bluuebunny/crossref_metadata_2025 huggingface dataset:
Performance of 3 Composite Measures for Disease Activity in Peripheral Spondyloarthritis
Authors: Beckers Esther , Been Marin , Webers Casper , Boonen Annelies , ten Klooster Peter M. , Vonkeman Harald E. , van Tubergen Astrid
Published: September 2021

Objective

To investigate concurrent validity and discrimination of the Disease Activity Index for Psoriatic Arthritis (DAPSA) score, Psoriatic Arthritis Disease Activity Score (PASDAS), and Ankylosing Spondylitis Disease Activity Score (ASDAS) in peripheral spondyloarthritis (pSpA) in clinical practice.

Methods

Data from a Dutch registry for SpA (SpA-Net) were used. Predefined hypotheses on concurrent validity of the composite measures with 15 other outcome measures of disease activity, physical function, and health-related quality of life were tested. Concurrent validity was considered acceptable if ≥ 75% of the hypotheses were confirmed. Discrimination was assessed by stratifying patients in DAPSA, PASDAS, and ASDAS predefined disease activity states and studying mean differences in health outcomes by 1-way ANOVA. Further, the concordance in disease activity states was determined. All analyses were repeated in subgroups with and without psoriasis (PsO).

Results

DAPSA, PASDAS, and ASDAS scores were available for 191, 139, and 279 patients with pSpA, respectively. The concurrent validity and discrimination of all composite measures were acceptable, as the strength of correlations were as hypothesized in ≥ 75% of the studied correlations. With increasing disease activity states, scores in nearly all outcome measures worsened significantly. The DAPSA, PASDAS, and ASDAS classified 22%, 56%, and 48% of the patients, respectively, in the 2 highest disease activity states. Stratified analyses for concomitant PsO revealed no relevant subgroup differences.

Conclusion

The performance of DAPSA, PASDAS, and ASDAS in pSpA was acceptable, and independent of concomitant PsO. Due to discrepancy in classification, the validity of existing thresholds for disease activity states warrants further study in pSpA.
COVID-19 in Pregnant Women With Rheumatic Disease: Data From the COVID-19 Global Rheumatology Alliance
Authors: Bermas Bonnie L. , Gianfrancesco Milena , Tanner Helen L. , Seet Andrea M. , Aguiar Mathia C. , Al Adhoubi Nasra K. , Al Emadi Samar , Cunha Bernardo M. , Flood Rachael , Kusevich Daria A. , McCarthy Eoghan M. , Patel Naomi J. , Ruderman Eric M. , Sattui Sebastian E. , Sciascia Savino , Siddique Faizah , Valenzuela-Almada Maria O. , Wise Leanna M. , Worthing Angus B. , Zell JoAnn , Bhana Suleman , Costello Wendy , Duarte-Garcia Ali , Grainger Rebecca , Gossec Laure , Hausmann Jonathan S. , Hyrich Kimme , Lawson-Tovey Saskia , Liew Jean W. , Sirotich Emily , Sparks Jeffrey A. , Sufka Paul , Wallace Zachary S. , Machado Pedro M. , Strangfeld Anja , Clowse Megan E.B. , Yazdany Jinoos , Robinson Philip C.
Published: September 2021

Objective

To describe coronavirus disease 2019 (COVID-19) and pregnancy outcomes in patients with rheumatic disease who were pregnant at the time of infection.

Methods

Since March 2020, the COVID-19 Global Rheumatology Alliance has collected cases of patients with rheumatic disease with COVID-19. We report details of pregnant women at the time of COVID-19 infection, including obstetric details separately ascertained from providers.

Results

We report on 39 patients, including 22 with obstetric detail available. The mean and median age was 33 years, range 24–45 years. Rheumatic disease diagnoses included rheumatoid arthritis (n = 9), systemic lupus erythematosus (n = 9), psoriatic arthritis/other inflammatory arthritides (n = 8), and antiphospholipid syndrome (n = 6). Most had a term birth (16/22), with 3 preterm births, 1 termination, and 1 miscarriage; 1 woman had yet to deliver at the time of report. One-quarter (n = 10/39) of pregnant women were hospitalized following COVID-19 diagnosis. Two of 39 (5%) required supplemental oxygen (both hospitalized); no patients died. The majority did not receive specific medication treatment for their COVID-19 (n = 32/39, 82%), and 7 patients received some combination of antimalarials, colchicine, anti–interleukin 1β, azithromycin, glucocorticoids, and lopinavir/ritonavir.

Conclusion

Women with rheumatic diseases who were pregnant at the time of COVID-19 had favorable outcomes. These data have limitations due to the small size and methodology; however, they provide cautious optimism for pregnancy outcomes for women with rheumatic disease particularly in comparison to the increased risk of poor outcomes that have been reported in other series of pregnant women with COVID-19.
Young-onset type 2 diabetes in South Korea: a review of the current status and unmet need
Authors: Yang Ye Seul , Han Kyungdo , Sohn Tae Seo , Kim Nam Hoon
Published: September 2021

The prevalence of young-onset (diagnosis at age < 40 years) type 2 diabetes mellitus (T2DM) is increasing globally. Young-onset T2DM has a common pathophysiology of glucose dysregulation as in late-onset T2DM. However, it presents a greater association with obesity and a more rapid decline in β-cell function than late-onset T2DM. Accumulating evidence indicates that disease progression in young-onset T2DM is rapid, resulting in early and frequent development of microvascular and macrovascular complications, as well as premature death. Improper management and low adherence to medical therapy are important issues in young-onset T2DM. This review discusses the epidemiology, disease entity, and clinical issues associated with young-onset T2DM. We also present the prevalence and clinical characteristics of patients with young-onset T2DM in South Korea.
Can one resurrect the dead?
Authors: Cape Chad
Published: September 2021

