bluuebunny/crossref_metadata_2025 huggingface dataset:
U.S. Army Medical Corps Recruitment, Job Satisfaction, and Retention: Historical Perspectives and Current Issues
Authors: Marble W Sanders , Cox E Darrin , Hundertmark Julie A , Goymerac Paul J , Murray Clinton K , Soderdahl Douglas W
Published: June 2020

Introduction

This study was conducted to identify and understand the current factors affecting recruitment, job satisfaction, and retention of U.S. Army Medical Corps officers and provide historical background to understand if the current factors are dissimilar.

Materials and Methods

An anonymous, voluntary questionnaire was sent to U.S. Army Medical Corps officers, and responses were tabulated and analyzed. Historical research was conducted and historical analysis applied.

Results

Recruiting, job satisfaction, and retention among Army Medical Corps Officers have been problematic throughout the 50-year history of the all-volunteer force. Recruiting has largely been of medical students, with very limited numbers of direct accessions. At times, satisfactory overall numbers have camouflaged shortages in key go-to-war specialties. Also, satisfactory numbers in a specialty have sometimes camouflaged problems in depth of experience. Satisfaction has been seen as a problem but apparently only studied informally and/or episodically. Retention has largely been addressed through service obligations, followed by monetary bonuses, although these have to be across the Department of Defense, limiting service flexibility. There has never been consistent, longitudinal sampling of opinion among Medical Corps Officers to allow senior leaders to influence the Department of Defense policy. A recent (2016) study provides substantial data but should be repeated rather than being isolated.

Conclusion

As the situation in the Department of Defense and Army Medical Department changes, with more focus on go-to-war specialties, the Army needs to better measure opinion among Medical Corps Officers to inform policy. These studies should be conducted regularly to generate reliable information on trends and allow prioritization of effort to areas that hamper recruiting, undermine satisfaction, and prevent retention.
Air Force Medical Personnel: Perspectives Across Deployment
Authors: Moore Brian A , Hale Willie J , Judkins Jason L , Lancaster Cynthia L , Baker Monty T , Isler William C , Peterson Alan L ,   STRONG STAR Consortium
Published: June 2020

Introduction

Contingency operations during the past 18 years have exposed millions of U.S. military service members to numerous combat and operational stressors. Despite this, a relative dearth of literature has focused on the experiences of deployed military medical personnel. As such, the present study aimed to address this gap in the literature by conducting individual and small group interviews with Air Force medical personnel who had recently returned from a deployment to Iraq. Interviews targeted self-reported factors related to psychological risk and resiliency across the deployment cycle, while also seeking recommendations for future military medical personnel preparing for medical deployments.

Materials and Methods

Inductive thematic analyses were conducted on transcripts from 12 individual and structured group interviews conducted with recently deployed U.S. Air Force medical personnel (N = 28). An interview script consisting of 18 prompts was carefully developed based on the experiences of study personnel. Two team members (n = 1 research psychologist; n = 1 military medical provider) coded exemplars from interview transcripts. A third team member (research psychologist) reviewed coded exemplars for consistency and retained themes when saturation was reached.

Results

In total we report on 6 primary themes. Participants reported feeling prepared to conduct their mission while deployed but often felt unprepared for the positions they assumed and the traumas they commonly experienced. Most participants reported deployment to be a rewarding experience, citing leader engagement, and social support as key protective factors against deployment-related stressors. Finally, following deployment, participants largely reported positive experiences reintegrating with their families but struggled to reintegrate into their workplace.

Conclusion

Findings from the present study indicate that the military is largely doing a good job preparing Air Force medical providers to deploy. Results of the present study indicate that military medical personnel would benefit from: (1) increased predictability surrounding deployment timelines, (2) improved cross-cultural training, (3) advanced training for atypical injuries in unconventional patient populations, and (4) improvements in postdeployment workplace reintegration. The present research has the potential to positively impact the overall quality of life for deploying military service members and their families; while simultaneously highlighting the successes and shortfalls in the deployment process for U.S. military medical personnel.
Maternity Leave Length Impact on Breastfeeding and Postpartum Depression
Authors: Shumbusho Diane I , Kucera Calen W , Keyser Erin A
Published: June 2020

Introduction

In January 2016, the U.S. Department of Defense increased the duration of paid maternity leave for active duty service members from 6 weeks to 12 weeks. Our study aims to determine the impact of maternity leave length on breastfeeding duration and postpartum depression rates in active duty service members.

