bluuebunny/crossref_metadata_2025 huggingface dataset:
Hemodynamic Assay of Hind Limb in Multiple Animal Models
Authors: Hansen Steven M , Schepers Luke E , Pratihar Ruchira , Tibbett Jackson , Vallejo Gilberto , Grubbs Graham , Fisher Thomas , Hansen Paul E , Goergen Craig J
Published: January 2021

Introduction

Measuring hemodynamic characteristics of injured limbs is paramount to early identification of potentially damaging ischemic conditions, but can often prove difficult attributable to a multitude of factors. Here, we present an in vivo optical imaging technique to characterize pulsatile blood flow quality through the distal extremity in multiple animal models that replicate the signs of distal extremity ischemia. The purpose of this study is to examine the feasibility of the optical imaging technique and relevance to hemodynamic complications such as acute compartment syndrome (ACS) and nonobvious hemorrhage.

Materials and Methods

In one pig and six mice, three different methods were used to create ischemic conditions in the lower extremity, producing symptoms similar to what is observed in ACS. In each condition, perfusion to the distal extremity was measured with the hemodynamic detection device (HDD; Odin Technologies), an optical assessment tool for perfusion and blood flow quality.

Results

We observed a profound decrease in extremity perfusion immediately after onset of ischemia in all three models. In the porcine model, the HDD’s measurements demonstrated similar characteristic flow between the various measurement locations. After the tourniquet was applied, the HDD revealed a 95% decrease in normalized perfusion value (npv) while the intracompartmental pressure rose from 5 to 52 mmHg (a 47mmHg increase). After the tourniquet was removed during reperfusion, the normalized blood flow returned to baseline and the intracompartmental pressure dropped from 20 to 6 mmHg in less than 5 minutes. For each mouse, the HDD test leg demonstrated a measurement of 0.97 npv before femoral ligation and 0.05 npv after femoral ligation, an 89% decrease (P < .01) in flow. Pulsed-wave Doppler ultrasound (PWDU) measurements on the test leg had pre-ligation measurement of 0.84 npv and a post-ligation measurement of 0.001 npv, a 99% decrease. These PWDU measurements revealed almost complete stoppage of blood flow during ischemia, followed by a substantial increase after the femoral artery ligation was removed.

Conclusions

Here, we show that a novel, optics-based sensing system can be used to diagnose and assess ACS in animal models. This technology is comparable to other standards used to monitor ACS and nonobvious hemorrhage and may also be a plausible alternative to prolonged invasive monitoring of patients with sustained extremity trauma.
What Goes On: The Beatles, their Music and their Time. By Walter Everett and Tim Riley
Authors: Rohr Nicolette
Published: January 2021

‘[T]he afterlife of the Beatles’, Adam Gopnik wrote in The New Yorker in 1995, ‘shows how it was that people came to write the Gospels: Don’t tell me what it means, just tell me again what happened.’ Although Gopnik’s review introduced one of the early and important examples of Beatles scholarship, Ian MacDonald’s Revolution in the Head: The Beatles’ Records and the Sixties, his observation remains relevant twenty-five years later, as the outpouring of Beatles chronologies, collections, and recollections continues. These popular volumes often retell familiar stories, deservedly celebrating The Beatles but struggling, or declining, to explain, really, why and how they mattered and matter still. The subsequent waves of the band’s popularity have secured their unparalleled status, but the vast particulars of their place in history remain understudied. It’s a tall task, to be sure, but an important one, nearly sixty years after the first writers introduced a growing public to The Beatles.
Predicting the Evolution of Sexual Dimorphism in Gene Expression
Authors: Houle David , Cheng Changde
Published: January 2021

Sexual dimorphism in gene expression is likely to be the underlying source of dimorphism in a variety of traits. Many analyses implicitly make the assumption that dimorphism only evolves when selection favors different phenotypes in the two sexes, although theory makes clear that it can also evolve as an indirect response to other kinds of selection. Furthermore, previous analyses consider the evolution of a single transcript or trait at a time, ignoring the genetic covariance with other transcripts and traits. We first show which aspects of the genetic-variance–covariance matrix, G, affect dimorphism when these assumptions about selection are relaxed. We then reanalyze gene expression data from Drosophila melanogaster with these predictions in mind. Dimorphism of gene expression for individual transcripts shows the signature of both direct selection for dimorphism and indirect responses to selection. To account for the effect of measurement error on evolutionary predictions, we estimated a G matrix for eight linear combinations of expression traits. Sex-specific genetic variances in female- and male-biased transcription, as well as one relatively unbiased combination, were quite unequal, ensuring that most forms of selection on these traits will have large effects on dimorphism. Predictions of response to selection based on the whole G matrix showed that sexually concordant and antagonistic selection are equally capable of changing sexual dimorphism. In addition, the indirect responses of dimorphism due to cross-trait covariances were quite substantial. The assumption that sexual dimorphism in transcription is an adaptation could be incorrect in many specific cases.
Return to apprenticeships: a comparison between existing apprentices and newly recruited apprentices
Authors: Speckesser Stefan , Xu Lei
Published: January 2021

