bluuebunny/crossref_metadata_2025 huggingface dataset:
Real-world Effectiveness of mRNA COVID-19 Vaccines Among US Nursing Home Residents Aged ≥65 Years in the Pre-Delta and High Delta Periods
Authors: Lu Yun , Lindaas Arnstein , Matuska Kathryn , Izurieta Hector S , McEvoy Rowan , Menis Mikhail , Shi Xiangyu , Steele Whitney R , Wernecke Michael , Chillarige Yoganand , Wong Hui Lee , Kelman Jeffrey A , Forshee Richard A
Published: January 2024

Background

Long-term care residents were among the most vulnerable during the COVID-19 pandemic. We estimated vaccine effectiveness of mRNA COVID-19 vaccines in Medicare nursing home residents aged ≥65 years during pre-Delta and high Delta periods.

Methods

We conducted a retrospective cohort study from 13 December 2020 to 20 November 2021 using Medicare claims data. Exposures included 2 and 3 doses of Pfizer-BioNTech and Moderna COVID-19 vaccines. We used inverse probability weighting and Cox proportional hazards models to estimate absolute and relative vaccine effectiveness.

Results

Two-dose vaccine effectiveness against COVID-19–related death was 69.8% (95% CI, 65.9%‒73.3%) during the pre-Delta period and 55.7% (49.5%‒61.1%) during the high Delta period, without adjusting for time since vaccination. We observed substantial waning of effectiveness from 65.1% (54.2%‒73.5%) within 6 months from second-dose vaccination to 45.2% (30.6%‒56.7%) ≥6 months after second-dose vaccination in the high Delta period. Three doses provided 88.7% (73.5%‒95.2%) vaccine effectiveness against death, and the incremental benefit of 3 vs 2 doses was 74.6% (40.4%‒89.2%) during high Delta. Among beneficiaries with a prior COVID-19 infection, 3-dose vaccine effectiveness for preventing death was 78.6% (50.0%‒90.8%), and the additional protection of 3 vs 2 doses was 70.0% (30.1%‒87.1%) during high Delta. Vaccine effectiveness estimates against less severe outcomes (eg, infection) were lower.

Conclusions

This nationwide real-world study demonstrated that mRNA COVID-19 vaccines provided substantial protection against COVID-19–related death. Two-dose protection waned after 6 months. Third doses during the high Delta period provided significant additional protection for individuals with or without a prior COVID-19 infection.
The alternative vagal maneuver; converting atrioventricular nodal re-entrant tachycardia by a rectal thermometer
Authors: Avidan Yuval , Aker Amir , Tabachnikov Vsevolod
Published: January 2024

Vagal maneuvers are techniques used to increase parasympathetic tone, particularly useful in the management of hemodynamically stable supraventricular tachycardias. If ineffective, adenosine can be attempted. We present a patient with atrioventricular nodal re-entrant tachycardia (AVNRT), who could not effectively perform Valsalva maneuvers and had contraindications for carotid massage and adenosine administration, that converted into sinus rhythm by using a rectal thermometer. This maneuver was reproduced on various occasions. We suggest that rectal vagal maneuver may provide an additional therapeutic modality for selected patients with AVNRT.
Recurrent cholangitis and bacteraemia due to Edwardsiella tarda: a case report
Authors: Hasegawa Makoto , Sanmoto Yohei
Published: January 2024

Edwardsiella tarda is typically isolated from aquatic environments. It rarely causes infections in humans. Edwardsiella tarda infections in humans result from the consumption of infected or contaminated food. Here, we present a case of recurrent cholangitis and bacteraemia associated with E. tarda. An 82-year-old man with no history of seafood inoculation was admitted to our hospital because of difficulty in moving his body. The patient was diagnosed with cholangitis, and the blood culture revealed the presence of E. tarda. The patient underwent bile duct stenting and received antibiotic therapy for 14 days. Forty-four days after discharge, cholangitis recurred, and blood culture again showed the presence of E. tarda. The patient underwent bile duct stenting and antibiotic therapy for 11 days. No cholangitis or bacteraemia associated with E. tarda was observed in the following 3 years. Our case strongly suggests that colonization with E. tarda results in recurrent cholangitis and bacteraemia.
Neurobrucellosis complicated by primary pyogenic ventriculitis: a case report
Authors: Alhatou Mohammed , Joudeh Anwar I , Alhatou Abraham , Ghamoodi Mohamed
Published: January 2024

