bluuebunny/crossref_metadata_2025 huggingface dataset:
A Randomized Controlled Trial to Assess the Cost-effectiveness of a Novel, Simple Modification to the Negative Pressure Wound Therapy System
Authors: Albayati Waleed K. , Youha Sarah Al , Ali Ali A. , Fakhra Zainab
Published: August 2021

Background:

Negative pressure wound therapy (NPWT) has shown remarkable adaptation in wound management worldwide. Numerous studies have provided evidence that demonstrates both the medical and financial advantages of NPWT. In this study, the VAC Therapy System, one of the leading commercially used NPWT systems, has been utilized to treat patients with either acute or chronic wounds requiring surgical intervention, with the aim of demonstrating the efficacy of using a modified version of the VAC system while reducing the total associated cost.

Method:

The patients were divided into two randomly selected groups using randomization generator software. A modification was made by replacing the disposable canister provided by Kinetic Concepts Inc., with an alternative reusable canister (Baxter, Inc.); one group was assigned to use the conventional VAC Therapy System, and the other was assigned to use the modified version. Our study aimed to investigate whether this modification would lower the cost of the VAC Therapy System while still achieving the desired outcome.

Results:

The VAC Therapy System contributed to improving the wound bed score in both groups, which supports previous findings on the effectiveness of NPWT while reflecting that the modification did not negatively impact the functionality and the integrity of the VAC Therapy System. Furthermore, the average daily consumables cost was markedly reduced in the modified group compared with the standard group, which reduced the overall cost of treatment.

Conclusion:

It is possible to use the VAC Therapy System to its full advantage, while minimizing the financial burden of using it.
ARE THERE TWO FORMS OF MULTIPLE EVANESCENT WHITE DOT SYNDROME?
Authors: Essilfie Juliet , Bacci Tommaso , Abdelhakim Aliaa H. , Ramtohul Prithvi , Turchi Federica , Freund K. Bailey , Yannuzzi Lawrence A.
Published: August 2021

Purpose:

To analyze the nature of multiple evanescent white dot syndrome (MEWDS) and differentiate an idiopathic or primary form of MEWDS from a secondary form that is seen in association with other clinical conditions affecting the posterior segment of the eye.

Methods:

Clinical and multimodal imaging findings including color fundus photography, fundus autofluorescence, fluorescein angiography, indocyanine green angiography, spectral-domain optical coherence tomography, and optical coherence tomography angiography of patients with secondary MEWDS are presented.

Results:

Twenty consecutive patients with secondary MEWDS were evaluated. Fifteen patients were female. Most were young adults aged between 20 to 40 years with myopia (less than −6 diopters). Pathologic conditions associated with the secondary MEWDS reaction were high myopia (greater than −6 diopters) in two eyes, previous vitreoretinal surgery for rhegmatogenous retinal detachment in 2 eyes, and manifestations of multifocal choroiditis in 18 eyes. In all eyes, the MEWDS lesions followed a course of progression and resolution independent from the underlying condition.

Conclusion:

Secondary MEWDS seems to be an epiphenomenon (“EpiMEWDS”) that may be seen in association with clinical manifestations disruptive to the choriocapillaris–Bruch membrane–retinal pigment epithelium complex.
Giant Fornix Syndrome: How Much Conjunctiva Should Be Resected?
Authors: Lam Stacey C. , Szeto Simon K. H. , Yuen Hunter K. L.
Published: August 2021

Purpose:

To characterize clinical profiles of Chinese patients with giant fornix syndrome (GFS), compare surgical outcomes with amount of Müller’s muscle-conjunctival resection (MMCR), and elicit risk factors for those who have prolonged recovery after MMCR.

Methods:

Retrospective, observational, interventional cohort study on GFS eyes. Two treatment groups were established: limited MMCR—as defined by 8 mm or less resection; maximal MMCR—as defined by 10–12 mm resection. Good responders were defined as eyes exhibiting disease resolution within 3 months after surgery. Primary outcome was disease resolution, secondary outcome was ptosis improvement.

Results:

Mean age was 81.9 years old (range, 76–89), with 6 (75%) females and 2 (25%) males. All 10 eyes presented with discharge, partial ptosis, and conjunctival injection. In the limited MMCR group, time to symptom resolution was longer at 5.56 months, while maximal MMCR group was 2.02 months (p = 0.004). Limited MMCR group also had lower primary surgical success and required additional surgery compared with maximal MMCR group (p = 0.008). At mean follow up of 34.4 months (range, 11–65 months), all eyes achieved disease resolution, no recurrence, and ptosis improvement.

Conclusions:

In the largest series on Chinese eyes with GFS to date, GFS is mainly a disease in elderly females. Maximal MMCR has a higher rate of surgical success with no additional complications. For those who underwent MMCR, additional treatment such as topical steroids and fortified antibiotics do not affect time to recovery. These findings may help ophthalmologists consider maximal MMCR as a definitive surgical treatment in GFS eyes.
Scrutinizing the causal relationship between schizophrenia and vitamin supplementation: a Mendelian randomization study
Authors: Fahira Aamir , Zhu Zijia , Li Zhiqiang , Shi Yongyong
Published: August 2021

Objective:

Observational studies have reported malnutrition and vitamin deficiency in patients with schizophrenia (SZ), which can lead to serious metabolic syndromes and decrease anti-psychiatric drug outcomes. Whereas, vitamin intake along with psychiatric medication can enhance the medication outcomes. However, it is still unknown if SZ induces vitamin deficiency. Herein, we conduct the Mendelian randomization analysis to explore the causal relationship between schizophrenia and vitamins supplementation.