In England, half of all apprentices are now of adult age. Most of them—and many of younger age, too—worked with their training firm for some time before starting their apprenticeship. In this article, we estimate the benefit of apprenticeship completion making the distinction between groups of newly recruited and existing staff. To deal with sources of endogeneity resulting from apprenticeship completion, we exploit an exogenous change in minimum duration of training affecting apprenticeship completion. Our findings show much higher benefits for new compared with existing staff. Also, increasing apprenticeship training only creates positive effects for new entrants, but not for existing workers. Therefore, policy should aim to refocus apprenticeships to be a mechanism of labour market entry combined with education to provide access to and acquire competences required for actual occupational roles, but not as a generic mechanism to train existing staff.
Single-cell RNA sequencing of batch Chlamydomonas cultures reveals heterogeneity in their diurnal cycle phase
Authors: Ma Feiyang , Salomé Patrice A , Merchant Sabeeha S , Pellegrini Matteo
Published: January 2021

The photosynthetic unicellular alga Chlamydomonas (Chlamydomonas reinhardtii) is a versatile reference for algal biology because of its ease of culture in the laboratory. Genomic and systems biology approaches have previously described transcriptome responses to environmental changes using bulk data, thus representing the average behavior from pools of cells. Here, we apply single-cell RNA sequencing (scRNA-seq) to probe the heterogeneity of Chlamydomonas cell populations under three environments and in two genotypes differing by the presence of a cell wall. First, we determined that RNA can be extracted from single algal cells with or without a cell wall, offering the possibility to sample natural algal communities. Second, scRNA-seq successfully separated single cells into nonoverlapping cell clusters according to their growth conditions. Cells exposed to iron or nitrogen deficiency were easily distinguished despite a shared tendency to arrest photosynthesis and cell division to economize resources. Notably, these groups of cells not only recapitulated known patterns observed with bulk RNA-seq but also revealed their inherent heterogeneity. A substantial source of variation between cells originated from their endogenous diurnal phase, although cultures were grown in constant light. We exploited this result to show that circadian iron responses may be conserved from algae to land plants. We document experimentally that bulk RNA-seq data represent an average of typically hidden heterogeneity in the population.
Impact of Faculty and Programmatic Resources on the Proportion of Academic Doctoral Degrees in Professional Physical Therapist Education Programs
Authors: Dickson Tara , Deschenes Beth , Gleeson Peggy , Zafereo Jason
Published: January 2021

Objective

The Commission on Accreditation in Physical Therapy Education has introduced a requirement that 50% of core faculty members in a physical therapist education program should have an academic doctoral degree, which many programs are not currently meeting. Competition between programs for prestige and resources may explain the discrepancy of academic achievement among faculty despite accreditation standards. The purpose of this study was to identify faculty and program characteristics that are predictive of programs having a higher percentage of faculty with academic doctoral degrees.

Methods

Yearly accreditation data from 231 programs for a 10-year period were used in a fixed-effects panel analysis.

Results

For a 1 percentage point increase in the number of core faculty members, a program could expect a decline in academic doctoral degrees by 14% with all other variables held constant. For a 1% increase in either reported total cost or expenses per student, a program could expect a 7% decline in academic doctoral degrees with all other variables held constant. Programs that have been accredited for a longer period of time could expect to have proportionately more faculty members with academic doctoral degrees.

Conclusions

Programs may be increasing their core faculty size to allow faculty with academic doctoral degrees to focus on scholarly productivity. The percentage of faculty with academic doctoral degrees declines as programs increase tuition and expenditures, but this may be due to programs’ tendency to stratify individuals (including part-time core faculty) into teaching- and research-focused efforts to maximize their research prowess and status.

Impact

This study illuminates existing relationships between physical therapist faculty staffing, time spent in research versus teaching, and program finances. The results of this study should be used to inform higher education policy initiatives aimed to lower competitive pressures and the costs of professional education.
Anyon Networks from Geometric Models of Matter
Authors: Atiyah Michael , Marcolli Matilde
Published: January 2021

This paper, completed in its present form by the second author after the first author passed away in 2019, describes an intended continuation of the previous joint work on anyons in geometric models of matter. This part outlines a construction of anyon tensor networks based on four-dimensional orbifold geometries and braid representations associated with surface-braids defined by multisections of the orbifold normal bundle of the surface of orbifold points.
TAKEDA UK LTD v F. HOFFMANN-LA ROCHE AG
Authors:   Patents Court
Published: January 2021

Patents – European patents – Revocation proceedings – Pharmaceuticals – Antibodies – Validity – Infringement – Construction – Numerical ranges – “at least 99%” – Novelty – Disclosure – Enablement – Obviousness – Lack of technical contribution – Hindsight – Insufficiency – Ambiguity – Fuzzy boundaries
ASSESSMENT OF THE RADIOACTIVITY OF GAMMA EMITTERS IN BABY FORMULA FOR DIFFERENT AGE GROUPS AND BABY CEREAL CONSUMED IN JORDAN
Authors: Ababneh Anas M , Jaradat Bayan , Samarah Qutad M , Ababneh Zaid Q
Published: January 2021

