bluuebunny/crossref_metadata_2025 huggingface dataset:
Embryology of the upper limb
Authors: Lam Wee-Leon , Davey Megan G.
Published: September 2021

Recent advances in research technology have allowed a rapid progression in the understanding of upper limb embryogenesis. Limb development occurs between 4 and 8 weeks of gestation and progresses along three axes, as controlled by three centres: proximal–distal by the apical ectodermal ridge, anterior–posterior by the zone of polarizing activity, and dorsal–ventral by the dorsal ectoderm. In addition, research into molecular anatomy has revealed the central role of the sonic hedgehog protein and the complex interconnections linking all three axes of development. Despite these advances in understanding normal limb development, the field of pathembryogenesis remained limited. Recent discoveries about the roles of HOX and TBX genes, as well as bone morphogenetic proteins and GLI transcription factors, have allowed important insights into the causations of common clinical conditions. This expanding field of knowledge has facilitated the establishment of a new classification system based entirely on embryogenesis, which should catalyse closer surgeon/scientist collaborations.
Management of children’s hand disorders
Authors: Bourke Grainne , Grant Ian , Smith Gill
Published: September 2021

Congenital hand anomalies form a broad spectrum of conditions. The assessment of the condition requires attention to the affected part as well as the child as a whole given the incidence of associated conditions. Congenital hand anomalies are classified according to the pattern and extent of the anomaly, and its aetiology. The most significant anomalies are described in this chapter with their individual classifications and options for treatment.
Psychological assessment
Authors: Rumsey Nichola , Paraskeva Nicole
Published: September 2021

Although research relating to the psychology of the cosmetic surgery patient is still in its infancy, there is a consensus among researchers that various combinations of psychological factors play a key role in the recent increase in demand for cosmetic surgery, in the motivation of prospective patients to undergo surgery, in their expectations of outcome, and in their postoperative adjustment. An appreciation of the psychological aspects of cosmetic surgery is therefore crucial and places the surgeon in a stronger position to evaluate a patient’s appropriateness for surgery. Indeed, appropriate patient selection is considered a vital part of a surgeon’s role in ensuring effective care and treatment. This chapter addresses why an understanding of psychological factors contributing to all stages of the treatment process is important to the provision of appropriate care and offers a framework for pre- and postoperative assessment.
Lipomodelling
Authors: Dickson John , Mercer Nigel
Published: September 2021

Lipomodelling refers to the transfer of fat, as an autologous graft. The technique is now widely performed for a great variety of conditions. It can be used to correct both congenital and acquired deformities and also for cosmetic enhancement at various sites around the body. The technique has become especially popular for treating contour deformities that can occur following breast surgery and also for facial deformities. Although increasingly popular, there remain many unknowns. Outcomes are difficult to predict and the optimal method of harvest and distribution is yet to be defined. There is concern that fat grafting in and around a site that has previously been treated for cancer may contribute to the development of new or recurrent disease. However, there is currently no evidence to support this in follow-up studies.
Genetics of craniofacial anomalies
Authors: Wilkie Andrew O.M.
Published: September 2021

The birth of a child with a craniofacial malformation is usually an unexpected and devastating event for the parents. One of the first questions asked is ‘Why did this happen?’ Later, they may go on to ask ‘Could this happen again and if so, can it be avoided?’ A clinical genetics assessment can make an important contribution to answering these and other questions. In general, craniofacial malformations represent defects in embryogenesis, which can arise either from altered genetic information (abnormal developmental programming of the embryo), environmental insult (disruption of development), or a combination of adverse genetic and environmental factors. The clinical geneticist’s approach is primarily directed towards deciding which of these scenarios is most likely to be correct and, if a specific genetic cause is suspected, to advising on the most appropriate genetic tests to perform.
Syndromic craniosynostosis
Authors: Dover Stephen , Evans Martin
Published: September 2021

Syndromic craniosynostoses result from a complex interaction between genetic factors, molecular and cellular events, as well as mechanical and deformational forces. They can all have secondary effects on growth and development. Approximately 180 craniofacial syndromes have been identified and it is thought that about 15% of all craniosynostoses are syndromic. They are due to genetic mutations and among the most common are mutations in the fibroblast growth factor receptor 2 gene (FGFR2). Multidisciplinary care for craniofacial patients is considered the optimal model of care and is based on the concept of management during childhood, the transition into adulthood, and finally support and treatment throughout adulthood.
Hypertelorism and orbital dystopia
Authors: Greig Aina V.H. , Dunaway David J.
Published: September 2021

Orbital hypertelorism is defined as an abnormally wide distance between the orbits. It is a physical finding often associated with other cranial and facial malformations. Orbital dystopia refers to an abnormal position or shape of the orbits. These orbital abnormalities can be associated with visual problems including amblyopia, astigmatism, squints, and loss of vision. Patients are managed by a multidisciplinary team.
Velopharyngeal dysfunction
Authors: Sainsbury David C.G. , Williams Caroline C. , Mehendale Felicity V.
Published: September 2021