Methods:

We retrieved the genome-wide summary statistical data for schizophrenia from recent SZ GWAS data (43,175 cases and 65,166 controls) and vitamins supplementation GWAS data from Neale’s GWAS datasets (more than 337,000 samples from the European population) and performed a two-sample Mendelian randomization analysis to determine the causal association of SZ with vitamin supplementation, in addition, we conduct the sensitivity analysis to obtain reliable results and remove confounding bias.

Results:

SZ have causal relationships with vitamins A, B, C, D, and E (SZ/vitamin A: β = 0.002, se= 0.001, 95% confidence interval (CI): 0.001 to 0.004,
P
= 1.41E-05, heterogeneity
P
= 0.4486; SZ/vitamin B: β= 0.004, se= 0.001, 95% CI: 0.002-0.005,
P
= 7.0E-05, heterogeneity
P
= 0.2217; SZ/vitamin C: β= 0.004, se= 0.001, 95% CI: 0.002-0.007,
P
= 0.001, heterogeneity
P
= 0.1349; SZ/vitamin D: β= 0.003, se= 0.001, 95% CI: 0.002-0.005,
P
= 0.001, heterogeneity
P
= 0.433; SZ/vitamin E: β= 0.003, se= 0.001, 95% CI: 0.002-0.005,
P
= 5.0E-05, heterogeneity
P
= 0.1382).

Conclusion:

Our findings suggest that vitamin levels and supplementation should be carefully controlled in patients with SZ, which in turn may enhance the therapeutic effects of antipsychotic drug treatments.
Value of Nurse Practitioner Inpatient Hospital Staffing
Authors: Aiken Linda H. , Sloane Douglas M. , Brom Heather M. , Todd Barbara A. , Barnes Hilary , Cimiotti Jeannie P. , Cunningham Regina S. , McHugh Matthew D.
Published: August 2021

Background:

Evidence indicates hospitals with better registered nurse (RN) staffing have better patient outcomes. Whether involving more nurse practitioners (NPs) in inpatient care produces better outcomes is largely unknown.

Objective:

The objective of this study was to determine whether the presence of more NPs produces better inpatient outcomes net of RN staffing.

Research Design:

This was a 2015–2016 cross-sectional data on 579 hospitals linked from: (1) RN4CAST-US nurse surveys; (2) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient surveys; (3) surgical patient discharge abstracts; (4) Medicare Spending per Beneficiary (MSPB) reports; (5) American Hospital Association (AHA) Annual Survey. Hospitals were grouped according to their NP/beds ratios [<1 NP/100 beds (N=132), 1–2.99 NPs/100 beds (N=279), and 3+ NPs/100 beds (N=168)].

Subjects:

RNs randomly sampled nurses from licensure lists yielded 22,273 RNs in study hospitals; discharge data for 1.4 million surgical patients; HCAHPS data for 86% of study hospitals.

Measures:

Mortality, readmissions, lengths of stay, MSPB, patient experience, and quality reported by patients and nurses.

Results:

After adjustments, patients in hospitals with 3+ NPs/100 beds had lower odds than patients in hospitals with <1 NP/100 beds of 30-day mortality [odds ratio (OR)2=0.76; 95% confidence interval (CI)=0.67–0.82; P<0.001] and 7-day readmissions (OR2=0.90; 95% CI=0.86–0.96; P<0.001), shorter average length of stay (incident rate ratio2=0.92; 95% CI=0.88–0.96; P<0.001) and 5.4% lower average MSPB (95% CI=3.8%–7.1%). Patients and nurses in the hospitals with higher NP/bed ratios were significantly more likely to report better care quality and safety, and nurses reported lower burnout, higher job satisfaction, greater intentions of staying in their jobs.

Conclusions:

Having more NPs in hospitals has favorable effects on patients, staff nurse satisfaction, and efficiency. NPs add value to existing labor resources.
Patients are Choosing Nurse Practitioners as Their Primary Care Provider in Many Communities Across the US
Authors: Kapu April
Published: August 2021

This month's column highlights why patients are choosing to see nurse practitioners (NPs) as primary care providers, for both urgent and chronic care needs. Nurse practitioners are 1 type of advanced practice RN. Advanced practice RNs are inclusive of NPs, nurse midwives, nurse specialists, and nurse anesthetists. Primary care NPs see patients in the ambulatory and community settings, focusing on disease prevention and health maintenance. Primary care NPs often work in rural communities, providing access to care for many underserved populations.
The Baptist Health Lexington Nursing Orientation Progression Tool
Authors: Rogers Allison , Fultz Julia , Clements-Hickman Alyssa L. , Davies Claire C.
Published: August 2021

OBJECTIVE

The purpose of this study was to develop and test a tool to monitor a nursing orientee's progress to competence.

BACKGROUND

The literature suggests that, during orientation, consistent documentation and communication among educators, preceptors, and nurse leaders facilitate a timely progression to independent practice for new nurses.