In the present work, different brands of baby formula and cereal consumed in Jordan were analyzed for their radioactivity content. The activity concentrations of 40K varied with the designated age group in formula with the average concentrations being (in Bq/kg): 160.2 ± 33.5, 219.0 ± 35.0 and 265.2 ± 56.3 for the age groups of 0–6 months, 6–12 months and 1–3 years, respectively. 226Ra was not detected in any of the samples, while 232Th was detected in nearly half the samples with concentrations ranging from 0.22 to 0.82 Bq/kg. 137Cs was detected in only two samples with concentrations of 0.94 and 3.15 Bq/kg. The concentrations of 40K and 232Th in cereal were in the ranges of 23–294 and 0.49–1.48 Bq/kg, respectively. The resulting committed dose was assessed and found in the range of 154–613 μSv, with insignificant contribution from 137Cs, which is within the worldwide range but generally higher than the worldwide average of 290 μSv.
Optimistic amnesia: how online and offline processing shape belief updating and memory biases in immediate and long-term optimism biases
Authors: Yao Ziqing , Lin Xuanyi , Hu Xiaoqing
Published: January 2021

When people are confronted with feedback that counters their prior beliefs, they preferentially rely on desirable rather than undesirable feedback in belief updating, i.e. an optimism bias. In two pre-registered EEG studies employing an adverse life event probability estimation task, we investigated the neurocognitive processes that support the formation and the change of optimism biases in immediate and 24 h delayed tests. We found that optimistic belief updating biases not only emerged immediately but also became significantly larger after 24 h, suggesting an active role of valence-dependent offline consolidation processes in the change of optimism biases. Participants also showed optimistic memory biases: they were less accurate in remembering undesirable than desirable feedback probabilities, with inferior memories of undesirable feedback associated with lower belief updating in the delayed test. Examining event-related brain potentials (ERPs) revealed that desirability of feedback biased initial encoding: desirable feedback elicited larger P300s than undesirable feedback, with larger P300 amplitudes predicting both higher belief updating and memory accuracies. These results suggest that desirability of feedback could bias both online and offline memory-related processes such as encoding and consolidation, with both processes contributing to the formation and change of optimism biases.
Phloem sap metabolites vary according to the interactive effects of nutrient supply and seasonal conditions inEucalyptus globulus(Labill)
Authors: Halder Nirmol Kumar , Fuentes David , Possell Malcolm , Bradshaw Ben , Ingram Lachlan , Merchant Andrew
Published: January 2021

Improving the efficiency of fertilizer application is paramount to both the sustainability and profitability of forest plantations. Therefore, developing reliable, cost-effective tools to assess tree nutritional status is of great interest. This investigation sought to assess the use of phloem sap-derived metabolites as an indicator of nutritional status on a background of seasonal water availability of Eucalyptus globulus (Labill) trees grown under field conditions. Phloem is a central conduit for long-distance transport and signaling in plants and offers great promise in reflecting plant-scale resource limitations. Changes in the abundance of solutes and isotopes in phloem sap are sensitive to environmental cues. With a focus on both water and nutrient availability, we characterize patterns in phloem sugars, amino acids and the abundance of carbon isotopes in phloem sap obtained from E. globulus among different seasons and fertilizer treatments. Phloem-derived total amino acid concentration was found to increase with an increasing nitrogen (N) supply; however, this response was lost with the concurrent addition of phosphorus and at the highest level of N supply. Significant seasonal variation in all measured parameters was also detected, highlighting the need for caution in making quantitative relationships with growth. Broader implications of the interactive effects of both water supply and multi-nutrient additions and relationships with growth are discussed.
Immediate Postoperative Imaging Following Elective Lumbar Fusion Provides Little Clinical Utility
Authors: Ronald Andrew A. , Herring Eric Z. , Gerges Christina , Shost Michael , Jella Tarun , Sajatovic Martha , Labak Collin M. , Smith Gabriel
Published: January 2021

Study Design.

Retrospective review at a single institution of all adult patients who underwent elective lumbar fusion surgery for degenerative spinal disease from 2013 to 2018. Reoperation rates and change in clinical management due to routine imaging findings were the primary outcomes.

Objective.

To investigate what effects immediate routine postoperative imaging has on the clinical management of patients following lumbar fusion surgery.

Summary of Background Data.

The clinical utility of routine postoperative imaging following lumbar fusion surgery remains uncertain. Existing studies on the clinical utility of postoperative imaging in lumbar fusion patients have largely focused on imaging obtained post-discharge. We present a retrospective analysis that to our knowledge is the first study reporting on the clinical utility of routine imaging in lumbar fusion patients during the immediate postoperative period.

Methods.

The medical records of patients who had undergone elective lumbar instrumented fusion for degenerative disease from 2013 to 2018 by neurosurgeons across one regional healthcare system were retrospectively analyzed. Inpatient records and imaging orders for patients were reviewed. Routine immediate postoperative imaging was defined by any lumbar spine imaging prior to discharge in the absence of specific indications.

Results.

Analysis identified 115 patients who underwent elective lumbar instrumented fusion for degenerative disease. One-hundred-twelve patients received routine postoperative imaging. Routine imaging was abnormal in four patients (4%). There was one instance (<1%) where routine immediate postoperative imaging led to change in clinical management. Abnormal routine imaging was not associated with either reoperation or development of neurological symptoms postoperatively (P = 0.10), however, new or worsening neurologic deficits did predict reoperation (P < 0.01).

Conclusion.

New neurologic deficit was the only significant predictor of reoperation. Routine imaging, whether normal or abnormal, was not found to be associated with reoperation. The practice of routine imaging prior to discharge following elective lumbar fusion surgery appears to provide little utility to clinical management.

