bluuebunny/crossref_metadata_2025 huggingface dataset:
Potential risk factors for caesarean scar pregnancy: a retrospective case–control study
Authors: Gull B , Klerelid V , Jormeus A , Strandell A
Published: April 2021

STUDY QUESTION

What are the important risk factors for having a caesarean scar pregnancy (CSP)?

SUMMARY ANSWER

Independent risk factors were smoking in the first trimester, higher parity, and previous caesarean section (CS) before the index caesarean delivery.

WHAT IS KNOWN ALREADY

A spectrum of risk factors for CSP has been suggested but not proven: parity, number of previous caesarean section, elective as opposed to emergency CS, IVF-pregnancy, breech presentation, previous gynaecological surgery as well as suture technique.

STUDY DESIGN, SIZE, DURATION

This retrospective case-control study included 31 women with a CSP during the period 2003–2018 treated at a tertiary care centre for gynaecology and reproduction. A control cohort of 8300 women with a history of a CS and a subsequent delivery during the same time period was formed.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Variables describing demography, lifestyle factors, and reproductive and obstetric history were retrieved from medical records and the obstetric hospital database. Logistic regression analyses were applied to identify potential risk factors.

MAIN RESULTS AND THE ROLE OF CHANCE

In a multivariable analysis, smoking in first trimester (adjusted odds ratio (OR) 3.03, 95% CI 1.01–9.07), higher parity (adjusted OR 1.30, 95% CI 1.03–1.64) and previous CS in addition to the preceding CS (adjusted OR 3.43, 95% CI 1.35–8.66) were independently predictive of a CSP. An elective CS at the index pregnancy was associated with an increased risk of CSP but did not remain significant in the multivariable analysis.

LIMITATIONS, REASONS FOR CAUTION

CSP is a very rare phenomenon and several of the risk factor estimates are imprecise. Nevertheless, significant risk factors could be identified. Another limitation is the lack of electronically recorded details on suture techniques.

WIDER IMPLICATIONS OF THE FINDINGS

The identified factors, namely higher parity and previous CS before the index caesarean section, are in accordance with previously suggested risk factors. Whether there is a true risk association between elective CS and future CSP needs to be investigated further. Smoking in the first trimester is a new finding, which has a plausible rationale. These factors should be recognised when counselling women after a caesarean delivery, particularly in a subsequent pregnancy with early complications.

STUDY FUNDING/COMPETING INTEREST(S)

This work was supported by a grant from the Swedish state under the agreement between the Swedish government and the county councils the ALF-agreement (ALFGBG-720291). None of the authors has any conflict of interest to declare.
Semantic Aspects of National Varieties of Spanish in a Dictionary of Neologisms, theAntenario
Authors: Adelstein Andreína , Boschiroli Victoria de los Ángeles
Published: April 2021

The process of including neologisms in dictionaries has usually been studied in Spanish from the point of view of only one specific kind of dictionary, the general language dictionary, in terms of how the headword list and entries are updated. This fails to address a key question: What does the inclusion of new words in a dictiXNnary of neologisms actually involve? The aim of this paper is to explore problems of representation of neological variation by discussing how the tension between neologicity and geolectal variation is dealt with in a non-pan-Hispanic dictionary, the Antenario. Diccionario en línea de neologismos de las variedades del español (http://www.antenario.wordpress.com), designed and written by the Antenas Neológicas Network (https://www.upf.edu/web/antenas), and thus contribute to further the characterization of dictionaries of neologisms. We will focus the analysis on three aspects of lexicographic representation which are clearly linked to geolectal variation: degrees of neologicity, synonymy and polysemy.
The Use of Online Writing Tools by Learners of English: Evidence From a Process Corpus
Authors: Gilquin Gaëtanelle , Laporte Samantha
Published: April 2021

This paper examines the use of online writing tools by French-speaking learners of English based on the analysis of screen recordings of a free composition task that come from the Process Corpus of English in Education, a process corpus of learner writing. The study charts learners’ use of online resources by investigating how often learners resort to tools, which tools they use, and what effect the use of tools has on their texts. Results show considerable individual variation in the extent to which learners use online tools and a general propensity to rely on a limited range of tool types, most often bilingual tools. Overall, the use of tools helps learners improve their texts, but a close examination of their consultation behaviour also reveals shortcomings in learners’ strategies, such as a tendency to carry out single-word searches or a lack of critical thinking about the information that tools provide.
An analysis of hospital pharmacy practice in Namibia, based on FIP’s Basel Statements
Authors: Bare Andrea , Ivey Marianne , Kibuule Dan , Stevenson James G
Published: April 2021

Background

Sub-Saharan Africa, a region faced with a double challenge of infectious and non-communicable diseases requires strengthening of hospital pharmacy practice to improve treatment outcomes and patient safety.

Objectives

The objectives of this study were to assess the current state of pharmacy practice in hospitals in Namibia and to identify opportunities for expanding pharmacists’ role in addressing public health challenges and improving medicines use outcomes.

Methods

A survey utilized FIP’s self-assessment tool to evaluate current hospital pharmacy practice in Namibia against best practices articulated in the Basel Statements. The study was conducted among hospital pharmacists across Namibia. Quantitative and qualitative data were analysed using descriptive statistics and thematic analysis.

