bluuebunny/crossref_metadata_2025 huggingface dataset:
Oxford Handbook of Pre-hospital Care
Authors: Greaves Ian , Porter Sir Keith
Published: November 2020

This handbook is the invaluable guide to providing high-quality care in a pre-hospital environment. Evidence-based and reflecting new developments in regulation and practice, this second edition is designed to provide key information for all immediate care practitioners, including doctors, paramedics, emergency medical technicians, and community responders. The text has been cross-referenced with the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) handbook and appropriate national clinical guidelines to ensure full clinical relevance. Reflecting the major advances in delivery of pre-hospital care, including the greater survival benefits for heart attacks and major trauma when delivering patients directly to higher levels of care, the evolution of the paramedic role into critical care paramedics, roadside rapid sequence induction of anaesthesia, and the introduction of mechanical chest compression devices, this new edition is the ideal companion for those involved in delivering pre-hospital care. It also links to relevant online databases and mobile apps that can assist with calculations, and contains key algorithms and formulae to ensure good care.
Estimating fast transient detection pipeline efficiencies at UTMOST via real-time injection of mock FRBs
Authors: Gupta V , Flynn C , Farah W , Jameson A , Venkatraman Krishnan V , Bailes M , Bateman T , Deller A T , Mandlik A , Sutherland A
Published: November 2020

Dedicated surveys using different detection pipelines are being carried out at multiple observatories to find more fast radio bursts (FRBs). Understanding the efficiency of detection algorithms and the survey completeness function is important to enable unbiased estimation of the underlying FRB population properties. One method to achieve end-to-end testing of the system is by injecting mock FRBs in the live data stream and searching for them blindly. Mock FRB injection is particularly effective for machine-learning-based classifiers, for which analytic characterization is impractical. We describe a first-of-its-kind implementation of a real-time mock FRB injection system at the upgraded Molonglo Observatory Synthesis Telescope (UTMOST) and present our results for a set of 20 000 mock FRB injections. The injections have yielded clear insight into the detection efficiencies and have provided a survey completeness function for pulse width, fluence, and dispersion measure (DM). Mock FRBs are recovered with uniform efficiency over the full range of injected DMs; however, the recovery fraction is found to be a strong function of the width and signal-to-noise ratio (SNR). For low widths (≲20 ms) and high SNR (≳9) the recovery is highly effective with recovery fractions exceeding 90 per cent. We find that the presence of radio-frequency interference causes the recovered SNR values to be systematically lower by up to 20 per cent compared to the injected values. We find that wider FRBs become increasingly hard to recover for the machine-learning-based classifier employed at UTMOST. We encourage other observatories to implement live injection set-ups for similar testing of their surveys.
Determination of the superoutburst cycle lengths of 206 SU UMa-type dwarf novae
Authors: Vogt N , Puebla E C , Contreras-Quijada A
Published: November 2020

SU UMa stars are characterized by ‘superoutbursts’, which are brighter at maximum light and which last much longer than the more frequent ‘ordinary’ outbursts of these dwarf novae. Although there are now more than 1180 SU UMa-type dwarf novae catalogued, our knowledge on their superoutburst cycle length Cso has hitherto been limited to about 6 ${{\ \rm per\ cent}}$ of the entire sample of known SU UMa stars. Using public data bases we have determined new Cso values for a total of 206 additional SU UMa stars in the range 17 d < Cso < 4590 d (including some ER UMa and WZ Sge-type representants) within total time intervals between 2 and 57 yr, and with an estimated uncertainty of $\pm 11{{\ \rm per\ cent}}$. This way, we are increasing our present knowledge of Cso values by a factor of ∼3.8. Their distribution is characterized by a broad maximum around Cso ≈ 270 d, and slowly decreasing numbers up to Cso ≈ 800 d. The domain Cso > 450 d was unexplored until now; we add here 106 cases ($\sim \! 51{{\ \rm per\ cent}}$ of our total sample) in this range of long cycles, implying a better statistical basis for future studies of their distribution. Our sample contains 16 known WZ Sge stars, and we propose WZ Sge membership for five others hitherto classified as ordinary SU UMa stars. Individual superoutburst timings deviate on average by about $\pm 7{{\ \rm per\ cent}}$ of the cycle length from their overall linear ephemeris, confirming the pronounced quasi-periodic repeatability of superoutbursts. All relevant parameters are listed with their errors, and a table with individual superoutburst epochs of our targets is given, enabling future researchers to combine our results with other (past or future) observations.
Searching for gravitational-wave bursts from cosmic string cusps with the Parkes Pulsar Timing Array
Authors: Yonemaru N , Kuroyanagi S , Hobbs G , Takahashi K , Zhu X-J , Coles W A , Dai S , Howard E , Manchester R , Reardon D , Russell C , M Shannon R , Thyagarajan N , Spiewak R , Wang J-B
Published: November 2020

Cosmic strings are potential gravitational-wave (GW) sources that can be probed by pulsar timing arrays (PTAs). In this work we develop a detection algorithm for a GW burst from a cusp on a cosmic string, and apply it to Parkes PTA data. We find four events with a false alarm probability less than 1 per cent. However further investigation shows that all of these are likely to be spurious. As there are no convincing detections we place upper limits on the GW amplitude for different event durations. From these bounds we place limits on the cosmic string tension of Gμ ∼ 10−5, and highlight that this bound is independent from those obtained using other techniques. We discuss the physical implications of our results and the prospect of probing cosmic strings in the era of Square Kilometre Array.
Multiconfiguration Dirac–Hartree–Fock radiative parameters for emission lines in Ce ii–ivions and cerium opacity calculations for kilonovae
Authors: Carvajal Gallego H , Palmeri P , Quinet P
Published: November 2020