Materials and Methods

An institutional review board-approved survey of 9 questions was given to patients at the Brooke Army Medical Center Obstetrics and Gynecology Clinic. Patients were offered voluntary participation if they had delivered a baby while on active duty in the preceding 20 years. The survey included questions about length of maternity leave, duration of breastfeeding, age at delivery, route of delivery, and whether the patient suffered from postpartum depression.

Results

A total of 214 surveys were collected. Fisher exact test was used to compare rates of breastfeeding and postpartum depression between the 2 groups. A total of 87% of service members initiated breastfeeding. Among women who had 6 weeks versus 12 weeks of maternity leave, 51.64% versus 56.96% breastfed up to 6 months, p = 0.45.

The overall rate of postpartum depression was 13.5%. Among women who had 6 weeks versus 12 weeks of maternity leave, 16.1% versus 9.5% reported postpartum depression, p = 0.11.

Conclusion

The ideal maternity leave duration is unknown. With recent changes to the Department of Defense maternity leave policy, we aimed to evaluate the effect this had on breastfeeding and postpartum depression rates. No statistically significant difference was seen when we compared rates of breastfeeding in women who had 6 weeks versus 12 weeks of maternity leave. Further research is required to determine the ideal maternity leave duration and best practices to promote breastfeeding.

When looking at postpartum depression, our study shows that postpartum depression was noted in 16% of patients who took 6 weeks versus 9% of those who took 12 weeks of maternity leave. No statistically significant difference was seen; however, this was likely because of the small sample size. Only 29 out of 214 women suffered from depression regardless of length of maternity leave. More research is needed to determine if maternity leave length does indeed impact postpartum depression rates.
STAG3 homozygous missense variant causes primary ovarian insufficiency and male non-obstructive azoospermia
Authors: Jaillard Sylvie , McElreavy Kenneth , Robevska Gorjana , Akloul Linda , Ghieh Farah , Sreenivasan Rajini , Beaumont Marion , Bashamboo Anu , Bignon-Topalovic Joelle , Neyroud Anne-Sophie , Bell Katrina , Veron-Gastard Elisabeth , Launay Erika , van den Bergen Jocelyn , Nouyou Bénédicte , Vialard François , Belaud-Rotureau Marc-Antoine , Ayers Katie L , Odent Sylvie , Ravel Célia , Tucker Elena J , Sinclair Andrew H
Published: June 2020

Infertility, a global problem affecting up to 15% of couples, can have varied causes ranging from natural ageing to the pathological development or function of the reproductive organs. One form of female infertility is premature ovarian insufficiency (POI), affecting up to 1 in 100 women and characterised by amenorrhoea and elevated FSH before the age of 40. POI can have a genetic basis, with over 50 causative genes identified. Non-obstructive azoospermia (NOA), a form of male infertility characterised by the absence of sperm in semen, has an incidence of 1% and is similarly heterogeneous. The genetic basis of male and female infertility is poorly understood with the majority of cases having no known cause. Here, we study a case of familial infertility including a proband with POI and her brother with NOA. We performed whole-exome sequencing (WES) and identified a homozygous STAG3 missense variant that segregated with infertility. STAG3 encodes a component of the meiosis cohesin complex required for sister chromatid separation. We report the first pathogenic homozygous missense variant in STAG3 and the first STAG3 variant associated with both male and female infertility. We also demonstrate limitations of WES for the analysis of homologous DNA sequences, with this variant being ambiguous or missed by independent WES protocols and its homozygosity only being established via long-range nested PCR.
Complete Replacement of the Galactolipid Biosynthesis Pathway with a Plant-Type Pathway in the Cyanobacterium Synechococcus elongatus PCC 7942
Authors: Apdila Egi Tritya , Inoue Shukumi , Shimojima Mie , Awai Koichiro
Published: June 2020