Key findings

The study was conducted in 24 hospital pharmacies across Namibia, the majority of which were public facilities (67%). Overall, current hospital pharmacy practice activities are focused on medicine procurement, preparation and distribution. The main barriers to optimal hospital pharmacy services are associated with limited human resources and collaboration across healthcare providers, as well as policy gaps.

Conclusions

There is a strong desire among hospital pharmacists to expand their contributions to improving medicines outcomes and solving public health problems. Namibia’s pharmacy educational system is a strength and should be utilized to continue advancing hospital pharmacy practice and medicines use. Therapeutics committees are usually part of each hospital’s structure and can be very effective for hospital-based policy change. The opportunity exists to optimize pharmacists’ contributions by utilizing the local therapeutics committees in combination with the educational system to advance hospital pharmacy practice in Namibia.
Performance Evaluation of an Automated Fentanyl Immunoassay
Authors: Tang Mei San , Lloyd Matthew , Williams Monette , Farnsworth Christopher W , Budelier Melissa M
Published: April 2021

Background

High-throughput fentanyl immunoassays have recently emerged for clinical use, but early reports have demonstrated relatively high false-positive rates. The purpose of this study was to compare 2 immunoassays, the ARK and ARK II fentanyl immunoassays, and to demonstrate the clinical impact of implementing the ARK II assay.

Methods

The ARK and ARK II fentanyl assays were performed on a Roche c 502 chemistry analyzer. Positive and negative percentage agreement was assessed for each assay with 112 residual patient specimens relative to liquid chromatography–tandem mass spectrometry (LC–MS/MS). Cross-reactivity was assessed with the primary metabolite, norfentanyl, and analogs acetylfentanyl, acrylfentanyl, and furanylfentanyl. The proportion of specimens that did not confirm was assessed retrospectively from the laboratory information system.

Results

The concordance of the ARK assay was 75% (kappa 0.46, 95%CI 0.28–0.63) and the ARK II was 93% (kappa 0.86, 95%CI 0.76–0.95) with LC–MS/MS. 30 ng/mL of norfentanyl was required for a positive result by ARK and 15 ng/mL by ARK II. Similar cross-reactivity was observed when fentanyl and norfentanyl were both present in the specimen and with fentanyl analogs. After implementing the ARK II assay, the proportion of specimens that did not confirm by LC–MS/MS decreased from 11.7% per month to 2.0% per month.

Conclusions

The ARK II fentanyl immunoassay has improved concordance relative to the original ARK fentanyl immunoassay using LC–MS/MS as the comparator method. Improved analyte specificity resulted in a reduced proportion of clinical samples that do not confirm.
How SARS-CoV-2 Transformed the Clinical Laboratory: Challenges and Lessons Learned
Authors: Tsai Jonathan M , Tolan Nicole V , Petrides Athena K , Kanjilal Sanjat , Brigl Manfred , Lindeman Neal I , Li Yen-Der , Tanasijevic Milenko J , Basu Sankha S , Melanson Stacy E F
Published: April 2021

The COVID-19 pandemic has made a devastating impact on global health and continues to challenge healthcare infrastructure and delivery. The clinical laboratories were no exception as they are responsible for diagnostic testing that dictates many clinical, infection control, and public health decisions. Information technology and laboratory management tools are critical assets for maintaining and adapting operations in response to crises. When utilized effectively, they promote the integration between the clinical laboratory specialties (e.g., chemistry, hematology, microbiology, and molecular pathology). During the COVID-19 pandemic, our systems and processes were strained due to high testing volumes, demand for rapid turnaround times, supply chain constraints, and constantly evolving testing algorithms and result interpretations as our knowledge of the virus and of diagnostics increased over time. In this report, we describe those challenges and subsequent adaptations made by each clinical laboratory section. We hope these details help to provide potential solutions and approaches for other hospitals facing COVID-19 surges or other future pandemics.
The Hidden Cost of Hemolyzed Blood Samples in the Emergency Department
Authors: Phelan Michael P , Ramos Christopher , Walker Laura E , Richland Gerald , Reineks Edmunds Z
Published: April 2021

Background

On average, patients with hemolyzed potassium samples spend about 1 h longer in the emergency department (ED), regardless of acuity level or disposition. We aimed to quantify the direct expenses associated with poor-quality preanalytic blood samples collected in the ED.

Methods

We created a simple table with a range of direct expenses (i.e., costs) and rates of hemolyzed sample draws, allowing for identification of potential high-level cost-of-care impact analysis. We included a range of costs informed by review of literature on the topic. Those costs range from $600 to $3000 per bed-hour. This amount was inflation adjusted from 1996 to 2020 (1.68 × [direct cost per visit] × [100 000 visits per year/365 days/24 h]). We provided a range of hemolysis incidence based on previously reported data.

Results

We showed that for an ED with 100 000 annual visits, a 40% draw rate for routine chemistries (including potassium), and a 10% hemolysis incidence, the direct cost impact of hemolysis waste is approximately $4 million/year as a result of the 1 h of added length of stay on average for a patient with a hemolyzed blood sample. This amount represents an annualized estimated cost of caring for a patient in the ED with an avoidable extended length of stay.