Large-scale calculations of atomic structures and radiative properties have been carried out for singly, doubly, and trebly ionized cerium. For this purpose, the purely relativistic multiconfiguration Dirac–Hartree–Fock (MCDHF) method was used, taking into account the effects of valence–valence and core–valence electronic correlations in detail. The results obtained were then used to calculate the expansion opacities characterizing the kilonovae observed as a result of neutron star mergers. Comparisons with previously published experimental and theoretical studies have shown that the results presented in this work are the most complete currently available, in terms of quantity and quality, concerning the atomic data and monochromatic opacities for Ce ii, Ce iii, and Ce iv ions.
Gaussian process foreground subtraction and power spectrum estimation for 21 cm cosmology
Authors: Kern Nicholas S , Liu Adrian
Published: November 2020

One of the primary challenges in enabling the scientific potential of 21 cm intensity mapping at the epoch of reionization (EoR) is the separation of astrophysical foreground contamination. Recent works have claimed that Gaussian process regression (GPR) can robustly perform this separation, particularly at low Fourier k wavenumbers where the EoR signal reaches its peak signal-to-noise ratio. We revisit this topic by casting GPR foreground subtraction (GPR-FS) into the quadratic estimator formalism, thereby putting its statistical properties on stronger theoretical footing. We find that GPR-FS can distort the window functions at these low k modes, which, without proper decorrelation, make it difficult to probe the EoR power spectrum. Incidentally, we also show that GPR-FS is in fact closely related to the widely studied inverse covariance weighting of the optimal quadratic estimator. As a case study, we look at recent power spectrum upper limits from the Low-Frequency Array (LOFAR) that utilized GPR-FS. We pay close attention to their normalization scheme, showing that it is particularly sensitive to signal loss when the EoR covariance is misestimated. This has possible ramifications for recent astrophysical interpretations of the LOFAR limits, because many of the EoR models ruled out do not fall within the bounds of the covariance models explored by LOFAR. Being more robust to this bias, we conclude that the quadratic estimator is a more natural framework for implementing GPR-FS and computing the 21 cm power spectrum.
The Surgical Autonomy Program: A Pilot Study of Social Learning Theory Applied to Competency-Based Neurosurgical Education
Authors: Haglund Michael M , Cutler Andrew B , Suarez Alexander , Dharmapurikar Rajeev , Lad Shivanand P , McDaniel Katherine E
Published: November 2020

Over the last decade, strict duty hour policies, pressure for increased work related value units from faculty, and the apprenticeship model of education have coalesced to make opportunities for intraoperative teaching more challenging. Evidence is emerging that graduating residents are not exhibiting competence by failing to recognize major complications, and perform routine operations independently. In this pilot study, we combine Vygotsky's social learning theory with a modified version of the competency-based scale called TAGS to study 1 single operation, anterior cervical discectomy and fusion, with 3 individual residents taught by a single faculty member. In order for the 3 residents to achieve “Solo and Observe” in all 4 zones of proximal development, the number of cases required was 10 cases for postgraduate year (PGY)-3a, 19 cases for PGY 3b, and 22 cases for the PGY 2. In this pilot study, the time required to complete an independent 2-level anterior cervical discectomy and fusion by the residents correlated with the number of cases to reach competence. We demonstrate the Surgical Autonomy Program's ability to track neurosurgical resident's educational progress and the feasibility of using the Surgical Autonomy Program (SAP) to teach residents in the operating room and provide immediate formative feedback. Ultimately, the SAP represents a paradigm shift towards a modern, scalable competency-focused subspecialty teaching, evaluation and assessment tool that provides increases in resident's autonomy and metacognitive skills, as well as immediate formative feedback.
Anterior Minimally Invasive Plate Osteosynthesis for Humeral Shaft Fractures Is Safer Than Open Reduction Internal Fixation: A Matched Case-Controlled Comparison
Authors: Randell Matthew , Glatt Vaida , Stabler Annabelle , Bussoletti Timothy , Hohmann Erik , Tetsworth Kevin
Published: November 2020

Objective:

Compare anterior minimally invasive plate osteosynthesis (MIPO) to open reduction/internal fixation (ORIF) for humeral shaft fractures, assessing complications and clinical outcomes.

Design:

Retrospective matched case-controlled cohort.

Setting:

Tertiary referral trauma centre.

Patients/Participants:

Humeral shaft fractures identified retrospectively over 5 years; 31 were treated by MIPO and 54 by ORIF. Matched-case cohort assembled according to fracture pattern, sex, age, and comorbidities, with 56 total patients (28 per group).

Interventions:

MIPO and ORIF.

Main Outcome Measures:

Complication rate was the primary outcome (radial nerve injury, nonunion, infection, and reoperation). Radiographic alignment and the Disabilities of the Arm, Shoulder and Hand Score were secondary outcomes.