Neurobrucellosis is a serious focal brucella infection. Ventriculitis is a special form of central nervous infection where pyogenic infection of the ependymal linings hinders antibiotics’ accessibility to the cerebrospinal fluids and leads to protracted infection. We present a case of a 37-year-old Shepherd who had low-grade fever for 5 months followed by a brief history of vomiting, abdominal pain, and gait imbalance. Investigations showed neutrophilic leukocytosis, high titers of serum anti-brucella antibodies, and lymphocytic pleocytosis. Mycobacterial tuberculosis workup was negative. Magnetic resonance imaging of the brain revealed cervical and spinal meningeal enhancement in addition to mild hydrocephalus. The patient was presumptively diagnosed with neurobrucellosis. He received treatment with ceftriaxone-based combination antibiotics therapy for 6 months with complete resolution of his symptoms. Central nervous infection by brucella is a challenging diagnosis. The possibility of primary ventriculitis due to Brucella infection mandates early recognition and prolonged antimicrobial therapy to achieve full recovery.
Bland White Garland syndrome with aneurysm and collaterals of coronary arteries in an Afghan girl: a case report.
Authors: Aslamzai Mansoor , Sharifi Abdul Muhib , Ekram Khesrow
Published: January 2024

Bland White Garland Syndrome is a very rare congenital heart defect in which the left coronary artery arises abnormally from the pulmonary artery. We present an extremely rare case of Bland White Garland Syndrome with an aneurysm of the left coronary artery in a 14-year-old Afghan girl. The patient was asymptomatic throughout her life except for one attack of exertional chest discomfort. The diagnoses of these anomalies were established by electrocardiography, echocardiography, coronary angiography, and computed tomography of the chest. During her hospital stay and on discharge, she had a stable condition and was referred for surgical management in an advanced setting abroad. Anomalous origin of the left coronary artery from the pulmonary artery may coexist with an aneurysm of the left coronary artery and not exhibit symptoms until adolescence.
Dissociation and EMDR
Authors: Steele Kathy , Mosquera Dolores
Published: January 2024

This chapter focuses on how to work with trauma-related dissociative disorders, such as other specified dissociative disorders Type 1 and dissociative identity disorder, both of which are trauma related and present specific challenges for trauma reprocessing within an EMDR therapy framework. Dissociation as a symptom is associated with an enormous range of issues, from normal to more pathological. Dissociation can be found in many mental health diagnoses in which it may not be the central problem, for example, spacing out in severe depression. Or it can be associated with dissociative disorders, in which it is the fundamental issue that requires treatment. EMDR therapists must be able to determine what kind of dissociative symptoms a client experiences, how severe and persistent they are, and whether an actual dissociative disorder is present, as treatment will need to be adapted from standard EMDR Therapy.
Cantos Nuevos (Federico García Lorca)
Authors: Robertson James ,   VOCES8
Published: January 2024

This audio chapter is a composition for choir and piano. The text, New Songs, is taken from an English translation of the poem Cantos Nuevos by the queer Spanish poet, Federico García Lorca (1898–1936). This commissioned work provides a musical opening for The Oxford Handbook of Queer and Trans Music Therapy. Cantos Nuevos is a powerful metaphor for the essential components of music, creativity, therapy, and life. The notes included in this chapter provide context for the music you will hear. The recording was made by the internationally acclaimed choir, VOCES8. Cantos Nuevos, like life itself, is a work that has twists, turns, and tensions. The music finally rests in joy.
Hierarchies of Justice
Authors: Aronson Ori
Published: January 2024

After reviewing the multiple ways hierarchy permeates adjudication worldwide, this chapter explores the possible rationales for this institutional feature and the ways it impacts judicial behaviour on both lower and upper courts. From a comparative perspective, hierarchies are shown to have diverse possible functions, each drawing on varying understandings of the social and political roles of adjudication, and each producing varying judicial behaviour traits. The inherent tension between independence and hierarchy reveals that judicial power can flow in different ways, and that the design of hierarchies of justice may sometimes allow for the challenging and even the inverting of apparent power structures. This leads to a consideration of possible new avenues for the exploration of hierarchy in adjudication: drawing on insights from social network analysis, the chapter suggests recasting courts and judges as interconnected discursive units, seeking mainly to learn from ‘mistakes’, rather that eliminate them.
Ghosts of Liberalism Past
Authors: Lieven Anatol
Published: January 2024

A systematic intellectual and political campaign is now under way to portray a clear-cut divide between “liberal democracy” and the mingled forces of authoritarianism and nationalism. As a picture of the longue durée of the past two and a half centuries, this portrait is largely false; and even today, it obscures as much as it illuminates. As a reformist ideology dedicated to smashing inherited traditions and institutions in the name of progress, liberalism has long been highly dependent not just on existing state powers but often on greatly expanded and widened state authority. Liberal programs also depended on the expanded powers of new national states, which in turn depended on nationalism for their legitimacy and mass support. For much of the twentieth century, the linkages between liberalism, authoritarianism, and nationalism were in abeyance in the West; in recent decades, however, these linkages have re-emerged and are likely to grow stronger.
From Natal to the Transvaal
Authors: du Toit Louise
Published: January 2024

