bluuebunny/crossref_metadata_2025 huggingface dataset:
Sustainability and Ecology
Authors: Thompson Paul B. , Norris Patricia E.
Published: February 2022

Ecologists deploy the systems concepts of stocks, flows, and feedbacks to develop models of
population dynamics, predator-prey relationships, and the movement of abiotic components
(energy, water, minerals) through ecosystems. These models are the basis for estimating the
sustainability of ecosystem processes. Ecology emphasizes the organization of sustainable
processes, such as stable predator-prey subsystems, within larger and more comprehensive systems
(hierarchies). Resilience, or an ecosystem's ability to recover its basic functions after
disruptive shocks, is an important concept that has influenced sustainability thinking in many
areas. Applied ecologists developed data-driven ways to measure sustainable yields in forest and
fishery management. Although the use of maximum sustainable yield is controversial, it provides
a basis for understanding sustainability in many domains.
Yemen
Authors: Orkaby Asher
Published: February 2022

This book provides a broad-ranging, historical overview of Yemen and its peoples that focuses in
particular on the contemporary situation. It covers the country's major political figures and ethnic
groups, explaining the origins of each and their impact on contemporary national politics. Throughout,
the book discusses tribalism, religious dynamics, regional identities, Yemen's African and Jewish
minorities, and the social impact of the Arab Spring on the country's women and youth. It also offers
readers a window into Yemen's rich past: its archaeological treasures, its ancient economic prosperity,
and its tribal and religious history. In addition, the book looks to Yemen's future, identifying
potential avenues through which Yemen can use its promising geographic location, natural resources, and
economic potential to achieve stability.
Imperial Yemen—Ottoman and British Empires
Authors: Orkaby Asher
Published: February 2022

This chapter examines Yemen's relationship with the Ottoman and British empires. For centuries,
invading armies and sporadic occupations prevented Yemen's tribes from coalescing under a single
central and indigenous governing authority. The lack of a single uniting Yemeni identity did not
mean that ancient Yemen did not thrive under foreign rule. Often considered the golden age of
South Arabia, the Rasulid Dynasty extended its border to include the geographic boundaries of
the modern Republic of Yemen, marking the only point in the country's history where Yemen was
"united." This golden era came to an end when local Zaydi imams staged a successful rebellion
and established temporary local dominance until the arrival of the Portuguese and the Ottoman
Empire less than a century later. The chapter then looks at the arrival of the British Empire in
Yemen. When Imam Yahya of the Hamid al-Din family declared North Yemen independent from the
Ottoman Empire on October 30, 1918, the Mutawakkilite Kingdom of Yemen became the first
independent Arab state in the Middle East. Imam Yahya used his nationalist popularity and
religious credentials to centralize the northern Yemeni state and consolidate authority around
the imam.
An Era of Modernization—the Formation of the Yemeni Republic
Authors: Orkaby Asher
Published: February 2022

This chapter investigates the formation of the modern Yemeni state. Arab nationalism emerged
during the 1950s as a dominant political movement across the Middle East and North Africa.
Championed by Egyptian president Gamal Abdel Nasser, nationalist movements gradually supplanted
religious and tribal identities and in the process overthrew a generation of post-colonial
monarchs and theocrats. September 1962 was the final stage of the 15-year revolution that
managed to overthrow not only the imam but also the entire institution of the imamate. The
chapter then looks at the first Yemeni civil war, before considering the first president of the
Yemen Arab Republic (YAR) and the kind of government that emerged during the 1970s. It also
assesses what kind of state emerged after the British withdrew from South Yemen in 1967.
The Houthi Wars (2004–2010)
Authors: Orkaby Asher
Published: February 2022

This chapter focuses on the Houthi wars with the Yemeni government. The Houthis are a family that
traces its origins to the Bayt Zayd al-Husniyyah family from Huth, a settlement near Khamir in
the 'Amran governorate in northern Yemen. The Houthi family brought to Sa'dah an extreme
religious devotion to self-proclaimed authentic Zaydi principles, stoking sectarian divisions in
a country where they had not previously been a factor. The movement, posthumously titled
"Houthi" after the death of Hussein Badr al-Din al-Houthi in 2004, has evolved into a unifying
call of protest for northerners who suffered from unequal distribution of state funds and
political power under Ali Abdullah Saleh. Underlying the Houthi conflict with the Yemeni
republic is a fundamental religious dispute between the historic Zaydi population of Yemen's
northern highlands and a republic that has marginalized the sayyid families while at the same
time adopting the judicial opinions of Yemeni Sunni scholars.
The Basics
Authors: Husbands Phil
Published: February 2022

This chapter discusses what a robot is. A typical
working definition goes something like this: a physical device capable of autonomous or
pre-programmed behavior in the world involving interactions with its environment through sensors
and actuators. The chapter then identifies the many different types of robots. These include
wheeled robots, legged robots, humanoid robots, flying robots, swimming or underwater robots,
and robot arms. Most of these are built from hard, rigid structures and casings. Some robot fish
are the exception: they have soft, flexible bodies or body parts. Soft bodies can provide highly
energy-efficient locomotion. Hence, the field of soft robotics has recently taken off. The
chapter also outlines the types of behaviors robots can exhibit, including remote-control
behavior; inflexibly dumb pre-programmed behavior; and intelligent, adaptive behavior. Finally,
it provides a broad account of how robots function, and considers robot design and virtual
robots.
Robots at Work
Authors: Husbands Phil
Published: February 2022