Results:

Cumulative complication rates were 3.6% after anterior MIPO and 35.7% after ORIF (P = 0.0004). The only complication after anterior MIPO was a nonunion, managed with revision ORIF and bone graft. The ORIF group had 10 complications, including 5 superficial infections, 4 iatrogenic radial nerve injuries, and 1 nonunion. The mean Disabilities of the Arm, Shoulder and Hand score after MIPO was 17.0 ± 18.0 and after ORIF was 24.9 ± 19.5. The mean coronal plane angulation after MIPO was 1.8 ± 1.3 degrees and after ORIF was 1.0 ± 1.2 degrees. The mean sagittal plane angulation after MIPO was 3.0 ± 2.9 degrees and after ORIF was 1.0 ± 1.2 degrees.

Conclusions:

The cumulative complication rate was 10 times higher after ORIF of humeral shaft fractures compared with the MIPO technique. MIPO achieved nearly equivalent radiographic alignment, with no clinically meaningful differences observed. MIPO is the safer option and should be considered for patients with humeral shaft fractures that would benefit from surgical intervention.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
The single portal percutaneous epiphysiodesis technique for treatment of leg length inequality stops growth as expected
Authors: Elizondo Tayler , Tompkins Bryan , Bronson William , Caskey Paul , McMulkin Mark , Baird Glen
Published: November 2020

One technique for distal femur and proximal tibia epiphysiodesis to treat leg length inequality is a single-incision percutaneous technique using reamers and curettes. The purpose of this study is to demonstrate the efficacy and reliability of this technique by quantifying the growth arrest produced from this method. Patients who underwent distal femur and proximal tibia epiphysiodesis with a single-incision percutaneous technique were retrospectively reviewed. Using scanogram data, derivative formulas of both the multiplier and arithmetic methods were used to predict bone length after physeal arrest at maturity. Patients included had at least 2-year follow-up after surgery. Predicted bone lengths were then compared to actual bone lengths obtained via scanogram at final follow-up. A total of 46 patients were included in the study (27 males; 19 females). Average age at surgery was: males 14.5 years, females 12.4 years. Surgery was performed on 40 distal femurs and 25 proximal tibias. Postoperative femurs demonstrated an actual mean length of 44.75 cm. Predicted femur bone lengths utilizing the multiplier and arithmetic methods were 45.08 and 44.08 cm, respectively. Postoperative tibias demonstrated an actual mean length of 38.12 cm. Predicted tibia lengths utilizing the multiplier and arithmetic method were 38.30 and 38.02 cm. No significance was found between actual and predicted bone lengths for both tibias and femurs. This study demonstrates that a single-incision percutaneous epiphysiodesis technique reliably arrests the growth as expected. Surgeons can confidently and accurately employ this technique to successfully treat leg length inequality.
Lumbar intervertebral disc degeneration, end-plates and paraspinal muscle changes in children and adolescents with low-back pain
Authors: Ekşi Murat Ş. , Özcan-Ekşi Emel E. , Özmen Berk B. , Turgut Veli U. , Huet Sibel E. , Dinç Taha , Kara Müjdat , Özgen Serdar , Özek M. Memet , Pamir M. Necmettin
Published: November 2020

The prevalence of low-back pain (LBP) in adolescents ranges from 7 to 72%. We aimed to define the radiologic characteristics of the lumbar spine in children and adolescents with LBP with/without leg pain. Two hundred and fourteen children and adolescents, who were born between 2001 and 2009 and had lumbar spine MRI for LBP with/without leg pain, were evaluated in terms of intervertebral disc degeneration (IVDD), end-plates and paraspinal muscle changes on lumbar spine MRIs. Severe IVDD was detected at all lumbar levels except for L2–L3. Modic changes were present in 4.2% of the patients. Modic changes were more common in patients with severe IVDD than in those with mild-to-moderate IVDD. Severe IVDD was significantly associated with Modic changes at the corresponding L1–L2 and L3–L4 disc levels. Girls had significantly more fatty infiltration in the paraspinal muscles when compared to boys. The risk of having severe IVDD concomitant with Modic changes was high [odds ratio (OR), 8.6]. The OR was 20.7 for predicting the presence of severe IVDD at any level if Modic changes presented particularly at the L3–L4 level. The ORs of Modic changes presented at any lumbar level at the background of fat-infiltrated multifidus at L3–L4 and L4–L5 levels were 8.3 and 9.1, respectively. Fatty infiltration in the paraspinal muscles and IVDD were closely associated with Modic changes in children and adolescents with LBP. Lumbar IVDD in children and adolescents could be the result of a mechanical pathology.
The Incidence of Propofol-Induced Hypertriglyceridemia and Identification of Associated Risk Factors
Authors: Corrado Michael J. , Kovacevic Mary P. , Dube Kevin M. , Lupi Kenneth E. , Szumita Paul M , DeGrado Jeremy R.
Published: November 2020

Objectives:

The objective of this study was to describe the incidence of propofol-induced hypertriglyceridemia and the risk factors associated with hypertriglyceridemia in mechanically ventilated ICU patients while receiving propofol.

Design:

This was a single-center case-control study.

Setting:

Brigham and Women’s Hospital, a tertiary academic medical center in Boston, MA.

Subjects:

Adult ICU patients who received continuous infusion propofol for at least 24 hours from May 1, 2019, to December 31, 2019, were included. Patients were excluded if they were diagnosed with acute pancreatitis upon admission or did not have any serum triglyceride levels evaluated during propofol administration.

Interventions:

None.