This chapter considers the 1913 march of striking mine and plantation workers and the broader campaign of non-violent resistance led by Gandhi for Indian rights in South Africa. The ambiguity resulting from Gandhi’s inspiration by women’s activism, on the one hand, and his reluctance to allow women on the front lines of Satyagraha, on the other, goes to the heart of Satyagraha activism itself. Satyagraha confounds gender stereotypes because of its steadfast resistance to physical violence (‘unmanly’) and its equally steadfast exertion of force on an oppressive system, which requires extraordinary courage (‘unwomanly’). Gandhi’s wife, Kasturba, convinced him to ‘allow’ women to join the front lines of the 1913 campaign, thus inaugurating a more radically inclusive and cross-cutting version of Satyagraha. Drawing on recent comparative empirical research into women’s role in the front lines of assemblies, the chapter shows why the appearance of women on the front lines of Satyagraha led to successful social transformation.
‘Riotous Assemblies’
Authors: Randall Adrian
Published: January 2024

This chapter examines the remarkable prevalence of popular disorder in eighteenth-century England. It examines the background to the 1715 Riot Act and reasons why the authorities had such difficulty in avoiding or controlling riotous assemblies. The chapter looks at the causes and character of major disorders, such as the extensive food riots, and suggests they may be better understood by using the model of ‘moral economy’ and recognizing that many popular protests evinced a deep-rooted belief in the liberties and rights of the citizen, encompassed in the idea of the ‘free-born Englishman’. Between them, these constituted a model for social and political relations which might at times prove acceptable to their rulers, if only grudgingly. It examines how attitudes amongst the elites towards disorder hardened in the last quarter of the century, undermining the effectiveness of protest after 1800. It suggests that the transition into the nineteenth century from riotous assemblies to more peaceful popular protests demanding the vote might be seen less as a ‘modernization’ of protest but more as stemming from the realization that older, more ‘riotous’, means of redress were no longer proving effective.
Beyond Regime Types
Authors: Li Yao
Published: January 2024

This chapter critically reviews literature on assemblies, State repressive responses, and the political implications of contentious politics. It argues that existing distinctions made when examining contentious politics in democracies versus authoritarian regimes requires reconsideration. First, the patterns, characteristics, and dynamics of assemblies across regimes may not be as distinct as commonly thought. Moreover, the similarities of repression across regime types caution us against overstating the regime-type bifurcation. Further, the political impact of assemblies on all types of regimes is blurring the dichotomy of regime-type effects. Finally, assemblies and repression across national borders require fresh thinking that breaks with the statist regime-type analysis. Reevaluating these issues beyond regime types allows a more nuanced and complex examination of assembly and has broader implications for the research of democracy and authoritarianism.
A Feminist Critique of Peaceful Assembly
Authors: Liu Shan-Jan Sarah
Published: January 2024

Peaceful assembly has traditionally been gendered and exclusive of women. This chapter examines how peaceful assembly, as a practice and an institution, is gendered by focusing on the gender gaps in individuals’ engagement with peaceful assembly and on the differential experiences of women and men in peaceful assembly. It argues for being more inclusive by taking feminist and intersectional approaches to studying peaceful assembly. It also offers thoughts on how nuanced insights can be made if future research considers various forms and tactics of peaceful assembly taking feminist perspectives, particularly in the (post-)COVID-19 era. It also advocates for more scholarship on feminist perspectives on peaceful assembly on and from the global South.
The October Days
Authors: Alpaugh Micah
Published: January 2024

Tens of thousands of Parisian women and men marched on Versailles on 5–6 October 1789, seeking better provisioning, the royal family’s return to Paris, and the resolution of constitutional debates. Though marching with weapons, women intervened to deter mass violence in conditions that might have led to civil war. In so doing, they helped innovate a modern tradition of political demonstrations in which women have often ably acted as non-violent intercessors. Techniques of peaceful assembly developed from revolutionary origins, making them consubstantial with the development of modern democratization. The march succeeded in its primary objectives, forcing the transfer of the central government and enabling the development of a closer collaborative relationship between the people of Paris and the new revolutionary government. Thereby, it created a powerful, enduring example of the possibilities for female intervention into politics.
Party-Based Regimes
Authors: Son Bui Ngoc
Published: January 2024

This chapter canvasses the constitutional role of the communist party in the party-based socialist regimes of China, Vietnam, Laos, and North Korea. It considers the concept of party–state constitutionism which refers merely to adherence to the text and spirit of the party constitution, the state constitution, and a communist constitutional order more generally. The chapter explores four dimensions that define the communist party’s constitutional role, namely the constitutional mandate of the “vanguard” role of the communist party, the constitutional significance of the party constitution, the party’s control of state constitution-making and amendment, and the party’s control of the formation, operation, and reform of state institutions.
Malaysia
Authors: Tew Yvonne
Published: January 2024

This chapter provides an account of constitutional law and adjudication in Malaysia against the broader political context of a dominant party state that has fractured into a fragile democracy. With a written constitution that came into force at the country’s independence in 1957, Malaysia has formal constitutional commitments to fundamental rights, the rule of law, and judicial review. Yet courts in Malaysia have traditionally adopted a rigid, insular approach to constitutional adjudication, characterized by strict formalism and extensive deference to the political branches. Fault lines of constitutional challenge involve religion and the state, as well as emergency powers and national security laws. For much of the country’s history, courts have navigated the fraught dynamics of dominant political power. Recent displays of assertiveness by the Malaysian judiciary toward developing the doctrinal tools to protect the constitution’s basic structure, however, signal judicial willingness to take on a more empowered role in constitutional governance.
Sanskritization
Authors: Kunnath George
Published: January 2024