Conclusions

The financial burden of poor-quality blood samples can be estimated using cost per bed-hour and rate of sample failure. Similar methodology may identify additional QC issues with previously invisible financial implications.
The role of the pharmacist in contraception and pre-pregnancy management for women with diabetes: a study of patient and pharmacist perspectives
Authors: Garsia Kathryn , MacMillan Freya , Dune Tinashe , Simmons David
Published: April 2021

Objectives

Women with diabetes are at increased risk of adverse pregnancy outcomes compared to women with gestational diabetes (GDM) or no diabetes. Pregnancy outcomes are improved by specialist pre-pregnancy care. We aimed to explore pharmacists’ and women with diabetes’ perceptions of the roles and barriers to pharmacist participation in a diabetes contraception and pre-pregnancy program in South-Western Sydney (SWS).

Methods

The Diabetes Contraception and Pre-pregnancy Program (DCAPP) aims to reduce adverse pregnancy outcomes among women with diabetes. This includes awareness raising among, and through, pharmacists. Surveys to explore pharmacists’ roles in contraception and pre-pregnancy management (CPPM) were completed by SWS pharmacists and women with diabetes from diabetes clinics aged 18–50 years. Survey themes were then discussed in interviews and focus groups with pharmacists across Australia. Thematic analysis of transcripts was undertaken.

Key findings

Pharmacists were seen to have a role in diabetes health promotion, information distribution and referral to pre-pregnancy clinics. Pharmacists and women recognised the need for increased knowledge and educational materials about CPPM and effective awareness and coordination of CPPM services. Some pharmacists recognised deficits in their knowledge regarding diabetes in pregnancy, including CPPM and differences to GDM. Barriers to pharmacists’ involvement in CPPM included difficulty identifying applicable women and reluctance to initiate pregnancy planning and contraception conversations, often due to language and cultural barriers.

Conclusions

Pharmacists and women with diabetes see an important role for pharmacists in CPPM. Co-designed diabetes training for pharmacists and increased communication about DCAPP were seen important for ongoing implementation.
Crystal structures of N-terminally truncated telomerase reverse transcriptase from fungi
Authors: Zhai Liu-Tao , Rety Stephane , Chen Wei-Fei , Song Ze-Yu , Auguin Daniel , Sun Bo , Dou Shuo-Xing , Xi Xu-Guang
Published: April 2021

Telomerase plays critical roles in cellular aging, in the emergence and/or development of cancer, and in the capacity for stem-cell renewal, consists of a catalytic telomerase reverse transcriptase (TERT) and a template-encoding RNA (TER). TERs from diverse organisms contain two conserved structural elements: the template-pseudoknot (T-PK) and a helical three-way junction (TWJ). Species-specific features of the structure and function of telomerase make obtaining a more in-depth understanding of the molecular mechanism of telomerase particularly important. Here, we report the first structural studies of N-terminally truncated TERTs from Candida albicans and Candida tropicalis in apo form and complexed with their respective TWJs in several conformations. We found that Candida TERT proteins perform only one round of telomere addition in the presence or absence of PK/TWJ and display standard reverse transcriptase activity. The C-terminal domain adopts at least two extreme conformations and undergoes conformational interconversion, which regulates the catalytic activity. Most importantly, we identified a conserved tertiary structural motif, called the U-motif, which interacts with the reverse transcriptase domain and is crucial for catalytic activity. Together these results shed new light on the structure and mechanics of fungal TERTs, which show common TERT characteristics, but also display species-specific features.
Detailed analysis of the poorly studied northern open cluster NGC 1348 using multi-color photometry and GAIA EDR3 astrometry
Authors: Bisht Devendra , Zhu Qingfeng , Elsanhoury W H , Sariya Devesh P , Rangwal Geeta , Yadav Ramakant Singh , Durgapal Alok , Jiang Ing-Guey
Published: April 2021

The membership determination for open clusters in noisy environments of the Milky Way is still an open problem. In this paper, our main aim is to provide the membership probability of stars using proper motions and parallax values of stars using Gaia Third Data Release astrometry. Apart from the Gaia astrometry, we have also used other photometric data sets like the UKIRT Infrared Deep Sky Survey, WISE, the American Association of Variable Star Observers (AAVSO) Photometric All-Sky Survey, and Pan-STARRS1 in order to understand cluster properties from optical to mid-infrared regions. We selected 438 likely members with membership probabilities higher than $50\%$ and G ≤ 20 mag. We obtained the mean value of proper motion as μx = 1.27 ± 0.001 and μy = −0.73 ± 0.002 mas yr−1. The cluster’s radius is determined as ${7{^{\prime }_{.}}5}$ (5.67 pc) using radial density profile. Our analysis suggests that NGC 1348 is located at a distance of 2.6 ± 0.05 kpc. The mass function slope is found to be 1.30 ± 0.18 in the mass range 1.0–4.1 M⊙, which is in fair agreement with Salpeter’s value within the 1σ uncertainty. The present study validates that NGC 1348 is a dynamically relaxed cluster. We computed the apex coordinates (A, D) for NGC 1348 as (A°, D°) = (−23.°815 ± 0.°135, −22.°228 ± 0.°105). In addition, calculations of the velocity ellipsoid parameters (VEPs), matrix elements μij, direction cosines (lj, mj, nj), and the galactic longitude of the vertex have been conducted in this analysis.
Origin of Antecrysts in Igneous Rocks from the Salavat Range (NW Iran): an Explanation for the Geochemical Signature of Potassic Alkaline Rocks
Authors: Soltanmohammadi Azam , Grégoire Michel , Ceuleneer Georges , Benoit Mathieu , Bédard L Paul , Gouy Sophie , Rabinowicz Michel
Published: April 2021