Measurements and Main Results:

The major outcome was the incidence and risk factors associated with the development of propofol-induced hypertriglyceridemia, defined as triglyceride level greater than or equal to 400 mg/dL. Minor outcomes included the prevalence of acute pancreatitis. A hybrid multivariate logistic regression analysis was used to evaluate the relation between individual risk factors and the dependent variable of hypertriglyceridemia. During the study period, 552 patients were evaluated for inclusion, of which 136 were included in the final analysis. A total of 38 patients (27.9%) developed hypertriglyceridemia with a median time to hypertriglyceridemia of 47 hours. The only significant independent risk factor for development of hypertriglyceridemia identified was the cumulative propofol dose (odds ratio, 1.04; 95% CI, 1.01–1.08; p = 0.016). Two of the 38 hypertriglyceridemia patients (5.3%) were diagnosed with acute pancreatitis.

Conclusions:

In our analysis, approximately one third of patients developed hypertriglyceridemia with cumulative propofol dose identified as a significant predictor of the development of hypertriglyceridemia. Despite a high incidence of hypertriglyceridemia, a significant number of patients continued propofol therapy, and a relatively low prevalence of pancreatitis was observed. Future analyses are warranted to further investigate these results.
Single vs. Recurrent Episodes of Preeclampsia-population–based Epidemiological and Clinical Characteristics
Authors: Mastrolia Salvatore Andrea , Taran Boris , Kachko Eric , Mor Omer , Beer-Wiesel Ruth , Eshkoli Tamar , Dukler Doron , Miodownik Shayna , Erez Offer
Published: November 2020

Objective:

The aims of this study were to determine the differences between women with single vs. recurrent episodes of preeclampsia in term of: (1) the outcome of the first pregnancy affected by preeclampsia; and (2) the perinatal outcomes of subsequent pregnancies.

Methods:

This population based retrospective cohort study included all multiparous patients with a singleton gestation who delivered at Soroka University Medical Center (Beer Sheva, Israel) from January 1988 until December 2012, meeting the inclusion criteria, those who had fetuses with chromosomal or anatomical abnormalities were exclude. Our cohort included 213,558 deliveries that met the inclusion criteria, of them 208,017 had normotensive pregnancies and 5541 had preeclampsia. The latter group was further divided into those who had a single episode of preeclampsia followed by normotensive gestations (n = 3879), and women who had recurrent preeclampsia (n = 1662). We used parametric and non-parametric statistics as appropriate.

Results:

(1) Women with recurrent preeclampsia had an increased rate of early ((130/1662) 7.8% vs. (171/3879) 4.4%, P < 0.001) and late ((268/1662) 16.1% vs. (438/3879) 11.3%, P < 0.001) preterm deliveries than a single episode of preeclampsia; (2) of interest, the rate of chronic hypertension is higher in the first pregnancy of those with a single preeclampsia episode (P < 0.001), while women with recurrent preeclampsia developed it in the subsequent gestations (P < 0.001); (3) the rate of small for gestational age neonates in the index pregnancy was higher in those with recurrent rather than a single episode of preeclampsia (single episode 450/3879,11.6%, recurrent preeclampsia 244/1662, 14.7%, P = 0.002); (4) patients with recurrent disease had an increased rate of cesarean deliveries in the subsequent pregnancies (P < 0.001); and (5) patients who developed severe preeclampsia in the subsequent gestations had lower mean birthweight (P < 0.001), a higher rate of perinatal mortality (P < 0.001), and a lower Apgar score at 1 and 5 minutes (P < 0.001), than those who developed mild preeclampsia in subsequent pregnancies, those with a single episode of preeclampsia and the control group.

Conclusion:

Recurrent preeclampsia increases the rate of pregnancy complications in the following gestations. Early onset preeclampsia at the index pregnancy of women with recurrent preeclampsia, is associated with increased risk for severe preeclampsia, placental abruption and perinatal mortality in subsequent pregnancies.
Endothelial Keratoplasty Update 2020
Authors: Price Marianne O. , Feng Matthew T. , Price Francis W.
Published: November 2020

Endothelial keratoplasty has revolutionized the treatment of corneal endothelial dysfunction and lowered the threshold for treatment by providing rapid visual rehabilitation and setting a high standard for safety and efficacy. Over time, endothelial keratoplasty techniques have evolved toward the use of thinner tissue to optimize visual outcomes; refinements have facilitated donor tissue preparation, handling, and attachment; and adaptations have expanded utilization in eyes with challenging ocular anatomy. Despite early concerns about graft longevity, emerging 10-year endothelial cell loss and graft survival data have been encouraging. A shortage of human donor corneas restricts utilization in many areas of the world and is driving a search for keratoplasty alternatives. Further work is needed to expand the donor supply, minimize impediments to adoption, optimize graft survival, and improve refractive predictability.
Employer-Sponsored Sports Programs Amid COVID-19
Authors: Kwon Youngbum , Seo Hyomin
Published: November 2020

Objective:

To examine the effect of bridging social capital through sports programs on the job insecurity–well-being relationship.

Methods:

A total of 473 Korean employees participated in a cross-sectional survey in May 2020. Using structural equation modeling, we tested the following hypotheses: (a) job insecurity will partially mediate the relationship between perceived threat and well-being and (b) social capital through sports programs will moderate the relationship between job insecurity and well-being. Socioeconomic status was used as a control variable for well-being.

Results:

The hypothesized relationships in the structural model were all significant (P < .001). Bridging social capital through sports programs had a significant moderating effect on the proposed relationship.