METHODS

A 2-phase methodological study was conducted. Nurse educators clarified goals, identified essential competencies, and developed the Baptist Health Lexington Nursing Orientation Progression Tool (OPT). The tool was used to monitor orientees' progression through orientation.

RESULTS

Content validity assessment of the OPT (content validity index = 0.98) demonstrated strong validity. Testing of the tool revealed 31 nurses completed orientation early, 12 completed orientation on time, and 18 nurses required extended orientation time. All requiring an extension were new graduates.

CONCLUSION

The OPT guided preceptors to facilitate timely completion of orientation among newly hired nurses. Findings suggest that new graduates may need more assistance than experienced nurses.
Long-Term Outcomes of a Collaborative Regional Evidence-Based Practice Fellowship
Authors: Smith Andrea Burdge , Baker Kathy A. , Weeks Susan Mace
Published: August 2021

Academic-practice partnerships provide a model for sharing resources, increasing professional knowledge and skills, improving patient outcomes, and strengthening organizational cultures of quality and safety. This article describes the long-term outcomes of a regional collaborative evidence-based practice fellowship. Results reveal the fellowship had a measurable positive impact on fellows' evidence-based practice knowledge and practice, project outcomes, professional growth, and the culture of excellence within partner organizations.
Evaluating Meaningful Levels of Financial Toxicity in Gynecologic Cancers
Authors: Esselen Katharine McKinley , Gompers Annika , Hacker Michele R. , Bouberhan Sara , Shea Meghan , Summerlin Sarah S. , Rucker Lindsay R. , Huh Warner K. , Pisu Maria , Liang Margaret I.
Published: August 2021

(Abstracted from Int J Gynecol Cancer 2021;31:801–806)

“Financial toxicity” is a term used to define financial hardship and associated stress that patients with cancer often experience due to the costs of care. The Comprehensive Score for Financial Toxicity (COST) is a validated 11-item tool used to measure financial toxicity as it relates to cancer diagnosis and treatment.
Adverse Cardiovascular Events Associated With Female Pelvic Reconstructive Surgery
Authors: Roberts Kasey , Slopnick Emily , Chapman Graham , Mangel Jeffrey , Sheyn David
Published: August 2021

(Abstracted from Female Pelvic Med Reconstr Surg 2021;27:230–237)

The lifetime risk of having female pelvic reconstructive surgery (FPRS) is estimated to be approximately 20% for American women. Most PRS occur in women aged 60 to 69 years.
Diagnosis Documentation of Critically Ill Children at Admission to a PICU*
Authors: Vivtcharenko Victoria Y. , Ramesh Sonali , Dukes Kimberly C. , Singh Hardeep , Herwaldt Loreen A. , Reisinger Heather Schacht , Cifra Christina L.
Published: August 2021

OBJECTIVES:

Multidisciplinary PICU teams must effectively share information while caring for critically ill children. Clinical documentation helps clinicians develop a shared understanding of the patient’s diagnosis, which informs decision-making. However, diagnosis-related documentation in the PICU is understudied, thus limiting insights into how pediatric intensivists convey their diagnostic reasoning. Our objective was to describe how pediatric critical care clinicians document patients’ diagnoses at PICU admission.

DESIGN:

Retrospective mixed methods study describing diagnosis documentation in electronic health records.

SETTING:

Academic tertiary referral PICU.

PATIENTS:

Children 0–17 years old admitted nonelectively to a single PICU over 1 year.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

One hundred PICU admission notes for 96 unique patients were reviewed. In 87% of notes, both attending physicians and residents or advanced practice providers documented a primary diagnosis; in 13%, primary diagnoses were documented by residents or advanced practice providers alone. Most diagnoses (72%) were written as narrative free text, 11% were documented as problem lists/billing codes, and 17% used both formats. At least one rationale was documented to justify the primary diagnosis in 91% of notes. Diagnostic uncertainty was present in 52% of notes, most commonly suggested by clinicians’ use of words indicating uncertainty (65%) and documentation of differential diagnoses (60%). Clinicians’ integration and interpretation of information varied in terms of: 1) organization of diagnosis narratives, 2) use of contextual details to clarify the diagnosis, and 3) expression of diagnostic uncertainty.

CONCLUSIONS:

In this descriptive study, most PICU admission notes documented a rationale for the primary diagnosis and expressed diagnostic uncertainty. Clinicians varied widely in how they organized diagnostic information, used contextual details to clarify the diagnosis, and expressed uncertainty. Future work is needed to determine how diagnosis narratives affect clinical decision-making, patient care, and outcomes.
Health-Related Quality of Life Following Delirium in the PICU*
Authors: Dervan Leslie A. , Killien Elizabeth Y. , Smith Mallory B. , Watson R. Scott
Published: August 2021

OBJECTIVES:

To evaluate whether delirium during pediatric critical illness is associated with post-discharge health-related quality of life.

DESIGN:

Retrospective cohort study.

SETTING:

Academic tertiary care center.

