bluuebunny/crossref_metadata_2025 huggingface dataset:
Development of New Observation Operators for Assimilating GOES-R Geostationary Lightning Mapper Flash Extent Density Data Using GSI EnKF: Tests with Two Convective Events over the United States
Authors: Kong Rong , Xue Ming , Liu Chengsi , Fierro Alexandre O. , Mansell Edward R.
Published: May 2022

In a prior study, GOES-R Geostationary Lightning Mapper (GLM) flash extent density (FED) data were assimilated using ensemble Kalman filter into a convection-allowing model for a mesoscale convective system (MCS) and a supercell storm. The FED observation operator based on a linear relation with column graupel mass was tuned by multiplying a factor to avoid large FED forecast bias. In this study, new observation operators are developed by fitting a third-order polynomial to GLM FED observations and the corresponding FED forecasts of graupel mass of the MCS and/or supercell cases. The new operators are used to assimilate the FED data for both cases, in three sets of experiments called MCSFit, SupercellFit, and CombinedFit, and their performances are compared with the prior results using the linear operator and with a reference simulation assimilating no FED data. The new nonlinear operators reduce the frequency biases (root-mean-square innovations) in the 0–4-h forecasts of the FED (radar reflectivity) relative to the results using the linear operator for both storm cases. The operator obtained by fitting data from the same case performs slightly better than fitting to data from the other case, while the operator obtained by fitting forecasts of both cases produce intermediate but still very similar results, and the latter is considered more general. In practice, a more general operator can be developed by fitting data from more cases.

Significance Statement

Prior studies found that assimilation of satellite lightning observation can benefit storm forecasts for up to 4 h. A linear lightning observation operator originally developed for assimilating pseudo-satellite lightning observations was tuned earlier through sensitivity experiments when assimilating real lightning data. However, the linear relation does not fit the model and observational data well and significant bias can exist. This study develops new lightning observation operators by fitting a high-order polynomial to satellite lightning observations and model-predicted quantities that directly relate to lightning. The new operator was found to reduce the frequency biases and root-mean-square innovations for lightning and radar reflectivity forecasts, respectively, up to several hours relative to the linear operator. The methodology can be applied to larger data samples to obtain a more general operator for use in operational data assimilation systems.
Privilege and the Legacy of an Insurrection: Critical Race Theory, January 6th, and Preserving Black Resistance
Authors: Hawkins Deion , Simon-Roberts Sharifa
Published: May 2022

The right to protest and freedom of expression are core principles of democracy; however, on January 6th, 2021, the right to protest spiraled into a full-fledged assault on American ideals. While the smoke was still smoldering, millions were left dumbfounded—the actions were way beyond a traditional protest, instead, the attack on January 6th was classified as an insurrection. Months prior, during the Summer of 2020, then President Trump threatened to invoke the Insurrection Act of 1807 to curb the mostly peaceful Black Lives Matter (BLM) protests. Thus, a clear paradox emerges. On one hand, an unjustified insurrection was met with minimal force, but on the other hand, peaceful protests against state-sanctioned murder were quelled almost immediately. To hypothesize about the insurrection of January 6th without examining the racism and racial privilege embedded in the actions would be immoral; this is especially true considering the historical importance of slave insurrections in advancing Black liberation. Thus, we argue that advancing the narrative of the January 6th insurrection as justified is a disservice to the legacy of protests, rebellions, and insurrections. Utilizing Critical Race Theory (CRT) as a framework, the article analyzes and compares the BLM protests against the insurrection of January 6th and draws attention to ways in which race served as a tool of oppression. The insurrection of January 6th, along with the rhetorical construction and justification of the events that unfolded that day, is steeped in privilege and white supremacy—luxuries that were not afforded to racial justice protests.
News Framing in the Aftermath of the January 6 Attacks on the U.S. Capitol: An Analysis of Labels, Definitional Uncertainty, and Contextualization
Authors: Zulli Diana , Coe Kevin , Isaacs Zachary
Published: May 2022

In the aftermath of a violent attack, questions of definition arise. News framing research has shown that the words chosen to define a given event can affect attitudes and decision-making, even when only a single word is varied. This study analyzes public discourse in the aftermath of the January 6 U.S. Capitol attacks to better understand which labels predominated and how different labels were explained/justified. We pair computer-assisted content analysis with qualitative textual analysis to identify patterns in public commentary during the week following the attacks. Results indicate that initial news coverage favored “protest(s)” as a descriptor, but “riot,” “attack(s),” and “insurrection” gained traction as the week unfolded. Many labels were also definitively applied and deployed to contextualize the attacks, providing a degree of contrast to framing norms. The results are considered in relation to ongoing debates over definitions of domestic terrorism and related crises, as well as normative considerations central to the maintenance of U.S. democracy.
Weight Bias: Examining Achalasia Therapy in the Obese Patient
Authors: Rhie Ryan Y. , Chamblee Dakota , Walker Savannah , Mehaffey Niall , Jenkins Haley , Kutcher Matthew E. , Moremen Jacob
Published: May 2022