Conclusions:

Strong bridging social capital through employer-sponsored sports programs is likely to buffer the detrimental effect of job insecurity on employee well-being.
Medically Unnecessary Female Genital Alteration
Authors: Joseph Rachel A. , Mullen Lora M.
Published: November 2020

Medically unnecessary female genital alteration (MUFGA) aka female genital mutilation or female circumcision is a cultural practice in several countries in the Middle East and Africa. There are four major types of MUFGA where parts of external genitalia of a girl are removed to varying levels leading to several complications such as infection, hemorrhage, obstetric complications, and even death. The United Nations has condemned this practice and called for abolition of MUFGA. However, this practice is continued in these countries, and when people migrate, they continue the practice. It is considered abuse or violation of human rights. Knowledge about MUFGA is scanty among health care providers in the West. This brief article attempts to raise awareness among health care providers, particularly nurses, so that they will provide the right care, both physical and emotional, to the girls and women who have experienced having MUFGA.
Effect of the Menstrual Cycle on Athletic Performance in NCAA Division III Collegiate Athletes
Authors: Tremback-Ball Amy , Fulton Kaitlin , Giampietro Nicole , Gibbons Megan , Kneller Arielle , Zelinka Hayley
Published: November 2020

Background:

Gender-specific aspects of physiology influence multiple systems including the cardiovascular, respiratory, neuromuscular, and musculoskeletal systems. Studies have shown that female athletes are 2 to 10 times more susceptible to ligamentous injury than men. Studies contributed these findings to varying anatomical structure between men and women, hormonal changes throughout the menstrual cycle, and some athletes taking oral contraceptives. A female athlete may be just as fit as her male counterpart, yet it is recognized that the menstrual cycle has unique physiological and psychological effects on athletic performance. Fluctuations in sex hormones and symptoms of the menstrual cycle may impact one's ability to train and compete.

Objectives:

To analyze the effect of the menstrual cycle on athletic performance in NCAA Division III collegiate athletes.

Study Design:

Prospective, nonexperimental, descriptive study.

Methods:

Participants were recruited from NCAA Division III universities in Pennsylvania. Data were collected on participants' demographics, menstrual cycle history, use of birth control, premenstrual symptoms, and athletic performance. Athletic performance was examined and compared during the follicular and luteal phases and during nonmenstruating and menstruating days.

Results:

Eight athletes were included in the analysis. No trends were observed when comparing athletic performance during the follicular and luteal phases. When examining nonmenstruating and menstruating days, most average race times slowed or increased.

Conclusion:

Incorporating menstrual cycle tracking into a plan of care can help therapists determine best exercises based on phase of cycle. Therapists can also educate patients at risk of injury, modifying training plans and expectations on performance.
Texas Team Action Coalition Advancing Health Through Nursing
Authors: Zolnierek Cindy , Watson James Jeffery , Ruiz Diana
Published: November 2020

When the Institute of Medicine released its report, commonly known as the Future of Nursing report, every state was challenged to take on the work of implementing the 8 recommendations. The Texas Team Action Coalition achieved measurable results in many areas; however, sustainability of efforts was challenging due to the volunteer nature of the work. As Robert Wood Johnson Foundation's focus shifted from Advancing Health Through Nursing to Building a Culture of Health for All, the Texas Team sought to realign its work accordingly. This article details initiatives of the Texas Team over the past 10 years and describes current efforts to position itself to champion anticipated recommendations from the 2020-2030 Future of Nursing report from the National Academy of Medicine.
Impact of a Nurse-Driven Opioid Titration Protocol on Quality of Orders at End of Life
Authors: Cardinale Maria , Kumapley Genevieve , Wong Cecilia , Kuc Mary Eileen , Beagin Erinn
Published: November 2020

At our community teaching hospital, orders for end of life often lacked instructions to titrate opioids based on evidence-based principles and failed to address nonpain symptoms. An order set and a nursing-driven opioid titration protocol were implemented in August 2016 after extensive education. The purpose of this retrospective preintervention and postintervention study was to evaluate the impact of this intervention on the quality of end-of-life orders. We evaluated 69 patients with terminal illness receiving morphine infusions. After implementation, more morphine infusion orders included an as-needed bolus dose with an objective indication and appropriate instructions on when and how to titrate the infusion compared with before the intervention (94.6% vs 18.8%, P < .0001). Morphine infusion orders were also significantly more likely to include a maximum dose (P = .041) and an initial bolus dose (P < .0001). In addition, prescribers were more likely to order additional medications to manage nausea/vomiting, constipation, anxiety, or pain using a nonopioid (P < .05 for all). In this study, implementation of a standardized opioid titration protocol and symptom management order set led to an improvement in the quality of morphine infusion orders for pain management at the end of life and increased the use of medications to manage nonpain symptoms in dying patients.
Topical Review: Causes of Refractive Error After Silicone-oil Removal Combined with Cataract Surgery
Authors: Shu Zhi-Min , Li Fu-Qiang , Che Song-Tian , Shan Chen-Li , Zhao Jin-Song
Published: November 2020

SIGNIFICANCE

This review summarizes the main factors of refractive error after silicone oil removal combined with cataract surgery.