This chapter examines M.N. Srinivas’ conceptualization of Sanskritization, which he defined as the emulation of the beliefs and practices of upper castes, particularly those of Brahmins, by lower castes in order to raise their status in the caste hierarchy. Conversely, critics of this concept argue that it falsely represents lower castes as eager imitators of upper castes, and thereby negates their agency and consciousness. The central argument of this chapter is that Srinivas’ concept of Sanskritization presents an ideational/imagined view of Indian society, and is guided by the integrative function of the caste system. Srinivas conceived it as a unifying principle that would ensure the integration of diverse castes and communities under Hindu civilization, built on Brahminical culture. In this sense, Sanskritization seems to share a common ideology with Hindutva as both concepts view Indian civilisation as Hindu, and Sanskritic culture as its unifying force.
The Idea of Caste Through the Ages
Authors: Lardinois Roland
Published: January 2024

The aim of this article is to question through ages the relationship between the concept of caste, the words and the facts they denote. The concept of caste varies from the notions of varna and jati, in the Brahmanic literature, which are criticized by Buddhists, to that of caste, from the Portuguese casta, but which is shown to be derived from the Sanskrit jati. The colonial censuses introduced a statistical logic that redefined the idea of caste. After India’s Independence, the notion of caste took on a new meaning linked to the policy of positive discrimination implemented by the State. One shows that the conglomerates of castes defined by the State for this purpose, are patterned on the structure of the varna system. This circular relationship leads us to question the social logics that the groups mobilize to get rid of the caste system.
The Economics of Caste
Authors: Cassan Guilhem
Published: January 2024

Caste is an important determinant of most economic decisions in India. However, despite this role of caste in economic behaviour, it is only recently that caste has begun to be studied in depth in economics. In the last decade, economists have entered the debate on the role of jatis in the Indian economy. This chapter discusses how, by using tools that were developed for different contexts as well as by developing specific ones for the study of the caste system, the contribution of economists has greatly broadened our knowledge of the role of caste in the Indian economy-in particular, the quantitative extent of this importance. With a decrease in data treatment costs, the quantitative analysis of jati data is ‘democratizing’, and economists are now increasingly able to study the role of jati with such publicly available data or via efficient ways of treating administrative data.
Transformations of Caste in Colonial India
Authors: Menon Dilip M.
Published: January 2024

This chapter addresses the question of the transformations of caste identities under colonialism. It addresses conceptualizations such as the colonial “invention” of caste and “sankritization” and makes a historical argument rooted more in the longue duree. Under the carapace of colonialism, there was much flux in social and economic relations as also the emergence of a labor diaspora across Empire. Much of what happened to social relations reflected the agency of people as much as the unintended consequences of policies aimed at settling the land. What may have remained unchanged was social hierarchy and relations of violence towards the lowest groups in society. That contemporary Indian society is characterised by what Ambedkar called an ascending hierarchy of respect and a dsecending hierarchy of contempt is arguably the result of a longer-term stasis as much as change that exceeds the effect of colonialism alone.
Risk factors for failure in 228 periprosthetic distal femur fractures: a multicenter study.
Authors: James Fairres Marshall , Dane Brodke , Nathan O'Hara , Sai Devana , Adolfo Hernandez , Cynthia Burke , Jayesh Gupta , Natasha McKibben , Robert O'Toole , John Morellato , Hunter Gillon , Murphy Walters , Colby Barber , Paul Perdue , Graham Dekeyser , Lillia Steffenson , Lucas Marchand , Loren Black , Zachary Working , Erika Roddy , Ashraf El Naga , Matthew Hogue , Trevor Gulbrandsen , Omar Atassi , Thomas Mitchell , Stephen Shymon , Christopher Lee
Published: January 2024

OBJECTIVES:

To identify risk factors for reoperation to promote union or to address deep surgical site infection (DSSI) in periprosthetic distal femur fractures (PPDFs) treated with lateral distal femoral locking plates (LDFLPs).

METHODS:

Design: Multicenter retrospective cohort study.

Setting:

Ten Level-I trauma centers.

Patient Selection Criteria:

Patients with OTA/AO 33A or 33C PPDFs PPDFs who underwent surgical fixation between January 2012 and December 2019 exclusively using LDFLPs were eligible for inclusion. Patients with pathologic fractures or with follow-up less than 3 months without an outcome event (unplanned reoperation to promote union or for deep surgical infection) prior to this time point were excluded. Fracture fixation constructs used medial plates, intramedullary nails, or hybrid fixation constructs were excluded from analysis

Outcome Measures and Comparisons: To examine the influence of patient demographics, injury characteristics, and features of the fracture fixation construct on the occurrence of unplanned reoperation to promote union or to a address a DSSI.