Abundant silica-undersaturated potassic lavas are found in the centre of the Turkish–Iranian plateau (NW Iran) as flows, pillows and dykes. They display abundant zoned clinopyroxene macrocrysts and xenoliths of igneous cumulates. We determined four types of zoned crystals (Type-I, -II, -III and -IV) on the basis of their composition and zoning patterns. Use of in situ compositional data, together with whole-rock major and trace elements and the isotopic signatures of the host lavas provided evidence for the derivation of the different types of zoned clinopyroxenes from at least two contrasting parental melts. Our findings are consistent with an origin of the ultrapotassic and sodic alkaline melts from the deep-seated compaction pockets inferred from our previous studies of the alkaline magmatism throughout the Turkish–Iranian plateau. The ultrapotassic melt, which accumulated at the top of the compaction pockets, eventually ponded close to the spinel–garnet mantle transition and generated colourless antecrysts (Type-I and Type-II) and clinopyroxenite cumulates. When the compaction pocket impinged on the continental lithosphere, interstitial melts segregated and flowed inside dykes where grass green antecrysts (Type-III) and zoned phenocrysts (Type-IVa) crystallized from a melt having a geochemical signature of sodic alkaline melt. Later, at the crustal level, melt crystallization processes produced Type-IVb zoned phenocrysts. Our results are at odds with the paradigm of potassic magmas in NW Iran being derived strictly from a single mantle source.
How Do We Semantically Individuate Natural Numbers?†
Authors: Buijsman Stefan
Published: April 2021

How do non-experts single out numbers for reference? Linnebo has argued that they do so using a criterion of identity based on the ordinal properties of numerals. Neo-logicists, on the other hand, claim that cardinal properties are the basis of individuation, when they invoke Hume’s Principle. I discuss empirical data from cognitive science and linguistics to answer how non-experts individuate numbers better in practice. I use those findings to develop an alternative account that mixes ordinal and cardinal properties to provide a detailed (though not conclusively proven) answer to the question: how do we in fact semantically individuate numbers?
Positivity for the curvature of the diffeomorphism group corresponding to the incompressible Euler equation with Coriolis force
Authors: Tauchi Taito , Yoneda Tsuyoshi
Published: April 2021

We investigate the geometry of the central extension $\widehat{\mathcal D}_{\mu}(S^{2})$ of the group of volume-preserving diffeomorphisms of the 2-sphere equipped with an $L^{2}$-metric, for which geodesics correspond to solutions of the incompressible Euler equation with Coriolis force. In particular, we calculate the Misiołek curvature of this group. This value is related to the existence of a conjugate point and its positivity directly implies the positivity of the sectional curvature.
Salt Stress Enhances Early Symbiotic Gene Expression in Medicago truncatula and Induces a Stress-Specific Set of Rhizobium-Responsive Genes
Authors: Chakraborty Sanhita , Driscoll Heather E. , Abrahante Juan E. , Zhang Fan , Fisher Robert F. , Harris Jeanne M.
Published: April 2021

Salt stress is a major agricultural concern inhibiting not only plant growth but also the symbiotic association between legume roots and the soil bacteria rhizobia. This symbiotic association is initiated by a molecular dialogue between the two partners, leading to the activation of a signaling cascade in the legume host and, ultimately, the formation of nitrogen-fixing root nodules. Here, we show that a moderate salt stress increases the responsiveness of early symbiotic genes in Medicago truncatula to its symbiotic partner, Sinorhizobium meliloti while, conversely, inoculation with S. meliloti counteracts salt-regulated gene expression, restoring one-third to control levels. Our analysis of early nodulin 11 (ENOD11) shows that salt-induced expression is dynamic, Nod-factor dependent, and requires the ionic but not the osmotic component of salt. We demonstrate that salt stimulation of rhizobium-induced gene expression requires NSP2, which functions as a node to integrate the abiotic and biotic signals. In addition, our work reveals that inoculation with S. meliloti succinoglycan mutants also hyperinduces ENOD11 expression in the presence or absence of salt, suggesting a possible link between rhizobial exopolysaccharide and the plant response to salt stress. Finally, we identify an accessory set of genes that are induced by rhizobium only under conditions of salt stress and have not been previously identified as being nodulation-related genes. Our data suggest that interplay of core nodulation genes with different accessory sets, specific for different abiotic conditions, functions to establish the symbiosis. Together, our findings reveal a complex and dynamic interaction between plant, microbe, and environment.