The post-operative refractive results of silicone oil removal combined with cataract surgery are closely related to the patient's future vision quality. This report summarizes the factors that influence the difference between the actual post-operative refractive power and the pre-operatively predicted refractive power after silicone oil removal combined with cataract surgery, including axial length, anterior chamber depth, silicone oil, commonly used tools for measuring intraocular lens power, and intraocular lens power calculation formulas, among others. The aim of the report is to assist clinical and scientific research on the elimination of refractive error after silicone oil removal combined with cataract surgery.
The Development of a Novel International Elective in Physical Medicine and Rehabilitation
Authors: Mathews Amy , Doobay-Persaud Ashti , Rydberg Leslie
Published: November 2020

Interest in global health is rising in graduate medical education. Trainees are increasingly seeking high-quality, ethically sound, and educationally robust opportunities for global medical rotations (Int J Gynecol Obstet. 2014;128(2):148–51). When based on best educational practices, these opportunities can provide a unique learning experience for residents in traditional physical medicine and rehabilitation programs. This article describes the development of an international rotation in physical medicine and rehabilitation including specific competency-based physical medicine and rehabilitation global health learning objectives, predeparture training, rotation structure, and postrotation feedback mechanisms. The aim is to present the development of the program as a resource for both residents and program directors to help create and maximize existing rotations at their own institutions. Learners must complete predeparture requirements that include completion of a musculoskeletal rotation and global health didactics intended to provide foundational knowledge in physiatry and global health. Postrotation requirements include the residency program’s standardized evaluation form, resident survey, and self-reflection essay. Experience from a novel 4-wk pilot rotation to Punta Gorda, Belize, is described to exemplify Accreditation Council for Graduate Medical Education–based learning objectives as well as the benefits of a formalized rotation structure. Using this unique set of learning objectives and proposed rotation requirements, the authors believe that physical medicine and rehabilitation residency programs can develop valuable global health learning experiences.
High Coverage of Antiretroviral Treatment With Annual Home-Based HIV Testing, Follow-up Linkage Services, and Implementation of Test and Start: Findings From the Chókwè Health Demographic Surveillance System, Mozambique, 2014–2019
Authors: Pathmanathan Ishani , Nelson Robert , de Louvado Alzira , Thompson Ricardo , Pals Sherri , Casavant Isabelle , Cardoso Maria Judite Antonio , Ujamaa Dawud , Bonzela Juvêncio , Mikusova Silvia , Chivurre Victor , Tamele Stelio , Sleeman Katrina , Zhang Guoqing , Zeh Clement , Dobbs Trudy , Vubil Adolfo , Auld Andrew , Briggs-Hagen Melissa , Vergara Alfredo , Couto Aleny , MacKellar Duncan
Published: November 2020

Background:

Early antiretroviral therapy (ART) is necessary for HIV epidemic control and depends on early diagnosis and successful linkage to care. Since 2014, annual household-based HIV testing and counseling and linkage services have been provided through the Chókwè Health and Demographic Surveillance System for residents testing HIV positive in this high HIV-burden district.

Methods:

District-wide Test and Start [T&S, ART for all people living with HIV (PLHIV)] began in August 2016, supported by systematic interventions to improve linkage to care and treatment. Annual rounds (R) of random household surveys were conducted to assess trends in population prevalence of ART use and viral load suppression (<1000 viral RNA copies/mL).

Results:

Between R1 (April 2014–April 2015) and R5 (April 2018–Mar 2019), 46,090 (67.2%) of 68,620 residents aged 15–59 years were tested for HIV at home at least once, and 3711 were newly diagnosed with HIV and provided linkage services. Population prevalence of current ART use among PLHIV increased from 65.0% to 87.5% between R1 and R5. ART population prevalence was lowest among men aged 25–34 years (67.8%) and women aged 15–24 (78.0%), and highest among women aged 35–44 years (93.6%) and 45–59 years (93.7%) in R5. Viral load suppression prevalence increased among all PLHIV aged 15–59 years from 52.0% in R1 to 78.3% in R5.

Discussion:

Between 2014 and 2019, Chókwè Health and Demographic Surveillance System residents surpassed the UNAIDS targets of ≥81% of PLHIV on ART and ≥73% virally suppressed. This achievement supports the combination of efforts from household-based HIV testing and counseling, support for linkage to care and treatment, and continued investments in T&S implementation.
Risk Factors for Wound Complications After Soft Tissue Sarcoma Resection
Authors: Perrault David P. , Lee Gene K. , Yu Roy P. , Carre Antoine Lyonel , Chattha Anmol , Johnson Maxwell B. , Gardner Daniel J. , Carey Joseph N. , Tseng William W. , Menendez Lawrence R. , Wong Alex K.
Published: November 2020

Soft tissue sarcomas are a heterogenous group of malignant tumors that represent approximately 1% of adult malignancies. Although these tumors occur throughout the body, the majority involved the lower extremity. Management may involve amputation but more commonly often includes wide local resection by an oncologic surgeon and involvement of a plastic surgeon for reconstruction of larger and more complex defects. Postoperative wound complications are challenging for the surgeon and patient but also impact management of adjuvant chemotherapy and radiation therapy. To explore risk factors for wound complications, we reviewed our single-institution experience of lower-extremity soft tissue sarcomas from April 2009 to September 2016. We identified 127 patients for retrospective review and analysis. The proportion of patients with wound complications in the cohort was 43.3%. Most notably, compared with patients without wound complications, patients with wound complications had a higher proportion of immediate reconstruction (34.5% vs 15.3%; P = 0.05) and a marginally higher proportion who received neoadjuvant radiation (30.9% vs 16.7%; P = 0.06).
Differences and Similarities Between Eastern and Western Rhinoplasty
Authors: Lao William Wei-Kai , Hsieh Tung-Ying , Ramirez Alejandro E.
Published: November 2020