La mort ne correspond pas uniquement à la cessation de la vie et de toute fonction biologique. Elle renvoie également à la cessation du développement psychique, ce qui peut mener à une mort symbolique. Les auteurs parlent souvent d’une mort psychique. Les parents qui n’occupent pas leur rôle symbolique peuvent engendrer ce type de mort. Ceci est particulièrement vrai pour l’enfant-thérapeute dont les parents ont renoncé à leur rôle puis se sont tournés vers l’enfant pour obtenir un soutien psychologique. La conséquence: l’enfant souffre d’une mort psychique. Au travers d’une étude issue de la clinique de l’auteur, il va explorer la vie et la mort psychique d’une enfant-thérapeute. Il vise à comprendre pourquoi la patiente est devenue une enfant-thérapeute, ainsi qu’à explorer la mort psychique qui en a découlé. Enfin, il abordera le travail effectué avec le psychothérapeute pour l’amener vers sa « résurrection ».
Faillir être mort, voir mourir, rester vivant. Faire face à la mort et au deuil traumatiques en réanimation
Authors: Sportouch Sabine
Published: September 2021

Si le risque de mort constitue un traumatisme psychique certain pour les patients de réanimation, les familles risquent aussi de vivre un deuil traumatique quand la mort survient. Quant aux soignants, ils sont confrontés à un risque constant de mort traumatique dont ils n’ont pas toujours conscience. Prenant appui sur son expérience clinique de psychologue en service de médecine intensive/réanimation, l’auteure de cet article analyse les enjeux psychiques à l’œuvre dans la mort, le deuil, et l’accompagnement nécessaire pour éviter autant que possible leurs effets traumatiques.
La voix génitale
Authors: Brault Anthony
Published: September 2021

La voix génitale est la voix que le sujet acquiert à l’adolescence. Le terme génital convoque le caractère sexué de la voix tant dans sa nature biologique que psychique. Mais si la biologie impose à l’adolescent une nouvelle voix, le temps et les résistances du psychisme ne sont pas les mêmes pour accepter cette transformation pubertaire. À partir de la cure d’un jeune garçon de 13 ans, l’auteur montre en quoi dans le travail analytique avec des adolescents tendre l’oreille à la voix de l’adolescent et plus largement à la relation que ce dernier entretient avec elle, et aussi avec la voix de l’analyste, peut contribuer à enrichir l’instrument d’écoute de l’analyste. Ce dernier pourrait davantage entendre la qualité du chemin que l’adolescent parcourt pour intégrer psychiquement la génitalisation de son corps.
Des traces en souffrance d’un dire
Authors: Corin Ellen
Published: September 2021

L’image d’Anna la servante prenant contre son sein dénudé le corps d’Agnès, souffrante ou morte, sert de point d’appui pour approcher la limite des représentations lorsqu’il s’agit de penser une origine dans laquelle Éros semble avoir fait alliance avec Thanatos. Trois situations cliniques permettent d’explorer les voies par lesquelles un vécu à la limite du pensable cherche à se frayer un chemin dans la psyché : des circonstances particulières d’adoption où la voie vers la mise en forme de l’angoisse emprunte le chemin de représentations de type pictographique et de représentations de choses ; une conception et une enfance situées sous le signe de Thanatos et où c’est à travers des mises en scène que se forment des représentations permettant de penser l’origine ; et une attaque violente mettant en cause une figure idéalisée, qui fragilise la légitimité d’exister et de devenir, et qui fait ressortir le poids d’un noyau mélancolique où le masochisme cherche à lier la violence subie.
Contourner la compétition par la compétition : les universités russes et les olympiades
Authors: Sigman Carole
Published: September 2021

Depuis les années 2000, les autorités fédérales russes cherchent à reprendre le contrôle de l’enseignement supérieur par des réformes mettant les universités en compétition entre elles. L’objet de cet article est d’analyser comment les universités parviennent à contourner en partie l’une de ces réformes en développant un dispositif original de recrutement des étudiants : les olympiades. Bien qu’ a priori marginal, celui-ci affecte en réalité tous les recrutements et, au-delà, l’ensemble du fonctionnement du champ universitaire. C’est sous l’angle de la compétition entre établissements qu’il sera analysé ici. Mobilisé à l’origine par les universités d’élite, il a rapidement été investi par les autres établissements. Victimes de leur succès, aussi inattendu qu’incontrôlable, les olympiades font à présent l’objet d’une régulation de la part des grandes universités et des autorités fédérales. Elles mettent ainsi en lumière les pratiques et enjeux de la compétition entre universités, ainsi que certains aspects du fonctionnement du pouvoir politique en Russie depuis une quinzaine d’années.
Apport des approches instrumentale et ergotoxicologique pour la conception : le cas du matériel de pulvérisation des pesticides en viticulture
Authors: Albert Marion , Judon Nathalie , Folcher Viviane , Bourmaud Gaëtan , Pueyo Valérie , Larbaigt Jean , Garrigou Alain
Published: September 2021