This chapter explores velopharyngeal dysfunction (VPD), its impact, aetiology, assessment, and management. VPD may cause hypernasal, weak, and unintelligible speech, facial grimacing, nasal turbulence and nasal regurgitation, middle ear problems, and sinusitis. Such manifestations may be distressing for the patient, be associated with poor academic outcomes, be negatively perceived by others, lead to bullying and withdrawal, and result in relationship and employment difficulties. Like the effect of a visible difference on psychosocial confidence and self-esteem, the manifestations of VPD on emotional well-being and social interaction do not necessarily correlate with the amount of speech, language, or communication dysfunction. Normal anatomy, neuromotor function, and speech learning are prerequisites for effective velopharyngeal function. A problem with any of these components may result in a velopharyngeal mechanism that fails to efficiently and fully close throughout oral speech sound formation leading to VPD and an ensuing speech disorder. Perceptual speech evaluation is used to diagnose VPD. Lateral videofluoroscopy and nasoendoscopy are commonly deployed to assess velopharyngeal function and determine management strategies. Surgical interventions include pharyngoplasty, pharyngeal flaps, and velopharyngeal augmentation. Non-surgical interventions include speech prostheses and nasal obturators for speech improvement.
Anatomy and embryology of the head and neck
Authors: Loh Charles Y.Y. , Wallace Christopher G.
Published: September 2021

An overview of the anatomy and embryology of the face, head, and neck that is most relevant to the plastic surgeon is presented in this chapter. Subsections focus on the scalp, forehead, cheek, nose, ears, eyelid, lips, oral cavity, oropharynx, mandible, muscles of mastication, nasopharynx, hypopharynx, and larynx.
Tumours of the oral cavity
Authors: Dunne Jonathan A. , Matteucci Paolo L.
Published: September 2021

Oral tumours are a common malignancy, with smoking and alcohol the principal aetiological factors. Squamous cell carcinoma is the commonest pathology, most frequently affecting the anterior tongue and floor of the mouth. Surgery is the mainstay of T1/T2 tumour management, and tracheostomy may be required. Sentinel node biopsy is an effective staging procedure; however, there is a high rate of occult nodal metastasis which may warrant elective supraomohyoid neck dissection. Macroscopic nodal disease requires modified radical neck dissection, preferably with adjuvant chemoradiotherapy. For unresectable tumours, radical external beam radiotherapy with cisplatin should be given. Reconstruction of soft tissue involves a range of skin grafts and local, regional, and free flaps, while bony reconstruction includes obturators and non-vascularized and vascularized bone grafts. Postoperative rehabilitation aims to restore speech, mastication, swallow, and dentition. Three-year survival is greater than 90% for stage I/II disease, with excellent functional outcomes.
Tumours of the salivary glands
Authors: Wokes James , McLean Neil
Published: September 2021

Malignant salivary gland tumours are rare and histologically diverse. The most common tumour site is the parotid gland and most tumours are benign. The aetiological factors are numerous. Presentation of a painless swelling of a salivary gland is always considered as suspicious. Ultrasonography, computed tomography, and magnetic resonance imaging are all useful imaging modalities. Fine-needle aspiration cytology and core biopsy are valuable diagnostic tools. Surgical excision represents the mainstay of treatment for resectable tumours. Radiotherapy, chemotherapy, and immunotherapy all have roles in management.
Tracheostomy
Authors: Kalu Peter , Ragbir Maniram
Published: September 2021

Tracheostomy is a frequently performed procedure which may be conducted percutaneously or in an open fashion. This chapter describes the indications, surgical technique, and complications of the procedure.
Scalp, forehead, and calvarial reconstruction
Authors: Rahman Kaz M.A.
Published: September 2021

Reconstruction of the scalp and forehead fall broadly into two categories: trauma and malignancy. Traumatic injuries include lacerations, avulsions, burns, and penetrating injuries. Excisional surgery is predominately due to cutaneous malignancies such as squamous and basal cell carcinomas. In both groups of patients, it is important to understand both the anatomical subunits requiring reconstruction and which layers are deficient in the soft tissues and bone. This can be further complicated by previous surgery and radiotherapy.
Management of facial palsy
Authors: Ahmed Omar A. , Chalmers Richard
Published: September 2021

Facial nerve palsy can be a significant functional and psychological pathology. This chapter discusses the aetiology of facial nerve palsy, its sequelae, and management priorities, and makes distinctions between the management of those which are acute and those chronic.
Bariatric surgery
Authors: Fiennes Alberic
Published: September 2021

This chapter is divided into three parts: it gives an overview of bariatric surgery, describes contemporary bariatric procedures and outcomes, and proposes a framework for a rational and ethical response to patients’ needs. The author is not a plastic surgeon: accordingly, individual body contouring procedures are not discussed.
Lower body lift and abdominal surgery after massive weight loss
Authors: Richter Dirk F. , Schwaiger Nina
Published: September 2021

Following the establishment of modern body lift procedures by Ted Lockwood, who sadly passed away in 2005, other innovative approaches are also now available. The main idea behind these operations, similar to modern face-lifting procedures, is to reconstruct the superficial and deep tissue layers (comparable to the superficial musculoaponeurotic system of the face) and the overlying skin. Large areas of tissue undermining and separation are, however, necessary to allow sufficient mobilization and tightening to achieve improvement in function and form. At the same time, it should not be forgotten that patients who have undergone major weight loss often have intrinsic medical problems such as diabetes mellitus, high blood pressure, nicotine abuse, and hormonal changes. These factors must be considered when planning the reconstruction. The problems and solutions derive from the authors’ experience over the last 15 years at the Department of Plastic Surgery at the Dreifaltigkeits-Hospital in Wesseling, Germany. These surgical procedures create great wound cavities but have associated risks that are manageable when planning and surgery are carried out meticulously.
Applied biomechanics of the hand, wrist, and forearm
Authors: Lees Vivien
Published: September 2021

