bluuebunny/crossref_metadata_2025 huggingface dataset:
Methamphetamines and Acetabular Reoperation Rates: Poor Outcomes From the Front Lines
Authors: Zusman Natalie L. , Woelber Erik , McKibben Natasha S. , Gallacher David M. , Thompson Austin R. , Friess Darin M. , Working Zachary M.
Published: September 2021

Objectives:

To compare acetabular fracture reoperation rates within 1 year of surgery in methamphetamine (“meth”) abusers and abstainers.

Design:

Retrospective database analysis.

Setting:

Level 1 academic trauma facility, 2008–2018.

Patients/Participants:

Three hundred seventy-one patients who underwent unilateral traumatic acetabular open reduction internal fixation during the study period, 36 of whom abused methamphetamines through self-report or toxicology. One hundred four were excluded for indeterminate abuse histories.

Intervention:

Open reduction internal fixation.

Main Outcome Measurements:

Reoperation resulting from major surgical complications, including hematoma, seroma, deep wound infection, failure of fixation, or arthrosis with conversion to arthroplasty.

Results:

More than 10% of our cohort used meth, representing patients who were a mean 8 years younger and sustained a higher rate of high-energy mechanisms than sober peers. Meth abusers had a greater than 2-fold reoperation rate at 90 days and 1 year compared with abstainers (17% vs. 7% and 25% vs. 11%, respectively). The adjusted odds ratio of 1-year reoperation in meth users was 3.2 (confidence interval 1.2–8.5, P = 0.03). The adjusted 1-year survival of native hip after acetabular fractures in meth users approaches 55%.

Conclusions:

Methamphetamine use is a nonmodifiable factor associated with a 3-fold increase in adjusted odds for 1-year reoperation after surgical fixation of acetabular fractures.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Assessing Readiness for Telehealth in Rural Communities
Authors: Bowen Annie
Published: September 2021

As rural communities often lack access to quality, affordable healthcare, telehealth has the potential to reduce healthcare gaps for rural residents. Qualitative research with interpretive phenomenology through use of the Health Promotion Model and Appreciative Inquiry was used to create and pilot a telehealth survey about residents' readiness in using telehealth. The survey of three rural counties in southern Ohio identified three themes: a knowledge gap related to telehealth; infrastructure; and a desire for easier access to healthcare. Telehealth can be considered a viable, cost-effective alternative for rural populations.
Combined DNA repair defects in testicular metastasis from prostate cancer sensitize to immune checkpoint blockade
Authors: Vlachostergios Panagiotis J.
Published: September 2021

Testicular metastasis in prostate cancer is uncommon and may be a culprit of widespread disease which portends a worse prognosis. Little is known about the molecular biology of metastases to the testicles and whether there is any role for targeted therapeutics. Here we report a case of prostate cancer recurring with testicular and lung metastases. Targeted sequencing of the patient's left testicular tumor after orchiectomy disclosed inactivating mutations in the CDK12 and ARID1A genes, and MSH2 and MSH6 loss resulting in high microsatellite instability and high tumor mutational burden. The patient experienced a complete radiographic and prostate-specific antigen response at 12 weeks of PD-1 immune checkpoint blockade with pembrolizumab and continues uneventfully on treatment. Molecular characterization of this rare phenotypic subtype of prostate cancer in larger studies may help deliver precision therapies with the potential to improve outcomes.
Development of a Sensitive and High-Throughput Assay for Simultaneous Quantification of 5 Tyrosine Kinase Inhibitors and 2 Active Metabolites in Human Plasma Using Ultra-high Performance Liquid Chromatography Coupled to Tandem Mass Spectrometry
Authors: Sumimoto Takahiro , Nakahara Ryosuke , Suzuki Yosuke , Tanaka Ryota , Yoshida Natsumi , Ogata Masao , Itoh Hiroki
Published: September 2021

Background:

Breakpoint cluster region-Abelson (BCR-ABL) tyrosine kinase inhibitors (TKIs) demonstrate improved therapeutic efficacy in chronic myeloid leukemia (CML). However, drug–drug interactions, nonadherence, and host-related factors may influence plasma concentrations. Therefore, therapeutic drug monitoring may be necessary for patients presenting inadequate treatment responses or adverse events. Herein, the authors aimed to develop a more sensitive and high-throughput method than those previously reported to simultaneously quantify 5 TKIs (imatinib, nilotinib, dasatinib, bosutinib, and ponatinib) and 2 active metabolites (N-desmethyl imatinib and N-desmethyl ponatinib) using ultra-performance liquid chromatography coupled with tandem mass spectrometry.

Methods:

Plasma samples were prepared according to a solid-phase extraction protocol using an Oasis MCX µElution plate. The assay fulfilled the requirements of the US Food and Drug Administration for assay validation, with a lower limit of quantification of 0.2 ng/mL for dasatinib, 0.3 ng/mL for N-desmethyl ponatinib, 0.5 ng/mL for N-desmethyl imatinib, bosutinib, and ponatinib, and 2.5 ng/mL for imatinib and nilotinib.

Results:

Within-batch and batch-to-batch precision at the lower limit of quantification and quality control levels were within 14.3% and 10.9%, respectively. Within-batch and batch-to-batch accuracies ranged from 15.5% to 13.0% and 5.70% to 7.03%, respectively. A positive electrospray ionization mode was used with a run time of 6.0 minutes. The assay applicability was verified by the successful measurement of 78 clinical samples from patients undergoing CML therapy.