We hypothesize that obesity is a common diagnosis in those with achalasia at our institution but time to diagnosis and treatment is longer compared to normal weight counterparts due to implicit bias. We retrospectively reviewed all adult patients between 1/1/2013 and 6/31/2020 with a diagnosis of achalasia. Demographics, comorbidities, Eckardt scores, interventions, complications, time to consult, duration of symptoms, and follow-up were evaluated. More than half of the patients were seen in the most recent 2 years following POEM introduction and 138 had available BMI data. 46 were obese (33%) and 92 were non-obese (67%). Obese patients reported a shorter duration of symptoms prior to seeking treatment 12 versus 24 months. There was no difference in time to intervention or procedure offered. There was a non-significant trend toward higher leak (11 vs 5%) and overall complication rate (19 vs 17%) in obese patients. In follow-up 98 patients had BMI data. There was a a significant difference in mean BMI change -1.2 +/- 4.2 kg/m2 in obese patients and +0.1 +/- 2.1 kg/m2 in normal weight patients. One year follow-up was available in 16 (47%) obese and 25 (33%) non-obese patients and showed a non-significant trend toward greater weight gain in the normal/overweight group (+3.2 +/- 1.1 kg/m2) compared to obese (+2.0 +/- 3.5 kg/m2). Obese patients with achalasia have unique considerations. Duration of symptoms may be shorter in the obese patient with esophageal dysphagia. We noted trends toward greater weight gain following interventions in non-obese patients with equivalent complication rates
Robotic Revision of Hepaticojejunostomy for Benign Biliary Stricture
Authors: Robinson Jordan , Tschuor Christoph , McKillop Iain H. , Baker Erin H. , Iannitti David A. , Vrochides Dionisios , Martinie John B.
Published: May 2022

Surgical revision of biliary enteric anastomoses (BEA) can be a challenging undertaking and a robotic platform may provide advantages that address many of the technical obstacles. We present our technical approach and outcomes for patients undergoing robotic revision of BEA for benign strictures. A retrospective review was performed for robot-assisted benign BEA revision at our institution. Operative details, perioperative metrics, and outcomes are reported. Four patients underwent anastomotic revision following previously failed non-operative management. There were no intraoperative complications, mean length of stay was 4-days, and all patients experienced resolution of presenting clinical signs and symptoms. No patients required reoperation and there was no mortality. Postoperative outcomes were consistent with findings reported for other interventional modalities. Based on our experience we conclude robotic intervention in this context is safe and improves the technical feasibility of this complex procedure.
Adolescent Trauma During the COVID Pandemic: Just Like Adults, Children, or Someone Else?
Authors: Ruhi-Williams Perisa , Yeates Eric O. , Grigorian Areg , Schellenberg Morgan , Owattanapanich Natthida , Barmparas Galinos , Margulies Daniel , Juillard Catherine , Garber Kent , Cryer Henry , Tillou Areti , Burruss Sigrid , Penaloza-Villalobos Liz , Lin Ann , Figueras Ryan Arthur , Coimbra Raul , Brenner Megan , Costantini Todd , Santorelli Jarrett , Curry Terry , Wintz Diane , Biffl Walter L. , Schaffer Kathryn B. , Duncan Thomas K. , Barbaro Casey , Diaz Graal , Johnson Arianne , Chinn Justine , Naaseh Ariana , Leung Amanda , Grabar Christina , Nahmias Jeffry
Published: May 2022

COVID-19 stay-at-home (SAH) orders were impactful on adolescence, when social interactions affect development. This has the potential to change adolescent trauma. A post-hoc multicenter retrospective analysis of adolescent (13-17 years-old) trauma patients (ATPs) at 11 trauma centers was performed. Patients were divided into 3 groups based on injury date: historical control (CONTROL:3/19/2019-6/30/2019, before SAH (PRE:1/1/2020-3/18/2020), and after SAH (POST:3/19/2020-6/30/2020). The POST group was compared to both PRE and CONTROL groups in separate analyses. 726 ATPs were identified across the 3 time periods. POST had a similar penetrating trauma rate compared to both PRE (15.8% vs 13.8%, P = .56) and CONTROL (15.8% vs 14.5%, P = .69). POST also had a similar rate of suicide attempts compared to both PRE (1.2% vs 1.5%, P = .83) and CONTROL (1.2% vs 2.1%, P = .43). However, POST had a higher rate of drug positivity compared to CONTROL (28.6% vs 20.6%, P = .032), but was similar in all other comparisons of alcohol and drugs to PRE and POST periods (all P > .05). Hence ATPs were affected differently than adults and children, as they had a similar rate of penetrating trauma, suicide attempts, and alcohol positivity after SAH orders. However, they had increased drug positivity compared to the CONTROL, but not PRE group.
Postoperative Outcomes in the Plain Community Population of Western Wisconsin
Authors: Seiler Rachel L. , Kallies Kara J. , Borgert Andrew J. , Reetz Scott R. , Jarman Benjamin T.
Published: May 2022

Background

Residents of plain communities constitute an underserved minority population that is not reliably captured in contemporary surgical outcomes research. We hypothesized that plain communities (PC) patients would have higher postoperative complication rates than a general surgical population.

Methods

A retrospective review of 30-day postoperative outcomes for PC patients compared to a majority (non-PC) matched patient population from September 2014 to March 2020 was performed. The primary outcome measure was any complication within 30 days of surgery.

Results

270 PC patients were matched with 493 non-PC patients. The 30-day complication rate was higher for the PC group (6.3% vs 3.7%, P = .09), though not statistically significant. There was significantly lower utilization of preventive care services, and postoperative follow-up among PC patients.