RESULTS:

There was an 8.3% (19/228) rate of unplanned reoperation to promote union. Predictive factors for the need for reoperation to promote union included increasing body mass index (BMI) (odds ratio [OR] =1.09; 95% confidence interval [CI]: 1.02-1.16; p=0.01), increasing number of screws in the distal fracture segment (OR =1.73 95% CI: 1.06-2.95; p=0.03), and decreasing proportion of proximal segment screws that are locking (OR = 0.17; 95% CI: 0.03-0.70; p=0.02) There was a 4.8% (11/228) rate of reoperation to address DSSI. There were no statistically significant predictive factors identified as risk factors for the need for reoperation to address DSSI (p > 0.05)

CONCLUSIONS:

8.3% of periprosthetic distal femur fractures treated at ten centers with lateral distal femoral locking plates underwent unplanned reoperation to promote union. Increasing patient BMI and increasing number of screws in the distal fracture segment were found to be predictive factors, while increased locking screws in the proximal segment was found to be protective. 4.8% of patients in this cohort underwent reoperation to address deep surgical site infection.

LEVEL OF EVIDENCE:

Level III. See Instructions for Authors for a complete description of levels of evidence.
Prognostic Implication of Preprocedural Pulmonary Hypertension in Patients with Severe Aortic Valve Stenosis Undergoing Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-analysis
Authors: Emami Meybodi Mahmood , Bamarinejad Atefe , Bamarinejad Fateme , Abhari Amir Parsa , Fakhrolmobasheri Mohammad , Khosravi Larijani Fareheh , Nasiri Shidrokh , Shafie Davood
Published: January 2024

Pulmonary hypertension (PH) is a common comorbidity in patients with aortic stenosis (AS) who are candidates for transcatheter aortic valve implantation (TAVI). Herein, we sought to elucidate the prognostic value of preprocedural PH on the early and late mortality after TAVI. The Cochrane Library, Scopus, PubMed, Web of Science, Embase, and ProQuest were screened using a predefined search query. We considered odds ratios (ORs) as the measure of effect. Meta-regression analysis was applied to investigate the potential impact of baseline characteristics on the outcomes. Egger’s and Begg’s tests were used to assess the publication bias. Thirty-three studies comprising 34 datasets representing 68,435 patients were included in the analysis. Regardless of the definition and severity of PH, pooled data analysis indicated that preprocedural PH was associated with higher cardiac and overall 30-day [OR, 1.45 (1.15–1.82) and OR, 1.75 (1.42–2.17), respectively], and 1-year mortality [OR, 1.63 (1.35–1.96) and OR, 1.59 (1.38–1.82), respectively]. Meta-regression analysis demonstrated that older age, higher New York Heart Association function class, history of hypertension, diabetes, and lower left ventricular ejection fraction were predictors of higher mortality rate following TAVI. Moreover, we found that preprocedural PH is significantly associated with higher in-hospital mortality and 30-day acute kidney injury. Our results demonstrated that preprocedural PH is associated with higher early and late cardiac and overall mortality following TAVI; however, this finding is limited regarding the considerable inconsistency in the definition of PH and PH severity among studies.
Does the distribution of musculoskeletal pain shape the fate of long-term sick leave? A prospective cohort study with register follow-up
Authors: Doménech-García Víctor , Skovlund Sebastian Venge , Bellosta-López Pablo , Calatayud Joaquín , López-Bueno Rubén , Andersen Lars Louis
Published: January 2024

Although multisite pain can markedly reduce work ability, the relevance of the bodily pain distribution as a predictor of long-term sick leave is still unknown. This study aimed to investigate the association between musculoskeletal pain distributions and long-term sick leave in the general working population of Denmark and included 66,177 currently employed wage earners without long-term sick leave during the prior 52 weeks. Participants reported whether they had pain in the lower extremity (hips/knees), upper extremity (neck/shoulders), or the low back. The analysis controlled for age, sex, year of survey reply, educational level, occupational group, psychosocial work factors, body max index, smoking, leisure-time physical activity, and mental health confounders. The results demonstrated that the risk of long-term sick leave increased with the number of pain sites. Compared with no pain, localized pain in any body region increased the risk/hazard by 25% to 29% (HR [95% CI]: 1.29 [1.07-1.54] for pain only in the low back), whereas pain in 2 regions increased the risk by 39% to 44% (HR [95% CI]: 1.41 [1.18-1.69] for pain in the low back + hips/knees). Workers reporting pain in all 3 regions experienced a 72% increased risk (HR [95% CI]: 1.72 [1.55-1.91]). Thus, the number of pain regions seems to matter more than the exact pain location. The spatial extension of musculoskeletal pain in workers functions as a gradient system, where pain spread throughout the body is an independent indicator of the high risk of long-term sick leave.
Hypertension Control During the Coronavirus Disease 2019 Pandemic
Authors: Korves Caroline , Peixoto Aldo J. , Lucas Brian P. , Davies Louise , Weinberger Daniel M. , Rentsch Christopher , Vashi Anita , Young-Xu Yinong , King Joseph , Asch Steven M. , Justice Amy C.
Published: January 2024

Design:

Retrospective cohort study.