This chapter explores some of the most important and
interesting examples of the kinds of jobs robots already do, including newly emerging
applications that are likely to have considerable impact. Mobile autonomous, or semi-autonomous,
robots are a particularly important class of devices which are destined to become much more
widespread. The chapter looks at autonomous industrial and agricultural robots, before assessing
when fully autonomous vehicles will appear widely. While there are already autonomous vehicles
that seem to work well in restricted areas and conditions, there are still challenges in dealing
with crowded, chaotic mixes of pedestrians and all kinds of other vehicles, some of which are
not necessarily following the rules of the road. The chapter then examines the use of robots in
health and social care, in education, in the military, in art, and in pure science. Ultimately,
robots will gradually transform the nature of many jobs—either taking them over or changing
their form by being used to augment human abilities. How extensive these transformations will
be, and how fast, is discussed in the context of pertinent socio-economic forces.
Early Administration of Remdesivir and Intensive Care Unit Admission in Hospitalized Pregnant Individuals With Coronavirus Disease 2019 (COVID-19)
Authors: Eid Joe , Abdelwahab Mahmoud , Colburn Nora , Day Shandra , Cackovic Michael , Rood Kara M. , Costantine Maged M.
Published: February 2022

Remdesivir has been shown to shorten the time to recovery in hospitalized patients with coronavirus disease 2019 (COVID-19). Data on its use in pregnancy are limited. In this single-center retrospective cohort study, our objective was to determine whether early remdesivir use in pregnant individuals is associated with decreased risk of admission to the intensive care unit (ICU). Forty-one pregnant patients were included in this study, and outcomes were compared between those who received remdesivir less than 7 days (early group) and 7 or more days (late group) from onset of patient-reported symptoms. Early remdesivir administration was associated with improved clinical outcomes, including lower rates of ICU admission, decreased length of hospitalization, and decreased progression to critical disease in pregnant individuals hospitalized with COVID-19.
Cast revision is effective for critical three-point index values in paediatric forearm fractures: a prospective study
Authors: Subaşi İzzet Özay , Alemdaroğlu Kadir Bahadir , Arican Gökhun , Iltar Serkan , Şibar Kemal , Özmeriç Ahmet
Published: February 2022

Three-point index (TPI) has been reported to be effective in predicting the displacement of forearm fractures. The aim of this prospective study was to investigate the clinical efficacy of recasting critical but acceptable casts according to three-point index (0.6 < TPI < 0.8) before a redisplacement occurs in childhood forearm fractures. A TPI of 0.6–0.8 was determined in 68 patients, and these were separated as group 1 (n = 34) applied with prophylactic recasting and group 2 (n = 34) where treatment was continued with same cast. The remaining 28 patients had TPI < 0.6 and were assigned as group 3. Groups were compared in respect of age, initial displacement, cast type, location of fracture, initial and late three-point index values and inter- and intraobserver reliabilities of TPI measurements. Significantly less displacement was seen in group 1 than in group 2 (P = 0.004). It was found that a 0.1 increase of index value in the initial and late TPIs increases the probability of redisplacement by 5.06 and 7.78 times, respectively. Late TPI, measured 1 week after casting, had better predictive value than the initial TPI with a sensitivity of 77.8%, specificity of 92.3%, positive predictive value of 70% and negative predictive value of 94.7%. Patients in the grey zone will be able to safely complete the cast treatment with prophylactic recasting without surgical intervention. TPI should be remeasured at the end of first week, as its predictive value becomes more accurate after swelling subsides.
The Clinical Significance of Infolded Limbus on Postreduction Arthrogram in Developmental Dysplasia of the Hip
Authors: Morris William Z. , Chilakapati Sai , Hinds Sean A. , Herring John A. , Kim Harry K.W.
Published: February 2022

Background:

The purpose of this study was to investigate whether presence of an infolded limbus on hip arthrogram at index closed reduction was associated with increased residual dysplasia or secondary surgery.

Methods:

We retrospectively reviewed all patients who underwent closed reduction for dysplasia of the hip with a minimum 2-year follow-up between 1980 and 2016. Demographic data was obtained including the age at reduction and severity of dislocation based on the International Hip Dysplasia Institute (IHDI) classification. Arthrograms performed at time of closed reduction were separately reviewed by 3 fellowship-trained pediatric orthopaedic surgeons to evaluate for an infolded limbus. The primary radiographic outcome was acetabular indices at 2 and 4 years postreduction. We also assessed the presence of avascular necrosis and rate of secondary reconstructive surgery for residual dysplasia.

Results:

A total of 182 hips in 165 patients underwent closed reduction at a mean age of 9.8±4.5 mo and were followed a mean of 9.0±4.9 y. An infolded limbus was identified in 20.3% (37/182) hips with substantial agreement among the 3 graders (Fleiss κ=0.75). The frequency of labral infolding increased with the severity of dislocation (8.8%% of IHDI II, 26.7% IHDI III, and 25.0% of IHDI IV hips; P=0.03). Hips with infolded limbus were older at reduction (12.4±5.3 vs. 9.2±5.8 mo, P=0.001). The mean acetabular index was higher in hips with infolded limbus than hips without at 2 years postreduction (34.8±4.8 vs. 32.6±5.8 degrees, respectively; P=0.04). However, multivariate analysis revealed that only the severity of dislocation predicted dysplasia at 2 years postreduction. No significant difference in acetabular index was seen at 4 years postreduction (27.2±7.4 vs. 25.4±6.5 degrees, P=0.24). There was no difference in avascular necrosis between groups (P=0.74). There was no difference in rate of secondary surgery between hips with labral infolding and those without (35% vs. 30%, respectively; P=0.52).