[Formula: see text] Copyright © 2021 The Author(s). This is an open access article distributed under the CC BY 4.0 International license .
Quantitative Lung Ultrasound: Technical Aspects and Clinical Applications
Authors: Mongodi Silvia , De Luca Daniele , Colombo Andrea , Stella Andrea , Santangelo Erminio , Corradi Francesco , Gargani Luna , Rovida Serena , Volpicelli Giovanni , Bouhemad Bélaid , Mojoli Francesco
Published: April 2021

Lung ultrasound is increasingly used in emergency departments, medical wards, and critical care units—adult, pediatric, and neonatal. In vitro and in vivo studies show that the number and type of artifacts visualized change with lung density. This has led to the idea of a quantitative lung ultrasound approach, opening up new prospects for use not only as a diagnostic but also as a monitoring tool. Consequently, the multiple scoring systems proposed in the last few years have different technical approaches and specific clinical indications, adaptable for more or less time-dependent patients. However, multiple scoring systems may generate confusion among physicians aiming at introducing lung ultrasound in their clinical practice. This review describes the various lung ultrasound scoring systems and aims to clarify their use in different settings, focusing on technical aspects, validation with reference techniques, and clinical applications.
Healing the Index Tibial Nonunion: Risk Factors for Development of a Recalcitrant Nonunion in 222 Patients
Authors: Wiss Donald A. , Garlich John , Sherman Randy
Published: April 2021

Objectives:

To compare and stratify the healing rates after our index nonunion surgery using contemporary methods of fixation, report the prevalence of recalcitrant non-union, and identify specific demographic, injury, and treatment-related risk factors for the development of a recalcitrant nonunion.

Design:

Retrospective analysis of a prospectively collected database.

Setting:

Academic Level 1 Trauma Center.

Patients/Participants:

Two hundred twenty-two tibial nonunions treated with internal fixation by a single surgeon.

Intervention:

Bivariate and multivariate regression analysis were performed to compare healing rates by the type of fixation and graft augmentation and to identify specific demographic, injury, and treatment-related risk factors for the development of a recalcitrant nonunion.

Results:

Of the 222 patients, 162 (73%) healed as intended and 51 (23%) required 1 or more subsequent interventions to achieve union (96%). Nine fractures (4%) failed to unite. The 60 fractures (27%) that required a subsequent intervention(s) or failed to consolidate were defined as recalcitrant nonunions. There were no statistically significant differences in the recalcitrant rate when we compared plates versus nails or types of bone graft. Risk factors for developing a recalcitrant nonunion were multifactorial and included grade III open fractures, compartment syndrome, deep infection, and 2 or more prior surgical procedures.

Conclusions:

Internal fixation remains a successful method of treatment for most tibial nonunions. However, 27% of patients required a subsequent intervention because of failure to heal our index nonunion procedure. Factors that are associated with recalcitrant nonunions were a grade III open fracture, compartment syndrome, deep infection, and 2 or more or more prior surgical procedures.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Surreal Becomes Real: Ethical Dilemmas Related to the COVID-19 Pandemic and Professional Identity Formation of Health Professionals
Authors: Wald Hedy S. , Ruddy Meaghan
Published: April 2021

Fundamental quandaries of clinical and biomedical ethics for health care professionals, committees, and systems have been raised into stark relief by the COVID-19 pandemic. The nature and extent of critical issues raised by this ongoing crisis, including challenging ethical dilemmas for the health care profession, is likely to have an indelible impact on the professional identity formation (PIF) of learners and practitioners across the trajectory of the professional lifecycle. The lifelong process of PIF for health care practitioners, from learner through independent practice, is supported in medical education by intentional reflection, relationships within community of practice include guidance from mentoring, as well as resilience, both emotional and moral. We consider how grappling with ethical dilemmas related to the COVID-19 pandemic can challenge, inform, and even potentially transform the PIF process, thereby supporting development of a morally resilient, humanistic professional identity in health care trainees and health care professionals.
Rapid Knowledge Mobilization and Continuing Professional Development: Educational Responses to COVID-19
Authors: Rowland Paula , Tavares Walter , Lowe Mandy , Tripp Tim , Richardson Juanita , Anderson Melanie , Oja Lori Anne , Paton Morag , Wiljer David , Woods Nicole , Ng Stella
Published: April 2021

Introduction:

The field of Continuing Professional Development (CPD) has a role to play in supporting health care professionals as they respond to the COVID-19 pandemic. However, the evolving science of COVID-19, the need for quick action, and the disruption of conventional knowledge networks pose challenges to existing CPD practices. To meet these emergent and rapidly evolving needs, what is required is an approach to CPD that draws insights from the domain of knowledge mobilization (KMb).

Methods:

This short report describes a research protocol for exploring rapid KMb responses to COVID-19 at one Canadian academic teaching hospital. The proposed research will proceed as a case study using a mixed methods design collecting quantitative (surveys and Web site use metrics) and qualitative data (interviews) from individuals involved in developing, using, and supporting the KMb resources. Analysis will proceed in two phases: descriptive analysis of data to share insights and integrative analysis of data to build theory.

Results:

Results from this study will inform the immediate KMb and CPD contribution to the COVID-19 response.

Discussion:

Findings from this study will also make a broader contribution to the field of CPD, theoretically informing intersections between KMb and CPD and therefore contributing to an integrated science of CPD.
Measurement of the Lower Lid Margin Thickness by Oculus Keratograph
Authors: Yao Jie , Liu Xin-Quan , Zhu Yi , Wang Da-Hu
Published: April 2021

Objectives:

To investigate the lower lid margin thickness (LLMT) from the posterior lash line to the anterior edge of tear meniscus with Oculus Keratograph 4 (K4).