Objective:

We sought to examine whether disruptions in follow-up intervals contributed to hypertension control.

Background:

Disruptions in health care were widespread during the coronavirus disease 2019 pandemic.

Patients and Methods:

We identified a cohort of individuals with hypertension in both prepandemic (March 2019–February 2020) and pandemic periods (March 2020–February 2022) in the Veterans Health Administration. First, we calculated follow-up intervals between the last prepandemic and first pandemic blood pressure measurement during a primary care clinic visit, and between measurements in the prepandemic period. Next, we estimated the association between the maintenance of (or achieving) hypertension control and the period using generalized estimating equations. We assessed associations between follow-up interval and control separately for periods. Finally, we evaluated the interaction between period and follow-up length.

Results:

A total of 1,648,424 individuals met the study inclusion criteria. Among individuals with controlled hypertension, the likelihood of maintaining control was lower during the pandemic versus the prepandemic (relative risk: 0.93; 95% CI: 0.93, 0.93). Longer follow-up intervals were associated with a decreasing likelihood of maintaining controlled hypertension in both periods. Accounting for follow-up intervals, the likelihood of maintaining control was 2% lower during the pandemic versus the prepandemic. For uncontrolled hypertension, the likelihood of gaining control was modestly higher during the pandemic versus the prepandemic (relative risk: 1.01; 95% CI: 1.01, 1.01). The likelihood of gaining control decreased with follow-up length during the prepandemic but not pandemic.

Conclusions:

During the pandemic, longer follow-up between measurements contributed to the lower likelihood of maintaining control. Those with uncontrolled hypertension were modestly more likely to gain control in the pandemic.
The Role of Advanced Practice Providers in Pediatric Emergency Care Across Nine Emergency Departments
Authors: Iqbal Ammarah U. , Whitfill Travis , Tiyyagura Gunjan , Auerbach Marc
Published: January 2024

Objectives

Advance practice providers (APPs) have been increasingly incorporated into emergency department (ED) staffing. The objective of this study was to describe patient factors that predict when pediatric patient care is provided by APPs and/or physicians. We hypothesized that APPs care for a significant proportion of pediatric patients and are more likely to care for lower acuity patients.

Methods

We performed a retrospective chart review of encounters in patients aged younger than 18 years across 9 EDs from January 2018 to December 2019. Data on age, acuity level, International Classification of Diseases, Tenth Revision code, procedures performed, disposition, provider type, and length of stay were extracted from the electronic health record.

Results

Of 159,035 patient encounters, 37% were cared for by an APP (30% APP independently, 7% physician + APP) and 63% by physicians independently. Advance practice providers were more likely to care for lower acuity patients (60.8% vs 4.4%, P < 0.05) and those in EDs with less pediatric emergency medicine (PEM) coverage (33.4% vs 6.8%, P < 0.05). In an adjusted multinomic regression model, APPs were less likely than physicians to care for high-acuity patients (odds ratio [OR], 0.03; 95% confidence interval [CI], 0.01–0.09), admitted patients (OR, 0.31; CI, 0.28–0.35) and patients in EDs with more PEM coverage (OR, 0.09; CI, 0.09–0.09).

Conclusions

Advance practice providers cared for more than one third of pediatric patients and tended to care for lower acuity patients and for patients in EDs with less PEM coverage. These data highlight the importance of integrating APPs into initiatives aiming to improve pediatric emergency care.
Dilute Povidone-Iodine Solution Soaking Is Ineffective in Improving Outcomes of Necrotizing Fasciitis Caused by Diabetic Foot
Authors: Lin Wen-Yu , Ma Chun-Yu , Fang Wei-Chieh , Wang Tien-Hsiang , Shih Yu-Chung , Lin Chih-Hsun , Wu Szu-Hsien , Perng Cherng-Kang , Chen Ching-En
Published: January 2024

Wound soaking is a physical debridement method that helps reduce bacterial colonization and consequently promotes wound healing. Although soaking in povidone-iodine solution was ineffective in reducing bacterial colonization in acute trauma wounds, there is still a lack of evidence supporting the efficacy of this method in treating severe soft tissue infection. This study aimed to explore the effects of wound soaking in 1% dilute povidone-iodine solution on necrotizing fasciitis caused by diabetic foot ulcers. We retrospectively reviewed and finally included 153 patients who were admitted because of diabetic foot ulcers after undergoing fasciotomy for necrotizing infection from January 2018 to December 2021. Results showed no statistical difference in the outcomes between patients in the soaking and nonsoaking groups. End-stage renal disease (P= 0.029) and high serum C-reactive protein level (P= 0.007) were the only independent factors for below-knee amputation in the univariate and multivariate logistic regression analyses. Therefore, soaking diabetic wounds with severe infection in 1% dilute povidone-iodine solution may not reduce the hospital length of stay, risk of below-knee amputation, and readmission rate.
Continuous External Tissue Expansion for Closure of Forehead Flap Donor Site
Authors: Shahzad Farooq , Disa Joseph J. , Matros Evan
Published: January 2024