Conclusions:

An infolded limbus was more common in older patients with more severe dislocations. However, it is not associated with increased residual dysplasia or secondary surgery and may have limited utility in decision-making during closed reduction.

Level of Evidence:

Level II—prognostic study.
Reliability and Validity of an MRI-Based Knee Sagittal Alignment Measure in a Pediatric Cohort
Authors: Williams Brendan A. , Oduwole Samuel , Mehta Nishank N. , Talwar Divya , Nguyen Jie C. , Wells Lawrence
Published: February 2022

Background:

Magnetic resonance imaging (MRI) sagittal alignment is a measure that has been described and validated in the adult population as a means of distinguishing normal knees from those with anterior cruciate ligament (ACL) injury, but this measure has not been formally assessed among pediatric patients. The purpose of this study was to (1) assess the reliability of this MRI-based measure in a pediatric cohort, and (2) validate its ability to distinguish between ACL and non-ACL-injured knees in this population.

Methods:

A consecutive series of knee MRI examinations performed at our center were reviewed to identify studies of pediatric patients (1) with ACL injury, and (2) without significant pathology. Patient age, sex, physeal status (open, closing, or closed), knee laterality, and magnet strength (1.5 or 3-Tesla) were collected. The sagittal alignment was measured in both medial and lateral tibiofemoral compartments using a previously described method. Mean anterior tibial translation was then calculated for each study. Inter-rater and intrarater reliability testing was performed on a subset of randomly-selected patients from each cohort by three raters by calculating intraclass correlation coefficients. Sagittal alignment measurements of all patients were then completed by a single author after reliability was confirmed. The medial and lateral compartment translation and mean anterior tibial translation measurements of normal and ACL-injured knees were compared.

Results:

Inclusion criteria were met by 131 studies: 86 from uninjured knees (normal cohort) and 45 knees with ACL injury (ACL cohort). Studies were performed at a mean age of 13.4 with a near equivalent sex distribution. Inter-rater and intrarater reliability were good to excellent for all measures for patients in both normal and ACL cohorts. Normal and ACL-injured knees demonstrated a significant difference in anterior tibial translation in all measured regions. The mean anterior tibia translation for ACL-injured knees was 2.01 mm (95% confidence interval: 1.03-2.98) versus −0.44 mm (95% confidence interval: −0.89-0.014).

Conclusion:

This study identified good to excellent inter-rater and intrarater reliability of knee sagittal alignment measurements among pediatric patients. It also demonstrated a significant difference in medial compartment, lateral compartment, and mean tibial translation in patients with and without ACL injury, validating previous findings demonstrated in adult cohorts. These findings may be useful in assisting providers in the confirmation of suspected ACL injury and insufficiency and guide operative management in cases of clinical uncertainty.

Level of Evidence:

Level III—retrospective comparative study.
Rates of Infection After ACL Reconstruction in Pediatric and Adolescent Patients: A MarketScan Database Study of 44,501 Patients
Authors: Eisenberg Matthew T. , Block Andrew M. , Vopat Matthew L. , Olsen Margaret A. , Nepple Jeffrey J.
Published: February 2022

Background:

Numerous studies have demonstrated an increase in the number of anterior cruciate ligament (ACL) reconstruction procedures performed in pediatric patients. Despite this, most knowledge of surgical site infection rates after these procedures are based on adult studies and data is currently limited in pediatric patients. The purpose of this study was to describe and analyze the rates of infection after ACL reconstruction among pediatric patients and adolescent patients (compared with young adult patients) utilizing the MarketScan Commercial Claims and Encounters Database.

Methods:

The Truven Health Analytics MarketScan Commercial Claims and Encounters database was assessed to access health care utilization data for privately insured individuals aged 5 to 30 years old. ACL reconstruction records performed between 2006 and 2018 were identified using Current Procedures Terminology (CPT) codes. International Classification of Diseases Ninth Revision (ICD-9), Tenth (ICD-10) codes and CPT codes were used to identify patients requiring treatment for infection. All patients had at least 180 days of insurance coverage after intervention.

Results:

A total of 44,501 individuals aged below 18 years old and 63,495 individuals aged 18 to 30 years old that underwent arthroscopic ACL reconstruction were identified. There were no differences in infection rates between those below 18 years old (0.52%) and those above 18 years old (0.46%, P=0.227). However, among patients below 18 years old, patients below 15 years old had a significantly lower rate of infection at 0.37% compared with adolescents (15 to 17 y old) at 0.55% (P=0.039). Among young adults, males had higher rates of infection than females (0.52% vs. 0.37%), while no difference was observed in the pediatric and adolescent population (0.58% vs. 0.47%, P=0.109).

Conclusion:

Utilizing an insurance database, this study demonstrated that rates of infection after ACL Reconstruction in a pediatric/adolescent population are low (0.52%) and similar to rates in young adults. Infection rates after ACLR reconstruction appear to be slightly lower in patients under 15 years of age (0.37%).