Cet article vise à développer une approche critique de la conception et des usages des pulvérisateurs en viticulture. Cette approche a pour ambition de souligner l’intérêt de lier les approches instrumentale et ergotoxicologique pour la conception de ce matériel. L’analyse de l’activité effectuée au sein de deux exploitations viticoles a mis en évidence un nombre important de difficultés d’usage et de variabilités rencontrées lors de l’utilisation de pulvérisateurs qui peuvent entraîner des situations d’exposition aux pesticides. Afin de rendre compte de l’inventivité des viticulteurs, cette analyse a également porté l’attention sur les genèses instrumentales présentes dans l’activité. Et c’est au regard de ces résultats que ce travail nous permet de mettre en évidence l’enjeu de coupler les approches instrumentale et ergotoxicologique pour viser un développement des démarches de prévention.
Allier les approches réglementaire et ergonomique de l’externalisation de la maintenance dans un objectif de prévention*
Authors: Grusenmeyer Corinne , Nivelet Thomas
Published: September 2021

Les activités de maintenance sont très largement externalisées. Pour autant, les relations entre l’externalisation de la maintenance et la santé et la sécurité restent peu documentées et les différentes formes d’externalisation de la maintenance ont rarement été définies ou étudiées. Cet article vise à développer la connaissance de ces différentes formes d’externalisation de la maintenance et la prévention des risques liés à ces activités, en alliant une approche réglementaire et une approche ergonomique de ces situations de travail. Dans une première étape, le cadre contractuel et réglementaire des interventions de maintenance externalisées a été examiné. Il a permis, sur la base des différents contrats de maintenance de droit privé (maintenance autonome, liée, sous-traitance) de distinguer différentes formes de contractualisation, et donc d’externalisation, de la maintenance. Dans une deuxième étape, le réseau des entreprises contractantes de maintenance auxquelles une entreprise exploitante fait appel pour ses équipements de production a été identifié, et la nature des relations contractuelles entretenues dans chaque cas a été caractérisée sur la base des résultats issus de la première étape. Il en ressort un réseau d’entreprises relativement complexe et des relations contractuelles diverses. Dans une troisième étape, des observations d’interventions de maintenance, se différenciant selon leur forme d’externalisation, ont été menées. Elles ont donné lieu à des analyses cliniques de situations impliquant des salariés des entreprises exploitante et contractante, pour lesquelles un événement « critique » lié à la répartition de leurs tâches, à la succession de leurs activités ou à leurs échanges d’informations, est survenu. L’analyse d’une telle situation révèle des ambiguïtés dans la répartition des tâches entre les différents personnels et permet d’identifier divers éléments contributifs, ainsi que des conséquences pour les conditions de travail des salariés. Ces résultats sont discutés en relation avec l’organisation désormais réticulaire des entreprises et donnent lieu à des pistes de prévention.
Developing Students' Clinical Reasoning Skills: A Faculty Guide
Authors: Gonzalez Lisa , Nielsen Ann , Lasater Kathie
Published: September 2021

Background:

Safe patient care relies on the ability of nurses to make timely, sound clinical judgments, yet new nurse graduates are underprepared. Nurse educators must take action with teaching to develop students' clinical reasoning skills and ultimately their clinical judgment. One first step is to consider strategies that integrate clinical judgment and clinical reasoning skills into nursing curriculum.

Method:

The literature was reviewed to uncover what is known about teaching strategies that intentionally teach clinical reasoning skills and are focused on the development of students' clinical judgment.

Results:

Although not exhaustive, this guide for faculty discusses first steps when considering integrating clinical reasoning and judgment into nursing curriculum, presents teaching strategies, and provides ideas for implementation within nursing curriculum.

Conclusion:

Teaching clinical reasoning skills, using a framework, and incorporating teaching strategies such as concept-learning, high-order questioning, and reflection focused on developing clinical reasoning skills may prove useful in developing students' clinical judgment.

[
J Nurs Educ
. 2021;60(9):485–493.]
Comparison of Health-Promoting Behaviors of Nursing Students From Different Racial/Ethnic Groups
Authors: Davis Beena , Badr Lina K. , Dee Vivien , Fongwa Marie N. , Doumit Rita
Published: September 2021

Background:

Despite the known benefits of maintaining a healthy lifestyle in preventing many health-related issues, few nursing students practice health-promoting behaviors (HPB).

Method:

This cross-sectional, descriptive, correlational study included 866 undergraduate nursing students who were members of the National Student Nurses' Association.

Results:

The difference in mean Health-Promoting Lifestyle Profile-II scores between White people and Asian Americans was statistically significant (F [4, 861]) = 2.95,p= .019). The difference in the mean self-efficacy scores between Black people and Asian Americans also was statistically significant (F [4, 861] = 4.41,p= .002). The regression model was significant (F [1, 862] = 6.683,p= .001, R2 =.235)], and self-efficacy (β= .457,t= 15.178,p= .001) significantly predicted nursing students' HPB.

Conclusion:

The differences between racial/ethnic groups noted in this study indicate nursing faculty need to render culturally sensitive interventions to promote self-efficacy and HPB among undergraduate nursing students.[J Nurs Educ. 2021;60(9):500–508.]
Uncovering Hidden Resources: Using Historical Narrative to Teach Social Determinants of Health
Authors: Adams Sara B.
Published: September 2021

Background:

Introducing population health concepts, such as social determinants of health (SDH), into undergraduate nursing programs is essential for the development of nurses who understand the impact of social environment on health outcomes.

Method:

Story, in the form of historical narrative, was used in an introductory, sophomore-level, population health course as an exemplar of SDH and other population health concepts. Reflective verbal and written data were collected from students (
n
= 38) and analyzed for content.