Conclusions:

The method allows assessment of trough concentrations of TKIs and active metabolites in patients with CML, and hence can be used to assess blood samples in routine clinical settings.
Impact of sleep disturbances on employment and work productivity among midlife women in the US SWAN database: a brief report
Authors: Kagan Risa , Shiozawa Aki , Epstein Andrew J. , Espinosa Robert
Published: September 2021

Objective:

Menopause is associated with an increased prevalence of sleep difficulties. We evaluated the economic burden of sleep disturbances among working midlife women.

Methods:

This retrospective, longitudinal cohort study collected data from the US Study of Women's Health Across the Nation (SWAN) database of women age 42-52 years at enrollment. We assessed the association between sleep disturbances (trouble falling asleep, waking early, or nocturnal awakenings) and workplace productivity (employment [yes/no] and work hours/wk) for women who were employed at the baseline visit and had ≥1 follow-up visit. We estimated overall economic burden by multiplying changes in productivity by median age-specific hourly US wages. Each woman's data were compared from visit to visit and were excluded after the first observed unemployment. Regression analysis was used to estimate associations between changes in sleep and changes in workplace productivity while controlling for relevant characteristics that varied over time.

Results:

The analysis included 2,489 working women (19,707 visits); 31% became unemployed during follow-up. Risk of unemployment was 31% higher for women with versus without new-onset sleep disturbances (P 
= 0.0474). Onset of sleep disturbances was associated with a 0.44-0.57 hours/wk reduction in work time (not significant). Using the more conservative reduction (0.44 h), sleep problems were associated with an annual loss of $517 to $524 per woman and $2.2 billion/yr in lost productivity among women age 42-64 nationwide.

Conclusions:

New-onset sleep problems in midlife women are associated with significant increases in risk of unemployment and ∼$2 billion/yr in lost productivity nationwide.

Video Summary:
http://links.lww.com/MENO/A798.
Self-care agency and associated factors in postmenopausal women
Authors: Bastos-Silva Yasmin , Aguiar Luiza Borges , Pacello Poliana , Baccaro Luiz Francisco , Orcesi Pedro Adriana , Costa-Paiva Lúcia
Published: September 2021

Objective:

The aging process in women is marked by several changes, including the transition to menopause. The evaluation of self-care management is essential and has great relevance for public health. The aim of the present study was to evaluate self-care management and associated factors in postmenopausal women.

Method:

This study was a cross-sectional study performed with 260 postmenopausal women who attended routine consultations at the Menopause Outpatient Clinic of the Hospital of the State University of Campinas-SP. Women aged 50 years or older with amenorrhea for at least 12 months were included. The women were interviewed by a researcher during the routine consultation, and the self-care agency assessment was performed using the Appraisal of Self-Care Agency Scale-Revised questionnaire.

Results:

The average total self-care score for the women in this study was 62.27 (± 9.64). Higher Appraisal of Self-Care Agency Scale-Revised scores were associated with performing outdoor activities, better self-perceived health, and a higher score on knowledge about vitamin D. Active smoking was associated with a lower self-care score.

Conclusion:

We observed that the self-care management of postmenopausal women was satisfactory and was associated with lifestyle, self-perceived health, and knowledge about vitamin D.
LONG-TERM VISUAL OUTCOMES AND THE TIMING OF SURGICAL REPAIR OF FOVEA-SPLITTING RHEGMATOGENOUS RETINAL DETACHMENTS
Authors: Lee Ramon , Shields Ryan A. , Maywood Michael J. , Nemeth Cire , Wa Christianne A. , Williams George A. , Hassan Tarek S. , Garretson Bruce R. , Capone Antonio , Ruby Alan J. , Drenser Kimberly A. , Faia Lisa J. , Randhawa Sandeep , Mahmoud Tamer H. , Wolfe Jeremy D.
Published: September 2021

Purpose:

To evaluate the visual outcomes and the affect of timing of surgical repair of fovea-splitting rhegmatogenous retinal detachments.

Method:

A retrospective, consecutive cohort from multiple surgeons at a single center. Fovea status (fovea-on, fovea-splitting, or fovea-off) was classified by preoperative optical coherence tomography. The primary outcome measure was the visual acuity at the last follow-up that was further correlated with the timing of surgical repair.

Results:

One hundred and ninety-five eyes were included with 62 fovea-on, 65 fovea-splitting, and 68 fovea-off detachments. The mean preoperative logarithm of the minimum angle of resolution visual acuity for fovea-on, fovea-splitting, and fovea-off groups was 0.16 ± 0.21, 0.70 ± 0.56, and 1.67 ± 0.87, respectively (P = <0.001). Mean postoperative logarithm of the minimum angle of resolution visual acuity for fovea-on, fovea-splitting, and fovea-off groups were 0.07 ± 0.13, 0.10 ± 0.15, and 0.20 ± 0.22, respectively (P = <0.001). A statistically significant difference in mean postoperative logMAR visual acuity was found between fovea-off and fovea-on groups (P = 0.003) and between fovea-off and fovea-splitting groups (P = 0.013), however not between fovea-on and fovea-splitting groups (P = 0.827). Visual acuity improved when repair was performed earlier after presentation for fovea-on (R = 0.378, P = 0.002) and fovea-off groups (R = 0.277, P = 0.022), but not for the fovea-splitting group (R = 0.089, P = 0.481).