Level of Evidence:

Level III—Retrospective comparative study.
Management of Pincer Nail Deformity by Realignment of Nailbed Using a Dermofascial Graft
Authors: Mourad Wasim , Thirkannad Sunil M.
Published: February 2022

Pincer nail deformity is an uncommon entity which can be painful and cosmetically unappealing. We describe our technique of correcting this deformity by realignment of the nailbed using a dermofascial graft. Pain relief as well as a cosmetically good result have been obtained in all patients, and this has been maintained over the long term. The technique has proven to be safe, effective, and reproducible.
Reduction Techniques in Volar Locking Plate Fixation of Distal Radius Fractures
Authors: Alter Todd H. , Varghese Bobby B. , DelPrete Cristina R. , Katt Brian M. , Monica James T.
Published: February 2022

Distal radius fractures are the most common upper extremity fracture and volar locking plate fixation has become a common modality for operative management of these injuries over the last 2 decades. However, despite the widespread use of volar locking plates, there remains no comprehensive guide detailing the available reduction techniques using these systems. This review aims to consolidate the reduction techniques from the literature along with the authors’ experiences into a blueprint for distal radius fracture reduction when using a volar plate. Techniques described include those with and without use of the plate and with supplementary means of fixation for both extra-articular and intra-articular fracture patterns.
Incidence and Predictors of Persistent Opioid Use in Survivors of Head and Neck Cancer Treated With Curative Radiation
Authors: Ganju Rohit , Neeranjun Rishi , Morse Ryan , Lominska Christopher , TenNapel Mindi , Chen Allen M.
Published: February 2022

Purpose:

We sought to characterize the incidence of chronic opioid dependence among head and neck cancer survivors treated by radiation, as well as to identify patient and treatment factors associated with persistent use.

Materials and Methods:

The medical records of patients with head and neck cancer who received radiation therapy from January 2012 to July 2016 were reviewed. All patients received 60 to 70 Gy with curative intent. Patients who progressed or died within 1 year were intentionally excluded. Opioid doses were calculated in morphine equivalent daily doses in milligrams (mg). Univariate and multivariate regression models were used to identify associations between demographic, medical, disease, and persistent opioid use.

Results:

Two hundred and sixty-one patients were included. The median follow-up was 39 months (range: 12 to 83 mo). Two hundred and eleven patients (80%) received opioids for pain control during radiation. The median morphine equivalent daily dose during treatment was 73.8 mg (range: 5 to 561 mg). Rates of persistent opioid use at 6 months, 1 year, and 2 years from completion of radiation were 41.8%, 30.1%, and 26.0%, respectively. On multivariate analysis, only preradiation opioid use correlated with persistent opioid use at all 3 time points (P<0.05). Smoking history and a Charlson comorbidity index ≥2 predicted for persistent opioid use at some time points, but not all.

Conclusions:

High rates of persistent opioid use exist in patients with head and neck cancer after radiation therapy. Early interventions to appropriately wean patients should be further investigated.
Glaucoma Cascade Screening in a High Risk Afro-Caribbean Haitian Population: A Pilot Study
Authors: Chang Ta C. , Celestin Linda , Hodapp Elizabeth A. , Grajewski Alana L. , Junk Anna , Rothman Adam L. , Duerr Eric R.H. , Swaminathan Swarup S. , Gedde Steven J. , Young Terri L. , Wiggs Janey , Olivier Mildred M.G. , Quintanilla Raquel , Arrieta Esdras , Savatovsky Eleonore J. , Vanner Elizabeth A. , Parrish Richard K.
Published: February 2022

Précis:

Glaucoma cascade screening in first-degree relatives (FDRs) of young Haitian glaucoma patients had high yield for diagnosing manifest and suspected glaucoma in 30.8% of those screened despite modest participation.

Purpose:

To evaluate the outcomes of glaucoma cascade screening in FDRs (parents, siblings, and offspring) of Haitian juvenile open-angle glaucoma (JOAG) patients.

Patients and Methods:

Consecutive index patients (Haitians with JOAG) were identified, and the number/type of FDRs residing in South Florida were recorded. These FDRs were invited for free glaucoma screening, which included a comprehensive ophthalmic exam, gonioscopy, automated visual field testing and optical coherence tomographic analysis of the retinal nerve fiber layers. FDR characteristics and clinical findings from screening are reported.

Results:

A total of 77 FDRs were invited, 26 (33.8%) agreed to undergo screening (18 females, 9 males), which revealed 2 (7.7%) with manifest glaucoma (mean age 77.5 y; one of whom was previously unaware of his glaucoma diagnosis), 6 (23.1%) with suspected glaucoma (mean age 29.8±18.3 y), and 18 (69.2%) without manifest or suspected glaucoma (mean age 37.2±21.8 y). Siblings of index patients were least likely to participate in cascade glaucoma screening when compared with index patients’ parents or offspring. FDR eyes with manifest glaucoma had significantly worse best-corrected visual acuities, higher intraocular pressures, thinner central corneal thicknesses, and thinner circumferential papillary retinal nerve fiber layer thicknesses than those without glaucoma.