Discussion

Although our regional PC surgical patient population utilized preventive and postoperative health care services less than the non-PC population, there was no statistically significant difference in overall 30-day postoperative morbidity or mortality.
Association of Postoperative Dieting, Exercise, Dietitian, and Surgeon Follow up With Bariatric Surgery Outcomes
Authors: Samaan Jamil S. , Srinivasan Nitin , Mirocha James , Premkumar Agnes , Toubat Omar , Qian Elaine , Subramanyam Chaitra , Malik Yousaf , Lee Nayun , Sandhu Kulmeet , Dobrowolsky Adrian , Samakar Kamran
Published: May 2022

Although postoperative diet modification, exercise, and regular dietitian and surgeon follow-up are often recommended after bariatric surgery (BS), their impact on weight loss is unclear. A Retrospective chart review was conducted for patients who received sleeve gastrectomy or Roux-en-Y gastric bypass (RYGB) between August 2000 and November 2017 with telephone follow-up. Multivariable logistic regression models were used for analyses. There were 514 patients included in our study. Most were female (76.3%), mean age was 46.9 years (Standard Deviation [SD] = 11.8), and mean weight loss was 11.6 (SD = 6.5) BMI points at a mean follow-up of 7 years (SD = 4.3). Current surgeon follow-up OR = 2.08 (P < .01) was positively associated with postoperative weight loss, while current dietitian follow-up=OR .41 (P < .01) was negatively associated. Current weight loss supplement use OR = .45 (P = .03) was associated with reduced willingness to undergo surgery again. Increasing preoperative BMI OR = 1.06 (P = .04) and increasing age OR = 1.04 (P = .02) were associated with improved quality of life (QoL) due to BS. Lack of surgeon follow-up and regular dietician consultation was associated with suboptimal weight loss after BS. Older age was positively associated with improved QoL, while current weight loss supplement use was associated with lower likelihood of undergoing surgery again, both independent of weight loss.
Complications and Transfusions on Therapeutic Anticoagulation After Trauma
Authors: Siletz Anaar E. , Dhillon Navpreet K. , Fierro Nicole M. , Muñiz Tobias , Loran Priya , Singer Matthew , Hashim Yassar M. , Ley Eric J.
Published: May 2022

Introduction

Trauma patients who develop indications for therapeutic anticoagulation (TAC) present a challenge due to concern for bleeding. Transfusion requirement has been described as a common complication of TAC after trauma but its clinical relevance is unclear.

Objective

Determine risk factors for and clinical outcomes associated with transfusion requirement on TAC after trauma.

Methods

All trauma patients admitted to an academic urban level I trauma center from January 2010 to August 2020 who received TAC were included in this retrospective cohort study. Data included injury characteristics; TAC indication and timing; transfusions; and interventions. Patients who required transfusion after TAC were compared to those who did not.

Results

Eighty-two patients were included. The most common reasons for TAC were deep vein thrombosis (67.1%) and pulmonary embolism (31.7%). Two (2.4%) patients developed gastrointestinal bleeding. One (1.2%) underwent endoscopic intervention. Two patients (4.9%) had intracranial hemorrhage progression. Blood transfusion after TAC initiation was required in 43.9% of patients. Patients who were transfused started TAC more quickly after traumatic injury (5.5 vs 10.0 days, P = .03), had fewer hospital-free days (54 vs 64 days, P < .01), ICU-free days (8.5 vs 16.5 days, P = .01), and higher mortality (13.9% vs 2.1%, P = .04).

Conclusion

Transfusions are common after starting TAC in trauma patients. Requiring transfusion after starting TAC was associated with shorter time from injury to starting TAC, higher mortality, and fewer ICU and hospital-free days.
The Association of Frailty With Outcomes for Older Adults Undergoing Appendectomy
Authors: Salzman Garrett A. , Saliba Debra , Ko Clifford Y. , Maggard-Gibbons Melinda , Russell Marcia M.
Published: May 2022

Background

Frailty is a potential modifiable predictor of surgical outcomes in older adults. The impact of frailty following appendectomy, a common urgent operation, is unknown for older adults. The study aim was to assess if frailty is associated with worse perioperative outcomes after appendectomy in older adults.

Methods

We used the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database from 2016 to 2018 and identified patients 65 and older who underwent appendectomy for acute appendicitis. We identified frailty as a Modified Frailty Index (MFI) score ≥2. Multivariate logistic regression was used to assess the association of frailty with 30-day mortality, serious complications, readmission, and discharge to facility.

Results

Five thousand seven hundred twenty-eight older adults underwent appendectomy, of which 29.1% were 75 or older, 53.3% female, 74.9% non-Hispanic White, and 17.1% frail. Frail patients experienced worse outcomes: mortality (frail: 1.0% vs non-frail: .3%, P = .001), serious complications (14.2% vs 8.0%, P = <.0001), and discharge to facility (9.3% vs 2.3%, P < .0001). On multivariate logistic regression, frailty was associated with increased mortality (odds ratio [OR] 3.34; 95% confidence interval [CI] 1.28-8.66), serious complications (OR 1.51; 95% CI: 1.17-1.93), and discharge to facility (OR 2.80; 95% CI: 2.00-3.93). Frailty was not significantly associated with readmission ( P = .180).