Level of Evidence: 3
Influence of Preoperative Difference in Lumbar Lordosis Between the Standing and Supine Positions on Clinical Outcomes After Single-level Transforaminal Lumbar Interbody Fusion
Authors: Ohyama Shuhei , Aoki Yasuchika , Inoue Masahiro , Kubota Go , Watanabe Atsuya , Nakajima Takayuki , Sato Yusuke , Takahashi Hiroshi , Nakajima Arata , Saito Junya , Eguchi Yawara , Orita Sumihisa , Inage Kazuhide , Shiga Yasuhiro , Nakagawa Koichi , Ohtori Seiji
Published: January 2021

Study Design.

Retrospective cohort study.

Objective.

The aim of this study was to investigate whether a preoperative difference in lumbar lordosis (D-LL) between the standing and supine positions is associated with clinical outcomes after transforaminal lumbar interbody fusion (TLIF).

Summary of Background Data.

Several factors have been reported to be associated with surgical outcomes after TLIF. However, the association between preoperative D-LL and clinical outcomes after TLIF is unknown.

Methods.

We enrolled 45 lumbar degenerative disease patients (mean age: 65.7 ± 11.3 years old; 24 males) treated with single-level TLIF. Surgical outcomes were assessed using Oswestry disability index, visual analog scale (VAS; low back pain [LBP], lower-extremity pain, numbness, LBP in motion, in standing, and in sitting), Japanese Orthopaedic Association Back Pain Evaluation Questionnaire, Japanese Orthopaedic Association score for intermittent claudication (JOA score), and Nakai's scoring system. The preoperative D-LL between the standing radiograph and computed tomography (CT) in the supine position was defined as LL in supine CT-standing radiograph. Patients were divided into two groups according to D-LL value (D-LL >−4°, and D-LL ≤−4°). Clinical outcomes were compared between the groups, and correlations between preoperative D-LL and clinical outcomes were analyzed.

Results.

There were no significant differences in preoperative clinical parameters between the two groups. Postoperative VASs for lower extremity pain, numbness, LBP in standing, and JOA score in D-LL >−4° group were significantly worse than in the D-LL ≤−4° group (P < 0.05). Preoperative D-LL showed a weak correlation with postoperative lower extremity pain and numbness (P < 0.05).

Conclusion.

This study revealed that lumbar degenerative disease patients, who have greater preoperative kyphotic lumbar alignment in the standing versus supine position, tend to have postoperative residual symptoms after TLIF. A preoperative comparison of lateral radiographs between the standing and supine positions is useful to predict patients’ postoperative residual symptoms.

Level of Evidence: 3
Equal Ratio Ventilation Reduces Blood Loss During Posterior Lumbar Interbody Fusion Surgery
Authors: Kim Hye Bin , Kweon Tae Dong , Chang Chul Ho , Kim Ji Young , Kim Kyung Sub , Kim Ji Young
Published: January 2021

Study Design.

A prospective randomized double-blinded study.

Objective.

The aim of this study was to compare the effect of two different ventilator modes (inspiratory to expiratory ratio [I:E ratio] of 1:1 and 1:2) on intraoperative surgical bleeding in patients undergoing posterior lumbar interbody fusion (PLIF) surgery.

Summary of Background Data.

During PLIF surgery, a considerable amount of blood loss is anticipated. In the prone position, engorgement of the vertebral vein increases surgical bleeding. We hypothesized that equal ratio ventilation (ERV) with I:E ratio of 1:1 would lower peak inspiratory pressure (PIP) in the prone position and consequentially decrease surgical bleeding.

Methods.

Twenty-eight patients were randomly assigned to receive either ERV (ERV group, n = 14) or conventional ventilation with I:E ratio of 1:2 (control group, n = 14). Hemodynamic and respiratory parameters were measured at 5 minutes after anesthesia induction, at 5 minutes after the prone position, at the time of skin closure, and at 5 minutes after turning to the supine position.

Results.

The amount of intraoperative surgical bleeding in the ERV group was significantly less than that in the control group (975.7 ± 349.9 mL vs. 1757.1 ± 1172.7 mL, P = 0.030). Among other hemodynamic and respiratory parameters, PIP and plateau inspiratory pressure (Pplat) were significantly lower and dynamic lung compliance (Cdyn) was significantly higher in the ERV group than those of the control group throughout the study period, respectively (all P < 0.05).

Conclusion.

Compared to conventional ratio ventilation, ERV provided lower PIP and reduced intraoperative surgical blood loss in patients undergoing PLIF surgery.

Level of Evidence: 2
The Association of Preinfection Daily Oral Anticoagulation Use and All-Cause in Hospital Mortality From Novel Coronavirus 2019 at 21 Days: A Retrospective Cohort Study
Authors: Harrison Raquel F. , Forte Kenneth , Buscher Michael G. , Chess Adam , Patel Amitkumar , Moylan Tatiana , Mize Charles Haviland , Werdmann Michael , Ferrigno Rockman
Published: January 2021

Objectives:

Practices regarding anticoagulation use in coronavirus disease 2019 focus primarily on its efficacy in the critically ill without a clear understanding of when to begin anticoagulation. We sought to understand the association of preinfection daily oral anticoagulation use and the short-term mortality of patients hospitalized with coronavirus disease 2019.

Design:

Retrospective chart review.

Setting:

Large health system with high coronavirus disease 2019 prevalence.

Patients:

Patients 60 years or older admitted to the hospital with positive coronavirus disease 2019 polymerase chain reaction test.