Results:

Student comments reflected an emerging understanding of SDH, health disparities, stigma, evidence, and advocacy, and how these concepts intersect and apply to current nursing practice.

Conclusion:

Using humanities content such as historical narrative has the potential to be a powerful exemplar for addressing multiple population health concepts in the nursing classroom.

[
J Nurs Educ
. 2021;60(9):522–525.]
Threading QSEN Competencies Across a Baccalaureate Nursing Program: The Development of Dedicated QSEN Labs
Authors: Young Christine , Ball Sarah , Flott Elizabeth , Goodman Joely , Hercinger Maribeth
Published: September 2021

Background:

In response to the development of the Quality and Safety Education for Nurses (QSEN) competencies and noting lower standardized test scores, nursing faculty at a midwestern United States university developed three safety and quality labs throughout a traditional baccalaureate curriculum.

Method:

These labs intentionally integrated the QSEN competencies and occurred over three semesters of the nursing program. Students' learning activities aligned with the QSEN competencies and were leveled across the labs.

Results:

Throughout all the labs, all six QSEN competencies provided a framework for students to learn the knowledge, skills, and attitudes essential to the profession of nursing. Students spent most of their time in the labs learning the QSEN competency of safety, followed by teamwork and collaboration, quality improvement, patient-centered care, informatics, and evidenced-based practice.

Conclusion:

The QSEN competencies provided a framework to teach pre-licensure nursing students the knowledge, skills, and attitudes essential in the profession of nursing. Safety and Quality I focused on foundational skills and individual patient safety. Safety and Quality II introduced intermediate skills with an emphasis on safety. The third and final lab introduced students to advanced quality improvement, teamwork and collaboration, and system safety. After the completion of the labs, the students stated they had gained knowledge and confidence in the application of all six QSEN competencies.

[
J Nurs Educ
. 2021;60(9):526–528.]
Flipped Clinical Teaching: Battling COVID-19 With Creative and Active Pedagogy
Authors: Hassler Linda J. , Moscarella Daniela , Easley Lisa , Olaode Sunday
Published: September 2021

Background:

During the onset of the coronavirus disease 2019 global pandemic, Schools of Nursing transitioned from the traditional clinical teaching and learning experiences to synchronous online learning.

Method:

As part of the Capstone experience in the second-degree, final semester course, students selected one clinical specialty area. Four full-time clinical faculty and five adjunct clinical instructors collaborated in flipped clinical lesson plans 3 weeks prior to the start of the semester. The lesson plan included three components: preconference, active learning, and postconference. Student evaluation of the experience was another critical component.

Results:

The student evaluation surveys supported that 95% of the respondents identified that the flipped clinical experience was a successful methodology to reinforce clinical concepts.

Conclusion:

The flipped clinical learning approach showed promise as an effective way to provide remote clinical instruction for students during public health emergencies, when shortage of clinical sites arise, or as a replacement for missed clinical hours.

[
J Nurs Educ
. 2021;60(9):534–537.]
How vulnerable is the fiscal posture in Turkey?
Authors: CAN Cansın Kemal ,   Department of Public Finance, Istanbul Medeniyet University, Göztepe, Kadıköy, Turkey
Published: September 2021

This study gauges the degree of fiscal vulnerability in Turkey by calculating the debt stabilising primary balance level and evaluates how this variable measures up against the actual primary balance levels for the 1978–2019 period. Based on this comparison, we build up a fiscal fragility index using the methodology described in Stoian (2012). In addition, the Toda-Yamamoto causality test is carried out to detect the direction of causality among these two variables. The index-based analysis reveals that the fiscal performance of Turkey was chiefly satisfactory for the estimation period. Also, the Toda-Yamamoto causality test results imply a unidirectional causality from the required primary balance to real primary balance, suggesting that the government uses the primary balance to stabilise fiscal imbalances, which is an affirmative effort by the government to restore fiscal sustainability. Nevertheless, notwithstanding the implementation of corrective fiscal actions to preserve stability, the index value is steadily moving up in recent years, indicating a mounting fiscal vulnerability risk. Back-loading fiscal adjustments involving spending cuts, full-fledged tax reform, proper scrutiny of public expenses, etc., are among the prominent policy options available to the government to alter the ongoing unfavourable trend in the fiscal vulnerability index.
Maximal and minimal iterative positive solutions for $ p $-Laplacian Hadamard fractional differential equations with the derivative term contained in the nonlinear term
Authors: Guo Limin ,   School of Science, Changzhou Institute of Technology, Changzhou 213002, China, Liu Lishan , Wang Ying ,   School of Mathematical Sciences, Qufu Normal University, Qufu 273165, China,   School of Mathematicacs and Statistics, Linyi University, Linyi 276000, China
Published: September 2021

In this paper, the maximal and minimal iterative positive solutions are investigated for a singular Hadamard fractional differential equation boundary value problem with a boundary condition involving values at infinite number of points. Green's function is deduced and some properties of Green's function are given. Based upon these properties, iterative schemes are established for approximating the maximal and minimal positive solutions.
Application of supervised machine learning as a method for identifying DEM contact law parameters
Authors: Klejment Piotr ,   Institute of Geophysics, Polish Academy of Sciences, Warsaw, Poland
Published: September 2021