Conclusions

Frailty is associated with worse postoperative outcomes following appendectomy in older adults. As frailty is potentially modifiable, it should be routinely assessed and utilized in perioperative optimization and counseling, especially with respect to patient-centered outcomes.
No Resuscitative Thoracotomy? When to Stop Chest Compressions After Prehospital Traumatic Cardiac Arrest
Authors: Fierro Nicole M. , Dhillon Navpreet K. , Yong Felix A. , Muniz Tobias , Siletz Anaar E. , Barmparas Galinos , Ley Eric J.
Published: May 2022

Introduction

Although indications and outcomes for trauma patients who require resuscitative thoracotomies are well studied, little is known about how prehospital chest compressions support survival in patients who do not meet criteria for subsequent resuscitative thoracotomy.

Methods

Data from a single institutional retrospective review of trauma patients who required prehospital chest compressions from 1/2015 to 12/2020 were collected. Patients who underwent compressions only were compared to those who underwent subsequent resuscitative thoracotomy. The primary outcome was in-hospital mortality.

Results

Fifty-two patients were identified, 22 of whom underwent compressions only and 30 of whom went on to undergo thoracotomy. Patients who underwent compressions only were more likely to be female (36% vs 10%, P = .04), older (mean 46 vs 35 years, P = .04), and to experience blunt trauma (78% vs 43%, P = .01). Injury severity score was similar between the cohorts (mean 18 vs 28, P = .11). One patient in the compressions only cohort had a REBOA placed compared to two in the thoracotomy cohort (1.9% vs 3.67%, P > .99). Return of spontaneous circulation (ROSC) was achieved in 17% of the compressions only cohort compared to 45% of the thoracotomy cohort (P = .03). In-hospital mortality in the compressions only cohort was 100%, whereas in-hospital mortality in the thoracotomy cohort was 94% (P = .50), with a mean of zero survival days in both groups (P = .33).

Conclusion

Prehospital chest compressions without thoracotomy were uniformly fatal, even if transient ROSC was obtained. Our findings support termination of chest compressions for those trauma patients who do not meet criteria for resuscitative thoracotomy.
Advancing Surgical Education: The Use of Artificial Intelligence in Surgical Training
Authors: Guerrero David T. , Asaad Malke , Rajesh Aashish , Hassan Abbas , Butler Charles E.
Published: May 2022

The technology of artificial intelligence (AI) has made significant in-roads into the field of medicine over the last decade. With surgery being a discipline where repetition is the key to mastery, the scope of AI presents enormous potential for resident education through the analysis of technique and delivery of structured feedback for performance improvement. In an era marred by a raging pandemic that has decreased exposure and opportunity, AI offers an attractive solution towards improving operating room efficiency, safe patient care in the hands of supervised residents and can ultimately culminate in reduced health care costs. Through this article, we elucidate the current adoption of the artificial intelligence technology and its prospects for advancing surgical education.
Beta-Blocker Therapy in Patients With Severe Traumatic Brain Injury: A Systematic Review and Meta-Analysis
Authors: Zagales Israel , Selvakumar Sruthi , Ngatuvai Micah , Fanfan Dino , Kornblith Lucy , Santos Radleigh G. , Ibrahim Joseph , Elkbuli Adel
Published: May 2022

Introduction

Traumatic brain injury (TBI), a leading cause of morbidity and mortality among trauma patients worldwide, poses the risk of secondary neurological insult due to significant catecholamine surge. We aim to investigate the effectiveness and outcomes of beta-blocker administration in patients with severe TBI.

Methods

A search through PubMed, EMBASE, JAMA network, and Google Scholar databases was conducted for relevant peer-reviewed original studies published before February 15, 2022. A standard random-effects model was used, as justified by a high Cohen’s Q test.

Results

Twelve studies met inclusion criteria and were included in the meta-analysis. Severe TBI patients who were administered beta-blockers had a significantly reduced incidence of in-hospital mortality compared to the non-beta-blocker group (14.5% vs 19.2%). However, the beta-blocker group was reported to have a significantly greater number of ventilator days (5.58 vs 2.60 days). Similarly, intensive care unit (9.00 vs 6.84 days) and hospital (17.30 vs 11.02 days) lengths of stay (LOS) were increased in the beta-blocker group compared to those who were not administered beta-blocker therapy, but only the difference in hospital-LOS was significant.

Conclusions

Beta-blockers have significantly decreased in-hospital mortality in patients with severe TBI despite being associated with an increase in ventilator days and hospital-LOS. The administration of beta-blocker therapy in the management of severe TBI may be warranted and should be discussed in future guidelines.
Difference in Presentation and Concomitant Intra-Abdominal Injury with Chance Fracture in Pediatric and Adult Populations
Authors: Hazen Benjamin J. , Keane Olivia A. , Vandewalle Robert J. , Grady Zachary , Wetzel Martha , Chern Joshua J. , Santore Matthew T.
Published: May 2022

Background

Chance fracture (CFx) with concomitant intra-abdominal injury has variable occurrence rates ranging from 33 to 89%. No single study has compared the incidence of simultaneous abdominal injury between pediatric and adult populations. This study compares the rate of simultaneous intra-abdominal injury and chance fracture in these populations.