Analysis of the biomechanics of the hand, wrist, and forearm demonstrates the complex interactions of structures that allow for the precise motion of pinch function and the stability of the wrist and forearm through a wide range of motion.
Chemical burns
Authors: Murray Alexandra
Published: September 2021

Chemical burn injuries represent a small proportion of all burns. They are, however, a unique and challenging subset with over 25,000 potential causative agents. Their management, requiring specialist knowledge and expertise, is ideally performed by specialist burns services. A large proportion of these injuries occur in the workplace, with significant socioeconomic implications. Health and safety standards are therefore paramount for prevention, particularly through ensuring adequate eye protection and clothing. The increasing numbers of acid-related assaults, chemical warfare, and terrorism comprise a complex part of burn care internationally. This chapter highlights the key features of chemical burns, the most commonly encountered agents, and their pathophysiology. A thorough and safe plan for assessment and acute management of these injuries is provided, emphasizing the importance of cross-speciality involvement when appropriate.
Granulomatous nephritis: A rare presentation of juvenile-onset sarcoidosis
Authors: Chotalia Prashant , Pandya Sapan , Srivastava Puja
Published: September 2021

Sarcoidosis is rare in children. Incidence and prevalence of sarcoidosis in India are not known. Renal involvement in childhood sarcoidosis is further rare with no clear data about prevalence. Here we report a case of a 13-year-old girl who presented with sarcoidosis with multi-system involvement including renal sarcoidosis. She initially presented with pyrexia of unknown origin and cervical lymphadenopathy – evaluation of which led to diagnosis of sarcoidosis. Later, after development of pulmonary involvement, she was treated with oral prednisolone and azathioprine. She again defaulted on medicines and later presented with renal failure and was diagnosed with a renal sarcoidosis. She was treated with oral prednisolone and mycophenolate mofetil with which she gradually improved with normal renal functions.
The effect of macropore size of hydroxyapatite scaffold on the osteogenic differentiation of bone mesenchymal stem cells under perfusion culture
Authors: Shi Feng , Xiao Dongqin , Zhang Chengdong , Zhi Wei , Liu Yumei , Weng Jie
Published: September 2021

Previous studies have proved that dynamic culture could facilitate nutrients transport and apply mechanical stimulation to the cells within three-dimensional scaffolds, thus enhancing the differentiation of stem cells towards the osteogenic phenotype. However, the effects of macropore size on osteogenic differentiation of stem cells under dynamic condition are still unclear. Therefore, the objective of this study was to investigate the effects of macropore size of hydroxyapatite (HAp) scaffolds on osteogenic differentiation of bone mesenchymal stem cells under static and perfusion culture conditions. In vitro cell culture results showed that cell proliferation, alkaline phosphate (ALP) activity, mRNA expression of ALP, collagen-I (Col-I), osteocalcin (OCN) and osteopontin (OPN) were enhanced when cultured under perfusion condition in comparison to static culture. Under perfusion culture condition, the ALP activity and the gene expression of ALP, Col-I, OCN and OPN were enhanced with the macropore size decreasing from 1300 to 800 µm. However, with the further decrease in macropore size from 800 to 500 µm, the osteogenic related gene expression and protein secretion were reduced. Computational fluid dynamics analysis showed that the distribution areas of medium- and high-speed flow increased with the decrease in macropore size, accompanied by the increase of the fluid shear stress within the scaffolds. These results confirm the effects of macropore size on fluid flow stimuli and cell differentiation, and also help optimize the macropore size of HAp scaffolds for bone tissue engineering.
15Economic Criticism
Authors: Valvo Nick
Published: September 2021

This overview of recent work on the relationship between economics and culture takes the occasion of the Covid-19 pandemic to reflect on the urgency of creative thinking about biopolitics, in the process questioning the utility of apparent divisions between Foucauldian- and Marxist-derived approaches to the question of social reproduction.
Species Determination and CYTB-G143A Monitoring of Ramulariopsis spp. Isolated from Cotton in Brazil
Authors: Mathioni Sandra M. , de Mello Flávia E. , Antunes Ricardo F. D. , Duvaresch Dhiego L. , Milanesi Diogo F. , Brommonschenkel Sérgio H. , Pinho Danilo B. , Rosa Daniel D.
Published: September 2021