Calibration of Discrete Element Method (DEM) models is an iterative process of adjusting input parameters such that the macroscopic results of simulations and experiments are similar. Therefore, selecting appropriate input parameters of a model effectively is crucial for the efficient use of the method. Despite the growing popularity of DEM, there is still an ongoing need for an efficient method for identifying contact law parameters. Commonly used trial and error procedures are very time-consuming and unpractical, especially in the case of models with many parameters to calibrate. It seems that machine learning may offer a new approach to that problem. This research aims to apply supervised machine learning to figure out the dependencies between specific microscopic and macroscopic parameters. More than 6000 DEM simulations of uniaxial compression tests gathered the data for two algorithms - Multiple Linear Regression and Random Forest. Promising results with an accuracy of over 99% give good hope for finding a universal relation between input and output parameters (for a specific DEM implementation) and reducing the number of simulations required for the calibration procedure. Another pertinent question concerns the size of the DEM models used during calibration based on the uniaxial compression test. It has been proven that calibration of certain parameters can be done on smaller samples, where the critical threshold is around 30% of the radius of the original model.
A deep learning based automatic segmentation approach for anatomical structures in intensity modulation radiotherapy
Authors: Zhou Han ,   School of Electronic Science and Engineering, Nanjing University, Nanjing, Jiangsu 210046, China, Li Yikun , Gu Ying , Shen Zetian , Zhu Xixu , Ge Yun ,   Department of Radiation Oncology The Fourth Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210002, China,   Department of Radiation Oncology, Jinling Hospital, Nanjing, Jiangsu, 210002, China
Published: September 2021

Objective

To evaluate the automatic segmentation approach for organ at risk (OARs) and compare the parameters of dose volume histogram (DVH) in radiotherapy. Methodology: Thirty-three patients were selected to contour OARs using automatic segmentation approach which based on U-Net, applying them to a number of the nasopharyngeal carcinoma (NPC), breast, and rectal cancer respectively. The automatic contours were transferred to the Pinnacle System to evaluate contour accuracy and compare the DVH parameters.

Results

The time for manual contour was 56.5 ± 9, 23.12 ± 4.23 and 45.23 ± 2.39min for the OARs of NPC, breast and rectal cancer, and for automatic contour was 1.5 ± 0.23, 1.45 ± 0.78 and 1.8 ± 0.56 min. Automatic contours of Eye with the best Dice-similarity coefficients (DSC) of 0.907 ± 0.02 while with the poorest DSC of 0.459 ± 0.112 of Spinal Cord for NPC; And Lung with the best DSC of 0.944 ± 0.03 while with the poorest DSC of 0.709 ± 0.1 of Spinal Cord for breast; And Bladder with the best DSC of 0.91 ± 0.04 while with the poorest DSC of 0.43 ± 0.1 of Femoral heads for rectal cancer. The contours of Spinal Cord in H & N had poor results due to the division of the medulla oblongata. The contours of Femoral head, which different from what we expect, also due to manual contour result in poor DSC.

Conclusion

The automatic contour approach based deep learning method with sufficient accuracy for research purposes. However, the value of DSC does not fully reflect the accuracy of dose distribution, but can cause dose changes due to the changes in the OARs volume and DSC from the data. Considering the significantly time-saving and good performance in partial OARs, the automatic contouring also plays a supervisory role.
Adherence to Guidelines for Managing Severe Traumatic Brain Injury in Children
Authors: Pajer Hengameh B. , Asher Anthony M. , Leung Dennis , Barnett Randaline R. , Joyner Benny L. , Quinsey Carolyn S.
Published: September 2021

Pediatric traumatic brain injury (TBI) protocols vary widely among institutions, despite the existence of published guidelines. This study seeks to identify significant differences in management of pediatric TBI across several institutions. Severe pediatric TBI protocols were collected from major US pediatric hospitals through direct communication with trauma staff. Of 24 institutions identified and contacted, 10 did not respond and 5 did not have a pediatric TBI protocol. Pediatric TBI protocols were successfully collected from 9 institutions. These 9 protocols were separated into treatment tiers analogous to those in the 2019 Society of Critical Care Medicine and World Federation of Pediatric Intensive and Critical Care Societies guidelines, and the intervention variables were identified and compared across the 9 institutions. First-line therapies were similar between institutions, including seizure prophylaxis, maintenance of normoglycemia and normothermia, and avoidance of hypoxia, hyponatremia, and hypotension. However, significant variation across institutions was found regarding timing of cerebrospinal fluid drainage, hyperventilation, and neuromuscular blockade. When included in institutional protocols, most therapies are in line with the 2019 guidelines, except for diversion of cerebrospinal fluid, hyperventilation, maintenance of cerebral perfusion pressure, and use of neuromuscular blocking agents. Although these variations may represent differences in style or preference, the optimal timing of these specific treatment variations should be studied to determine the impact of each protocol on clinical outcomes.
Decreased Incidence of Rib Fractures in Pregnant Patients After Motor Vehicle Collisions
Authors: Di Napoli Marissa , DeVoe William B. , Leon Stuart , Crookes Bruce , Privette Alicia , Graybill Whitney , Eriksson Evert A.
Published: September 2021

Background

Rib fractures are common after motor vehicle collisions. The hormonal changes associated with pregnancy decrease the stiffness and increase the laxity of cartilage and tendons. The effect of these changes on injury mechanics is not completely understood.

Objectives

To compare the incidences of chest wall injury following blunt thoracic trauma between pregnant and nonpregnant women.

Methods

The authors conducted a retrospective review of female patients seen at a level I trauma center from 2009 to 2017 after a motor vehicle collision. Patient characteristics were compared to determine if pregnancy affected the incidence of chest wall injury. Statistics were calculated with SPSS version 24 and are presented as mean (SD) or median (interquartile range).