Methods

A retrospective review of pediatric and adult patients with chance fracture in comparable pediatric and adult trauma centers was performed. Patient demographics, mechanism of injury (MOI), and injury patterns were collected from 2002 to 2019 for pediatric patients and 2015 to 2018 for adults. Student t-test analyses were performed to determine statistical significance between the cohorts.

Results

The pediatric group had a similar incidence of abdominal solid organ injuries compared to adults (16 [20.5%] vs. 40 [19.7%], p<0.879), but the pediatric group had a greater number of total intra-abdominal (49 [62.8%] vs. 47 [23.1%], p < 0.001) and hollow organ injuries (40 [51.3%] vs. 17 [8.4%], p < 0.001). Motor vehicle collision was the most common mechanism of injury for both groups (72 pediatric [92.3%] vs. 85 adult [41.7%]) but adults suffered from more falls (3 pediatric vs. 81 adult, p < 0.001). Pediatric patients with CFx caused by MVCs had more intra-abdominal injuries (48 [66.7%] vs. 25[29.8%], p < 0.001) and hollow organ injuries compared to adults (39 [54.2%] vs. 8[9.5%], p < 0.001).

Conclusion

In the setting of Chance fracture after trauma, pediatric patients are more likely to have a concomitant intra-abdominal organ injury (63% vs. 23%), especially hollow viscus injury (51.3% vs. 8.4%) compared with adults regardless of mechanism.
Effect of Seasonality on Variation Among Patients Presenting With Rib Fractures in the United States
Authors: Sheira Dina , Tennakoon Lakshika , Forrester Joseph D.
Published: May 2022

Background

A prior single-site study from the Midwest exploring seasonality of traumatic rib fractures found injuries are more common during summer months and lower in winter months. There have been no modern studies evaluating seasonality of these common injuries nationally. Our aim was to describe temporal and spatial distribution of rib fractures in the United States. We hypothesized presentations for traumatic rib fractures follow a seasonal pattern, with greater frequency of rib fractures in the summer and lower levels in the winter.

Methods

We obtained hospital emergency department (ED) encounter data from Nationwide Emergency Department Sample (NEDS) from January 1, 2018 to December 31, 2018. We used ICD-10 codes to identify all patients with diagnostic codes specific to rib fractures. To examine seasonal patterns, we constructed negative binomial regression models using seasons as covariates to predict incidence of rib fracture encounters across regions.

Results

Of 15,439,004 trauma-related ED encounters in 2018, 384 431 (2%) encounters included a diagnosis of rib fracture(s). The percentage of ED trauma encounters with rib fractures was similar across the 4 regions. Rib fractures were more common in the summer in the Midwest, South, and West as compared to winter [22% (95% CI = 10-34%, P = .007), 12% (95% CI = 5-20%, P = 0.02), and 11% (95% CI = 5-17%, P = .008), respectively].

Discussion

Our hypothesis was generally supported by our evaluation of NEDS. However, while seasonal variation in rib fractures does appear to exist in the Midwest, South, and West, this variation is not ubiquitous across the United States.
Outcomes of Local versus Free Flaps for Lower Extremity Trauma
Authors: Kondra Katelyn , Roohani Idean , Swerdlow Mark , Brown Michael , O’Brien Devon , Pekcan Asli , Stanton Eloise , Carey Joseph
Published: May 2022

Background

Lower extremity reconstruction often requires soft tissue transfer for limb salvage. Flaps are allocated based on injury size, location, and shape coupled with surgeon expertise. Ideally, vascularized tissue should have similar outcomes across local and free tissue transfers. By evaluating outcomes from a Level 1 trauma center, we aim to provide recommendations regarding surgical management of leg reconstruction with respect to local versus free flap implementation.

Methods

This retrospective review evaluated patient medical history, demographics, flap characteristics, and outcomes from LAC + USC between 2007-2021 using an internal database. Outcomes included failure rates, complications, and ambulation.

Results

357 lower extremity flaps were placed on 322 patients; 187 (52.4%) were local and 170 (47.6.%) were free flaps. Twenty-one (11.2%) local flaps suffered significantly more postoperative hardware infections and/or osteomyelitis compared to nine (5.3%) free flaps. Eleven (5.9%) local flaps developed partial necrosis, four requiring revision; 12 (6.4%) total local flaps required revision. Comparatively, sixteen (9.4%) free flaps developed partial necrosis, seven requiring revision; 18 (10.6%) total free flaps required revision. Flap survival was 96.3% for local versus 93.5% for free flaps. Percentage of fully ambulatory patients and time to final ambulation was not significant across cohorts.