PATIENTS:

Children 1 month to 18 years old admitted to the PICU or cardiac ICU and enrolled in the Seattle Children’s Hospital Outcomes Assessment Program.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Delirium was assessed twice daily using the Cornell Assessment of Pediatric Delirium; a score greater than or equal to 9 (with fluctuating level of arousal for children with developmental disability) indicated delirium. Baseline (pre-admission) and post-discharge health-related quality of life were assessed by the Pediatric Quality of Life Inventory (Mapi Research Trust, Lyon, France) or the Functional Status II-R (for children with developmental disability). Among 534 patients, delirium was common (44%), as was clinically important decline in health-related quality of life (≥ 4.5 points) from baseline to follow-up (22%), measured at median 6.6 weeks post-hospital discharge (interquartile range, 5.1–8.5). On univariate analysis, children with delirium had similar likelihood of health-related quality of life decline compared with those without (25.5% vs 19.7%; p = 0.1). Using multivariable logistic regression adjusting for age, medical complexity, predicted risk of mortality, admission diagnosis, receipt of noninvasive ventilation, hospital length of stay, time to follow-up, and parent age, delirium was independently associated with health-related quality of life decline among children assessed by the Pediatric Quality of Life Inventory (adjusted odds ratio, 2.0; 95% CI, 1.1–3.5). Among children evaluated with the Functional Status II-R, delirium was not independently associated with health-related quality of life decline (odds ratio, 1.4; 95% CI, 0.6–3.2). In both groups, longer time to follow-up was also independently associated with improvements in health-related quality of life.

CONCLUSIONS:

Delirium during the ICU stay is associated with decline in health-related quality of life from baseline to post-discharge follow-up among children assessed by the Pediatric Quality of Life Inventory, who were generally characterized by normal baseline cognitive function and less medical comorbidity. This association was not present among children assessed by the Functional Status II-R, potentially due to their higher overall risk of health-related quality of life decline, or other clinical differences that modify the effects of delirium in this group.
Temperature Management and Health-Related Quality of Life in Children 3 Years After Cardiac Arrest
Authors: Magee Aidan , Deschamps Rachel , Delzoppo Carmel , Pan Kevin C. , Butt Warwick , Dagan Misha , Forrest Anri , Namachivayam Siva P.
Published: August 2021

OBJECTIVES:

Therapeutic hypothermia minimizes neuronal injury in animal models of hypoxic-ischemic encephalopathy with greater effect when used sooner after the insult. Clinical trials generally showed limited benefit but are difficult to perform in a timely manner. In this clinical study, we evaluated the association between the use of hypothermia (or not) and health-related quality of life among survivors of pediatric cardiac arrest as well as overall mortality.

DESIGN:

Single-center, retrospectively identified cohort with prospective assessment of health-related quality of life.

SETTING:

PICU of a pediatric hospital.

PATIENTS:

Children with either out-of-hospital or in-hospital cardiac arrest from January 2012 to December 2017.

INTERVENTIONS:

Patients were assigned into two groups: those who received therapeutic hypothermia at less than or equal to 35°C and those who did not receive therapeutic hypothermia but who had normothermia targeted (36–36.5°C). The primary outcome was health-related quality of life assessment and the secondary outcome was PICU mortality.

MEASUREMENTS AND MAIN RESULTS:

We studied 239 children, 112 (47%) in the therapeutic hypothermia group. The median (interquartile range) of lowest temperature reached in the 48 hours post cardiac arrest in the therapeutic hypothermia group was 33°C (32.6–33.6°C) compared with 35.4°C (34.7–36.2°C) in the no therapeutic hypothermia group (p < 0.001). At follow-up, 152 (64%) were alive and health-related quality of life assessments were completed in 128. Use of therapeutic hypothermia was associated with higher lactate and lower pH at baseline. After regression adjustment, therapeutic hypothermia (as opposed to no therapeutic hypothermia) was associated with higher physical (mean difference, 15.8; 95% CI, 3.5–27.9) and psychosocial scores (13.6 [5.8–21.5]). These observations remained even when patients with a temperature greater than 37.5°C were excluded. We failed to find an association between therapeutic hypothermia and lower mortality.

CONCLUSIONS:

Out-of-hospital or in-hospital cardiac arrest treated with therapeutic hypothermia was associated with higher health-related quality of life scores despite having association with higher lactate and lower pH after resuscitation. We failed to identify an association between use of therapeutic hypothermia and lower mortality.
Effect of Time of Daily Data Collection on the Calculation of Catheter-associated Urinary Tract Infection Rates
Authors: Donnelly Lane F. , Wood Matthew , Loh Ling , Tekic Natasa , Shin Andrew Y. , Scheinker David
Published: August 2021

Introduction:

According to the National Healthcare Safety Network (NHSN) definitions for Catheter-associated urinary tract infections (CAUTI) rates, determination of the number of urinary catheter days must occur by calculating the number of catheters in place “for each day of the month, at the same time of day” but does not define at what time of day this occurs. The purpose of this review was to determine if a data collection time of 11 am would yield a greater collection of urinary catheter days than that done at midnight.

Methods:

During a 20-month period, the number of urinary catheter days was calculated using once-a-day electronic measurements to identify a urinary catheter presence. We used data collected at 11 am and collected at midnight (our historic default) in comparing the calculated urinary catheter days and resultant CAUTI rates.

Results:

There were 7,548 patients who had a urinary tract catheter. The number of urinary catheter days captured using the 11 am collection time was 15,425, and using the midnight collection time was 10,234, resulting in a 50.7% increase. The CAUTI rate per 1,000 urinary catheter days calculated using the 11 am collection method was 0.58, and using the midnight collection method was 0.88, a reduced CAUTI rate of 33.6%.