Interventions:

We compared both those on warfarin and those on a direct oral anticoagulant prior to admission and throughout disease course with those who were never exposed to an oral anticoagulant.

Results:

Our primary outcome was inhospital mortality at 21 days from the first coronavirus disease 2019 test ordered. Patients in the direct oral anticoagulant group (n = 104) were found to have significantly lower 21-day all-cause in hospital mortality than patients in the control group (n = 894) both prior to adjustment (14.4% vs 23.8%; odds ratio, 0.57 [0.29–0.92]; p = 0.03) and after controlling for age, gender, and comorbidities (odds ratio, 0.44 [0.20–0.90]; p = 0.033). Patients on warfarin (n = 28) were found to have an elevated unadjusted mortality rate of 32% versus 23.8% in the control group (odds ratio, 1.51 [0.64–3.31]; p = 0.31). After adjustment, a reduction in mortality was observed but not found to be statistically significant (odds ratio, 0.29 [0.02–1.62]; p = 0.24). There was no statistical difference noted in the number of bleeding events in each group.

Conclusions:

In this retrospective cohort study evaluating oral anticoagulant use among patients with coronavirus disease 2019, we found that patients who are on daily oral anticoagulation at the time of infection and throughout their disease course had significantly lower risk of all-cause mortality at 21 days. Validation of these findings should be performed on population-based levels. While research regarding anticoagulation algorithms is ongoing, we believe these results support future randomized control trials to understand the efficacy and risk of the use of early oral anticoagulation.
Critical Ethics: How to Balance Patient Autonomy With Fairness When Patients Refuse Coronavirus Disease 2019 Testing
Authors: Kopar Piroska K. , Kramer Jessica B. , Brown Douglas E. , Bochicchio Grant V.
Published: January 2021

Objectives:

A cornerstone of our healthcare system’s response to the coronavirus disease 2019 pandemic is widespread testing to facilitate both isolation and early treatment. When patients refuse to undergo coronavirus disease testing, they compromise not only just their own health but also the health of those around them. The primary objective of our review is to identify the most ethical way a given healthcare system may respond to a patient’s refusal to undergo coronavirus disease 2019 testing.

Data Sources:

We apply a systematic approach to a true clinical case scenario to evaluate the ethical merits of four plausible responses to a patient’s refusal to undergo coronavirus disease testing. Although our clinical case is anecdotal, it is representative of our experience at our University Tertiary Care Center.

Data Extraction:

Each plausible response in the case is rigorously analyzed by examining relevant stakeholders, facts, norms, and ethical weight both with respect to individuals’ rights and to the interests of public health. We use the “So Far No Objections” method as the ethical approach of choice because it has been widely used in the Ethics Modules of the Surgical Council on Resident Education Curriculum of the American College of Surgeons.

Data Synthesis:

Two ethically viable options may be tailored to individual circumstances depending on the severity of the patient’s condition. Although unstable patients must be assumed to be coronavirus disease positive and treated accordingly even in the absence of a test, stable patients who refuse testing may rightfully be asked to seek care elsewhere.

Conclusions:

Although patient autonomy is a fundamental principle of our society’s medical ethic, during a pandemic we must, in the interest of vulnerable and critically ill patients, draw certain limits to obliging the preferences of noncritically ill patients with decisional capacity.
Dysphagia in Patients With Severe Coronavirus Disease 2019—Potential Neurologic Etiologies
Authors: Dziewas Rainer , Hufelschulte Lisa-Marie , Lepper Johannes , Sackarnd Jan , Minnerup Jens , Teismann Inga , Ahring Sigrid , Claus Inga , Labeit Bendix , Muhle Paul , Suntrup-Krüger Sonja , Warnecke Tobias , Padberg Jan-Sören
Published: January 2021

Importance:

Dysphagia is a common complication of critical illness, and many known risk factors are also present in critically ill coronavirus disease 2019 victims.

Objectives:

To investigate dysphagia in patients with severe coronavirus disease 2019.

Design, Setting, and Participants:

In this case series, we report results of dedicated evaluation of swallowing function in six consecutive, tracheotomized coronavirus disease 2019 patients after they had survived acute respiratory distress syndrome and were weaned from the respirator.

Main Outcomes and Measures:

Dysphagia was assessed with flexible endoscopic evaluation of swallowing.

Results:

Three patients suffered from severe dysphagia and airway compromise precluding decannulation, whereas in the other, three swallowing was less critically impaired, and the tracheal cannula could be removed. Four patients presented with additional laryngeal dysfunctions not typically seen in acute respiratory distress syndrome survivors.

Conclusion and Relevance:

Dysphagia with impaired airway protection is a key feature in coronavirus disease 2019 acute respiratory distress syndrome survivors. Apart from critical illness polyneuropathy, coronavirus disease 2019–related involvement of the peripheral and central nervous system may contribute to swallowing impairment and laryngeal dysfunction.
Acneiform Presentations of Folliculotropic Mycosis Fungoides
Authors: Shamim Huma , Riemer Christie , Weenig Roger , Sokumbi Olayemi , Sciallis Gabriel , McEvoy Marian , Mischke Daniel , Comfere Nneka
Published: January 2021

Background:

Folliculotropic mycosis fungoides (FMF) is a variant of cutaneous T-cell lymphoma that has clinical overlap with a variety of inflammatory follicular unit disorders. However, we describe distinctive presentations of FMF with acneiform features that can be diagnostically challenging, leading to diagnostic delay.