Conclusion:

Glaucoma cascade screening of Haitian JOAG patients’ FDRs revealed that 30.8% had suspected or manifest glaucoma. Future efforts centered on provider-initiated recruitment and improving public glaucoma awareness and education may increase screening participation.
Recent insights into the use of immune checkpoint inhibitors in gastric cancer
Authors: Rodrigues Soraia , Figueiredo Ceu
Published: February 2022

Gastric cancer (GC) is the fifth most incident and the fourth deadliest cancer worldwide. GC is a heterogeneous disease from the histological and molecular standpoints. This malignancy is mostly diagnosed at advanced stages of the disease, where the available therapeutic interventions are not effective. The emergence of immunotherapy has transformed the landscape of cancer treatment, including GC, and currently immune checkpoint inhibitors have been approved for the treatment of patients with recurrent/metastatic GC. This review summarizes the main clinical trials evaluating the use of immune checkpoint inhibitors in GC. It also highlights the potential of biomarkers for patient selection for GC immune checkpoint inhibition therapy, including programmed cell death ligand 1 expression and tumor mutational burden, and characteristics of the GC molecular classification, such as microsatellite instability status and Epstein-Barr virus infection, as predictors of response to blockade of the programmed cell death 1/programmed cell death ligand 1 axis.
Perioperative screening and management in elective complex hepatobiliary surgery
Authors: Rajakumar Akila , Rammohan Ashwin , Rela Mohamed
Published: February 2022

Purpose of review

Preoperative optimization and structured evidence-based perioperative care of a patient undergoing complex hepatobiliary (HPB) surgery are essential components in their management. Apart from advances in surgical technique, these perioperative measures have resulted in substantial reductions in morbidity and mortality. There hence, remains a continued need to have evidence-based updation in their management algorithm to ensure optimal outcomes.

Recent findings

We present an evidence-based overview of the preoperative screening, optimization and perioperative management of patients undergoing complex HPB surgery.

Perioperative care of these fragile patients is an evidence-based dynamic process. Optimal patient management undergoing HPB surgery requires risk assessment and stratification, and meticulous attention to the correction of underlying conditions. Despite this, postoperative morbidity remains relatively high and requires a cohesive multidisciplinary approach to minimize complications.
Irritable bowel syndrome and diet
Authors: Weber H. Christian
Published: February 2022

Purpose of review

Irritable bowel syndrome (IBS) is a highly prevalent functional gastrointestinal disorder (FGID) characterized by chronic abdominal pain and altered bowel habits. The diagnosis of IBS is based on the presence of defined clinical Rome IV criteria in the absence of alarm features. The majority of patients with IBS report of food triggers eliciting typical IBS symptoms and trying to modify their dietary intake.

Recent findings

FGID including IBS are defined as disorders of the gut-brain interaction. A large proportion of individuals with IBS link their symptoms to dietary factors, and recent clinical studies have shown benefits of a diet low in FODMAPs (Fermentable Oligo-, Di-, and Monosaccharides and Polyols) on IBS symptoms and quality of life. Dietary interventions mediate directly changes of luminal gut contents affecting chemosensing-enteroendocrine cells in the modulation of the gut brain microbiome axis in IBS patients. Long-term assessment of clinical outcomes in patients on a low FODMAP diet is needed. Professional guidelines have incorporated the suggestion to offer IBS patients a diet low in FODMAPs.

The FGIDs, including IBS, are defined as gut-brain disorders. Low FODMAP diet has been shown in clinical trials to reduce IBS symptoms but long-term efficacy and nutritional side-effects remain uncertain.
PIEZO1, sensing the touch during erythropoiesis
Authors: Caulier Alexis , Garçon Loïc
Published: February 2022

Purpose of review

Awarding the 2021 Nobel to Ardem Patapoutian for the discovery of the PIEZO mechanotransducers has emphasized the importance of touch-sensing mechanisms in cell physiology. It is well known that PIEZO1 is expressed at the surface of red blood cells where it adjusts their hydration status under mechanical constraints. Besides this, recent findings suggest that PIEZO1 plays a broader role in erythroid lineage. This review aims to actualize the knowledge on PIEZO1 functions all along erythropoiesis.

Recent findings

PIEZO1 is expressed in erythroid progenitors, and controls proliferation and differentiation of nucleated cells, as well as maturation of reticulocytes. As PIEZO1 detects displacements in the range of cell–cell interactions, it might mediate the interaction between the differentiating cells and their microenvironment through an inside-out activation of integrins on human erythroblasts as suggested by in-vitro data. Moreover, PIEZO1 is also expressed at the surface of macrophages where it regulates red blood cells clearance through erythrophagocytosis.

These new findings on PIEZO1 suggest a continuous effect of mechanotransduction all over erythropoiesis from progenitors to clearance of red blood cells. Therefore, they open a new era in the understanding of hereditary xerocytosis pathophysiology, helping identify new potential therapeutic targets for the future.
Prediction of Pediatric Patient Admission/Discharge in the Emergency Department
Authors: Hannon Colm , Roland Damian , O'Sullivan Ronan
Published: February 2022

Objective

The aim of this study was to evaluate the ability of the Irish Paediatric Early Warning Score (PEWS), the Paediatric Observation Priority Score (POPS), and the Irish Children's Triage System (ICTS) to predict patient disposition pathways in an emergency department (ED) setting.