Ramularia leaf spot is a disease of major importance on cotton fields in Brazil due to its effects on yield and cotton fiber quality. Two Ramulariopsis (syn. Ramularia) species, R. gossypii and R. pseudoglycines, are reported as the causal agents of this disease, but it is unknown which species is the most prevalent in Brazilian cotton fields. The goal of this work was to determine the most frequent species occurring on field samples from a molecular monitoring program that sampled from all cotton-growing regions in Brazil from 2017 to 2020 seasons. We also used molecular tools for genotyping a region of the CYTB gene for all sampled isolates. Sequencing of an ITS-rDNA region was used for Ramulariopsis species determination, and a DNA fragment from the CYTB gene was amplified, sequenced, and analyzed for all 165 isolates. The ITS-rDNA sequencing confirmed that all isolates belong to Ramulariopsis, and most notably, all the single nucleotide polymorphisms observed in this region, are of the R. pseudoglycines species for all 165 isolates; thus all analyzed isolates were assigned to this species. The analysis of the CYTB gene fragment sequenced showed the presence of the G143A substitution, and absence of G137R substitution, in all 165 isolates.
Ambient air pollution and inflammatory effects in a Canadian pregnancy cohort
Authors: Gogna Priyanka , King Will D , Villeneuve Paul J , Kumarathasan Premkumari , Johnson Markey , Lanphear Bruce , Shutt Robin H , Arbuckle Tye E , Borghese Michael M
Published: September 2021

Background:

Epidemiologic studies have consistently reported associations between air pollution and pregnancy outcomes including preeclampsia and gestational diabetes. However, the biologic mechanisms underlying these relationships remain unclear as few studies have collected relevant biomarker data. We examined relationships between ambient PM2.5 and NO2 with markers of inflammation during pregnancy in a prospective cohort of Canadian women.

Methods:

We analyzed data from 1170 women enrolled in the Maternal-Infant Research on Environmental Chemicals study. Daily residential PM2.5 and NO2 exposures during pregnancy were estimated using satellite-based and land-use regression models and used to create 14-day and 30-day exposure windows before blood-draw. Inflammatory markers C-reactive protein, interleukin-6, interleukin-8, and tumor necrosis factor-α were measured in third trimester plasma samples. Multivariable linear regression was used to estimate associations for an interquartile range (IQR) increase in PM2.5 and NO2 and markers of inflammation, while adjusting for individual-level confounders.

Results:

Fourteen-day (IQR: 6.85 µg/m3) and 30-day (IQR: 6.15 µg/m3) average PM2.5 exposures before blood-draw were positively associated with C-reactive protein after adjustment for covariates (24.6% [95% CI = 9.4, 41.9] and 17.4% [95% CI = 1.0, 35.0] increases, respectively). This association was found to be robust in several sensitivity analyses. Neither PM2.5 nor NO2 exposures were associated with interleukin-6, interleukin-8, or tumor necrosis factor-α.

Conclusion:

Exposure to ambient PM2.5 is positively associated with maternal inflammatory pathways in late pregnancy. This may contribute to positive associations between ambient PM2.5 and risk of adverse pregnancy outcomes.
Association of Lifetime History of Traumatic Brain Injury With Prescription Opioid Use and Misuse Among Adults
Authors: Adams Rachel Sayko , Corrigan John D. , Ritter Grant A. , Hagemeyer Abby , Pliskin Madeline B. , Reif Sharon
Published: September 2021

Objective:

To investigate associations of lifetime history of traumatic brain injury (TBI) with prescription opioid use and misuse among noninstitutionalized adults.

Participants:

Ohio Behavioral Risk Factor Surveillance System (BRFSS) participants in the 2018 cohort who completed the prescription opioid and lifetime history of TBI modules (n = 3448).

Design:

Secondary analyses of a statewide population-based cross-sectional survey.

Main Measures:

Self-report of a lifetime history of TBI using an adaptation of the Ohio State University TBI-Identification Method. Self-report of past year: (1) prescription pain medication use (ie, prescription opioid use); and (2) prescription opioid misuse, defined as using opioids more frequently or in higher doses than prescribed and/or using a prescription opioid not prescribed to the respondent.

Results:

In total, 22.8% of adults in the sample screened positive for a lifetime history of TBI. A quarter (25.5%) reported past year prescription opioid use, and 3.1% met criteria for prescription opioid misuse. A lifetime history of TBI was associated with increased odds of both past year prescription opioid use (adjusted odds ratio [AOR] = 1.52; 95% CI, 1.27-1.83; P < .01) and prescription opioid misuse (AOR = 1.65; 95% CI, 1.08-2.52; P < .05), controlling for sex, age, race/ethnicity, and marital status.

Conclusion:

Results from this study support the “perfect storm” hypothesis—that persons with a history of TBI are at an increased risk for exposure to prescription opioids and advancing to prescription opioid misuse compared with those without a history of TBI. Routine screening for a lifetime history of TBI may help target efforts to prevent opioid misuse among adults.
Evaluation of Patient Information Material in the Consent Process for Surgical Stabilization of Rib Fractures
Authors: Hung Gary S. L. , Gardiner Ben , Patel Bhavik M.
Published: September 2021

Background:

Surgical stabilization of rib fractures is a procedure carried out in most trauma centers; however, data on evaluation of patient information material regarding this procedure are limited. The trauma service at our hospital implemented slide presentation as an adjunct tool to the consenting process for patients undergoing this procedure.

Objective:

The aim was to evaluate information material for patients undergoing surgical stabilization of rib fractures procedure and subjective outcomes from education on components of knowledge, emotion, and behavior for patients undergoing this procedure.