Continuous external tissue expansion has been shown to be effective in the management of craniofacial wounds resulting from tumor resection, trauma, and wound dehiscence. Forehead flap donor sites are typically managed with secondary intention healing. However, this can create esthetic problems in pigmented skin because of the tendency to form thick scars. Here, the authors describe the use of continuous external tissue expansion for the management of a paramedian forehead flap donor site. A Dermaclose device was used at the time of forehead flap elevation and removed at the pedicle division and inset. Sufficient skin expansion was achieved for primary closure. The final scar was esthetically pleasing. External tissue expansion is ideal for forehead flap donor sites as the second stage of the operation provides an opportunity for expander removal and wound closure.
Infratemporal Fossa Abscess Managed by Nasal Endoscopic Drainage Using a Navigation System
Authors: Soo Kyung , Min Hyun Jin
Published: January 2024

The infratemporal fossa (ITF) is an area surrounded by bony structures and contains vital organs. Although a large abscess in the ITF is not common, it requires prompt surgical management. Recently, the authors had a patient who presented with fever, pain, and trismus. The patient was diagnosed with an abscess in the ITF, although the authors were not able to determine the exact cause of the infection. The lesion was accessed through the posterolateral maxillary wall using nasal endoscopy with a navigation system. The abscess was safely drained through a small bony window. This case suggests that the nasal endoscopic approach, combined with the use of a navigation system, allows for an easy and safe surgical approach to the ITF. In addition, the authors’ observations indicate that minimal mucosal thickening without definite evidence of sinusitis could result in an abscess in the ITF in immune-compromised patients, as was the case with the authors’ patients.
Socioeconomic disparities based on shooting intent in pediatric firearm injury
Authors: Cain Cary M. , Oluyomi Abiodun O. , Levine Ned , Pompeii Lisa , Rosales Omar , Naik-Mathuria Bindi
Published: January 2024

BACKGROUND

Pediatric firearm injury is often associated with socioeconomically disadvantaged neighborhoods. Most studies only include fatal injuries and do not differentiate by shooting intent. We hypothesized that differences in neighborhood socioeconomic disadvantage would be observed among shooting intents of fatal and nonfatal cases.

METHODS

A linked integrated database of pediatric fatal and nonfatal firearm injuries was developed from trauma center and medical examiner records in Harris County, Texas (2018–2020). Geospatial analysis was utilized to map victim residence locations, stratified by shooting intent. Area Deprivation Index (ADI), a composite measure of neighborhood socioeconomic disadvantage at the census tract level was linked to shooting intent. Differences in high ADI (more deprived) versus low ADI among the shooting intents were assessed. Unadjusted and adjusted regression models assessed differences in ADI scores across shooting intent, adjusted models controlled for age, gender, and race/ethnicity.

RESULTS

Of 324 pediatric firearm injuries, 28% were fatal; 77% were classified as interpersonal violence, 15% unintentional, and 8% self-harm. Differences were noted among shooting intent across the ADI quartiles; with increases in ADI score, the odds of interpersonal violence injuries compared with self-harm injuries significantly increased by 5%; however, when adjusting for individual-level variables of age, gender, and race and ethnicity, no significant differences in ADI were noted.

CONCLUSION

Our results suggest that children living in disadvantaged neighborhoods are more likely to be affected by interpersonal firearm violence compared with self-harm; however, when differences in race/ethnicity are considered, the differences attributable to neighborhood-level disadvantage disappeared. Resources should be dedicated to improving structural aspects of neighborhood disadvantage, which disproportionately impact racial/ethnic minoritized populations. Furthermore, firearm self-harm injuries occurred among children living in the less disadvantaged neighborhoods. Understanding the associations among individual and neighborhood-level factors are important for developing streamlined injury prevention interventions by shooting intent.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level IV.
QTc Shortening on Electrocardiogram With Amitriptyline May Indicate No Effect on Pain Relief in Burning Mouth Syndrome
Authors: Nagamine Takahiko , Watanabe Takeshi , Toyofuku Akira
Published: January 2024

Objective

Burning mouth syndrome (BMS) is an intractable chronic pain disorder characterized by a burning sensation without organic abnormalities in the oral mucosa. Amitriptyline may be effective for BMS or, conversely, may exacerbate pain. QTc is necessary for monitoring psychotropic adverse effects, but it is not known if it is a predictor of efficacy for BMS. We investigated the efficacy of amitriptyline in BMS and its effect on QTc.

Methods

Visual analog scale and electrocardiogram were examined before and 1 month after treatment in 51 consecutive patients diagnosed with BMS according to the International Classification of Headache Disorders, Third Edition (ICHD-3), criteria and treated with amitriptyline.

Results

There were 26 amitriptyline responders and 25 nonresponders, with no differences in age, sex, and amitriptyline dosage. Amitriptyline responders showed little change in QTc, whereas nonresponders showed a trend toward significantly shorter QTc. Changes in visual analog scale correlated statistically significantly with changes in QTc (Spearman rank correlation coefficient: 0384;P= 0.0054). The degree of pain tended to worsen with QTc shortening.