Conclusion:

The data collection time can significantly impact the calculation of urinary catheter days and on calculated CAUTI rates. Variations in how healthcare systems define their denominator per current National Healthcare Safety Network policy may result in significant differences in reported rates.
Disparities between Operative Time and Relative Value Units for Plastic Surgery Procedures
Authors: Blau Jared A. , Marks Caitlin E. , Phillips Brett T. , Hollenbeck Scott T.
Published: August 2021

Background:

Plastic surgeons are evaluated not only by the number of patients served but also by relative value, quantified by the Medicare relative value unit system, which can affect advancement and compensation. Procedures that demand a high operative time without an increase in relative value units are, by definition, inefficient. The purpose of this study was to determine whether the number of relative value units actually corresponds to operative time.

Methods:

The National Surgical Quality Improvement Program data sets over a 9-year period were queried for plastic surgery operations. The primary CPT codes representing the 100 most common operations were compared for operative time and total relative value units.

Results:

A total of 53,701 cases were included. There was a high degree of correlation between operative time and number of relative value units (Pearson correlation coefficient, 0.82). The average efficiency was 10.201 ± 3.386 relative value units per hour. Pressure ulcer excisions and breast reconstruction were among the most efficient (e.g., Excision, sacral pressure ulcer, CPT 19357, generated 20.819 relative value units per hour). Skin excisions, débridements, and flap delays were among the least efficient (e.g., Excision, excessive skin and subcutaneous tissue, CPT 15847, generated 1.752 relative value units per hour).

Conclusions:

As a general trend, the most common plastic surgical procedures requiring longer operative times are associated with more relative value units. Cases with higher relative value units assigned tended to be more efficient. For the 100 most common procedures, relative value units and operative time are not evenly distributed. These data suggest modifications to the current relative value unit designation system to more equally allocate these units based on effort and time.
Refining Indications for Orbital Floor Fracture Reconstruction: A Risk-Stratification Tool Predicting Symptom Development and Need for Surgery
Authors: Basta Marten N. , Rao Vinay , Roussel Lauren O. , Crozier Joseph W. , Liu Paul Y. , Woo Albert S.
Published: August 2021

Background:

Challenges in orbital floor fracture management include delayed symptom onset and controversial surgical indications based on radiographic findings. This study assessed which imaging characteristics most reliably predict symptomatology to generate a tool quantifying individual need for surgery on initial presentation.

Methods:

The clinical course for all patients with isolated orbital fractures at a single institution from 2015 to 2017 were reviewed. Trauma mechanism, computed tomographic scan findings, and symptoms necessitating surgery (diplopia, enophthalmos) were noted. Univariable and multivariable regression modeling was used to generate a predictive risk model for operative fractures.

Results:

One hundred twenty-one patients with isolated orbital fractures were identified. Mechanism of injury included falls (41 percent), assault (37 percent), and vehicular trauma (17 percent). Patient follow-up averaged 4.4 ± 4.8 months. Average orbital floor fracture area was 2.4 cm2 (range, 0.36 to 6.18 cm2), and orbital volume herniation averaged 0.70 cm3 (range, 0.01 to 4.23 cm3). Twenty-one patients (17.3 percent) required surgical intervention for symptomatic fractures. The strongest predictors of symptoms were orbital volume increase greater than 1.3 cm3 (OR, 10.5; p = 0.001) and inferior rectus displacement within/below the fracture line (OR, 3.7; p = 0.049). Mechanical fall was risk-reducing (OR, 0.08; p = 0.005). Symptom risk was stratified from low (3.6 percent) to high risk (71 percent) (C-statistic = 0.90). The volume of herniated orbital contents was significantly more predictive of symptoms than fracture area (C-statistic = 0.81 versus C-statistic = 0.66; p = 0.02).

Conclusions:

The proposed risk tool allows highly accurate, early prediction of symptomatic orbital floor fractures. Findings suggest that orbital volume change, not fracture area, more reliably informs operative indications, along with inferior rectus muscle caudal malposition. A simplified stepwise decision algorithm demonstrates the potential utility of this risk-assessment tool.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, III.
Mentorship in Plastic Surgery: A Critical Appraisal of Where We Stand and What We Can Do Better
Authors: Myers Paige L. , Amalfi Ashley N. , Ramanadham Smita R.
Published: August 2021

Mentorship is a critical tool for professional development and career success. In academic surgery, supportive mentorship affords higher job satisfaction, academic productivity, and diversity and inclusion. It protects against burnout and increasing academic surgery attrition rates. Women, underrepresented minorities, and junior plastic surgeons report lower job satisfaction and fewer mentorship opportunities. Given the unique challenges these groups face in a constantly changing health care system, the importance of mentorship cannot be overstated. Through a survey of American Society of Plastic Surgeons members, this study evaluated different aspects of mentorship to describe the current state in plastic surgery. Despite 94.05 percent of plastic surgeons believing that mentorship is valuable, only 15.16 percent reported a structured mentorship system, often without evaluation. Male and female participants agree that mentorship is needed for both professional (clinical judgment) and personal (work-life balance) development. Interestingly, women plastic surgeons felt it was important for mentees to have gender and race/ethnicity concordance to their mentors (p < 0.001). There was no agreement regarding the most effective method to implement mentorship programs, highlighting the challenges of this problem. Through thoughtful planning and commitment, mentorship programs can be instituted to benefit not just the mentee, but the mentor as well.
A Minimally Invasive Full Endoscopic Approach to Tibial Nerve Neurolysis in Diabetic Foot Neuropathy: An Alternative to Open Procedures
Authors: Uemura Tetsuji , Watanabe Hidetaka , Yanai Tetsu , Kawano Hiroshige , Yoshida Aya , Okutsu Ichiro
Published: August 2021