Methods

Data were prospectively collected on patients aged less than 16 years presenting to an Irish mixed adult/pediatric ED over 3 weeks during December 2018. After calculating a once-off PEWS, POPS, and ICTS, we investigated the ability of the scoring systems to predict admission or discharge from the ED. Primary comparison of the index tests was conducted using receiver operating characteristic (ROC) curves.

Results

A total of 550 patients were included in this study. There were 114 admissions (20.7%) and 436 discharges (79.3%). The POPS had an area under the ROC curve of 0.7 [95% confidence interval (CI), 0.65–0.75]. The PEWS had an area under the ROC curve of 0.58 (95% CI, 0.53–0.64). The ICTS had an area under the ROC curve of 0.58 (95% CI, 0.53–0.63).

Conclusions

The POPS has greater accuracy as a predictor of admission from the ED than PEWS and ICTS. Possible future implementation of POPS into pediatric EDs as a cognitive prompt before admission decision seems to be merited. Further multicenter validation in Ireland would be helpful.
Tenofovir diphosphate in dried blood spots predicts future viremia in persons with HIV taking antiretroviral therapy in South Africa
Authors: Jennings Lauren , Robbins Reuben N. , Nguyen Nadia , Ferraris Christopher , Leu Cheng-Shiun , Dolezal Curtis , Hsiao Nei-yuan , Mgbako Ofole , Joska John , Castillo-Mancilla Jose R. , Myer Landon , Anderson Peter L. , Remien Robert H. , Orrell Catherine
Published: February 2022

Objectives:

Tenofovir diphosphate (TFV-DP) in dried blood spots (DBS) is used as a biomarker of antiretroviral therapy (ART) adherence. Recent treatment studies have shown that TFV-DP predicts future viremia in persons with HIV (PWH) but there are few data from high-burden settings. We investigated whether TFV-DP in DBS predicts future viral breakthrough in South African PWH.

Design:

Prospective observational cohort.

Methods:

We enrolled 250 adults receiving tenofovir-containing regimens, currently virally suppressed (<50 copies/ml) but at risk of future viral breakthrough, from four primary health clinics in Cape Town. Paired viral load and DBS for TFV-DP were collected monthly for 12 months. Viral breakthrough was the first confirmed viral load greater than 400 copies/ml. Logistic regression estimated the odds ratio (OR) and 95% confidence intervals for future viral breakthrough at the next visit.

Results:

Participants provided 2944 paired DBS and viral load samples. Median (IQR) age was 34 (27–42) years; median duration on ART at study entry was 11 (4–12) months;78% were women. Twenty-one (8%) participants developed viral breakthrough. Participants with TFV-DP 400 fmol/punch or less had an adjusted OR of 16.1 (95% CI: 3.9–67.4; P < 0.001) for developing viral breakthrough 1 month later compared with participants with TFV-DP greater 800 fmol/punch.

Conclusion:

TFV-DP in DBS strongly predicted future viral breakthrough in a clinical cohort of South African PWH. A biomarker able to identify PWH at risk for future viral breakthrough has the potential to improve health outcomes through timely intervention. Future studies exploring the clinical use of TFV-DP in DBS in conjunction with viral load in ART monitoring are warranted.
Improving Influenza Vaccination Rates in an Underserved Primary Care Clinic Using a Simple Educational Tool
Authors: Baltes Matthew , Pronovost Emma , Kanuch Stephanie , Caron Aleece
Published: February 2022

Background and Objectives:

Influenza is a preventable communicable illness that has a significant impact on people of all ages. In 2018, it was estimated that 80 000 people died of influenza-related illnesses. In the 2018-2019 influenza season, only 34.9% of individuals in the 18 to 49 years age group received the influenza vaccine. Despite the low vaccination rate for influenza, the vaccine has multiple evidence-based benefits that demonstrate the importance of improving its uptake among adults. According to data from the Centers for Disease Control and Prevention (CDC), the vaccine prevented around “6.2 million influenza illnesses, 3.2 million influenza-associated medical visits 91 000 influenza-associated hospitalizations, and 5700 influenza-associated deaths” in the 2017-2018 influenza season. In a suburban family medicine clinic, a primary care provider (PCP) observed that greater than 50% of adult patients in his family medicine practice declined influenza vaccine when offered during the 2018-2019 season compared with the site rate of 43.4% and the department rate of 47.9%.

Methods:

The goal of this project was to educate patients who initially decline the vaccine to agree to receive the vaccine and to increase the percentage of patients who get an influenza vaccine from 43.4% to 50% in adult patients at a suburban primary care clinic by having them read the CDC document and asking them after they read the document whether they would like to receive the vaccine. From October 1, 2018, to February 28, 2019, adult patients in a primary care clinic were asked whether they wanted to receive the influenza vaccination and responses were recorded. During this time, 589 patients were questioned, with 56% (n = 330) answering no, or 43% of patients receiving the influenza vaccination.

Results:

In total, 658 patients were offered the flu shot during the intervention period, representing 27.7% of the patients seen in this clinic. While there was some monthly variation, the PCP was able improve the percentage of patients receiving the influenza vaccination from 43% to 60.9% with this simple educational intervention. The overall clinic rate for this time frame increased from 56.6% to 58.2%.

