen hormone therapy. ERG amplitude and contrast sensitivity decreased when HRT was discontinued, suggesting that retinal function in the presence of estrogen receptors may be related to the development of PD.
Clinical characteristics, risk factors, and outcomes of patients with polymicrobial Pseudomonas aeruginosa bloodstream infections
Authors: Zheng Cheng , Wang Guangtao , Qiu Lingling , Luo Xinhua , Zhang Xijiang , Zhong Li , Zhang Chuming , Lin Ronghai , Chen Qingqing
Published: October 2023

Background:

Previous studies on polymicrobial Pseudomonas aeruginosa bloodstream infections (Pa-BSIs) are dated, and it is necessary to reanalyze polymicrobial Pa-BSIs. The aim of this study was to investigate clinical characteristics and risk factors for polymicrobial Pa-BSI in comparison with monomicrobial Pa-BSI.

Methods:

A double-center retrospective observational study was performed between January 1, 2013 and June 30, 2022, in two tertiary hospitals. All patients with Pa-BSI were enrolled, and their clinical data were collected by reviewing electronic medical records.

Results:

A total of 278 patients with Pa-BSI were enrolled, including 77 patients (27.7%) with polymicrobial Pa-BSI. Compared with monomicrobial Pa-BSI, the main source of polymicrobial Pa-BSI was pneumonia (49.4% vs 31.3%, p < 0.01), whereas the main source of monomicrobial Pa-BSI was primary BSIs (21.9% vs 2.6%, p = 0.04). In multivariate analysis, a history of cerebrovascular accident (CVA) (adjusted odds ratio [OR], 3.62; 95% CI, 1.46-8.92) was independently associated with polymicrobial Pa-BSI. Primary BSI was associated with monomicrobial Pa-BSI (OR, 0.08; 95% CI, 0.02-0.38). Patients with polymicrobial Pa-BSI had a longer intensive care unit (ICU) length of stay after onset of BSI than those with monomicrobial Pa-BSI (2 [2, 16] vs 13 [3.75, 29], p = 0.02).

Conclusion:

Patients with Pa-BSI and the presence of CVA need to be alert to the possibility of polymicrobial BSI occurrence. Prolonged ICU stay and pneumonia as a source of BSI warrant clinician attention for polymicrobial Pa-BSI, and primary BSIs are likely associated with monomicrobial BSIs.
Clinical Preceptor Development and the Benefit of Structured Teaching Techniques: A Scoping Review
Authors: Cushing Rachel
Published: October 2023

Introduction

Physician assistant (PA) education in the clinical year is dependent on clinical preceptors. Recruitment of preceptors has been identified as a significant barrier for programs. As a result of the preceptor shortage, evaluation of the barriers to recruitment and retention has been considered. The lack of development and training was identified as a barrier to recruitment and retention of preceptors.

The aim of this scoping review article was to identify structured teaching strategies to reduce the development and training barrier and improve preceptor efficacy and efficiency. Structured teaching techniques, such as the One-Minute Preceptor and Summarize, Analyze, Narrow, Probe, Plan, and Select (SNAPPS), are proven to be effective and efficient ways to train learners.

Methods

Online databases were used to identify articles published from 2014 to 2022 using the following terms: “physician assistant” or “nurse practitioner,” “preceptor development,” “preceptorship,” “teaching methods,” “pedagogy,” “clinical teaching,” and “medical education.” Seventeen articles formed the basis of the scoping review of the literature. A singular author reviewed the articles.

Results

Training resources help ease student instruction burden that preceptors experience. Many preceptors rely on clinical experience to guide their teaching methods. Introducing formal, structured teaching strategies can improve preceptors' effectiveness. By implementing preceptor training using structured teaching strategies, PA programs can decrease barriers for preceptors and potentially increase preceptor effectiveness and efficiency.

Conclusions

Training preceptors on using structured teaching strategies through workshops, asynchronous learning modules, and podcasts could provide preceptors with the support needed to educate clinical phase PA students. Physician assistant programs must explore best practices in clinical teaching and the associated education and operational outcomes.
An international multi-institution real-world study of the optimal surveillance frequency for stage II/III gastric cancer: The more, the better?
Authors: Wu Dong , Lu Jun , Lin Jia , Xu Bin-bin , Xue Zhen , Zheng Hua-Long , Lin Guo-sheng , Huang Jiao-bao , Shen Li-li , Zheng Chao-Hui , Li Ping , Xie Jian-Wei , Wang Jia-Bin , Lin Jian-Xian , Chen Qi-Yue , Cao Long-Long , Ma Yu-Bin , Truty Mark J. , Huang Chang-Ming
Published: October 2023

Background:

Due to lacking evidence on surveillance for gastric cancer (GC), this study aimed to determine the optimal postsurgical surveillance strategy for pathological stage (pStage) II/III GC patients and compare its cost-effectiveness with traditional surveillance strategies.

Methods:

Prospectively collected data from stage II/III GC patients (n=1,661) who underwent upfront surgery at a large-volume tertiary cancer center in China (FJMUUH cohort) between January 2010 and October 2015. For external validation, two independent cohorts were included, which were composed of 380 stage II/III GC patients at an tertiary cancer center in U.S.A (Mayo cohort) between July 1991 and July 2012 and 270 stage II/III GC patients at another tertiary cancer center in China (QUAH cohort) between May 2010 and Oct 2014. Random forest models were used to predict dynamic recurrence hazards and to construct individual surveillance strategies for stage II/III GC. Cost-effectiveness was assessed by Markov model.

Results:

The median follow-up period of the FJMUUH, the Mayo, and QUAH cohorts were 55, 158, and 70 months, respectively. In the FJMUUH cohort, the 5-year recurrence risk was higher in pStage III compared with pStage II GC patients (P<0.001). Our novel individual surveillance strategy achieved optimal cost-effectiveness for pStage II GC patients (ICER = $490/QALY). The most intensive NCCN surveillance guideline was more cost-effective (ICER = $983/QALY) for pStage III GC patients. The external validations confirmed our results.

Conclusion:

For patients with pStage II GC, individualized risk-based surveillance outperformed the JGCTG and NCCN surveillance guidelines. However, the NCCN surveillance guideline may be more suitable for patients with pStage III GC. Even though our results are limited by the retrospective study design, we believe that our findings should be considered when recommending postoperative surveillance for stage II/III gastric cancer with upfront surgery in the absence of a randomized clinical trial.

Trial Registration:

Clinical Trials.gov.