Discussion

Local flaps may portent higher risk for infection; though the cause is not clear, the results may be confounded by comorbidities. Nevertheless, there were no significant differences in flap survival or number of fully ambulatory patients across cohorts. Future studies should evaluate aesthetic results and patient satisfaction across flap types.
Predictive Value of C2HEST Score for Atrial Fibrillation Recurrence Following Successful Cryoballoon Pulmonary Vein Isolation in Paroxysmal Atrial Fibrillation
Authors: Levent Fatih , Kanat Selçuk , Tutuncu Ahmet
Published: May 2022

The C2HEST score ((coronary artery disease (CAD) or chronic obstructive pulmonary disease (COPD) [C2, 1 point each]; hypertension [H, 1 point]; elderly [E, age ≥75 years, 2 points]; systolic heart failure [S, 2 points]; thyroid disease [T, hyperthyroidism, 1 point]) has been validated for predicting incidental atrial fibrillation (AF) in both the general population and patients with ischemic stroke. The present study evaluated the performance of this score in predicting AF recurrence in 252 patients following cryoballoon ablation (CRYO) for paroxysmal AF. The AF recurrence rate in 3–12 months following CRYO was 20,2%. The predictive value of the C2HEST score was significantly better than that of the CHA2DS2-VASc score ((congestive heart failure, hypertension, age (>65 = 1 point, >75 = 2 points), diabetes, previous stroke/transient ischemic attack (2 points), vascular disease, age 65–74 years, and sex category)) (area under curve [AUC]: .881 vs .741; P = .0017). C2HEST score of ≥2, increased atrial diameter, and E/e’ ratio as well as, the presence of COPD and systolic heart failure (SHF) were independent predictors for AF recurrence (P < .05). In patients undergoing CRYO for paroxysmal AF, the C2HEST, a simple clinical score, could be useful to assess the risk of AF recurrence.
Nasal Nitric Oxide as a Biomarker in the Diagnosis and Treatment of Sinonasal Inflammatory Diseases: A Review of the Literature
Authors: Benedict Jacob J. , Lelegren Matthew , Han Joseph K. , Lam Kent
Published: May 2022

Objective:

To critically review the literature on nasal nitric oxide (nNO) and its current clinical and research applicability in the diagnosis and treatment of different sinonasal inflammatory diseases, including acute bacterial rhinosinusitis (ABRS), allergic rhinitis (AR), and chronic rhinosinusitis (CRS).

Methods:

A search of the PubMed database was conducted to include articles on nNO and sinonasal diseases from January 2003 to January 2020. All article titles and abstracts were reviewed to assess their relevance to nNO and ABRS, AR, or CRS. After selection of the manuscripts, full-text reviews were performed to synthesize current understandings of nNO and its applications to the various sinonasal inflammatory diseases.

Results:

A total of 79 relevant studies from an initial 559 articles were identified using our focused search and review criteria. nNO has been consistently shown to be decreased in ABRS and CRS, especially in cases with nasal polyps. While AR is associated with elevations in nNO, nNO levels have also been found to be lower in AR cases with higher symptom severity. The obstruction of the paranasal sinuses is speculated to be an important variable in the relationship between nNO and the sinonasal diseases. Treatment of these diseases appears to affect nNO through the reduction of inflammatory disease burden and also mitigation of sinus obstruction.

Conclusion:

nNO has been of increasing interest to researchers and clinicians over the last decade. The most compelling data for nNO as a clinical tool involve CRS. nNO can be used as a marker of ostiomeatal complex patency. Variations in measurement techniques and technology continue to impede standardized interpretation and implementation of nNO as a biomarker for sinonasal inflammatory diseases.
Exploring Homicide Diversity: Femicide Across Sociocultural Groups
Authors: Dayan Hava , Kugel Chen , Enosh Guy
Published: May 2022

This study followed the current scholarly interest in seeking possible links between social and cultural factors and homicide by offering comparative nation-based observations on femicide. To this end, the study analyzed femicide events across social groups in Israel (veteran Jews, Jewish immigrants from the former USSR, Ethiopian immigrant Jews, Arabs, Christians, Druze, Muslims, and Bedouin) and foreigners (asylum seekers and foreign workers) during a 6-year period (2010–2015). Data from 162 cases were collected and coded based on 25 sociodemographic and criminological variables. Empirical observations suggest sociocultural diversity in the femicide phenomenon across social groups. Femicide’s frequency and sociodemographic characteristics seem to be related to cultural dimensions pertaining to individualistic versus collectivistic cultures, with social factors such as level of education, socioeconomic status, and immigration possible overriding the effects of cultural dimensions on femicide. Highlighting sociocultural criminal diversity, the article’s observations may be of great relevance to societies facing the challenge of assimilating diverse sociocultural groups.
Investigating Confidence Intervals of Item Parameters When Some Item Parameters Take Priors in the 2PL and 3PL Models
Authors: Paek Insu , Lin Zhongtian , Chalmers Robert Philip
Published: May 2022

To reduce the chance of Heywood cases or nonconvergence in estimating the 2PL or the 3PL model in the marginal maximum likelihood with the expectation-maximization (MML-EM) estimation method, priors for the item slope parameter in the 2PL model or for the pseudo-guessing parameter in the 3PL model can be used and the marginal maximum a posteriori (MMAP) and posterior standard error (PSE) are estimated. Confidence intervals (CIs) for these parameters and other parameters which did not take any priors were investigated with popular prior distributions, different error covariance estimation methods, test lengths, and sample sizes. A seemingly paradoxical result was that, when priors were taken, the conditions of the error covariance estimation methods known to be better in the literature (Louis or Oakes method in this study) did not yield the best results for the CI performance, while the conditions of the cross-product method for the error covariance estimation which has the tendency of upward bias in estimating the standard errors exhibited better CI performance. Other important findings for the CI performance are also discussed.
Older Adult Patients and Care Partners as Knowledge Brokers in Fragmented Health Care
Authors: Wust Kathryn L. , Carayon Pascale , Werner Nicole E. , Hoonakker Peter L. T. , Salwei Megan E. , Rutkowski Rachel , Barton Hanna J. , Dail Paula v. W. , King Barbara , Patterson Brian W. , Pulia Michael S. , Shah Manish N. , Smith Maureen
Published: May 2022

Objective

To describe older adult patients’ and care partners’ knowledge broker roles during emergency department (ED) visits.