Methods:

A one-group posttest prospective design study was conducted over 18 months at a Level I trauma center. Supplementary visual material was provided as an adjunct to the consent process of surgical rib fixation. Evaluation from the patient's perspective was undertaken utilizing the usefulness scale for patient information material. This tool was based on a tripartite model of reading, evaluating, and responding to patient information material.

Results:

Over the period of 18 months, 60 patients underwent surgical stabilization of rib fractures. Fifty-two (91.7%) patients reviewed the information material, and 41 (78.8%) patients completed the feedback. The results reflect that the majority of patients perceived positive responses in emotional support (M = 8.42, SD = 6.6); behavioral motivation (M = 8.57, SD = 6.4); and education on knowledge (M = 9.09, SD = 4.6).

Conclusion:

In this novel study, visual aids as an adjunct to the informed consent process augmented patient knowledge regarding surgical stabilization of rib fractures and received positive subjective patient feedback on knowledge about the procedure.
A Survey-Based Assessment of “Matter of Balance” Participant Fall-Related Experience
Authors: Valatka Robin , Krizo Jessica , Mallat Ali
Published: September 2021

Background:

Falls are a substantial cause of injury in older adults, which can be attributed to progressive lack of physical activity, associated comorbidities, social isolation, and chronic health conditions. Fall prevention courses are designed to educate participants on fall safety and increase activity levels and social engagement.

Objective:

The purpose of this study was to evaluate the perceived effectiveness of a nationally recognized fall prevention course on self-reported fall frequency and lifestyle habits.

Methods:

This was a single-group pretest–posttest study of a convenience sample of older adults enrolled in a group fall prevention program, A Matter of Balance, in a community setting between March 2019 and March 2020. Questionnaires were distributed at the first and final sessions of the course to evaluate participant perceptions of the program and its impact on their fall history, exercise habits, and social engagement. Comparisons were made using Wilcoxon rank sum tests.

Results:

A total of 40 class members agreed to participate, with 29 (73%) completing both the presurvey and the postsurvey. Responses indicated no change in the number of falls or participants following an established exercise routine. However, of those who fell prior to the course, 75% reported a reduction in falls. In addition, the participants reported an overall increase in weekly exercise frequency. In those who reported fear of falling, 71% reported a reduction in fear following the course.

Conclusions:

The participants in this study self-reported a decrease in fall rate, a decrease in fear of falling, and an increase in exercise frequency. The course is not fall protective but can be considered an adjunct to fall prevention measures that include medical, medication, visual, and environmental management.
Trigeminal Metastasis of Malignant Melanoma
Authors: Pompanin Sara , De Rossi Costanza , La Marra Francesco
Published: September 2021

Introduction:

Perineural spread of malignant melanoma (MM) along cranial nerves is a rare complication of MM of the head and neck.

Case Report:

A 78-year-old man presented with untreatable facial pain and cutaneous hypoesthesia in V2/V3 branches of right trigeminal nerve. Six months earlier patient removed a lentigo maligna melanoma in his right upper lip and a MM in his right gingiva. Brain magnetic resonance imaging showed pathologic thickening of the right maxillary and mandibular nerves and of the intracranial trigeminal nerve. Infraorbital nerve biopsy confirms MM neural metastasis. BRAFV600E mutation was identified only in the lentigo maligna melanoma. Patient was treated with brain proton therapy but 5 months later developed sensorimotor deficit of his right arm because of a cervical metastasis.

Conclusions:

In patients presenting with atypical facial pain and history of head and neck melanoma a trigeminal spreading should be considered. Magnetic resonance imaging can detect early perineural spread and target biopsy.
Subacute Herpes Simplex Type 1 Encephalitis
Authors: Elshony Hosna , Idris Abdelrahman , Al-Ghamdi Abdulazuiz , Alharbi Bashaer , Almalki Abdulrahman , Alharbi Ahmed , Faqih Norah
Published: September 2021

Introduction:

The typical herpes simplex viral encephalitis (HSVE) course is an acute illness, less commonly it may present as a chronic course, mainly in children, and rarely may it be subacute. Subacute HSVE is rarely described in the literature being reported 4 times only.

Case Report:

We here report 2 cases of subacute HSV1 encephalitis diagnosed based on cerebrospinal fluid polymerase chain reaction and magnetic resonance imaging findings and review the literature trying to find any specific clinical, laboratory, radiologic diagnostic or prognostic criteria regarding this subacute form of HSVE.

Conclusion:

There is subacute form of HSVE and should be suspected with any subacute febrile illness with nonspecific cognitive impairment even in the absence of focal neurological symptoms and in cases with rapidly progressive dementia. This form has similar radiologic finding and good response to acyclovir but carry even better prognosis than that the acute HSVE.
Pericapsular nerve group block for hip fracture is safe and effective in the emergency department: a prospective observational study comparing pericapsular nerve group block to fascia iliaca compartment block and femoral nerve block
Authors: Fahey Alan , Cripps Elinor , Ng Aloysius , Sweeny Amy , Snelling Peter J.
Published: September 2021

Background

The pericapsular nerve group (PENG) block was first described for the treatment of hip fracture, including neck of femur, in 2018. We hypothesise that the PENG block is safe and effective for patients with hip fracture when provided by emergency physicians and trainees in the emergency department (ED), for which it may be superior to fascia iliaca compartment block (FICB) and femoral nerve block (FNB).