Conclusions:

This simple intervention was effective in improving influenza vaccine rates for one provider in a suburban safety-net clinic. It added minimal workload to the provider, and the intervention is easily replicable in other settings.
Improving Utilization of an After-Hours Phone Triage Service: A Resident Quality Improvement Initiative
Authors: Abraham Claire , Avis Emily , Caddle Steve , Lane Mariellen , Friedman Suzanne
Published: February 2022

Background/Objective:

Phone triage systems are increasingly used by primary care clinics to improve patient satisfaction and direct low-acuity patients to appropriate care settings. Despite the prevalence of telephone triage, the majority of pediatric training programs do not include this practice in their curricula. Our aim was to increase the volume of after-hours patient phone calls per week by 25% and to secondarily reduce “treat and release” emergency department (ED) visits by 5% over the course of a 9-month quality improvement (QI) study.

Methods:

A resident-led QI project was conducted from 2017 to 2019 at a mixed faculty-resident pediatric primary care practice providing care for an urban, primarily immigrant, underserved population. Eight Plan-Do-Study-Act cycles were developed on the basis of identified key drivers and included efforts to increase the visibility of the call service to patient families. After-hours calls were tracked and compared with similar practices, and ED visits for the first week of each month were reviewed using the electronic medical record system.

Results:

After promoting the service via various modalities, the number of after-hours calls increased by 30%, from an average of 6.5 calls per week to 8.5. Treat and release ED visits decreased by 6%, from a baseline of 64.3 to 60.3 visits per week.

Conclusions:

The increased patient awareness of and availability of a reliable after-hours call service in pediatric practices are promising tools for reducing unnecessary ED visits, leveraging resident direction and implementation to promote the service through varying modalities.
Physician Satisfaction With Telehealth: A Systematic Review and Agenda for Future Research
Authors: Hoff Timothy , Lee Do-Rim
Published: February 2022

Background and Objectives:

The use of telehealth has risen dramatically due to the Covid-19 pandemic and is expected to be a regular part of patient care moving forward. We know little currently about how satisfied physicians are with this type of patient care. The present systematic review examines physician satisfaction with telehealth, as physician acceptance remains vital to telehealth gaining wider and more permanent adoption.

Methods:

A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)–guided systematic review of empirical articles published between 2010 and 2020 that contain a finding examining physician satisfaction with using telehealth, using 4 article databases (PubMed, Web of Science, COCHRANE, and CINAHL), to identify relevant studies. A standardized data abstraction Excel sheet was used to extract relevant information from each of the included studies. Relevant study findings related to physician satisfaction with telehealth were reviewed for each of the 37 studies by the coauthors.

Results:

A total of 37 published studies were included in the review. Thirty-three of the 37 (89%) studies reviewed were classified as having findings showing moderate to high levels of physician satisfaction with telehealth. Just under 60% of the studies focused on physician satisfaction with providing telemedicine to patients (21/37). Twelve other studies focused on physician satisfaction with teleconsultations with other providers. Four studies examined physician satisfaction with both. The type of patient telemedicine or provider teleconsultation performed varied greatly across the 37 studies, with several different diagnoses or care situations included. Research designs used in the studies were less robust, with all studies using primary data for assessing physician satisfaction but only one study providing any type of multivariate analysis of physician satisfaction with telehealth.

Conclusion:

The results of this review support the observation that physicians across different specialties, geographic locations, practice locations, and care situations appear satisfied with engaging in telehealth for both patient care and consultations with other physicians. The research on telehealth should be enhanced, given how ubiquitous telehealth has become due to the Covid-19 pandemic. This enhancement should include larger physician sample sizes in studies of telehealth satisfaction; more research focused on telehealth in the primary care setting; and the types of virtual modalities that have become more commonplace for physicians to use due to the Covid-19 pandemic.
Pterygoid Implant-Based “VIV” Design for Rehabilitation of Extreme Maxillary Atrophy
Authors: Ren Jie , Shu Ling
Published: February 2022

Rehabilitation of severe maxillary atrophy using implant-supported fixed prostheses is challenging due to limited bone volume. Although the all-on-4 concept offers a potential treatment option, sufficient residual bone in the anterior region remains a prerequisite for these prostheses. Pterygoid implants have been used in conjunction with the all-on-4 technique to eliminate the cantilevered prosthetic design, with good long-term results reported. However, when the bone volume in the anterior region is limited or the bucco-palatal dimension is insufficient, use of the traditional all-on-4 approach is problematic. This article describes the clinical management and good short-term success achieved in the treatment of severe maxillary atrophy with a novel ‘‘VIV’’ design, using a combination of 3 anterior and 2 pterygoid implants.
Solitary Neurofibroma of the Zygoma: Three-Dimensional Virtual Resection and Patient-Specific Polyetheretherketone Implant Reconstruction
Authors: Shi Huan , Yin Xuelai , Hu Yongjie
Published: February 2022