Results

In total, 1618 patients were identified. The incidence of rib/sternal fracture was significantly lower in pregnant patients (7.9% vs 15.2%, P = .047), but the incidence of intrathoracic injury was similar between the groups. Pregnant and nonpregnant patients with rib/sternal fractures had similar Injury Severity Score results (21 [13-27] vs 17 [11-22], P = .36), but pregnant patients without fractures had significantly lower scores (1 [0-5] vs 4 [1-9], P < .001).

Conclusions

Pregnant patients have a lower rate of rib fracture after a motor vehicle collision than nonpregnant patients. The difference in injury mechanics may be due to hormonal changes that increase elasticity and resistance to bony injury of the ribs. In pregnant trauma patients, intrathoracic injury without rib fracture should raise concerns about injury severity. A multicenter evaluation of these findings is needed.
Moral Distress in Clinicians Caring for Critically Ill Patients Who Require Mechanical Circulatory Support
Authors: Emple Artem , Fonseca Laura , Nakagawa Shunichi , Guevara Gina , Russell Cortessa , Hua May
Published: September 2021

Background

Although use of mechanical circulatory support is increasing, it is unclear how providing such care affects clinicians’ moral distress.

Objective

To measure moral distress among intensive care unit clinicians who commonly care for patients receiving mechanical circulatory support.

Methods

In this prospective study, the Moral Distress Scale-Revised was administered to physicians, nurses, and advanced practice providers from 2 intensive care units in an academic medical center. Linear regression was used to assess whether moral distress was associated with clinician type, burnout, or desire to leave one’s job. Clinicians’ likelihood of reporting frequent moral distress when caring for patients receiving mechanical circulatory support vs other critically ill patients also was assessed.

Results

The sample comprised 102 clinicians who had a mean (SD) score of 100.5 (51.6) on the Moral Distress Scale- Revised. After adjustment for clinician characteristics, moral distress was significantly higher in registered nurses than physicians/advanced practice providers (115.9 vs 71.0, P < .001), clinicians reporting burnout vs those who did not (114.7 vs 83.1, P = .003), and those considering leaving vs those who were not (121.1 vs 89.2, P = .001). Clinicians were more likely to report experiencing frequent moral distress when caring for patients receiving mechanical circulatory support (26.5%) than when caring for patients needing routine care (10.8%; P = .004), but less likely than when caring for patients with either chronic critical illness (57.8%) or multisystem organ failure (56.9%; both P < .001).

Conclusion

Moral distress was high among clinicians who commonly care for patients receiving mechanical circulatory support, suggesting that use of this therapy may affect well-being among intensive care unit clinicians.
Effect of Coconut (Cocos nucifera) Water Extract on the Development of Adventitious Roots in Polyscias fillicifolia Stem Cuttings
Authors: Jayawardena B. M. , Agampodi V. A. , Abeywickrama K. P.
Published: September 2021

Purpose Vegetative propagation continues to be a popular method to propagate ornamental plant species. Coconut water (CW) can be considered as an abundant source of hormones and other plant growth regulators (PGRs). In this study, vegetative propagation of Polyscias fillicifolia was attempted using PGRs isolated from CW. Research method Stem cuttings were treated with varying concentrations (5, 10, 25, 50,100 μg mL-1) of PGR isolated from CW. The results were compared with a control set (treated with distilled water) and with those treated with solutions of pure synthetic indole acetic acid (IAA). Findings P. fillicifolia canes treated with a 25 μg mL-1 concentration of IAA, isolated from CW, showed the highest levels of root induction and development. Root development was more rapid (5 weeks) in the samples treated with PGRs isolated from CW compared to the canes propagated in the field by placing the canes on coir beds in plant nurseries. (6 weeks). Originality This is the first study to use PGRs isolated from CW extracts to improve lateral root proliferation, induce shoot development and leaf emergence in P. fillicifolia.
Automated indicator-mineral analysis of the fine-sand heavy-mineral concentrate fraction of till: a promising exploration tool for porphyry copper mineralization
Authors: Plouffe A , Wilton D H C , McNeil R , Ferbey T
Published: September 2021

Previous studies indicated that heavy mineralogy (specific gravity (SG) = 2.8-3.2 and >3.2) of the medium-sand fraction (0.25-0.50 mm) of till contains porphyry copper indicator minerals (PCIM) derived from mineralization or alteration zones. To
improve the PCIM method for mineral exploration, we analyzed the heavy mineralogy (>3.2 SG) of the fine-sand fraction (0.125-0.180 mm) of till using an automated method that combines scanning electron microscopy (SEM) and mineral-liberation analysis (MLA). The MLA-SEM method identifies
mineralogy based on grain composition determined by SEM-energy dispersive spectroscopy. The distributions of epidote and chalcopyrite in till at four porphyry copper deposits in British Columbia show similarities between the fine-sand fraction analyzed by MLA-SEM and the medium-sand fraction
analyzed by optical mineralogy: both show dispersal parallel to ice-flow movements. Analyzing the fine-sand, heavy-mineral concentrate (HMC) fraction of till by MLA-SEM can be used in exploration for porphyry copper mineralization. We estimate 5 to 8 kg of bulk till is sufficient to prepare 0.3 g
aliquots of fine-sand HMC for MLA-SEM; this is smaller than the 9 to 15 kg required for optical mineral analysis of the medium-sand HMC fraction. Smaller field samples can lower costs for reconnaissance mineral exploration.
Multimodality imaging in a case of multiple pulmonary hyalinizing granulomas - A decade follow-up
Authors: Soni Neetu , Ora Manish , Gupta Sarika , Maheshwarappa Ravishankar Pillenahalli , Priya Sarv , Graham Michael M.
Published: September 2021