Methods

From October 2019 to July 2020, consecutive patients receiving regional anaesthesia for hip fracture in the ED of a single large regional hospital were prospectively enrolled. Pain scores were assessed prior to regional anaesthesia then at 15, 30 and 60 minutes after regional anaesthesia. Maximal reduction in pain scores within 60 minutes were assessed using the Visual Analogue Scale (at rest and on movement) or the Pain Assessment IN Advanced Dementia tool (at rest). Patients were followed for opioid use for 12 hours after regional anaesthesia and adverse events over the duration of their admission.

Results

There were 67 eligible patients during the enrolment period, with 52 (78%) prospectively enrolled. Thirty-three received femoral blocks (19 FICB, 14 FNB) and 19 received a PENG block. There was no difference in maximum pain score reduction between the groups whether measured at rest or on movement. Clinicians providing the PENG block were less experienced in the technique than those providing FICB or FNB. There was no difference in adverse effects between groups. Although opioid use was similar between the groups, more patients were opioid free after a PENG block.

Conclusions

Although there was no difference in maximal pain score reduction, this study demonstrated that the PENG block was feasible and could be provided safely and effectively to patients with hip fracture in the ED. On this basis, a larger randomised controlled study should now be designed.

Key Messages

What is already known on this subject

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There is a solid neuroanatomical rationale to suggest the PENG block may provide superior anaesthesia of hip fractures than FNB or FICB.

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The technique utilises bony sonographic and tactile landmarks which make it an ideal block for emergency physicians to safely and effectively perform.

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What this study adds

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This is the first comparative study of the PENG block to FNB or FICB in patients with hip fracture in ED, which will provide a scaffold for future research.

□

This pragmatic observation of evolving practice showed that emergency physicians and trainees inexperienced in the technique could provide it safely and effectively in the ED
How does migratory status affect non-communicable disease risk in a global context? A systematic review
Authors: Gordon-Firing Sandberg Roy
Published: September 2021

Challenges pertaining to the study of migrant health have been reported in medical and sociological literature. A literature review was thus conducted to gauge what research currently holds about the risk of non-communicable disease within migrant populations globally. The search strategy is outlined; CASP checklists were used to critically appraise articles, and the relevant data was synthesised and analysed. The research identifies several overarching quantitative themes regarding risk patterns. Recommendations are made.
Effectiveness of the mRNA BNT162b2 vaccine six months after vaccination: findings from a large Israeli HMO
Authors: Kertes Jennifer , Baruch Gez Sharon , Saciuk Yaki , Supino-Rosin Lia , Shamir Stein Naama , Mizrahi-Reuveni Miri , Ekka Zohar Anat
Published: September 2021

Israel is currently experiencing a new wave of CoVid-19 infection, six months after implementing a national vaccination campaign. We carried out three discrete analyses using data from a large Israeli HMO to determine whether IgG levels of those fully vaccinated drop over time, the relationship between IgG titer and subsequent PCR-confirmed infection, and compare PCR-confirmed infection rates by period of vaccination. We found that mean IgG antibody levels steadily decreased over the six-month period in the total tested population, and in all age groups. An inverse relationship was found between IgG titer and subsequent CoVid-19 infection (PCR-positive). Those participants vaccinated in the first two months of the campaign were more likely to become infected than those subsequently vaccinated. The 60+ vaccinated had lower initial IgG levels, and were at greater risk of infection. The findings support the decision to add a booster vaccine for those aged 60 and over.

Article Summary Line

The BNT162b2 vaccine was found to be less effective in protecting against Covid-19 infection after six months, and vaccination with a third dose is indicated.
A semi-parametric, state-space compartmental model with time-dependent parameters for forecasting COVID-19 cases, hospitalizations, and deaths
Authors: O’Dea Eamon B. , Drake John M.
Published: September 2021

Short-term forecasts of the dynamics of COVID-19 in the period up to its decline following mass vaccination was a task that received much attention but proved difficult to do with high accuracy. However, the availability of standardized forecasts and versioned data sets from this period allows for continued work in this area. Here we introduce the Gaussian Infection State Space with Time-dependence (GISST) forecasting model. We evaluate its performance in 1-4 week ahead forecasts of COVID-19 cases, hospital admissions, and deaths in the state of California made with official reports of COVID-19, Google’s mobility reports, and vaccination data available each week. Evaluation of these forecasts with a weighted interval score shows them to consistently outperform a naive baseline forecast and often score closer to or better than a high-performing ensemble forecaster. The GISST model also provides parameter estimates for a compartmental model of COVID-19 dynamics, includes a regression submodel for the transmission rate, and allows for parameters to vary over time according to a random walk. GISST provides a novel, balanced combination of computational efficiency, model interpretability, and applicability to large multivariate data sets that may prove useful in improving the accuracy of infectious disease forecasts.
Infectiousness of places: The impact of human settlement and activity space in the transmission of COVID-19
Authors: Liu Lun , Wang Hui , Zhang Zhu , Zhang Weiyi , Zhuang Shengsheng , Lv Tingmiao , Chio Chi On , Wang Yifan , Na Daori , Tang Chuchang , Ao-Ieong On Ieng
Published: September 2021