Conclusion:

We described the favorable visual outcomes of surgery for fovea-splitting rhegmatogenous retinal detachment and correlated these with the timing of surgical repair, which may help guide the management of this urgent, vision-threatening condition.
STEP-WISE APPROACH TO THE MANAGEMENT OF SUBMACULAR HEMORRHAGE USING PNEUMATIC DISPLACEMENT AND VITRECTOMY
Authors: Chew Grace W. M. , Ivanova Tsveta , Patton Niall , Dhawahir-Scala Felipe , Jasani Kirti M. , Turner George , Charles Stephen , Jalil Assad
Published: September 2021

Purpose:

To evaluate a sequential approach of pneumatic displacement followed by vitrectomy (pars plana vitrectomy) in failed cases to deal with submacular hemorrhage (SMH) of various etiologies.

Methods:

Retrospective, nonrandomized interventional case series of consecutive patients with SMH of up to 2 weeks’ duration, who were treated with a stepwise approach. Step 1 involved intravitreal injection of 0.3 mL 100% C3F8 and recombinant tissue plasminogen activator 50 μg/0.1 mL. If unsuccessful, a prompt pars plana vitrectomy with subretinal recombinant tissue plasminogen activator 50 μg/0.1 mL and 20% SF6 gas tamponade was performed as a second attempt to displace the SMH.

Results:

Thirty-one patients with SMH underwent pneumatic displacement; 24 (77.4%) had a successful outcome without further intervention. The mean presenting visual acuity of the “successful cohort” was 1.34 logMAR (20/440 Snellen), improving to 0.83 logMAR (20/135 Snellen) 1 month after treatment. Five of the seven patients with failed pneumatic displacement underwent pars plana vitrectomy with subretinal recombinant tissue plasminogen activator at an average of 5 days poststep 1, with successful SMH displacement in 3 patients, giving an overall success of 87.1% for this treatment protocol.

Conclusion:

A sequential approach of expansile gas injection followed by prompt pars plana vitrectomy, aided by recombinant tissue plasminogen activator at both steps, is a coherent, logical pathway to treat SMH with high anatomical and functional success.
Corneal Nerve Fiber and Sensitivity Loss After Repeated Intravitreal Anti-VEGF Injections: An In Vivo Confocal Microscopy Study
Authors: Polat Osman Ahmet , Şener Hidayet , Erkiliç Kuddusi
Published: September 2021

Purpose:

The purpose of this study was to investigate corneal sensation, subbasal nerve plexus (SBNP), and ocular surface symptoms in patients who underwent multiple intravitreal antivascular endothelial growth factor (anti-VEGF) injections for age-related macular degeneration (AMD) and diabetic macular edema (DME).

Methods:

Forty patients with previous anti-VEGF intravitreal injections (20 AMD and 20 DME) and 30 healthy controls were included in this study. In vivo corneal confocal microscopy (IVCM) of the SBNP, corneal sensitivity measurement with a Cochet–Bonnet esthesiometer, noninvasive tear break-up times, and ocular surface disease score index (OSDI) calculation were performed for each participant. Corneal nerve fiber density, corneal nerve branch density, total length of all nerve fibers, corneal total branch density, corneal nerve fiber area, corneal nerve fiber width, and corneal nerve fiber fractal dimension parameters were obtained by automatic digital analysis.

Results:

Corneal nerve fiber density, corneal nerve branch density, total length of all nerve fibers, and corneal nerve fiber fractal dimension in IVCM imaging and corneal sensitivity were significantly decreased in both AMD and DME groups compared with the control group. Corneal nerve fiber width and OSDI scores were significantly increased in AMD and DME groups compared with the control group. None of the IVCM parameters were significantly different between AMD and DME groups. Corneal sensitivity was decreased in patients with DME compared with patients with AMD. Tear break-up time was not different among the groups.

Conclusions:

Corneal SBNP parameters were affected, corneal sensitivity was decreased, and OSDI scores were increased in patients with multiple intravitreal anti-VEGF injections. IVCM parameters were not significantly different between AMD and DME groups.
Thermokeratoplasty for Keratoconus: A More Than 30-Year Follow-Up Study
Authors: Itoi Motohiro , Higashihara Hisayo , Yamagishi Keiko , Hyakutake Yoko , Okahisa Takashi , Matui Futoshi , Nakayama Toshio , Sotozono Chie
Published: September 2021

Purpose:

The aim of this study was to investigate the long-term outcomes of thermokeratoplasty (TKP) surgery in patients with keratoconus (KC).

Methods:

We retrospectively reviewed our clinical database of 2949 patients with KC seen at the Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan, between April 1979 and December 1991. Patients with KC who underwent TKP with a greater-than 30-year postoperative follow-up were included. The occurrence of adverse events including infectious keratitis, corneal perforation, corneal melting, bullous keratopathy, consistency of contact lenses (CL) wear at the final visit, and a history of corneal transplantation post-TKP was assessed.