Background:

Dellon et al. have reported that chronic nerve compression of the tibial nerve inside the tarsal tunnel, caused by diabetes mellitus, can be relieved following open decompression surgery. However, the large skin incision resulting from Dellon’s procedure may cause wound healing problems. The authors report the possibility of a minimally invasive full endoscopic procedure.

Methods:

Operations were performed under local anesthesia without a pneumatic tourniquet. An anesthetic agent was applied at the proximal part of the flexor retinaculum of the foot, and a hypodermic needle was advanced into the tarsal tunnel. Tarsal tunnel pressure and blood circulation of the tibial nerve using indocyanine green assessment were measured preoperatively. One 1-cm portal skin incision was made at the anesthetized area and the Universal Subcutaneous Endoscope system was inserted into the tarsal tunnel. The flexor retinaculum, tibial nerve, blood vessels, and abductor hallucis muscle fascia were identified under endoscopic observation. After decompression of the tarsal tunnel, the authors measured tarsal tunnel pressure and blood circulation of the tibial nerve for analysis of the effectiveness of the endoscopic decompression during the procedure.

Results:

Fourteen operations were compiled and analyzed. Postoperative clinical status was improved based on the preoperative modified Toronto Clinical Neuropathy Score. The mean tarsal tunnel pressure dropped to 4.5 mmHg during surgery from the initial preoperative 49.4 mmHg in resting position. Endoscopic indocyanine green assessment showed more than 30 percent improvement of the vascularity surrounding the tibial nerve.

Conclusion:

The authors’ minimally invasive full endoscopic procedure is a viable alternative approach for tarsal tunnel syndrome patients with diabetic foot neuropathy.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Firearm injuries during legal interventions: Nationwide analysis
Authors: Liasidis Panagiotis K. , Lewis Meghan , Jakob Dominik A. , Inaba Kenji , Demetriades Demetrios
Published: August 2021

INTRODUCTION

There is limited literature on firearm injuries during legal interventions. The purpose of this study was to examine the epidemiology, injury characteristics, and outcomes of both civilians and law enforcement officials (LEOs) who sustained firearm injuries over the course of legal action.

METHODS

Retrospective observational study using data from the National Trauma Data Bank (2015–2017) was performed. All patients who were injured by firearms during legal interventions were identified using the International Classification of Disease, Tenth Revision, external cause of injury codes. The study groups were injured civilian suspects and police officers. Demographics, injury characteristics, and outcomes were analyzed and compared between the groups. Primary outcomes were the clinical and injury characteristics among the victims.

RESULTS

A total of 1,411 patients were included in the study, of which 1,091 (77.3%) were civilians, 289 officers (20.5%), and 31 bystanders (2.2%). Overall, 95.2% of patients were male. Compared with LEOs, civilians were younger (31 vs. 34 years, p = 0.007) and more severely injured (median Injury Severity Score, 13 vs. 10 [p = 0.005]; Injury Severity Score >15, 44.4% vs. 37.1% [p = 0.025]). Civilians were more likely to sustain severe (Abbreviated Injury Scale, ≥3) intra-abdominal injuries (26.8% vs. 16.1%, p < 0.001) and spinal fractures (13.0% vs. 6.9%, p = 0.004). In-hospital mortality and overall complication rate were similar between the groups (mortality: civilians, 24.7% vs. LEOs, 27.3% [p = 0.360]; overall complications: civilians, 10.3% vs. LEOs, 8.4% [p = 0.338]).

CONCLUSION

Firearm injuries during legal interventions are associated with significant injury burden and a higher mortality than the reported mortality in gunshot wounds among civilians. The mortality and overall complication rate were similar between civilian suspects and law enforcement officials.

LEVEL OF EVIDENCE

Epidemiologic, level IV.
A data driven agent-based model that recommends non-pharmaceutical interventions to suppress Coronavirus disease 2019 resurgence in megacities
Authors: Yin Ling , Zhang Hao , Li Yuan , Liu Kang , Chen Tianmu , Luo Wei , Lai Shengjie , Li Ye , Tang Xiujuan , Ning Li , Feng Shengzhong , Wei Yanjie , Zhao Zhiyuan , Wen Ying , Mao Liang , Mei Shujiang
Published: August 2021