Methods:

This was a prospective, single-center, observational study. A total of 90 volunteers aged 18 to 79 years with no ocular diseases were included in this study. The LLMT of 90 subjects was measured twice by the same person with K4. To determine the reliability of K4, measuring the LLMT of 30 normal subjects was separately performed by two operators.

Results:

The LLMT measurements with K4 between two operators demonstrated a good reproducibility (0.94±0.18 vs. 0.96±0.16 mm; intraclass correlation coefficient=0.88; P=0.18). The mean age of 90 volunteers (42 men and 48 women) was 45.5±14.1 years. The LLMT was 0.95±0.17 mm, which was a significant positive correlation with age (r
s=0.57; P<0.001). In addition, there was no significant difference in the LLMT between genders (0.97±0.16 vs. 0.93±0.18 mm; P=0.32).

Conclusions:

We found that K4 was a reliable tool in the LLMT measurements, and the LLMT seemed to be closely related to age but not to gender.
Effect of Eye Spray Phospholipid Concentration on the Tear Film and Ocular Comfort
Authors: Pult Heiko , Khatum Farzana S. , Trave-Huarte Sonia , Wolffsohn James S.
Published: April 2021

Objectives:

To evaluate the effect of eye spray phospholipid concentration on symptoms and tear film stability.

Methods:

High-concentration (Tears Again, Optima Pharma GmbH, Hallbergmoos, Germany) and low-concentration (Ocuvers, Innomedis AG, Germany) phospholipid eye sprays were sprayed onto the closed eyelids of 30 subjects (33.2±1.8 years; 20 women) in a multicentered, prospective, crossover study. Ocular comfort (visual analog scale) and noninvasive tear film stability (NIBUT) of each eye were evaluated before application (along with the Ocular Surface Disease Index), 10 min after application, and 30 min after application.

Results:

Comfort (high concentration: 68.5±16.4 vs. low concentration: 70.7±14.5 phospholipid) and NIBUT (high concentration: 11.5±4.6 sec vs. low concentration: 11.2±6.0 sec phospholipid) were not different (P>0.3) between sprays before application, but comfort (by 12 points, P=0.001) and NIBUT (by 5 sec, P=0.016) were significantly better with a high-concentration phospholipid spray at both 10 min and 30 min time points than those with the low-concentration phospholipid spray.

Conclusions:

The liposomal eye spray with higher concentration of phospholipids significantly improved ocular comfort and tear film stability in contrast to the eye spray with lower concentration of phospholipids, hence practitioners need to choose an appropriate eye spray to maximize the patient benefit.
Risk of Depression Associated With Finasteride Treatment
Authors: Pompili Maurizio , Magistri Carlo , Maddalena Stefano , Mellini Cristiano , Persechino Severino , Baldessarini Ross J.
Published: April 2021

Background

Finasteride is one of several inhibitors of the 5α-reductase that converts testosterone to dihydrotestosterone used to treat hair loss and benign prostatic enlargement. Emerging clinical observations indicate that such treatment may be associated with depression, anxiety, and possibly increased suicidal risks, in addition to sexual dysfunction, even after its discontinuation.

Methods

We carried out a systematic review of reports pertaining to association of finasteride treatment with clinical depression or other adverse psychiatric effects. We analyzed reported risks of depression by pooling of rates and by meta-analysis of comparisons of subjects treated with finasteride or not.

Findings

Crude pooled rates of depressive symptoms with versus without finasteride were 3.33% (confidence interval, 3.22%–3.44%) versus 2.54% (2.44%–2.64%); random-effects meta-analysis yielded an odds ratio of 2.14 (1.40–3.27) (both P < 0.0001). In addition, risk of suicidal ideation or behavior was greater with versus without finasteride (21.2% [21.0%–21.5%] vs 14.0% [13.8%–14.2%], P < 0.0001), and risk of sustained sexual dysfunction was high (60.1% [37.3%–82.9%]).

Conclusions

The findings support a growing impression that finasteride is associated with adverse psychiatric effects that can persist in association with sexual dysfunction after discontinuing finasteride treatment.
Association of Aripiprazole With Reduced Hippocampal Atrophy During Maintenance Treatment of First-Episode Schizophrenia
Authors: Wang John , Hart Kamber L. , Qi Wei , Ardekani Babak A. , Li Chenxiang , Marx Julia , Freudenreich Oliver , Cather Corinne , Holt Daphne , Bello Iruma , Diminich Erica D. , Tang Yingying , Worthington Michelle , Zeng Botao , Wu Renrong , Fan Xiaoduo , Zhao Jingping , Wang Jijun , Goff Donald C.
Published: April 2021

Purpose/Background

Hippocampal volume loss in early schizophrenia has been linked with markers of inflammation and oxidative stress, and with less response of negative symptoms. Aripiprazole has been reported to preserve hippocampal volume and to reduce inflammation.