A 44-year-old male was referred to our clinic (2015) to evaluate multiple lung nodules with increasing fatigue, dyspnea, and weight loss. He was being assessed to an outside hospital for the same since 2010. The X-ray and computed-tomography (CT)-chest showed numerous pulmonary nodules and bilateral hilar adenopathy. Imaging workup at our institute (2015) redemonstrated extensive calcified pulmonary nodules. 18fluoro-2-deoxy-d-glucose positron emission tomographyCT showed widespread pulmonary nodules with low-grade uptake. Video-assisted thoracic surgery lung biopsy revealed pulmonary hyalinizing granuloma (PHG). Recently because of increasing symptoms, he is being evaluated for a lung transplant. This case represents a rare diagnosis of PHG with a decade follow-up.
Mediastinal and pleural lipomatosis as a manifestation of myotonic dystrophy type 1
Authors: Finsterer Josef , Scorza Fulvio A
Published: September 2021

Mediastinal and pleural lipomatosis is a rare but usually benign and asymptomatic disease. Mediastinal lipomatosis is associated with steroid use, obesity, hyperlipidemia, diabetes, or Cushing syndrome. In some cases, it becomes symptomatic manifesting with dyspnea, thoracic pain, coughing, dysphonia, dysphagia, supraventricular tachycardia, or persistent pneumonia. Mediastinal lipomatosis has not been reported in association with myotonic dystrophy type 1 (MD1). In a 65yo male with a long-term history of progressive muscle weakness, hyper-creatine-kinase-emia, bilateral cataract, sleep apnea syndrome, gynecomastia, hepatic steatosis, arterial hypertension, atrioventricular block 1, QTc prolongation, hyperlipidemia, hyperuricemia, and hepatopathy, MD1 was diagnosed upon the clinical presentation and a heterozygous CTG repeat expansion of 1200–1400 repeats in DMPK. Work-up for dyspnea and leg edema revealed heart failure and mediastinal and pleural lipomatosis. Upon standard treatment, heart failure resolved. In conclusion, mediastinal and pleural lipomatosis can be a rare manifestation of MD1 and can manifest with heart failure. In patients with mediastinal lipomatosis, MD1 should be excluded.
Magnetic resonance imaging in response assessment of mediastinal tuberculous lymphadenopathy
Authors: Singh Rashmi , Naranje Priyanka , Bhalla Ashu Seith , Pandey Shivam
Published: September 2021

Background:

Assessment of response to antitubercular treatment (ATT) in mediastinal tuberculous lymph nodes (LNs) is challenging. Gold standard techniques such as biopsy and culture involve invasive procedures. Radiographic persistence of mediastinal LNs even after completion of ATT poses a treatment dilemma. In this study, we evaluated the changes in signal intensity (SI) and apparent diffusion coefficient (ADC) values of mediastinal LNs on magnetic resonance imaging (MRI), for response assessment to ATT.

Materials and Methods:

After institute ethics approval, a retrospective analysis of MRI images of 22 patients with 55 mediastinal tuberculous LNs was done. Clinically responsive patients of mediastinal tuberculous LNs who underwent chest MRI prior to ATT, or within 1 month of starting ATT, and second MRI performed at least after 2 months of start of the treatment were included. LN size, T1 and T2 signal characteristics (homogenously/heterogeneously and hyperintense or hypointense), T2 and T1 SI ratio, ADC values, and contrast enhancement characteristics were compared. Paired t-test and McNemar test were performed at a significance level of α =0.05.

Results:

Size of LN reduced, but 45 LNs measured >8 mm in second MRI. There was statistically significant decrease in the T2 and T1 SI ratios in second MRI, P = 0.026 and 0.008, respectively. No statistically significant difference was found in ADC values, P = 0.31.

Conclusions:

Decrease in T2 and T1 SI ratios of mediastinal tuberculous LNs can be used as a noninvasive imaging parameter to suggest response to ATT. However, ADC value is not a useful indicator of treatment response.
Spontaneous posterior lung herniation
Authors: Kollipara Venkateswara K , Lutchmedial Sanjiva , Patel Brijesh B , Ie Susanti , Rubio Edmundo E
Published: September 2021

Intercostal lung hernias are uncommon and usually a consequence of trauma or surgery. True spontaneous lung hernias are extremely rare, with only 51 cases identified over the past four-and-half decades. We report a case of nontraumatic chest wall ecchymosis secondary to spontaneous posterior-lateral lung herniation followed by a review of the literature. Interesting radiographic images are presented. The pathophysiology and therapeutic options of this condition are discussed. The case highlights that advanced chronic obstructive pulmonary disease (COPD) may be an etiological factor for the development of this rare entity, with cough being the precipitating event. Given the increasing prevalence of COPD, the authors believe further awareness of this pathology is needed.
Is the SORT score reliable in predicting postoperative 30-day mortality after a nonemergency surgery in Saudi population?
Authors: Ul Huda Anwar , Khan Asad Z. , Memon Abdul S. , Sheikh Nasrullah , Anazi Abdullah A.
Published: September 2021

Context:

The process of stratifying patient risk preoperatively helps in the decision about the best-possible postoperative care for patients. There have been many scoring systems that are used in anesthesia practice.

Aims:

To find out whether there is any difference between the mortality predicted from SORT scoring and the observed mortality among Saudi patients.