Results:

Forty-two patients (29 male and 13 female patients) with a mean age at initial visit of 23.4 years (range: 13.9–39.5 yrs) were included, and TKP was performed unilaterally in all cases. The mean follow-up period was 35.2 years (range: 30.1–41.6 yrs). As for adverse events/complications, no cases of infectious keratitis, corneal perforation, corneal melting, and/or BK were observed. However, 11 eyes received corneal transplants at an average of 24.9 years postoperatively because of the inability to wear CL continuously. At the last visit, 31 eyes were able to continue wearing CL without corneal transplantation, and the remaining 11 eyes were able to continue wearing contact lenses in all cases after corneal transplantation.

Conclusions:

TKP for KC resulted in relatively favorable surgical outcomes over the long-term postoperative period.
Posterior Polymorphous Corneal Dystrophy in a Pediatric Population
Authors: Elhusseiny Abdelrahman M. , Saeed Hajirah N.
Published: September 2021

Purpose:

The aim of this study was to evaluate the clinical and topographic features of posterior polymorphous corneal dystrophy (PPCD) in children aged 15 years or younger with a long-term follow-up. Retrospective case series.

Methods:

A retrospective chart review of patients who were diagnosed with PPCD at Boston Children's Hospital from 1999 to 2020 was performed. Data collected included age at the time of diagnosis, slit lamp findings, cycloplegic refraction, best-corrected visual acuity, central corneal thickness, specular microscopy, and corneal topography findings whenever available.

Results:

Twenty-seven eyes of 19 patients were included (11 unilateral and 8 bilateral cases). Ten patients were girls (52.6%). Left eye was affected in 14 eyes. The mean age at the time of diagnosis was 8.5 ± 3.3 years, with a mean follow-up of 5.3 years. In unilateral cases, there was a statistically significant difference in the endothelial cell density (P = 0.01), coefficient variation (P = 0.03), and hexagonality (P = 0.01) between the affected and the contralateral unaffected eyes. The mean best-corrected visual acuity at initial presentation was 0.8 ± 0.2 compared with 0.9 ± 0.08 in unaffected eyes (P = 0.04). The mean astigmatism was higher in the affected eye (+1.7 diopters) compared with (+1.00) the unaffected eye (P = 0.07). At initial presentation, 7 of 27 eyes had amblyopia, which resolved, either partially or completely, in 5 eyes after treatment.

Conclusions:

PPCD can present early in children with astigmatism and anisometropic amblyopia. A careful slit lamp examination for children presenting with anisoastigmatism is necessary to diagnose PPCD. Contrary to adults, presentation is often unilateral. Such patients should be followed up regularly with cycloplegic retinoscopy to prevent and treat refractive amblyopia if present.
Epithelial ingrowth after LASIK September consultation #1
Authors: Nuijts Rudy M.M.A. , Kartal Serdar
Published: September 2021

A 62-year-old woman presented to our clinic in April 2021 with a painful right eye and increased light sensitivity for 1 week, 30 years after laser in situ keratomileusis (LASIK) in both eyes for myopia of −2.5 diopters. There were no complaints of the left eye. There were no abnormalities in her medical history. The uncorrected distance visual acuity (UDVA) of the right eye at presentation was 20/20.

Slitlamp biomicroscopy revealed epithelial ingrowth on the right eye with stromal edema and inflammation and fine keratic precipitates on the endothelium (Figures 1 and 2

JOURNAL/jcrs/04.03/02158034-202109000-00024/figure1/v/2023-08-19T002615Z/r/image-tiff

JOURNAL/jcrs/04.03/02158034-202109000-00024/figure2/v/2023-08-19T002615Z/r/image-tiff

). The cornea of the left eye was unremarkable. The anterior chamber of the right eye showed 1 + cells (SUN grading). There were no abnormalities in the posterior segment. Figure 3

JOURNAL/jcrs/04.03/02158034-202109000-00024/figure3/v/2023-08-19T002615Z/r/image-tiff

shows the corneal epithelial ingrowth with a swept-source optical coherence tomography (OCT) and Figure 4

JOURNAL/jcrs/04.03/02158034-202109000-00024/figure4/v/2023-08-19T002615Z/r/image-tiff

an axial corneal Scheimpflug tomography map.

What is your treatment advice for this patient from a short- and long-term perspective?
Anorectal malignant melanoma with multiple organ metastases
Authors: Zheng Honghong , Song Jia , Li Jianjun , Zheng Shuai , Zhao Enhong
Published: September 2021

Introduction:

Anal malignant melanoma (ARMM) is a fatal malignancy with high malignant potential and poor patient prognosis. The ARMM incidence account for 0.4% to 1.6% of all malignant melanomas (MM), and 37% of patients already have distant or local metastases during the initial diagnosis. However, the low ARMM incidence and the lack of definitive studies have led to a very high rate of misdiagnosis and missed diagnosis. This case report describes brain metastasis and liver metastasis in ARMM patient.

Patient Concerns:

The patient, a 49-year-old Chinese male, was admitted to the hospital because of altered defecation habits for four years, hematochezia, and difficult defecation for 2 months.

Diagnoses:

Rectal palpation found a mass 2 cm from the anus. Colonoscopy revealed an infiltrative growing mass 2 cm from the anus. Pathological results confirmed MM. The diagnosis was Rectal MM with incomplete intestinal obstruction.

Interventions:

The patient underwent laparoscopic assisted combined abdominal perineal resection under general anesthesia.

Outcomes:

On the second day after surgery, the patient developed sensory impairment and motor dysfunction in the right upper extremity. Cranial computed tomography and magnetic resonance imaging suggested multiple occupying lesions in the brain. On the eighth postoperative day, the patient's condition deteriorated. The patient died after a one-month follow-up.