Methods/Procedures

Study 1 was a 12-month multicenter randomized placebo-controlled trial of citalopram added to clinician-determined second-generation antipsychotic medication in 95 patients with first-episode schizophrenia (FES), 19 of whom received aripiprazole. We compared participants taking aripiprazole with those on other antipsychotics to determine whether those on aripiprazole had less hippocampal volume loss. We also examined peripheral biomarker data from medication-naive patients with schizophrenia receiving 8 weeks of antipsychotic treatment (n = 24) to see whether markers of inflammation and oxidative stress that previously predicted hippocampal volume differed between aripiprazole (n = 9) and other antipsychotics (study 2).

Findings/Results

Aripiprazole was associated with a mean increase in hippocampal volume of 0.35% (SD, 0.80%) compared with a 0.53% decrease (SD, 1.2%) with other antipsychotics during the first year of maintenance treatment in patients with FES. This difference was significant after adjusting for age, sex, citalopram treatment, and baseline Brief Psychiatric Rating Scale score (B = 0.0079, P = 0.03). Aripiprazole was also associated with reduced concentrations of the inflammatory cytokines interleukin-8 and tumor necrosis factor (P < 0.01) during the first 8 weeks of treatment in medication-naive patients with FES.

Implications/Conclusions

These results suggest that aripiprazole may protect against hippocampal atrophy via an anti-inflammatory mechanism, but these results require replication in larger, randomized trials, and the clinical relevance of hippocampal volume loss is not established.
Systematic Literature Review of Pediatric Male and Female Genital Hair Thread Tourniquet Syndrome
Authors: Adjei Naomi N. , Lynn Anna Y. , Grimshaw Alyssa , Brault Marie A. , Dugan Katherine , Vash-Margita Alla
Published: April 2021

Objective

The aim of this study was to describe genital hair thread tourniquet syndrome (HTTS) and its treatment by pediatric and adolescent health care providers through a systematic literature review.

Methods

We performed a systematic literature review on pediatric male and female genital HTTS. Studies were included if they involved genital HTTS in males or females 21 years and younger and were published in English. The main outcomes were body parts involved, symptoms, treatment, anesthetic type, providers involved in diagnosis and management, and implications of delayed or missed diagnosis.

Results

There were 38 female cases from 33 publications (1973–2020) and 147 male cases from 47 publications (1951–2019). The average age among females and males was 9.1 and 5.1 years, respectively. Among cases involving female patients, 93% of them were premenarchal; patients were circumcised in 90% of reviewed cases of male HTTS. The most commonly involved body parts were clitoris and labia minora in females, and penis and urethra in males. Males most commonly presented with edema and urinary symptoms, whereas females most commonly presented with edema and pain. General anesthesia was used for tourniquet excision in most cases. Male and female genital HTTS were mostly managed by urologists and emergency medicine physicians, respectively.

Conclusion

This systematic literature review of more than 150 cases of male and female genital HTTS describes evaluation and management of genital HTTS spanning 7 decades. The main treatment of genital HTTS remains prompt diagnosis and removal of the tourniquet, as well as education on prevention strategies. Delayed diagnosis due to lack of recognition of the HTTS can lead to serious sequelae. Development of national guidelines regarding best practices in management of genital HTTS disseminated to all providers taking care of pediatric and adolescent patients will lead to improved patient care.
Pediatric Emergency Medicine Training
Authors: Mota Curiel César , Yock-Corrales Adriana , Contreras Cristina , Corona Lisandra , Pavlichiv Viviana , Álvarez Eugenia , González del Rey Javier
Published: April 2021

Pediatric emergency medicine (PEM) is a relatively new and rapidly evolving subspecialty in many countries. The purposes of this study were to describe the characteristics and to find common/shared practices in current available PEM fellowship programs across Latin America.

Methods

An electronic, multicenter survey was created and stored on Google forms. The survey was in Spanish language and included 30 questions about the characteristics of the pediatric emergency program, history of the program, and support expected from the Latin American Pediatric Emergency Society.

Results

A total of 11 PEM programs in 6 countries were acknowledged in Latin America. All programs are placed in pediatric tertiary care hospitals. All PEM programs were approved by the local universities and the Ministries of Health in each country. Difficulties to start a PEM program included a lack of physicians properly trained in PEM who could direct the program, physician instructors in specific topics, places to complete rotations of the future fellows, and getting the local health authorities to acknowledge the importance of the program. With regard to the duration of the program, 72.7% (8) have a 2-year curriculum and 27.3% (3) have a 1-year curriculum. Four (36.4%) program directors mentioned an admission examination as a requirement, 4 (36.4%) needed an examination plus an interview, 3 (27.3%) mentioned that it is necessary just like an interview, and 2 (18.2%) mentioned that the physicians are admitted with a scholarship. With regard to the structure of the programs and rotations included, most of the programs have rotations that are compulsory in different pediatric subspecialties. In 80% of the programs, fellows are evaluated based on different technical skill procedures that they need to learn and perform during PEM fellowship training. The PEM fellowship is recognized by different societies in emergency medicine and pediatrics, except in Dominican Republic where it is only recognized by the Ministry of Health and the university. After completion of the program in 90% (10) of the programs, graduates are not guaranteed a job, and in half, there is no mechanism implemented for recertification of the pediatric emergency physicians by the local medical council.