Conclusion

Amitriptyline provides analgesia in about half of BMS patients, but some BMS patients have worse pain with amitriptyline. Not only do changes in the QTc detect amitriptyline adverse effects with prolongation, but also, conversely, its shortening predicts amitriptyline ineffectiveness.
PATHOGENECITY AND ENZYME SCREENING OF SOME SELECTED NON-DERMATOPHYTIC MOLDS
Authors: Nwofor CN , Onyenwe NE , Osuoha CB
Published: January 2024

A total of 10 non-dermatophytic molds isolated from both symptomatic and asymptomatic cattle skin which includes Penicillumcitrinum, Aspergillus welwitschiae, Aspergillus aculeatus, Curvulariakusanol, Cladosporium teniussmum, Pestalotiopsismicrospora, Fusarium oxysporum,Fusarium linchenicola, Absidia sp. and Aspergillus fumigatus were subjected to a pathogenecity test using albino mice. These isolates were also screened for five enzymes using standard plate method.Result from pathogenecity test showed that Absidiasp, C.tenuissimum and Aspergillus welwitschiae were able to elicit discolouration, lesion production and alopecia on the albino mice skin respectively which are evidences of clinical symptoms associated of cutaneous mycoses. For enzyme screening  resultrevealed the highest zone of activity for keratinase (65mm), amylase (86mm), protease (60mm), lipase (60mm) and cellulase (86mm) which were observed on P.microspora, A.welwitschiae, C.tenuissimum, A.welwitschiae and  A. welwitschiaerespectively.  Pathogenecity test from this study shows that some of these molds are highly virulent and that can be attributed to their ability to posses some virulent factors which includes secretion of hydrolytic enzyme.
A novel optimised pre-embedding antibody-labelling correlative light electron microscopy technique
Authors: Doyle Nicole , Simpson Jennifer , Hawes Philippa C , Maier Helena J
Published: January 2024

In the intricate environment of a cell, many studies seek to discover the location of specific events or objects of interest. Advances in microscopy in recent years have allowed for high detail views of specific areas of cells of interest using correlative light electron microscopy (CLEM). While this powerful technique allows for the correlation of a specific area of fluorescence on a confocal microscope with that same area in an electron microscope, it is most often used to study tagged proteins of interest. This method adapts the correlative method for use with antibody labelling. We have shown that some cellular structures are more sensitive than others to this process and that this can be a useful technique for laboratories where tagged proteins or viruses, or dedicated CLEM instruments are not available.
Body size is a better predictor of intra- than interspecific variation of animal stoichiometry across realms
Authors: Nessel Mark P. , Dézerald Olivier , Merder Julian , Andraczek Karl , Brose Ulrich , Filipiak Michał , Jackson Michelle , Jochum Malte , Harpole Stan , Hillebrand Helmut , Leroux Shawn J. , Onstein Renske , Perry George L W , Paseka Rachel , Rugenski Amanda , Sitters Judith , Sperfeld Erik , Striebel Maren , Zandona Eugenia , Doi Hideyuki , Eisenhauer Nico , Farjalla Vinicius F. , Gotelli Nicholas J. , Hood James , Kratina Pavel , Moody Eric K. , Nash Liam N. , Potapov Anton M. , Romero Gustavo Q. , Roussel Jean-Marc , Scheu Stefan , Seeber Julia , Susanti Winda Ika , Tiunov Alexei , González Angélica L.
Published: January 2024

Animal stoichiometry affects fundamental processes ranging from organismal physiology to global element cycles. However, it is unknown whether animal stoichiometry follows predictable scaling relationships with body mass and whether adaptation to life on land or water constrains patterns of elemental allocation. To test both interspecific and intraspecific body-size scaling relationships of the nitrogen (N), phosphorus (P), and N:P content of animals, we used a subset of the StoichLife database encompassing 9,933 individual animals (vertebrates and invertebrates) belonging to 1,543 species spanning 10 orders of magnitude of body size from terrestrial, freshwater, and marine realms. Across species, body mass did not explain much variation in %N and %P composition, although the %P of invertebrates decreased with size. The effects of body size on species elemental content were small in comparison to the effects of taxonomy. Body size was a better predictor of intraspecific than interspecific elemental patterns. Between 42 to 45% in intraspecific stoichiometric variation was explained by body size for 27% of vertebrate species and 35% of invertebrate species. Further, differences between organisms inhabiting aquatic and terrestrial realms were observed only in invertebrate interspecific %N, suggesting that the realm does not play an important role in determining elemental allocation of animals. Based on our analysis of the most comprehensive animal stoichiometry database, we conclude that (i) both body size and realm are relatively weak predictors of animal stoichiometry across taxa, and (ii) body size is a good predictor of intraspecific variation in animal elemental content, which is consistent with tissue-scaling relationships that hold broadly across large groups of animals. This research reveals a lack of general scaling patterns in the elemental content across animals and instead points to a large variation in scaling relationships within and among lineages.