Conclusions:

This study describes a ARMM patient with brain and liver metastases that was diagnosed late. Pathology combined with immunohistochemistry is important to diagnose ARMM and proper auxiliary examinations can help in early diagnosis.
Interpreting Organizational-Level Financial Statements
Authors: Smith Todd B. , Welch Teresa D.
Published: September 2021

An organization's financial statements reflect their financial well-being and determine their ability to meet the health care needs of the citizens in their community. It is imperative that nursing leadership recognize the key components of an organization's annual consolidated financial statements, the balance sheet and income statement, and know how to interpret them to provide efficient, high-quality health care and to be successful in their role as nurse leaders. This article provides exemplars of these key documents with detailed instructions for the interpretation and understanding of the organization's financial statements, which will enable the reader to accurately and adeptly interpret their own organization's financial statements, as well as the statements from other organizations.
Boundary Spanning Leadership in Response to the COVID-19 Pandemic
Authors: Caramanica Laura , O'Rourke Pamela
Published: September 2021

This article provides insight into the impact of boundary spanning for nurse leaders in a large integrated post–acute health care system in the southeastern part of the United States as they responded (not reacted) to the COVID-19 pandemic that threatened the lives of 2 of society's most vulnerable populations, the elderly and the disabled. Through illustrative examples, the authors describe the 6 strategies of boundary spanning leadership—buffering, reflecting, connecting, mobilizing, weaving, and transforming—that enabled these nurse leaders to respond effectively during this crisis. The literature informs on the merit of situational leadership, as no single type of leadership is right for all circumstances. Today's new novel pandemic served as a powerful catalyst for a group of nurse leaders in a large non–acute network of health care organizations, their colleagues, and other key stakeholders to reframe the boundaries that existed between their organizations and associations, thus enabling them to successfully problem solve together to accomplish several high-stakes goals.
Traumatic Brain Injury in Children
Authors: Ryan Emer , Kelly Lynne , Stacey Catherine , Duff Eimear , Huggard Dean , Leonard Ann , Boran Gerard , McCollum Danielle , Doherty Dermot , Bolger Turlough , Molloy Eleanor J.
Published: September 2021

Objectives

Glial fibrillary acidic protein (GFAP) is a neuronal protein released after traumatic brain injury (TBI) and detectable in serum samples. GFAP correlates with symptom severity in adults and may be a marker of brain injury in children with milder symptoms or preverbal children.

Methods

GFAP was examined in children with severe TBI (initial Glasgow Coma Scale score <8), with mild TBI (Glasgow Coma Scale score 14/15), and at 0 to 4 and at 10 to 14 days after TBI and was compared with healthy age-matched controls. Mechanism, time points from injury, and symptoms were recorded.

Results

The study enrolled 208 children including 110 with TBI (n = 104 mild, 6 severe) and controls (n = 98). GFAP was higher in mild TBI than in controls and highest in the severe TBI cohort, with a maximum value at 6 hours from injury. Vomiting was significantly associated with higher GFAP levels, but no association was found with amnesia, loss of consciousness, and the Sports Concussion Assessment Tool. Children reporting >1-point changes from their preinjury functioning on the Post-Concussive Symptom Inventory had higher initial GFAP but not total Post-Concussive Symptom Inventory score changes.

Conclusions

GFAP identifies children with TBI, even at the milder end of the spectrum, and is strongly associated with postinjury vomiting. It may be a useful marker of pediatric TBI; however, sampling is time critical.
Personalized Chest Computed Tomography
Authors: May Matthias , Heiss Rafael , Koehnen Julia , Wetzl Matthias , Wiesmueller Marco , Treutlein Christoph , Braeuer Lars , Uder Michael , Kopp Markus
Published: September 2021

Objectives

The purpose of this study was to evaluate the minimum diagnostic radiation dose level for the detection of high-resolution (HR) lung structures, pulmonary nodules (PNs), and infectious diseases (IDs).

Materials and Methods

A preclinical chest computed tomography (CT) trial was performed with a human cadaver without known lung disease with incremental radiation dose using tin filter-based spectral shaping protocols. A subset of protocols for full diagnostic evaluation of HR, PN, and ID structures was translated to clinical routine. Also, a minimum diagnostic radiation dose protocol was defined (MIN). These protocols were prospectively applied over 5 months in the clinical routine under consideration of the individual clinical indication. We compared radiation dose parameters, objective and subjective image quality (IQ).

Results

The HR protocol was performed in 38 patients (43%), PN in 21 patients (24%), ID in 20 patients (23%), and MIN in 9 patients (10%). Radiation dose differed significantly among HR, PN, and ID (5.4, 1.2, and 0.6 mGy, respectively; P < 0.001). Differences between ID and MIN (0.2 mGy) were not significant (P = 0.262). Dose-normalized contrast-to-noise ratio was comparable among all groups (P = 0.087). Overall IQ was perfect for the HR protocol (median, 5.0) and decreased for PN (4.5), ID-CT (4.3), and MIN-CT (2.5). The delineation of disease-specific findings was high in all dedicated protocols (HR, 5.0; PN, 5.0; ID, 4.5). The MIN protocol had borderline IQ for PN and ID lesions but was insufficient for HR structures. The dose reductions were 78% (PN), 89% (ID), and 97% (MIN) compared with the HR protocols.