Conclusions

In Latin America, postgraduate programs in pediatric emergencies are a response to a need for health systems. Being an innovative specialty, it surpassed each country's own challenges, until it was able to reach an internationally standardized level, with a great diversity of pedagogical methodology, which the product has been to offer a high quality of emergency care to children.
Point-of-Care Ultrasound Identification of Right-Sided Cardiac Chamber Collapse Associated With Pericardial Effusions Without Hypotension
Authors: Bergmann Kelly R. , Riera Antonio , Whitcomb Valerie , Toney Amanda G. , Tessaro Mark O.
Published: April 2021

We present a case series of 6 children in whom point-of-care ultrasound revealed a pericardial effusion with right atrial or ventricular collapse, and show how this may heighten concern for development of pericardial tamponade and expedite care.
Pediatric Emergency Department Return Visits Within 72 Hours
Authors: Smith Jaron A. , Fletcher Ashley , Mirea Lucia , Bulloch Blake
Published: April 2021

Objectives

In the United States, approximately 2.2% to 5% of children discharged from the emergency department (ED) return within 72 hours. There is limited literature examining caregivers' reasons for return to the ED, and none among Hispanics and Spanish-speaking caregivers. We sought to examine why caregivers of pediatric patients return to the ED within 72 hours of a prior ED visit, and assess roles of ethnicity and primary language.

Methods

A previously validated survey was prospectively administered to caregivers returning to the ED within 72 hours of discharge at a freestanding, tertiary care, children's hospital over a 7-month period. Reasons for return to the ED, previous ED discharge processes, and events since discharge were summarized according to Hispanic ethnicity, and English or Spanish language preference, and compared using the Fisher exact test.

Results

Among 499 caregiver surveys analyzed, caregivers returned mostly because of no symptom improvement (57.5%) and worsening condition (35.5%), with no statistically significant differences between Hispanic/non-Hispanic ethnicity, or English/Spanish preference. Most (85.2%) caregivers recalled reasons to return to the ED. Recall of expected duration until symptom improvement was significantly higher among Hispanic (60.4%) versus non-Hispanic (52.1%) (P = 0.003), and for Spanish- (68.9%) versus English-speaking (54.6%) (P = 0.04), caregivers.

Conclusions

Most caregivers returned to the ED because their child's condition was not better or had worsened. Ethnicity and language were not associated with variations in reasons for return. Non-Hispanic and English-speaking caregivers were less likely to recall being informed of time to improvement and may require additional intervention.
Morel-Lavallee Lesion
Authors: Potocki Ronald , Deanehan J. Kate
Published: April 2021

This case describes an 18-year-old woman who presented to the pediatric emergency department with 2 days of worsening right knee pain and swelling. The patient's history was remarkable for a motor vehicle accident 12 days before presentation, as well as recent treatment for a gonococcal sexually transmitted infection 9 days before presentation. Her examination was notable for a large area of fluctuance of her right knee without overlying erythema or appreciable intraarticular effusion. Point-of-care-ultrasound (POCUS) revealed a large, subcutaneous fluid collection containing multiple, mobile septations. This was confirmed by radiology ultrasound, and the patient was seen by an orthopedic surgeon who recommended conservative management without aspiration of the fluid collection. To our knowledge, this is the first reported case of a Morel-Lavallee lesion being diagnosed by POCUS in a pediatric patient. This case demonstrates the utility of POCUS in facilitating the prompt recognition of shear injuries in children and guiding management in the emergency department.
An Evaluation of High Preprocedural Anxiety and Venipuncture Pain Experienced by Young Children
Authors: Lunoe Maren M. , Bolin Ashley E. , Drendel Amy L.
Published: April 2021

Objective

The aim of this study was to determine if young children with high preprocedural anxiety experience increased pain at venipuncture.

Methods

This was secondary analysis of prospectively obtained data from a randomized controlled trial comparing vapocoolant spray with jet-injected lidocaine for venipuncture pain. Children aged 1 to 6 years were enrolled and videotaped. Videos were reviewed and scored for anxiety using the modified Yale Preoperative Anxiety Scale score for preprocedural anxiety (score range, 23–100). High anxiety was defined as greater than 40. Pain at the time of venipuncture was scored using the Face, Legs, Activity, Cry, and Consolability scale (score range 0–10). Moderate to severe pain was defined as greater than 3. Logistic regression assessed patient factors associated with high preprocedural anxiety and evaluated the relationship between preprocedural anxiety and pain during venipuncture.

Results

Two hundred five patients were enrolled; 59.5% of patients were male, and 53.7% were White. Mean age was 3.2 years. Prior to the procedure, 67% of patients had high anxiety. Patient age, race, sex, and previous venipuncture were not associated with increased odds of high anxiety. Moderate to severe pain at venipuncture was observed in 65% of children. High preprocedural anxiety was associated with increased odds of moderate to severe pain at venipuncture when controlled for patient characteristics (adjusted odds ratio, 4.62; 95% confidence interval, 2.03–8.54).

Conclusions

Most young children undergoing venipuncture experienced high preprocedural anxiety. Children with high preprocedural anxiety had increased odds of moderate to severe pain at venipuncture. Anxiety-reducing interventions should be explored to reduce pain experienced during venipuncture.