Before herd immunity against Coronavirus disease 2019 (COVID-19) is achieved by mass vaccination, science-based guidelines for non-pharmaceutical interventions are urgently needed to reopen megacities. This study integrated massive mobile phone tracking records, census data and building characteristics into a spatially explicit agent-based model to simulate COVID-19 spread among 11.2 million individuals living in Shenzhen City, China. After validation by local epidemiological observations, the model was used to assess the probability of COVID-19 resurgence if sporadic cases occurred in a fully reopened city. Combined scenarios of three critical non-pharmaceutical interventions (contact tracing, mask wearing and prompt testing) were assessed at various levels of public compliance. Our results show a greater than 50% chance of disease resurgence if the city reopened without contact tracing. However, tracing household contacts, in combination with mandatory mask use and prompt testing, could suppress the probability of resurgence under 5% within four weeks. If household contact tracing could be expanded to work/class group members, the COVID resurgence could be avoided if 80% of the population wear facemasks and 40% comply with prompt testing. Our assessment, including modelling for different scenarios, helps public health practitioners tailor interventions within Shenzhen City and other world megacities under a variety of suppression timelines, risk tolerance, healthcare capacity and public compliance.
Antibiotic treatment protocols revisited: the challenges of a conclusive assessment by mathematical modelling
Authors: Uecker Hildegard , Bonhoeffer Sebastian
Published: August 2021

Hospital-acquired bacterial infections lead to prolonged hospital stays and increased mortality. The problem is exacerbated by antibiotic-resistant strains that delay or impede effective treatment. To ensure successful therapy and to manage antibiotic resistance, treatment protocols that draw on several different antibiotics might be used. This includes the administration of drug cocktails to individual patients (combination therapy) but also the random assignment of drugs to different patients (mixing) and a regular switch in the default drug used in the hospital from drug
A
to drug
B
and back (cycling). For more than 20 years, mathematical models have been used to assess the prospects of antibiotic combination therapy, mixing and cycling. But while tendencies in their ranking across studies have emerged, the picture remains surprisingly inconclusive and incomplete. In this article, we review existing modelling studies and demonstrate by means of examples how methodological factors complicate the emergence of a consistent picture. These factors include the choice of the criterion by which the effects of the protocols are compared, the model implementation and its analysis. We thereafter discuss how progress can be made and suggest future modelling directions.
Strong support for a heterogeneous speciation decline model in Dinosauria: a response to claims made by Bonsor
et al
. (2020)
Authors: Sakamoto Manabu , Benton Michael J. , Venditti Chris
Published: August 2021

Through phylogenetic modelling, we previously presented strong support for diversification decline in the three major subclades of dinosaurs (Sakamoto
et al
. 2016
Proc. Natl Acad. Sci. USA
113
, 5036–5040. (
doi:10.1073/pnas.1521478113
)). Recently, our support for this model has been criticized (Bonsor
et al
. 2020
R. Soc. Open Sci.
7
, 201195. (
doi:10.1098/rsos.201195
)). Here, we highlight that these criticisms seem to largely stem from a misunderstanding of our study: contrary to Bonsor
et al
.'s claims, our model accounts for heterogeneity in diversification dynamics, was selected based on deviance information criterion (DIC) scores (not parameter significance), and intercepts were estimated to account for uncertainties in the root age of the phylogenetic tree. We also demonstrate that their new analyses are not comparable to our models: they fit simple, Dinosauria-wide models as a direct comparison to our group-wise models, and their additional trees are subclades that are limited in taxonomic coverage and temporal span, i.e. severely affected by incomplete sampling. We further present results of new analyses on larger, better-sampled trees (
N
= 961) of dinosaurs, showing support for the time-quadratic model. Disagreements in how we interpret modelled diversification dynamics are to be expected, but criticisms should be based on sound logic and understanding of the model under discussion.
The hidden influence of communities in collaborative funding of clinical science
Authors: Vasan Kishore , West Jevin D.
Published: August 2021

Every year the National Institutes of Health allocates $10.7 billion (one-third of its funds) for clinical science research while the pharmaceutical companies spend $52.9 billion (90% of its annual budget). However, we know little about funder collaborations and the impact of collaboratively funded projects. As an initial effort towards this, we examine the co-funding network, where a funder represents a node and an edge signifies collaboration. Our core data include all papers that cite and receive citations by the Cochrane Database of Systemic Reviews, a prominent clinical review journal. We find that 65% of clinical papers have multiple funders and discover communities of funders that are formed by national boundaries and funding objectives. To quantify success in funding, we use a
g
-index metric that indicates efficiency of funders in supporting clinically relevant research. After controlling for authorship, we find that funders generally achieve higher success when collaborating than when solo-funding. We also find that as a funder, seeking multiple, direct connections with various disconnected funders may be more beneficial than being part of a densely interconnected network of co-funders. The results of this paper indicate that collaborations can potentially accelerate innovation, not only among authors but also funders.
Cytokine storms and pyroptosis are primarily responsible for the rapid death of mice infected with pseudorabies virus
Authors: Sun Wei , Liu Shanshan , Huang Xuefei , Yuan Rui , Yu Jiansheng
Published: August 2021