The authors collectively reviewed their experiences in performing rhinoplasty in North America, Asia, and South America and categorized common undesirable features in Eastern and Western rhinoplasty and their respective surgical algorithms. In Western rhinoplasty, the surgery is often reduction in nature. The proposed algorithm is a dorsum-first, tip-second surgical sequence to better suit the need of this population. Meanwhile in Eastern rhinoplasty, the surgery is often augmentation in nature with extra materials needed to build the nose. The proposed algorithm is the opposite, a tip-first and dorsum-second surgical sequence.
The degeneration of upper and lower motor neuron from the perspective of clinical neurological examination and MRI-electromyography manifold detection in amyotrophic lateral sclerosis
Authors: Jin Jiaoting , Hu Fangfang , Zhang Qiuli , Chen Qiaoyi , Li Haining , Qin Xing , Ji Rui , Kang Li , Dang Yonghui , Dang Jingxia
Published: November 2020

Objective

The aim of this study was to explore the upper motor neurons (UMN) and lower motor neurons (LMN) degeneration in amyotrophic lateral sclerosis (ALS) from the perspective of the clinical neurological examination and MRI-electromyography manifold detection, respectively.

Methods

The clinical data, cortical thickness of corresponding areas in different body regions in MRI and electromyography data were collected from 108 classical ALS patients.

Results

The kappa value of UMN and LMN involvement signs in the bulbar region (0.31) was higher than that of the left upper limb (−0.13), right upper limb (−0.27), left lower limb (−0.05) and right lower limb (−0.08). The cortical thickness in the positive LMN damage group was thinner than that of the negative LMN damage group in the left head–face area (P < 0.05; Cohen’s d = 0.84); however, cortical thickness showed no significant differences in the right head–face, bilateral tongue–larynx, upper-limb, trunk and lower-limb areas between LMN-damage-positive and LMN-damage-negative groups.

Conclusion

The degeneration of motor neuron could be independent through UMN and LMN levels. The degenerative process was not only confined to UMN and LMN levels but can also expand to white matter fiber tracts. Thus, the degeneration of UMN and LMN might be independent of the motor system’s three-dimensional anatomy.
Minocycline, but not doxycycline attenuates NMDA-induced [Ca2+]i and excitotoxicity
Authors: Lu Yaqin , Yang Yusheng , Chen Wanqiang , Du Nicole , Du Yansheng , Gu Huiying , Liu Qi
Published: November 2020

Minocycline and doxycycline, two semisynthetic second-generation tetracyclines, are reported to provide neuroprotection against brain injury and glutamate-induced neurotoxicity in neuronal cultures. Doxycycline has been postulated as the potential ideal candidate for further therapeutic development as it has fewer adverse effects than minocycline. In this study, we determined whether minocycline and doxycycline could similarly protect neurons against excitotoxic insults. We treated cultured rat cortical neurons and cerebellar granule neurons (CGN) with excitotoxic concentrations of NMDA or glutamate in the presence or absence of minocycline or doxycycline. Intracellular Ca2+ concentration ([Ca2+]i) was also measured using a Fluorescent Light Imaging Plate Reader (FLIPR; Molecular Devices) with the calcium sensitive dye Fluo-3 AM. We found that minocycline and tetracycline markedly protected neurons against NMDA- and glutamate-induced neuronal death. In contrast, the structurally related tetracycline, doxycycline, was ineffective at concentrations up to 100 μM. Furthermore, minocycline, but not doxycycline, also significantly attenuated NMDA- or glutamate-induced [Ca2+]i in both cortical neurons and CGN. Our results suggest that minocycline but not doxycycline is able to directly block NMDA- or glutamate-induced excitotoxicity in neurons most likely by inhibiting NMDA- and glutamate-induced [Ca2+]i. This finding may contribute to our understanding of the molecular mechanisms underlying doxycycline- and minocycline-induced neuroprotection.
Lidocaine inhibits glioma cell proliferation, migration and invasion by modulating the circEZH2/miR-181b-5p pathway
Authors: Wen Jian , Li Xin , Ding Yan , Zheng Shaohua , Xiao Ying
Published: November 2020

Background

Lidocaine is well known as a local anesthetic that has been reported to play an antitumor role in numerous cancers, including glioma. Circular RNAs (circRNAs) play multiple biological roles in cancers. The aim of this study was to determine the effects of lidocaine in glioma in vitro and in vivo and explore functional mechanisms.

Methods

The effects of lidocaine on glioma progression were investigated by cell proliferation, migration and invasion using 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay, colony formation assay and transwell assay. The expression of CD133 and glial fibrillary acidic protein (GFAP) was quantified by western blot to assess cell differentiation. The expression of circEZH2 and miR-181b-5p was detected by a quantitative real-time PCR (qRT-PCR). The target relationship between circEZH2 and miR-181b-5p was verified by dual-luciferase reporter assay and RNA immunoprecipitation (RIP) assay. The effect of lidocaine on tumor growth in vivo was investigated by establishing Xenograft models.

Results

Lidocaine inhibited proliferation, migration, invasion and induced differentiation of glioma cells in vitro. Lidocaine suppressed the expression of circEZH2, and circEZH2 was highly expressed in glioma tissues and cells. CircEZH2 overexpression partly inhibited the function of lidocaine. CircEZH2 was a sponge of miR-181b-5p, and miR-181b-5p was downregulated in glioma tissues and cells. Besides, miR-181b-5p restoration reversed the effects of circEZH2 overexpression to repress the malignant behaviors of glioma cells. In addition, lidocaine mediated the circEZH2/miR-181b-5p axis to inhibit tumor growth in vivo.