Objective:

To highlight the importance of histopathologic and immunohistochemical evaluation for diagnostic confirmation of presumed inflammatory follicular unit–based disorders that are unusual in presentation or unresponsive to standard therapies.

Methods:

A cross-sectional retrospective study of 5 consecutive patients with a histopathologic diagnosis of FMF was conducted. The clinical, histopathologic, immunophenotypic, and molecular genetic features of cases are presented.

Results:

We describe 5 patients with clinical and histopathologic presentations of FMF masquerading as hidradenitis suppurativa, furunculosis, or acne vulgaris (age range 34–66 years, 4:1 female to male). Clinical morphologies included open and closed comedones, inflammatory pustules, papules and nodules, follicular papules with keratotic plugging, cysts, and scarring involving the face, trunk, and intertriginous areas. All patients failed to respond to standard therapies, including topical and oral antibiotics, topical and oral retinoids, or topical corticosteroids, before receiving the diagnosis of FMF. Lesional skin biopsies showed a perifollicular CD4-positive T-lymphocytic infiltrate with pilotropism, intrafollicular mucin deposition, foreign-body granulomatous inflammation, acute inflammation, and follicular epithelial necrosis. None had concurrent systemic mycosis fungoides.

Limitations:

Small retrospective cohort study.

Conclusion:

We present these cases to expand the clinical and histopathologic spectrum of FMF that may strikingly resemble acneiform disorders and to highlight the importance of diagnostic reconsideration with histopathologic evaluation.
Advanced Concepts in Rheology for the Evaluation of Hyaluronic Acid–Based Soft Tissue Fillers
Authors: Faivre Jimmy , Gallet Mélanie , Tremblais Elodie , Trévidic Patrick , Bourdon François
Published: January 2021

BACKGROUND

Crosslinked hyaluronic acid (HA)-based soft tissue fillers possess unique viscoelastic properties intended to match specific product indications. Manufacturing has an impact on HA chain integrity and on filler properties.

OBJECTIVE

This study introduces 2 new rheological parameters to evaluate the macroscopic characteristics of fillers.

METHODS AND MATERIALS

A library of reference commercialized HA fillers was selected to cover the full spectrum of product indications. Gels were assessed in terms of size of released HA fragments as a readout of gel integrity, degree of modification, cohesivity, and rheological properties.

RESULTS

The elastic modulus G′ often used to characterize fillers was shown not to follow macroscopic mechanical properties. To improve the mechanical characterization of fillers, Strength and Stretch scores were developed and tested. The Strength score defined the ability of a filler to sustain constant viscoelasticity over a wide range of constraints and represented the filler mechanical resilience. The Stretch score measured the propensity of a filler to deform in view to improve implant adaptation to facial animation for natural-looking results.

CONCLUSION

Strength and Stretch scores sorted rheological parameters to macroscopic cohesivity assays more accurately than G′ and may thus help predict the gel behavior once implanted and submitted to facial dynamics.
Two Randomized Controlled Trials of Hyaluronic Acid Fillers for the Correction of Nasolabial Folds
Authors: Yang So Dam , Shin Seonghye , Lee Jiyoon
Published: January 2021

Background:

YVOIRE Classic s (YC) and Restylane (RES) have similar rheological properties, which suit mid-dermis injection, while the rheological properties of YVOIRE Volume s (YV) are comparable to those of Perlane (PER), which suit deep dermis injection to treat deep wrinkles. Two similarly designed studies aimed to evaluate the performance and safety of YC and YV injected into the nasolabial folds (NLFs).

Methods:

These were split-face designed, evaluator-blind, noninferiority studies. Fifty-eight subjects with moderate-to-severe NLFs were enrolled in the first study and treated with YC and RES, and 57 subjects were enrolled in the second study and treated with YV and PER. The Wrinkle Severity Rating Scale ranged from 1 (no visible fold) to 5 (extremely deep and long folds), and subject satisfaction was evaluated.

Results:

The least squares mean Wrinkle Severity Rating Scale scores (standard error) at week 26 were 2.56 (0.09) for both YC- and RES-treated NLFs and 2.89 (0.08) and 2.91 (0.08) for YV- and PER-treated NLFs, respectively. The difference between the groups was 0 and 0.02, and the lower limit of its 95% confidence interval was −0.0725 and −0.0125, which was greater than the predefined margin (−0.29), proving the noninferiority of YC and YV to RES and PER, respectively. The safety profiles and subject satisfaction of YC and YV were similar to those of RES and PER, respectively.

Conclusion:

YC is comparable to RES and YV is comparable to PER in terms of performance and safety profiles, with NLF-correcting effects lasting for up to 26 weeks.
Sympathetic overdrive in the metabolic syndrome: meta-analysis of published studies
Authors: Quarti Trevano Fosca , Dell’Oro Raffaella , Biffi Annalisa , Seravalle Gino , Corrao Giovanni , Mancia Giuseppe , Grassi Guido
Published: January 2021

Objective:

The microneurographic technique has shown that sympathetic overactivity may characterize patients with the metabolic syndrome. However, technical and methodological limitations of the studies prevented to draw definite conclusions. The present meta-analysis evaluated 16 microneurographic studies including 650 individuals, 444 metabolic syndrome patients and 206 healthy controls, respectively. The analysis was primarily based on muscle sympathetic nerve traffic (MSNA) quantified by microneurography in metabolic syndrome.