Settings and Design:

This was a prospective, observational study in which we included patients underoing nonemergency surgical procedures at the Security Forces Hospital, Riyadh.

Methods and Material:

We calculated the SORT scores for all the included patients. We then collected the 30-day mortality data of all the patients having nonemergency surgical procedures.

Statistical Analysis Used:

We calculated the expected mortality ratio. A P value of less than 0.05 was considered significant.

Results:

The mean SORT mortality risk score (%) for the whole sample was 0.30. The expected number of deaths was 1.638 while the observed deaths were 2, which yields an O/E ratio of 0.819 (p-value: 0.006). The O/E mortality ratios for patients in each individual ASA class were found to be statistically insignificant which means that SORT score can reliably predict mortality for each ASA class.

Conclusions:

SORT scores can be used to predict 30-day mortality after nonemergency surgeries in Saudi population.
When to abandon single-lung anesthesia during video-assisted thoracoscopic surgery (VATS) in infants and young children
Authors: Goonasekera Chulananda , Mathew Malcolm , Kurup Meera , James Steve
Published: September 2021

Video-assisted thoracoscopic surgery (VATS) in infants and young children increasingly require one-lung anesthesia. However, the maintenance of norms of gas exchange is difficult during one-lung anesthesia in some infants. A combination of factors including added dead space of HME and the circle Y piece, intrathoracic inflation of CO2 and its pressure, airway resistance and bilateral lung disease contribute. Seeping blood from the operating lung soiling the endobronchial tube causes airway narrowing and obstruction adding to this difficulty especially during prolonged thoracoscopy. We report two cases: hypoxemia in one and hypercapnia in the other. Guidance on safe limits of permissive hypoxemia or hypercarbia in this scenario is vague. Therefore, irreversible hypoxemia and hypercarbia with changes in acid–base status should be considered as indications for swift conversion to open thoracotomy and abandon one-lung ventilation.
Opioid-free anesthesia with interfascial dexmedetomidine in a high-risk infant
Authors: Rebollar Ramón Eizaga , Rodríguez Elena Borreiros , Olmos Irene Delgado , Torres Morera Luis Miguel
Published: September 2021

Despite the advances in pediatric anesthesia, infants have higher mortality and critical incidents rates than children, especially ex-prematures and those with comorbidity. We present the case of a high-risk infant who underwent elective laparoscopic gastrostomy under opioid-free anesthesia (OFA) combined with transversus abdominis plane (TAP) block with Dexmedetomidine (DEX). Perioperative opioids were entirely avoided, and intraoperative anesthetics and postoperative analgesic were considerably reduced. The infant showed cardiorespiratory stability and optimal analgesia during the uneventful procedure and the postoperative period. We consider OFA and TAP block with DEX a safe and effective anesthetic combination for high-risk infants.
Parental Awareness of Risks and Causes of Hearing Loss and the Acceptance of the Intervention in Taif City, Saudi Arabia
Authors: Aljuaid Sattam M. , Alotaibi Ghaida Hassan , Alsharif Maha Othman , Aljuaid Ahlam Mohammed , Alzahrani Waad Saeed , Alotaibi Ohoud Dhaifallah , Alharthi Rahaf Sifron
Published: September 2021

Background and Objectives:

Pediatric hearing loss (HL) hinders or delays a child's auditory and speech development. This issue that results in anxiety and stress among parents affects the child's ability to engage in communication, participation in age-appropriate activities, and functional and language skills. This study aimed to assess parents' knowledge about risks and causes of HL and the acceptance of the intervention among Saudi parents living in Taif city.

Methodology:

A cross-sectional study was conducted between July 2020 and December 2020 through a pretested questionnaire that was published using an online-based (electronic) form. The questionnaire included items related to sensorineural HL, otitis media, conductive HL, and oto-acoustic emission. The total knowledge scores were calculated based on correct and wrong answers, and the relationship between knowledge level and other variables was determined.

Results:

In this study, the reported prevalence of HL among children was 5.6%. The knowledge related to various types of HL and their risk factors was determined to be good at only 4.5% of the participants. There was no statistically significant difference observed in knowledge between male and female parents (P = 0.620), different age groups (P = 0.591), and education levels of the participants (0.096).

Conclusion:

Parents need to be educated about conventional risk factors for HL because there was inadequate knowledge among our study population. In addition, it is necessary to increase awareness about various audiology services to facilitate early detection and intervention.
The unbounded Kasparov product by a differentiable module
Authors: Kaad Jens
Published: September 2021

In this paper we investigate the unbounded Kasparov product between a differentiable module and an unbounded cycle of a very general kind that includes all unbounded Kasparov modules and hence also all spectral triples. Our assumptions on the differentiable module are weak and we do in particular not require that it satisfies any kind of smooth projectivity conditions. The algebras that we work with are furthermore not required to possess a smooth approximate identity. The lack of an adequate projectivity condition on our differentiable module entails that the usual class of unbounded Kasparov modules is not flexible enough to accommodate the unbounded Kasparov product and it becomes necessary to twist the commutator condition by an automorphism.

We show that the unbounded Kasparov product makes sense in this twisted setting and that it recovers the usual interior Kasparov product after taking bounded transforms. Since our unbounded cycles are twisted (or modular) we are not able to apply the work of Kucerovsky for recognizing unbounded representatives for the bounded Kasparov product, instead we rely directly on the connection criterion developed by Connes and Skandalis. In fact, since we do not impose any twisted Lipschitz regularity conditions on our unbounded cycles, even the passage from an unbounded cycle to a bounded Kasparov module requires a substantial amount of extra care.