Places are fundamental factors in the spread of epidemics, as they are where people agglomerate and interact. This paper explores how different types of places—activity spaces at micro-level and human settlements at macro-level—impact the transmission of infections using evidences from COVID-19. We examine eleven types of activity spaces and find heterogeneous impacts across countries, yet we also find that non-essential activity spaces tend to have larger impacts than essential ones. Contrary to common beliefs, settlement size and density are not positively associated with reproduction numbers. Further, the impacts of closing activity spaces vary with settlement types and are consistently lower in larger settlements in all sample countries, suggesting more complex pattern of virus transmission in large settlements. This work takes first steps in systematically evaluating the epistemological risks of places at multiple scales, which contributes to knowledge in urban resilience, health and livability.

Teaser

Activity spaces and human settlement characteristics impact the spread of epidemics in multiple ways and should be considered in policy making.
Vulnerability and informal caregiver: a scoping review
Authors: Marta Landoni , Milica Petrovic , Chiara Ionio , Andrea Gaggioli
Published: September 2021

Objective

This review paper examines the concept of vulnerability in the overall literature and its relation to informal caregivers.

Vulnerability is frequently associated with the sense of being at risk of harm instead of being acknowledged as a human trait to embrace.

Taking a cue from two well-known videos of Brené Brown on how to enact “vulnerability,” we aimed to see if emotional vulnerability - posed/explored as strength or weakness - exists in the informal care context, potentially acting as a powerful resource that teaches individuals to look inward and inspires them to work on themselves.

Design

Scoping review

Data sources

Following PRISMA-ScR checklist for scoping review, the literature was searched in various databases, including PubMed, Scopus and ScienceDirect.

Study selection and data extraction

We systematically searched for: 1) observational studies, experimental studies, and systematic reviews 2) that examined the topic of emotional vulnerability in a caregiving context 3) that were relevant to informal caregivers of older adults 4) that were published from 1976 to 2021 5) in English 6) that included populations ≥18 years old 7) and excluded conceptualization of vulnerability outside of the emotional perspective (i.e., environmental, financial, social, biological, genetic, medical). Two reviewers independently reviewed titles and abstracts, reviewed the full text of relevant articles, and extracted the data

Results

From 2502 articles, 21 were determined as eligible.

Conclusion

The reviewed articles showed the complexity of the vulnerability construct and several different approaches taken to explore this topic. This research concludes the value of vulnerability for human beings. The paucity of literature on the concept of vulnerability for informal caregivers offers a promising avenue for future research in this field.

Article summary: Strengths and limitations of this study

This study reviews the conceptualization of vulnerability across literature from 1976 to date, which was never done before

This study draws a unique parallel between vulnerability in formal care settings and informal care

This study re-defines the concept of emotional vulnerability in informal care

The study lacks more concrete first-person perspectives on vulnerability shared by informal caregivers, hence more concrete involvement of informal caregivers would be desirable for representative understanding of the concept of emotional vulnerability in informal care.
Reemergence of yellow fever virus in southeastern Brazil, 2017-2018: what sparked the spread?
Authors: Rosser Joelle I. , Nielsen-Saines Karin , Saad Eduardo , Fuller Trevon
Published: September 2021

Background

The 2017-2018 yellow fever virus (YFV) outbreak in southeastern Brazil marked a reemergence of YFV in urban states that had been YFV free for nearly a century. Unlike earlier urban YFV transmission, this epidemic was also driven by forest mosquitos. The objective of this study was to evaluate environmental drivers of this outbreak.

Methodology/Principal Findings

Using surveillance data from the Brazilian Ministry of Health of human and non-human primate (NHP) cases of yellow fever, we traced the spatiotemporal progression of the outbreak. We then assessed the epidemic timing in relation to drought using a monthly Standardized Precipitation Evapotranspiration Index (SPEI). Lastly, we evaluated demographic risk factors for rural or outdoor exposure amongst YFV cases. Both human and NHP cases were first identified in a hot, dry, rural area in northern Minas Gerais before spreading southeast into the more cool, wet urban states of Espírito Santo, São Paulo, and Rio de Janeiro. Outbreaks also coincided with drought in all four southeastern states of Brazil. Confirmed YFV cases had an increased odds of being male (OR 2.58; 95% CI 2.28-2.92), working age (OR: 2.03; 95% CI: 1.76-2.35), and reporting recent travel from an urban to a rural area (OR: 5.02; 95% CI: 3.76-6.69).

Conclusions/Significance

The 2017-2018 YFV epidemic in Brazil originated in hot, dry rural areas of Minas Gerais before expanding south into urban centers. An unusually severe drought in this region may have created environmental pressures that sparked the reemergence of YFV in Brazil’s southeastern cities.