Methods:

Assessment was extended to the relationships of MSNA with an indirect neuroadrenergic marker, such as heart rate (HR), anthropometric variables, as BMI, waist–hip ratio and metabolic profile.

Results:

Metabolic syndrome individuals displayed MSNA values (means ± SEM) significantly greater than controls (58.6 ± 4.8 versus 41.6 ± 4.1 bursts/100 heart beats, P < 0.01). This result was independent on the concomitant presence of sleep apnea and drug treatment. MSNA was directly and significantly related to clinic SBP (r = 0.91, P < 0.01) but not to BMI (r = 0.17, P = NS), whereas no significant relationship was found between MSNA and metabolic variables included in the definition of metabolic syndrome. No significant correlation was found between MSNA and HR.

Conclusion:

These data provide evidence that metabolic syndrome is characterized by a marked increase (about 30%) in MSNA. They also show that among the variables included in metabolic syndrome definition and related to the sympathetic overdrive blood pressure appears to be the most important one, at variance from what described in obesity in which metabolic and anthropometric factors play a major role. Finally in metabolic syndrome HR does not appear to represent a faithful mirror of the occurring sympathetic activation.
NOVEL OPTICAL COHERENCE TOMOGRAPHY FINDINGS IN SEROUS MACULAR DETACHMENT AFTER PANRETINAL PHOTOCOAGULATION
Authors: Ahmad Meleha , Cai Sophie , Nti Akosua , Liu Tin Yan Alvin
Published: January 2021

Purpose:

To describe a novel optical coherence tomography finding in a case of macular serous retinal detachment after pars plana vitrectomy and panretinal photocoagulation.

Methods:

Retrospective case report.

Results:

A 52 year old male with diabetes underwent uncomplicated pars plana vitrectomy with panretinal photocoagulation for non-clearing vitreous hemorrhage, Postoperative course was complicated by significantly decreased vision and a macular serous retinal detachment that was characterized on optical coherence tomography by a reticular network of hyperreflective bands in the subretinal space. Fluid and hyperreflective material in the subretinal space resolved by postoperative Week 6 with standard postoperative eye drops. However, persistent ellipsoid zone disruption was seen up to postoperative Week 20.

Conclusion:

Extensive subretinal bands can be seen after panretinal photocoagulation. This novel finding can pose diagnostic and management challenges but may resolve with conservative medical management.
Effect of Bandage Contact Lens Exchange on Pain and Healing After Photorefractive Keratectomy—A Randomized Control Trial
Authors: AlDahash Faisal , AlAmeer Ahmad , Hussain Omar ben , Khandekar Rajiv , Ahmad Abeer , Ahad Muhammad
Published: January 2021

Objective:

To evaluate the corneal re-epithelialization and patient-perceived pain after bandage contact lens (BCL) exchange on day one, after photorefractive keratectomy (PRK).

Methods:

A randomized controlled trial, of all patients who underwent bilateral transepithelial-PRK (trans-PRK) or bilateral alcohol debridement and PRK (A-PRK), between March and October 2019. One eye of each patient was randomly assigned to BCL exchange on the first postoperative day (exchange group) and the BCL was not exchanged in the fellow eye (control group). Patients were evaluated daily until healing was complete. At each visit, the corneal epithelial defect was measured, and a questionnaire was used to assess pain, photophobia, and excessive tearing. P<0.05 was statistically significant.

Results:

The study sample was comprised of 56 patients (mean age 27.2±5.7 years). Trans-PRK was performed in 20 (34.5%) and A-PRK in 36 (64.3%) patients. At day 3, 40 (71.4%) eyes of the exchange group healed completely compared with 38 (67.9%) eyes of the control group (P=0.5). At day-1 follow-up, the pain score was 1.87±1.4 in the exchange group and 2.29±1.3 in the control group (P=0.009). The mean pain score was 1.58±1.4 among patients who underwent A-PRK and 2.35±1.2 among patients operated by trans-PRK (P=0.04).

Conclusion:

The epithelial healing did not vary when BCL was exchanged one day after refractive surgery. However, postoperative pain score after PRK was lower at day 1, when the BCL was exchanged. Compared with A-PRK, trans-PRK group demonstrated a higher pain score in the early postoperative phase.
Manhattan Vision Screening and Follow-up Study in Vulnerable Populations (NYC-SIGHT): Design and Methodology
Authors: Hark Lisa A. , Kresch Yocheved S. , De Moraes Carlos Gustavo , Horowitz Jason D. , Park Lisa , Auran James D. , Gorroochurn Prakash , Stempel Stella , Maruri Stefania C. , Stidham Elizabeth M. , Banks Aisha Z. , Saaddine Jinan B. , Lambert Bianca C. , Pizzi Laura T. , Sapru Saloni , Price Simani , Williams Olajide A. , Cioffi George A. , Liebmann Jeffrey M.
Published: January 2021

Précis:

The Manhattan Vision Screening and Follow-up Study in Vulnerable Populations is a 5-year prospective, cluster-randomized study to improve detection and management of glaucoma and other eye diseases in vulnerable populations living in affordable housing developments.