Intraosseous benign lesions rarely involve the zygoma, and intraosseous venous malformation is most commonly reported condition in the previous literature. A neurofibroma (NF) arising from the zygoma has not been reported before. Here, the authors present a 37-year-old female who developed solitary NF of the right zygoma. Surgical intervention is usually required for the treatment of a solitary NF. However, the complex three-dimensional (3D) anatomy of the zygoma increases the difficulty of the reconstruction for the operating surgeon. In this case, a preoperative digital surgical design was used to promote the efficiency of the surgery. A 3D printing surgical guide plate was used intraoperatively, and the defect was reconstructed by a patient-specific polyetheretherketone implant. Postoperative computed tomography imaging confirmed the accuracy of the reconstruction and that there was no recurrence of the tumor. The authors believe that the 3D print guide plate-assisted accurate resection combined with polyetheretherketone implant reconstruction is an ideal methodology for benign lesions of the zygoma.
Rahnella perminowiae sp. nov., Rahnella bonaserana sp. nov., Rahnella rivi sp. nov. and Rahnella ecdela sp. nov., isolated from diverse environmental sources, and emended description of the genus Rahnella
Authors: Brady Carrie , Asselin Jo Ann , Beer Steven , Brurberg May Bente , Crampton Bridget , Venter Stephanus , Arnold Dawn , Denman Sandra
Published: February 2022

Bacteria isolated from onion bulbs suffering from bacterial decay in the United States and Norway were previously shown to belong to the genus

Rahnella

based on partial housekeeping gene sequences and/or fatty acid analysis. However, many strains could not be assigned to any existing

Rahnella

species. Additionally, strains isolated from creek water and oak as well as a strain with bioremediation properties were assigned to

Rahnella

based on partial housekeeping gene sequences. The taxonomic status of these 21 strains was investigated using multilocus sequence analysis, whole genome analyses, phenotypic assays and fatty acid analysis. Phylogenetic and phylogenomic analyses separated the strains into five clusters, one of which corresponded to

Rahnella aceris

. The remaining four clusters could be differentiated both genotypically and phenotypically from each other and existing

Rahnella

species. Based on these results, we propose the description of four novel species: Rahnella perminowiae sp. nov. (type strain SL6T=LMG 32257T=DSM 112609T), Rahnella bonaserana sp. nov. (H11bT=LMG 32256T=DSM 112610T), Rahnella rivi sp. nov. (FC061912-KT=LMG 32259T=DSM 112611T) and Rahnella ecdela sp. nov. (FRB 231T=LMG 32255T=DSM 112612T).
Acoustic Epidemiology of Pulmonary Tuberculosis (TB) & Covid19 leveraging AI/ML
Authors: Pathri Rahul , Jha Shekhar , Tandon Samarth , GangaShetty Suryakanth
Published: February 2022

Involuntary cough is a prominent symptom for many a Lung Ailments ranging from Infectious to non-Infectious diseases. Early research around human cough established that the spectral signatures do not vary between Involuntary and Voluntary coughs. The study aimed at evaluating voluntary human cough sounds recorded under a stringent clinical protocol. India’s ambitious goal to eliminate and eradicate TB by 2025 shall be facilitated by Machine Learning tools that address subjectivity in that the healthcare worker can now take the solution as a screening modality to the last mile as a part of outreach programs without having to rely on infrastructure & connectivity. In this paper we present the findings of Clinical Trials for Pulmonary TB registered at CTRI/2019/02/017672 conducted independently and included Covid19 during the pandemic as a part of Bi-Directional screening modality. The reference standards used were CBNAAT (Cartridge based nucleic acid amplification test) & CXR (Chest X-Ray) for TB while for Covid19; RT-PCR was used as the reference standard. As a non-invasive and contactless screening modality, a sophisticated third party Microphone Array was used to record the cough under a stringent infection control protocol. Sensitivity achieved across the sites for TB ranged between 80% - 83% and Specificity was to the tune of 92% while using CBNAAT as a reference standard. CXR when used as a reference standard for TB achieved a sensitivity and specificity of 59% and 60% respectively. Covid19 achieved a sensitivity & specificity of 92% and 96% while using RT-PCR as the reference standard. The study was primarily focused on the Frequency domain that paved way for feature extraction and explainable Machine Learning Models operating upon lossless WAV files hypothesizing acoustic theory and demographic inputs. The solution titled “TimBre” can now be added to the healthcare workers arsenal in situations where a RT-PCR or CXR is not available and seamlessly conduct bi-directional screening with a single recording of cough and also offer insights into Non-Communicable diseases as a part of differential diagnosis.
Comparable Neutralization of the SARS-CoV-2 Omicron BA.1 and BA.2 Variants
Authors: Yu Jingyou , Collier Ai-ris Y. , Rowe Marjorie , Mardas Fatima , Ventura John D. , Wan Huahua , Miller Jessica , Powers Olivia , Chung Benjamin , Siamatu Mazuba , Hachmann Nicole P. , Surve Nehalee , Nampanya Felix , Chandrashekar Abishek , Barouch Dan H.
Published: February 2022

The SARS-CoV-2 Omicron variant (B.1.1.529) has three major lineages BA.1, BA.2, and BA.31. BA.1 rapidly became dominant and has demonstrated substantial escape from neutralizing antibodies (NAbs) induced by vaccination2-4. BA.2 has recently increased in frequency in multiple regions of the world, suggesting that BA.2 has a selective advantage over BA.1. BA.1 and BA.2 share multiple common mutations, but both also have unique mutations1 (Fig. 1A). The ability of BA.2 to evade NAbs induced by vaccination or infection has not yet been reported. We evaluated WA1/2020, Omicron BA.1, and BA.2 NAbs in 24 individuals who were vaccinated and boosted with the mRNA BNT162b2 vaccine5 and in 8 individuals who were infected with SARS-CoV-2 (Table S1).