Background

Older adult patients are vulnerable to communication and coordination challenges during an ED visit, which can be exacerbated by the time and resource constrained ED environment. Yet, as a constant throughout the patient journey, patients and care partners can act as an information conduit, or knowledge broker, between fragmented care systems to attain high-quality, safe care.

Methods

Participants included 14 older adult patients ([Formula: see text] 65 years old) and their care partners (e.g., spouse, adult child) who presented to the ED after having experienced a fall. Human factors researchers collected observation data from patients, care partners and clinician interactions during the patient’s ED visit. We used an inductive content analysis to determine the role of patients and care partners as knowledge brokers.

Results

We found that patients and care partners act as knowledge brokers by providing information about diagnostic testing, medications, the patient’s health history, and care accommodations at the disposition location. Patients and care partners filled the role of knowledge broker proactively (i.e. offer information) and reactively (i.e. are asked to provide information by clinicians or staff), within-ED work system and across work systems (e.g., between the ED and hospital), and in anticipation of future knowledge brokering.

Conclusion

Patients and care partners, acting as knowledge brokers, often fill gaps in communication and participate in care coordination that assists in mitigating health care fragmentation.
Book review: Meeta and Rajivlochan, Making India Great Again: Learning from our History
Authors: Phatak Jairaj
Published: May 2022

Meeta and Rajivlochan, Making India Great Again: Learning from our History. Delhi: Manohar Publishers and Distributors, 2020, 300pp., ₹1495. ISBN: 9781000194449.
How to de-escalate dangerous nuclear weapons and force deployments in Europe
Authors: Pearson Frederic S , Simpson Erika
Published: May 2022

Amidst the war in Ukraine, it is important to raise the prospect and vision of creating mutual security guarantees and ridding Europe of its dangerous nuclear weapon systems and provocative force deployments. In view of reckless Kremlin rhetoric and aggressive military action in Russia’s so-called near abroad, it is time for renewed approaches to arms control. As the Ukraine situation plays out, Russia, the United States, and allies in the North Atlantic Treaty Organization must return to their bargaining tables and negotiate strict limits, verification measures, and overarching controls over their nuclear use doctrines, weapon stockpiles, and conventional force deployments. All sides will have to make deep concessions and de-alert and de-operationalize mid- and short-range nuclear weapons while improving command and control safeguards—because, as we see, brandishing weapons and threatening escalation heightens tensions and increases the danger of crises spiralling uncontrollably.
A Proposal to Increase Value and Equity in the Development and Distribution of New Pharmaceuticals
Authors: Sorum Paul , Stein Christopher , Wales Danielle , Pratt David
Published: May 2022

The process of developing and marketing new pharmaceuticals in the United States is driven by a need to maximize returns to shareholders. This results all too often in the production of new medications that are expensive and of marginal value to patients and society. In line with our heightened awareness of the importance of social justice and public health—and in light of our government‘s alliance with private companies in bringing us COVID-19 vaccines—we need to reconsider how new pharmaceuticals are developed and distributed. Accordingly, we propose the creation of a new agency of the Food and Drug Administration (FDA) that would direct the whole process. This agency would fund the research and development of high-value medications, closely monitor the clinical studies of these new drugs, and manage their distribution at prices that are value-based, fair, and equitable.
Wellbeing, burnout and substance use amongst medical students: A summary of results from nine countries
Authors: Kadhum Murtaza , Ayinde Olatunde O , Wilkes Chris , Chumakov Egor , Dahanayake Dulangi , Ashrafi Agaah , Kafle Bikram , Lili Rossalina , Farrell Sarah , Bhugra Dinesh , Molodysnki Andrew
Published: May 2022

Objective:

There has been increasing interest in the physical health, mental wellbeing and burnout afflicting medical students over recent years. This paper describes the overall results from phase two of an international study including a further nine countries across the world.

Methods:

We sampled large groups of medical students in nine countries at the same time and with exactly the same method in order to aid direct comparison of demographics, burnout and mental wellbeing through validated instruments.

Results:

A total of 4,942 medical students from these countries participated in this study. Around 68% of respondents screened positive for mild psychiatric illness using the General Health Questionnaire-12. Around 81% and 78% of respondents were found to be disengaged or exhausted respectively using the Oldenburg Burnout Inventory. Around 10% were found to be CAGE positive and 14% reported cannabis use. The main source of stress reported by medical students was their academic studies, followed by relationships, financial difficulties and housing issues.