Pseudorabies virus (PRV), the causative agent of Aujeszky's disease, is one of the most harmful pathogens to the pig industry. PRV can infect and kill a variety of mammals. Nevertheless, the underlying pathogenesis related to PRV is still unclear. This study aims to investigate the pathogenesis induced by PRV in a mouse model. The mice infected with the PRV-HLJ strain developed severe clinical manifestations at 36 h post-infection (hpi), and mortality occurred within 48–72 hpi. Hematoxylin-eosin staining and qRT-PCR methods were used to detect the pathological damage and expression of cytokines related to an immune reaction in brain tissue, respectively. The cytokine storms caused by IFN-α, IFN-β, TNF-α, IL-1β, IL-6 and IL-18 were related to the histopathological changes induced by PRV. This pattern of cytokine secretion depicts an image of typical cytokine storms, characterized by dysregulated secretion of pro-inflammatory cytokines and imbalanced pro-inflammatory and anti-inflammatory responses. In addition, the pyroptosis pathway was also activated by PRV by elevating the expression levels of nod-like receptor protein 3, Caspase-1, Gasdermin-D and interleukin-1β/18. These findings provide a way for further understanding the molecular basis in PRV pathogenesis.
Τhe role of surface energy in the apparent solubility of two different calcite crystal habits
Authors: Hadjittofis Eftychios , Vargas Silvia M. , Litster James D. , Sedransk Campbell Kyra L.
Published: August 2021

The interplay between polymorphism and facet-specific surface energy on the dissolution of crystals is examined in this work. It is shown that, using cationic additives, it is possible to produce star-shaped calcite crystals at very high supersaturations. In crystallization processes following the Ostwald rule of stages these star-shaped crystals appear to have higher solubility than both their rhombohedral counterparts and needle-shaped aragonite crystals. The vapour pressures of vaterite, aragonite, star-shaped calcite and rhombohedral calcite crystals are measured using thermogravimetric analysis and the corresponding enthalpies of melting are obtained. Using inverse gas chromatography, the surface energy of the aforementioned crystals is measured as well and the surface energy of the main crystal facets is calculated. Combining the effect of facet-specific surface energies and the enthalpies of melting on a modified version of the classical solubility equation for regular solutions, it is proved that the star-shaped calcite crystals can indeed have higher apparent solubility than aragonitecrystals.
Unconditionally secure relativistic multi-party biased coin flipping and die rolling
Authors: Pitalúa-García Damián
Published: August 2021

We introduce relativistic multi-party biased die-rolling protocols, generalizing coin flipping to

M
≥
2

parties and to

N
≥
2

outcomes for any chosen outcome biases and show them unconditionally secure. Our results prove that the most general random secure multi-party computation, where all parties receive the output and there is no secret input by any party, can be implemented with unconditional security. Our protocols extend Kent’s (Kent A. 1999
Phys. Rev. Lett.
83
, 5382) two-party unbiased coin-flipping protocol, do not require any quantum communication, are practical to implement with current technology and to our knowledge are the first multi-party relativistic cryptographic protocols.
Giant clam growth in the Gulf of Aqaba is accelerated compared to fossil populations
Authors: Killam Daniel , Al-Najjar Tariq , Clapham Matthew
Published: August 2021

The health of reef-building corals has declined due to climate change and pollution. However, less is known about whether giant clams, reef-dwelling bivalves with a photosymbiotic partnership similar to that found in reef-building corals, are also threatened by environmental degradation. To compare giant clam health against a prehistoric baseline, we collected fossil and modernTridacnashells from the Gulf of Aqaba, Northern Red Sea. After calibrating daily/twice-daily growth lines from the outer shell layer, we determined that modern individuals of all three species (Tridacna maxima,T. squamosaandT. squamosina) grew faster than Holocene and Pleistocene specimens. Modern specimens also show median shell organic δ15N values 4.2‰ lower than fossil specimens, which we propose is most likely due to increased deposition of isotopically light nitrate aerosols in the modern era. Nitrate fertilization accelerates growth in culturedTridacna, so nitrate aerosol deposition may contribute to faster growth in modern wild populations. Furthermore, colder winter temperatures and past summer monsoons may have depressed fossil giant clam growth. Giant clams can serve as sentinels of reef environmental change, both to determine their individual health and the health of the reefs they inhabit.
Disease-driven mass mortality event leads to widespread extirpation and variable recovery potential of a marine predator across the eastern Pacific
Authors: Hamilton S. L. , Saccomanno V. R. , Heady W. N. , Gehman A. L. , Lonhart S. I. , Beas-Luna R. , Francis F. T. , Lee L. , Rogers-Bennett L. , Salomon A. K. , Gravem S. A.
Published: August 2021

The prevalence of disease-driven mass mortality events is increasing, but our understanding of spatial variation in their magnitude, timing and triggers are often poorly resolved. Here, we use a novel range-wide dataset comprised 48 810 surveys to quantify how sea star wasting disease affected
Pycnopodia helianthoides
, the sunflower sea star, across its range from Baja California, Mexico to the Aleutian Islands, USA. We found that the outbreak occurred more rapidly, killed a greater percentage of the population and left fewer survivors in the southern half of the species's range.
Pycnopodia
now appears to be functionally extinct (greater than 99.2% declines) from Baja California, Mexico to Cape Flattery, Washington, USA and exhibited severe declines (greater than 87.8%) from the Salish Sea to the Gulf of Alaska. The importance of temperature in predicting
Pycnopodia
distribution rose more than fourfold after the outbreak, suggesting latitudinal variation in outbreak severity may stem from an interaction between disease severity and warmer waters. We found no evidence of population recovery in the years since the outbreak. Natural recovery in the southern half of the range is unlikely over the short term. Thus, assisted recovery will probably be required to restore the functional role of this predator on ecologically relevant time scales.