Conclusions

Personalized chest CT tailored to the clinical indications leads to substantial dose reduction without reducing interpretability. More than 50% of patients can benefit from such individual adaptation in a clinical routine setting. Personalized radiation dose adjustments with validated diagnostic IQ are especially preferable for evaluating ID and PN lesions.
Factors Associated With Increased Mortality in Severe Abdominopelvic Injury
Authors: Patel Neerav , Harfouche Melike , Stonko David P. , Elansary Noha , Scalea Thomas M. , Morrison Jonathan J.
Published: September 2021

Background:

Associated injuries are thought to increase mortality in patients with severe abdominopelvic trauma. This study aimed to identify clinical factors contributing to increased mortality in patients with severe abdominopelvic trauma, with the hypothesis that a greater number of concomitant injuries would result in increased mortality.

Methods:

This was a retrospective review of the Trauma Quality Improvement Program (TQIP) database of patients ≥ 18 years with severe abdominopelvic trauma defined as having an abdominal Abbreviated Injury Score (AIS) ≥ 3 with pelvic fractures and/or iliac vessel injury (2015–2017). Primary outcome was in-hospital mortality based on concomitant body region injuries. Secondary outcomes included mortality at 6 h, 6 to 24 h, and after 24 h based on concomitant injuries, procedures performed, and transfusion requirements.

Results:

A total of 185,257 patients were included in this study. Survivors had more severely injured body regions than non-survivors (4 vs. 3, P < 0.001). Among those who died within 6 h, 28.5% of patients required a thoracic procedure and 43% required laparotomy compared to 6.3% and 22.1% among those who died after 24 h (P < 0.001). Head AIS ≥ 3 was the only body region that significantly contributed to overall mortality (OR 1.26, P < 0.001) along with laparotomy (OR 3.02, P < 0.001), neurosurgical procedures (2.82, P < 0.001) and thoracic procedures (2.28, P < 0.001). Non-survivors who died in < 6 h and 6–24 h had greater pRBC requirements than those who died after 24 h (15.5 and 19.5 vs. 8 units, P < 0.001).

Conclusion:

Increased number of body regions injured does not contribute to greater mortality. Uncontrolled noncompressible torso hemorrhage rather than the burden of concomitant injuries is the major contributor to the high mortality associated with severe abdominopelvic injury.
Challenging the Ex Vivo Lung Perfusion Procedure With Continuous Dialysis in a Pig Model
Authors: De Wolf Julien , Glorion Matthieu , Jouneau Luc , Estephan Jérôme , Leplat Jean-Jacques , Blanc Fany , Richard Christophe , Urien Céline , Roux Antoine , Le Guen Morgan , Journois Didier , Schwartz-Cornil Isabelle , Sage Edouard
Published: September 2021

Background.

Normothermic ex vivo lung perfusion (EVLP) increases the pool of donor lungs by requalifying marginal lungs refused for transplantation through the recovery of macroscopic and functional properties. However, the cell response and metabolism occurring during EVLP generate a nonphysiological accumulation of electrolytes, metabolites, cytokines, and other cellular byproducts which may have deleterious effects both at the organ and cell levels, with impact on transplantation outcomes.

Methods.

We analyzed the physiological, metabolic, and genome-wide response of lungs undergoing a 6-h EVLP procedure in a pig model in 4 experimental conditions: without perfusate modification, with partial replacement of fluid, and with adult or pediatric dialysis filters.

Results.

Adult and pediatric dialysis stabilized the electrolytic and metabolic profiles while maintaining acid-base and gas exchanges. Pediatric dialysis increased the level of IL-10 and IL-6 in the perfusate. Despite leading to modification of the perfusate composition, the 4 EVLP conditions did not affect the gene expression profiles, which were associated in all cases with increased cell survival, cell proliferation, inflammatory response and cell movement, and with inhibition of bleeding.

Conclusions.

Management of EVLP perfusate by periodic replacement and continuous dialysis has no significant effect on the lung function nor on the gene expression profiles ex vivo. These results suggest that the accumulation of dialyzable cell products does not significantly alter the lung cell response during EVLP, a finding that may have impact on EVLP management in the clinic.
John Philip Grime. 30 April 1935—19 April 2021
Authors: Pierce Simon , Fridley Jason D.
Published: September 2021

John Philip ‘Phil’ Grime developed fundamental theory in plant ecology that emerged from a lifetime of fieldwork and experimental studies in the Sheffield region, South Yorkshire, UK. His approach was an unusual combination of observation, experiment and theory: he conducted detailed, intensive observations of natural communities, alongside experimental manipulation of those communities and simulated ‘microcosms’ in the service of formulating general rules (‘strategies’) by which plants evolve with respect to their environment. In this way, Grime was one of several key figures that propelled plant ecology away from descriptive methods focusing on vegetation composition and toward a science more integrated with other fields, including evolutionary biology and Earth science. Grime's investigative approach was an inspiration for the modern field of global change biology, and, by focusing on understanding the contrasting roles species and their traits play in the functioning of ecosystems, marked the beginning of the field of plant functional ecology. For much of his career Grime held the post of full professor (and in retirement, emeritus professor of ecology) at the University of Sheffield, where he also served as the director of the Unit of Comparative Plant Ecology and of the Buxton Climate Change Impacts Laboratory. Awarded an honorary doctorate by Radboud University (Nijmegen, The Netherlands) and a foreign membership of the Royal Netherlands Academy of Arts and Sciences, Grime was the first person awarded the Alexander von Humboldt Award of the International Association for Vegetation Science.
Comparing approaches for modelling indirect contact transmission of infectious diseases
Authors: Wilson Amanda M. , Weir Mark H. , King Marco-Felipe , Jones Rachael M.
Published: September 2021