Conclusion

Lidocaine suppressed glioma progression by modulating the circEZH2/miR-181b-5p pathway.
Molecular identification of pathogenic fungi in formalin-fixed and paraffin-embedded tissues
Authors: Jillwin Joseph , Rudramurthy Shivaprakash M. , Singh Shreya , Bal Amanjit , Das Ashim , Radotra Bishan , Prakash Hariprasath , Dhaliwal Manpreet , Kaur Harsimran , Ghosh Anup K. , Chakrabarti Arunaloke
Published: November 2020

Introduction. Histopathological examination (HPE) of tissue helps in the diagnosis of invasive fungal infections (IFIs) but cannot identify the fungus to the genus/species level

Gap Statement Available protocols for the molecular identification of fungi from formalin-fixed and paraffin-embedded (FFPE) tissues have limitations in terms of extraction and target selection, and standardisation.

Aim. Development of sequence-based fungal identification protocol after extraction of DNA from formalin-fixed and paraffin-embedded (FFPE) tissues.

Methodology. A total of 63 FFPE tissues from histopathology proven IFI cases were used to standardize the DNA extraction (commercial QIAamp kit-based extraction and conventional phenol-chloroform-isoamyl alcohol [PCI] method) and sequence-based fungal identification protocols. The PCR targeted different ribosomal DNA (rDNA) regions including complete internal transcribed spacer (ITS1-5.8S-ITS2), separate ITS1 and ITS2, 18S and D1/D2 of 28S regions. Semi-nested PCR targeting Mucorales-specific 18S rDNA region was performed in tissues having aseptate hyphae. The optimized ITS1-PCR protocol was evaluated in 119 FFPE tissues containing septate hyphae or yeast, and Mucorales-specific semi-nested PCR in 126 FFPE tissues containing aseptate hyphae.

Results. The DNA yield by conventional PCI method was significantly higher (P<0.0001) than commercial kit, though the quality of DNA was similar by both protocols. The test accuracy was best while using ITS1 (61.9 %) as the target compared to 7.9, 29.9 and 22.2 % on targeting ITS1-5.8S-ITS2, ITS2, the D1/D2 region of 28S, respectively. The test accuracies of ITS1-PCR in tissues containing septate hyphae, aseptate hyphae and yeasts were 75.5, 18.7 and 100 %, respectively. The amplification (targeting ITS1 region) improved by increasing the thickness of tissue section (up to 50 µm) used for DNA extraction. ITS1-PCR protocol could amplify fungal DNA in 76 (63.8 %) tissues and Mucorales-specific semi-nested PCR in 86 (68.3 %) tissues.

Conclusion. Conventional PCI-based DNA extraction from thick tissue (50 µm) may be used until optimal commercial fungal DNA extraction kit is developed. Subsequent ITS1-PCR for septate fungi and yeast, and semi-nested PCR targeting 18S rDNA for Mucorales are recommended to identify the fungus in FFPE tissues.
Clinical characteristics and mortality associated with COVID-19 in Jakarta, Indonesia: a hospital-based retrospective cohort study
Authors: Surendra Henry , Elyazar Iqbal RF , Djaafara Bimandra A , Ekawati Lenny L , Saraswati Kartika , Adrian Verry , Widyastuti  , Oktavia Dwi , Salama Ngabila , Lina Rosa N , Andrianto Adhi , Lestari Karina D , Burhan Erlina , Shankar Anuraj H , Thwaites Guy , Baird J. Kevin , Hamers Raph L.
Published: November 2020

Background

Data on COVID-19-related mortality and associated factors from low-resource settings are scarce. This study examined clinical characteristics and factors associated with in-hospital mortality of COVID-19 patients in Jakarta, Indonesia, from March 2 to July 31, 2020.

Methods

This retrospective cohort included all hospitalised patients with PCR-confirmed COVID-19 in 55 hospitals. We extracted demographic and clinical data, including hospital outcomes (discharge or death). We used Cox regression to examine factors associated with mortality.

Findings

Of 4265 patients with a definitive outcome by July 31, 3768 (88%) were discharged and 497 (12%) died. The median age was 46 years (IQR 32–57), 5% were children, and 31% had at least one comorbidity. Age-specific mortalities were 11% (7/61) for <5 years; 4% (1/23) for 5-9; 2% (3/133) for 10-19; 2% (8/638) for 20-29; 3% (26/755) for 30-39; 7% (61/819) for 40-49; 17% (155/941) for 50-59; 22% (132/611) for 60-69; and 34% (96/284) for ≥70. Risk of death was associated with higher age; pre-existing hypertension, cardiac disease, chronic kidney disease or liver disease; clinical diagnosis of pneumonia; multiple (>3) symptoms; and shorter time from symptom onset to admission. Patients <50 years with >1 comorbidity had a nearly six-fold higher risk of death than those without (adjusted hazard ratio 5·50, 95% CI 2·72-11·13; 27% vs 3% mortality).

Interpretation

Overall mortality was lower than reported in high-income countries, probably due to younger age distribution and fewer comorbidities. However, deaths occurred across all ages, with >10% mortality among children <5 years and adults >50 years.