Purpose:

To describe the study design and methodology of the Manhattan Vision Screening and Follow-up Study in Vulnerable Populations, which aims to investigate whether community-based vision screenings can improve detection and management of glaucoma, vision impairment, cataract, and other eye diseases among vulnerable populations living in affordable housing developments in upper Manhattan.

Materials and Methods:

This 5-year prospective, cluster-randomized, controlled trial consists of vision screening and referral for follow-up eye care among eligible residents aged 40 and older. Visual acuity, intraocular pressure (IOP), and fundus photography are measured. Participants with visual worse than 20/40, or IOP 23 to 29 mm Hg, or unreadable fundus images fail the screening and are scheduled with the on-site optometrist. Those with an abnormal image and/or IOP ≥30 mm Hg, are assigned as “fast-track” and referred to ophthalmology. Participants living in 7 developments randomized to the Enhanced Intervention Group who fail the screening and need vision correction receive complimentary eyeglasses. Those referred to ophthalmology receive enhanced support with patient navigators to assist with follow-up eye care. Participants living in 3 developments randomized to the Usual Care Group who fail the screening and need vision correction are given an eyeglasses prescription only and a list of optical shops. No enhanced support is given to the Usual Care Group. All participants referred to ophthalmology are assisted in making their initial eye exam appointment.

Conclusion:

This study targets vulnerable populations where they live to ensure improved access to and utilization of eye care services in those who are least likely to seek eye care.
Cost of Quality Pilot: A Systematic Methodology for Examining the Cost of Pressure Injury
Authors: Polancich Shea , Miltner Rebecca , Poe Terri , Williamson Jason , Vander Noot Ross , Shirey Maria
Published: January 2021

Health care costs in the United States are considerable, and total national cost of preventable adverse events in the United States ranges from billions to trillions of dollars annually. Achieving the highest quality of health services requires delivering care that mitigates the risk of patient adverse events. Pressure injuries are a significant and costly adverse event. Mitigating or eliminating harm from pressure injuries not only improves quality and increases patient safety but also decreases costs of care. The purpose of this article is to pilot a systematic methodology for examining the differences in the cost of care for a subset of patients with and without hospital-acquired pressure injuries in an acute care setting.
Pride and Uncertainty
Authors: Marsaa Kristoffer , Mendahl Janni , Heilman Henriette , Johansson Hélène , Husum Mette , Lippert Dorthe , Sandholm Niels , Konradsen Hanne
Published: January 2021

There is limited knowledge about the psychosocial stress among the nursing staff working on the COVID-19 wards. This article reports on the experiences of frontline health care workers as it was described to supervisors counseling the nursing staff engaged in the response to the outbreak of COVID-19. Frontline health care workers, nurses, and nurses' aides experienced major work changes. Some were transferred to the newly formed COVID-19 wards in a large Danish hospital, were given new tasks, and had to collaborate with new colleagues, while treating a new deadly and contagious disease. This study aimed to describe the reflections and experiences of the nursing staff attending supervision sessions. The palliative unit offered supervision from April 2020. A total of 9 supervision sessions were held as part of this study, and 57 nursing staff members participated in the sessions. The supervision was available to employees until the first COVID wave subsided in June 2020. During each session, supervisors took field notes and wrote field memos. The topics raised by the nursing staff during the supervision sessions ranged between pride and uncertainty. Nursing staff in COVID-19 wards were at risk of feeling an increasing burden, and there was a need for ongoing managerial attention as well as continuous visible presence and support.
Implicit/Explicit Beliefs About God, Uncertainty, and Anxiety
Authors: Aryeh Rebecca , Pirutinsky Steven , Rosmarin David H.
Published: January 2021

Intolerance of uncertainty (IU) refers to the incapacity to cope with a perceived lack of information sustained by negative perceptions about uncertainty and its implications. Previous research regarding the role of religion and spirituality (R/S) in coping with uncertainty is unclear. The current research assessed if implicit and explicit beliefs about God are related to these discrepancies. Participants completed an explicit task, an implicit association task, the Intolerance of Uncertainty Scale, and the Hospital Anxiety and Depression Scale. Results indicated that explicit and implicit beliefs independently correlated with IU and anxiety. Regression analyses suggested that these correlations were primarily due to the relationship between negative beliefs of God and IU and that IU partially mediated the relationship between R/S and anxiety. The current findings add to the growing literature on IU and suggest the need to address R/S as a possible correlate of IU.
Total Knee Arthroplasty in the Ambulatory Surgery Center Setting
Authors: Smith Mary Atkinson , Smith William Todd , Atchley Danielle , Atchley Lance
Published: January 2021

As the current population continues to increase in age, so does the degeneration of the musculoskeletal system and the development of knee osteoarthritis. Total knee arthroplasty (TKA) will be the treatment of choice when it comes to improving physical function and decreasing pain associated with osteoarthritis of the knee. The global push for more cost-effective healthcare services has led to new models of care and payment delivery methods such as performing TKA in the ambulatory surgery center (ASC) setting. With deeply invasive surgical procedures such as TKA being done in the ASC setting, orthopaedic nurses must be mindful of best practices that will promote quality and safety while considering the importance of using current evidence to guide nursing practice when promoting appropriate patient selection and effective patient education of self-management of postoperative care pertaining to TKA being performed in the ASC setting. This is critical to consider during a time when financial profits in the ASC setting may take a front seat to the delivery of high-quality and safe patient care.