Mathematical models describing indirect contact transmission are an important component of infectious disease mitigation and risk assessment. A model that tracks microorganisms between compartments by coupled ordinary differential equations or a Markov chain is benchmarked against a mechanistic interpretation of the physical transfer of microorganisms from surfaces to fingers and subsequently to a susceptible person's facial mucosal membranes. The primary objective was to compare these models in their estimates of doses and changes in microorganism concentrations on hands and fomites over time. The abilities of the models to capture the impact of episodic events, such as hand hygiene, and of contact patterns were also explored. For both models, greater doses were estimated for the asymmetrical scenarios in which a more contaminated fomite was touched more often. Differing representations of hand hygiene in the Markov model did not notably impact estimated doses but affected pathogen concentration dynamics on hands. When using the Markov model, losses due to hand hygiene should be handled as separate events as opposed to time-averaging expected losses. The discrete event model demonstrated the effect of hand-to-mouth contact timing on the dose. Understanding how model design influences estimated doses is important for advancing models as reliable risk assessment tools.
A unique yet technically simple type of joint allows for the high mobility of scorpion tails
Authors: Günther Alice , Drack Manfred , Monod Lionel , Wirkner Christian S.
Published: September 2021

Although being one of the most well-known animal groups, functional and constructional aspects of scorpions and especially of their tail (metasoma) have so far been overlooked. This tail represents a special construction, as it consists of five tube-shaped segments made up of strong cuticle, which are movable against each other and thus manoeuvre the notorious stinger both quickly and very precisely in space. This high mobility of an exoskeletal structure can be attributed to the connection between the segments described here for the first time. This joint allows for the twisting and bending at the same time in a single, simple construction: adjoining metasomal segments each possess an almost circular opening posteriorly, where the next segment is lodged. Anteriorly, these segments possess two saddle-like protrusions laterally, which are able to rotate in two directions on the rim of the posterior circular opening of the previous segment allowing for twisting and bending. The metasomal joint is particularly noteworthy since its mechanism can be compared to that of arthropod appendages. The scorpion metasoma is actually the only known case in Chelicerata, in which an entire body section has been modified to perform tasks similar to that of an appendage while containing digestive organs. The joint mechanism can also inspire technical applications, for instance in robotics.
Fractal Pennes and Cattaneo–Vernotte bioheat equations from product-like fractal geometry and their implications on cells in the presence of tumour growth
Authors: El-Nabulsi Rami Ahmad
Published: September 2021

In this study, the Pennes and Cattaneo–Vernotte bioheat transfer equations in the presence of fractal spatial dimensions are derived based on the product-like fractal geometry. This approach was introduced recently, by Li and Ostoja-Starzewski, in order to explore dynamical properties of anisotropic media. The theory is characterized by a modified gradient operator which depends on two parameters:Rwhich represents the radius of the tumour andR0which represents the radius of the spherical living tissue. Both the steady and unsteady states for each fractal bioheat equation were obtained and their implications on living cells in the presence of growth of a large tumour were analysed. Assuming a specific heating/cooling by a constant heat flux equivalent to the metabolic heat generation in the tissue, it was observed that the solutions of the fractal bioheat equations are robustly affected by fractal dimensions, the radius of the tumour growth and the dimensions of the living cell tissue. The ranges of both the fractal dimensions and temperature were obtained, analysed and compared with recent studies. This study confirms the importance of fractals in medicine.
Mary Proctor: an astronomical popularizer in the shadows
Authors: Bush Martin
Published: September 2021

The popularizer of astronomy Mary Proctor was well known in her days but has been little remembered since. A prominent lecturer and author, Proctor was trained in the craft of science writing by her father, Richard Proctor. She ‘held the very first place in the profession as a woman’ and promoted the role of women in science throughout her career. Her life illuminates many themes. Mary Proctor spanned the period between entrepreneurial science popularizers and professional science communicators. I suggest that one of her most important legacies is as an early pioneer of the practices of science journalism in the early twentieth century when the relations between science and society were in flux. Yet her legacy has been largely overlooked. A study of Proctor's life reveals multiple interests, diverse opportunities and the way that people are differently remembered.
Cell wall deficiency as an escape mechanism from phage infection
Authors: Ongenae Véronique , Briegel Ariane , Claessen Dennis
Published: September 2021

The cell wall plays a central role in protecting bacteria from some environmental stresses, but not against all. In fact, in some cases, an elaborate cell envelope may even render the cell more vulnerable. For example, it contains molecules or complexes that bacteriophages recognize as the first step of host invasion, such as proteins and sugars, or cell appendages such as pili or flagella. In order to counteract phages, bacteria have evolved multiple escape mechanisms, such as restriction-modification, abortive infection, CRISPR/Cas systems or phage inhibitors. In this perspective review, we present the hypothesis that bacteria may have additional means to escape phage attack. Some bacteria are known to be able to shed their cell wall in response to environmental stresses, yielding cells that transiently lack a cell wall. In this wall-less state, the bacteria may be temporarily protected against phages, since they lack the essential entities that are necessary for phage binding and infection. Given that cell wall deficiency can be triggered by clinically administered antibiotics, phage escape could be an unwanted consequence that limits the use of phage therapy for treating stubborn infections.
Intermolecular hydrogen bond ruptured by graphite with different lamellar number
Authors: Yin Yanchao , Zhang Guoliang , Xu Xianmang , Zhao Peiyu , Ma Liran
Published: September 2021