Author Summary

In 2017-2018, cities in southeastern Brazil experienced an unusual outbreak of yellow fever virus. In the early 20thcentury, these cities had large outbreaks of yellow fever, spread byAedesmosquitos. But until this recent outbreak, they had been free of yellow fever for nearly a century. While this outbreak was spread byHaemagogousforest mosquitos, the reemergence of yellow fever in densely populated urban areas raises serious concerns about it reestablishing ongoing transmission in cities, spread by urbanAedesmosquitos. Our study sought to understand how and why yellow fever virus remerged in this area. We traced the outbreak, finding that it started in hot, dry, rural areas and spread south into cool, wet urban areas. Additionally, the outbreak coincided with a severe drought; this extreme weather may have promoted the spread of yellow fever. Infection was also associated with rural and outdoor exposure, further suggesting this epidemic originated in rural areas.
Attitudes Towards Digital Health Technology: Introducing the Digital Health Scale
Authors: Cassidy Ridley
Published: September 2021

Objective

The study sought to investigate the relationship between attitude towards digital health technology and age, gender and frequency of use of digital health technology and to consider whether age, gender and frequency of use present potential barriers to accessing future healthcare in the UK. Differences in technological affinity are likely to lead to differences in the adoption of digital health technology and subsequent inequalities in healthcare between older and younger people and between men and women.

Design

The study represents an example of a technology adoption study employing a survey-based cross sectional correlational design. Attitude towards digital health technology was measured using the 20 item Digital Health Scale. Age, gender, frequency of use of health technology and employment status data were gathered using a demographics questionnaire. The opportunity sample (N = 247) included volunteer participants aged 16-84 years (M = 31.7, SD = 19.35, 156 females and 91 males).

Results

Results indicated a significant negative correlation between age and positive attitude towards digital health technology (r = -0.24, p < .01). Gender differences in attitudes towards digital health technology were non-significant (p > .05). Significant differences in frequency of use were also found, where occasional and frequent use resulted in more positive attitudes than never having used digital health technology (p < 0.05) and participants reporting frequent use were significantly older than those reporting never or occasional use (p < .05)

Conclusion

Findings identified age, but not gender, as a significant factor in attitude towards digital health technology, suggesting that continued and increased reliance on digital technology in healthcare may lead to age, but not gender, related inequalities in access to healthcare in the UK. That frequent users of digital health technology were also older, highlights the greater demand for healthcare services by older individuals and is further evidence for the potential of digital healthcare to lead to age related inequalities in access to and provision of healthcare. Recommendations for successful application of digital healthcare technology are considered in the light of these findings.
SUDMEX CONN: The Mexican MRI dataset of patients with cocaine use disorder
Authors: Angeles-Valdez Diego , Rasgado-Toledo Jalil , Issa-Garcia Victor , Balducci Thania , Villicaña Viviana , Valencia Alely , Gonzalez Olvera Jorge Julio , Reyes-Zamorano Ernesto , Garza-Villarreal Eduardo A.
Published: September 2021

Cocaine use disorder (CUD) is a substance use disorder (SUD) characterized by compulsion to seek, use and abuse of cocaine, with severe health and economic consequences for the patients, their families and society. Due to the lack of successful treatments and high relapse rate, more research is needed to understand this and other SUD. Here, we present the SUDMEX CONN dataset, a Mexican open dataset of CUD patients and matched healthy controls that includes demographic, cognitive, clinical, and magnetic resonance imaging (MRI) data. MRI data includes: 1) structural (T1-weighted), 2) multishell high-angular resolution diffusion-weighted (DWI-HARDI) and 3) functional (resting state fMRI) sequences. The repository contains unprocessed MRI data available in brain imaging data structure (BIDS) format with corresponding metadata available at the OpenNeuro data sharing platform. Researchers can pursue brain variability between these groups or use a single group for a larger population sample.
Secondary transmission of SARS-CoV-2 in educational settings in Northern Italy from September 2020 to April 2021: a population-based study
Authors: Djuric Olivera , Larosa Elisabetta , Cassinadri Mariateresa , Cilloni Silvia , Bisaccia Eufemia , Pepe Davide , Vicentini Massimo , Venturelli Francesco , Bonvicini Laura , Rossi Paolo Giorgi , Pezzotti Patrizio , Urdiales Alberto Mateo , Bedeschi Emanuela ,   the Reggio Emilia Covid-19 Working Group
Published: September 2021

Background

We aimed to quantify the risk of transmission of SARS-CoV-2 in the school setting by type of school, characteristics of the index case and calendar period in the Reggio Emilia province (RE), Italy. The secondary aim was to estimate the promptness of contact tracing.

Methods

A population-based analysis of surveillance data of all COVID-19 cases occurring in RE, Italy, from September 1, 2020, to April 4th, 2021, for which a school contact and/or exposure was suspected. Indicator of the delay in contact tracing was computed as the time elapsed since positivity of the index case and the date on which the swab for classmates was scheduled (or most were scheduled).

Results

Overall, 30,184 and 13,608 contacts among classmates and teachers/staff, respectively, were identified and received recommendation for testing; 43,214 (98.7%) performed the test. Secondary transmission occurred in about 40% of the investigated classes, and the overall secondary case attack rate was 4%, slightly higher when the index case was a teacher, but with almost no differences by type of school and stable during the study period. Promptness of contact tracing increased during the study period, reducing the time from index case identification and testing of contacts from 7 to 3 days, as well the ability to identify possible source of infection in the index case.

Conclusions

Despite the spread of the Alpha variant during the study period in RE, the secondary case attack rate remained stable from school reopening in September 2020 until the beginning of April 2021.