Conclusion:

Cultural, religious and socioeconomic factors within each country are important and understanding their effects is fundamental in developing successful local, regional and national initiatives. Further quantitative and qualitative research is required to confirm our results, clarify their causes and to develop appropriate preventative strategies.
The Politics of Ethnonational Accommodation Under a Dominant Party Regime: Ethiopia’s Three Decades’ Experience
Authors: Yimenu Bizuneh Getachew
Published: May 2022

Ethiopia is the most prominent example of the late 20th-century adoption of federalism to accommodate diversity and complete state-building. This article explores the implementation of federalism and accommodation of ethnonational diversity in dominant party regimes by using Ethiopia as a case. Drawing on legal documents, literature, news sources and government reports, the article argues that federalism enabled distinctive groups to promote their culture, use their languages and exercise self-rule in their territory. However, ethnonationalities’ constitutionally proclaimed self-determination rights and the practice rarely correspond. Although all ethnonationalities have the same constitutional rights, some are still subjugated, and self-rule remains their dream. The dominant party regime in Ethiopia met demands for self-rule and accommodation with suppression and violence. The constitution grants regions to use their legislative powers to accommodate region-specific demands; nevertheless, regions cannot operate out of the narrow framework of the federal ruling party. Thus, regions became repressive agents of the centre rather than genuine self-rule agents. Insights from Ethiopia have broader implications for states embracing federalism.
Problems of Research Funding in the Agro-Industrial Complex of Kazakhstan
Authors: Taubayev Ayapbergen , Rakhmetova Aibota , Kalkabayeva Gaukhar , Saifullina Yulia , Zhukenov Batyrkhan
Published: May 2022

The purpose of the research was to find out why the reforms of the long-term state policy for the development of national science did not lead to an increase in the funding of scientific research and an increase in the role of science in the national innovation system, including in the field of agricultural science. The study was conducted using questionnaire-based survey methods and focused expert interviews. The results obtained in the course of the research are of practical interest to the authorized bodies of the state scientific and innovation policy of Kazakhstan, subjects of innovation infrastructure and entrepreneurs in the field of science and innovation. According to the results of the survey, the trend of scientists’ dissatisfaction with the existing system of financing agro-industrial science is clearly traced, as well as their own opinions on specific measures to solve problems existing in this area.
Beyond Police Brutality: Interrogating the Political, Economic and Social Undercurrents of the #EndSARS Protest in Nigeria
Authors: Aniche Ernest Toochi , Iwuoha Victor Chidubem
Published: May 2022

On 20 October 2020, the military and police force opened fatal shootings at peaceful unarmed #EndSARS protesters. This article examines the political and socio-economic undercurrents of #EndSARS protest. It argues that the predatory state–society relations where the state is the predator and citizens are the preys nurtured the increasing distrust between the state and its citizens, and ultimately, resulted in the deepening mutual mistrust between the police and people. The article concludes that the #EndSARS protest created opportunity for the Nigerian state to accelerate and accumulate its bourgeoning repressive character instead of reducing it. It recommends symbiotic state–society relations.
A Contested Pill: Transnational Controversies over Medical Abortion in Germany, France, and the United States
Authors: Roesch Claudia
Published: May 2022

In 1988, French pharmaceutical company Roussel Uclaf introduced Mifepristone (RU 486), a pill which medically induces abortion, but withdrew the drug one month later after severe protests. The abortion pill caused transnational controversies from 1988 to 1993. This article examines these controversies as a gateway to the entanglements between biomedical research, economic interests, and social protests in the last third of the twentieth century, as the American antiabortion movement initiated protests against the drug's French producer and its German parent company after its market release in France. The movement used boycotts against French products and utilized discomforting references to Germany's Nazi past to put pressure on pharmaceutical executives. In contrast, German, French, and American feminists and family-planners relied on transnational networks to enable medical trials and ensure the global distribution of Mifepristone. The article highlights how feminist demands for individual choice and public health concerns clashed with the antiabortion movements’ demands and entrepreneurs’ concerns about crude Holocaust comparisons. It shows that actors on both sides of the abortion controversy employed nonmedical arguments to influence scientific research and social movements acted on a transnational level to influence the market introduction of new biomedical advances.
Cultural Similarities and Differences in Explaining Others’ Behavior in 4- to 9-Year-Old Children From Three Cultural Contexts
Authors: Jurkat Solveig , Iza Simba Nancy Beatriz , Hernández Chacón Ledys , Itakura Shoji , Kärtner Joscha
Published: May 2022

Previous studies suggest that people from the Western hemisphere tend to explain others’ behavior based on a person’s traits and dispositions, while participants from non-Western cultural settings more likely refer to situational factors. From a developmental perspective, it has been suggested that culture-specific modes of explaining behavior gradually emerge during late childhood and adolescence. The present study explored whether traces of a corresponding culture-specific development can be found at earlier ages when using simplified assessments. In total, 438 children between 4 and 9 years old from Münster (urban Germany), Kyoto (urban Japan), and Cotacachi (rural Ecuador), were asked to explain positive and deviant behaviors of children depicted in simple picture-based vignettes. While more internal attributions were given in Münster than in Kyoto and Cotacachi children at 4 to 5 years old, these cultural differences disappeared as internal attributions significantly increased with age in Kyoto and Cotacachi but not Münster children. Analyzing children’s explanations on a level of subcategories revealed more subtle cultural specificities. For example, when giving internal explanations, Cotacachi children focused on stable traits, while Münster children emphasized individual desires and Kyoto children highlighted more volatile aspects. Cross-cultural differences in children’s social explanations could partially be explained by mothers’ preference for autonomy-related socialization goals. Taken together, this study provides evidence for an earlier onset of internal explanations when they are culturally accentuated and further calls for a more nuanced approach to capture culture-specific meaning systems reflected in everyday social explanations.