Intermolecular hydrogen bonds are formed through the electrostatic attraction between the hydrogen nucleus on a strong polar bond and high electronegative atom with an unshared pair of electrons and a partial negative charge. It affects the physical and chemical properties of substances. Based on this, we presented a physical method to modulate intermolecular hydrogen bonds for not changing the physical–chemical properties of materials. The graphite and graphene are added into the glycerol, respectively, by being used as a viscosity reducer in this paper. The samples are characterized by Raman and 1H-nuclear magnetic resonance. Results show that intermolecular hydrogen bonds are adjusted by graphite or graphene. The rheology of glycerol is reduced to varying degrees. Transmission electron microscopes and computer simulation show that the spatial limiting action of graphite or graphene is the main cause of breaking the intermolecular hydrogen bond network structure. We hope this work reveals the potential interplay between nanomaterials and hydroxyl liquids, which will contribute to the field of solid–liquid coupling lubrication.
Pollen nutrition fosters honeybee tolerance to pesticides
Authors: Barascou Lena , Sene Deborah , Barraud Alexandre , Michez Denis , Lefebvre Victor , Medrzycki Piotr , Di Prisco Gennaro , Strobl Verena , Yañez Orlando , Neumann Peter , Le Conte Yves , Alaux Cedric
Published: September 2021

A reduction in floral resource abundance and diversity is generally observed in agro-ecosystems, along with widespread exposure to pesticides. Therefore, a better understanding on how the availability and quality of pollen diets can modulate honeybee sensitivity to pesticides is required. For that purpose, we evaluated the toxicity of acute exposure and chronic exposures to field realistic and higher concentrations of azoxystrobin (fungicide) and sulfoxaflor (insecticide) in honeybees provided with pollen diets of differing qualities (namedSandBQpollens). We found that pollen intake reduced the toxicity of the acute doses of pesticides. Contrary to azoxystrobin, chronic exposures to sulfoxaflor increased by 1.5- to 12-fold bee mortality, which was reduced by pollen intake. Most importantly, the risk of death upon exposure to a high concentration of sulfoxaflor was significantly lower for theSpollen diet when compared with theBQpollen diet. This reduced pesticide toxicity was associated with a higher gene expression of vitellogenin, a glycoprotein that promotes bee longevity, a faster sulfoxaflor metabolization and a lower concentration of the phytochemicalp-coumaric acid, known to upregulate detoxification enzymes. Thus, our study revealed that pollen quality can influence the ability of bees to metabolize pesticides and withstand their detrimental effects, providing another strong argument for the restoration of suitable foraging habitat.
Short- and long-term predictions of chaotic flows and extreme events: a physics-constrained reservoir computing approach
Authors: Doan N. A. K. , Polifke W. , Magri L.
Published: September 2021

We propose a physics-constrained machine learning method—based on reservoir computing—to time-accurately predict extreme events and long-term velocity statistics in a model of chaotic flow. The method leverages the strengths of two different approaches: empirical modelling based on reservoir computing, which
learns
the chaotic dynamics from data only, and physical modelling based on conservation laws. This enables the reservoir computing framework to output physical predictions when training data are unavailable. We show that the combination of the two approaches is able to accurately reproduce the velocity statistics, and to predict the occurrence and amplitude of extreme events in a model of self-sustaining process in turbulence. In this flow, the extreme events are abrupt transitions from turbulent to quasi-laminar states, which are deterministic phenomena that cannot be traditionally predicted because of chaos. Furthermore, the physics-constrained machine learning method is shown to be robust with respect to noise. This work opens up new possibilities for synergistically enhancing data-driven methods with physical knowledge for the time-accurate prediction of chaotic flows.
Coupling spectral and resource-use complementarity in experimental grassland and forest communities
Authors: Schweiger Anna K. , Cavender-Bares Jeannine , Kothari Shan , Townsend Philip A. , Madritch Michael D. , Grossman Jake J. , Gholizadeh Hamed , Wang Ran , Gamon John A.
Published: September 2021

Reflectance spectra provide integrative measures of plant phenotypes by capturing chemical, morphological, anatomical and architectural trait information. Here, we investigate the linkages between plant spectral variation, and spectral and resource-use complementarity that contribute to ecosystem productivity. In both a forest and prairie grassland diversity experiment, we delineated
n
-dimensional hypervolumes using wavelength bands of reflectance spectra to test the association between the spectral space occupied by individual plants and their growth, as well as between the spectral space occupied by plant communities and ecosystem productivity. We show that the spectral space occupied by individuals increased with their growth, and the spectral space occupied by plant communities increased with ecosystem productivity. Furthermore, ecosystem productivity was better explained by inter-individual spectral complementarity than by the large spectral space occupied by productive individuals. Our results indicate that spectral hypervolumes of plants can reflect ecological strategies that shape community composition and ecosystem function, and that spectral complementarity can reveal resource-use complementarity.