Monogalactosyldiacylglycerol (MGDG) and digalactosyldiacylglycerol (DGDG) are the major components of thylakoid membranes and well-conserved from cyanobacteria to chloroplasts. However, cyanobacteria and chloroplasts synthesize these galactolipids using different pathways and enzymes, but they are believed to share a common ancestor. This fact implies that there was a replacement of the cyanobacterial galactolipid biosynthesis pathway during the evolution of a chloroplast. In this study, we first replaced the cyanobacterial MGDG biosynthesis pathway in a model cyanobacterium, Synechococcus elongatus PCC 7942, with the corresponding plant-type pathway. No obvious phenotype was observed under the optimum growth condition, and the content of membrane lipids was not largely altered in the transformants. We next replaced the cyanobacterial DGDG biosynthesis pathway with the corresponding plant-type pathway using the strain described above and isolated the strain harboring the replaced plant-type pathway instead of the whole galactolipid biosynthesis pathway. This transformant, SeGPT, can grow photoautotrophically, indicating that cyanobacterial galactolipid biosynthesis pathways can be functionally complemented by the corresponding plant-type pathways and that the lipid products MGDG and DGDG, and not biosynthesis pathways, are important. While SeGPT does not show strong growth retardation, the strain has low cellular chlorophyll content but it retained a similar oxygen evolution rate per chlorophyll content compared with the wild type. An increase in total membrane lipid content was observed in SeGPT, which was caused by a significant increase in DGDG content. SeGPT accumulated carotenoids from the xanthophyll groups. These results suggest that cyanobacteria have the capacity to accept other pathways to synthesize essential components of thylakoid membranes.
Effect of superabsorbent polymer on mechanical properties of cement stabilized base and its mechanism
Authors: Guan Yongsheng , Zhang Zhixiang , Zhang Xiaorui , Zhu Junqing , Zhou Wen , Huang Qi , Zhang Yuqing
Published: June 2020

Superabsorbent polymers (SAPs) are cross-linked polymers that can absorb and retain large amounts of water. In recent years, a growing interest was seen in applying SAPs in concrete to improve its performance due to its efficiency in mitigating shrinkage. This paper presents findings in a study on effect of SAPs on performance of cement-treated base (CTB), using the experience of internal curing of concrete. CTB specimens with and without SAPs were prepared and tested in the laboratory. Tests conducted include mechanical property testing, dry shrinkage testing, differential thermal analysis, mercury intrusion porosimetry and scanning electron microscope testing. It was found that 7-day and 28-day unconfined compressive strength of CTB specimens with SAPs was higher than regular CTB specimens. 28d compressive strength of CTB specimens with SAPs made by Static pressure method was 5.87 MPa, which is 27% higher than that of regular CTB specimens. Drying shrinkage of CTB specimens with SAPs was decreased by 52.5% comparing with regular CTB specimens. Through the microstructure analysis it was found that CTB specimens with SAPs could produce more hydration products, which is also the reason for the strength improvement.
Adaptability evaluation of pavement structure to replacement treatment subgrade of black cotton soil
Authors: Luan Yingcheng , Ma Yuan , Zhang Weiguang , Zhang Yuqing , Ma Tao , Lee Jusang
Published: June 2020

Aiming at the typical engineering problem of black cotton soil (BCS) subgrade under the alternation of dry and wet climate in the region of Nairobi, Kenya, this paper takes the pavement structure as the research object, and the numerical calculation model of BCS subgrade is established based on the consolidation coupling theory of unsaturated soil. Taking the modulus and thickness of the subbase as variables, the deformation characteristics and additional stresses of different pavement structures are analysed. Then the adaptability of different pavement structures to replacement treatment subgrade of BCS is evaluated by gray incidence decision analysis method. The results show that whatever the pavement structure is, neither subgrade modulus nor thickness is sensitive to the pavement surface deformation, and the deformation differences between each pavement structure are more obvious in wet season; the additional stress at control layer bottom and pavement surface decreases with the increase of subbase modulus, whereas the stress may increase at subbase bottom; the additional stress at subbase bottom, control layer bottom and pavement surface all decreases with the increase of subbase thickness for pavement Structure I and II. For pavement Structure III, the change of subbase thickness is not sensitive to the additional stress at the control layer bottom and pavement surface, whereas the stress at subbase bottom increases with the increase of subbase thickness. It is concluded that the most adaptable structure is pavement Structure I, which can minimize the comprehensive level of pavement settlement and additional stress.
A Teaching Model to Promote NCLEX-RN Success
Authors: Wilson-Anderson Kaye
Published: June 2020

Nurse educators in RN programs are called to address the nursing shortage, assist increasingly diverse learners to succeed on the National Council Licensure Examination the first time, and prepare the new nurse graduate to transition into an ever-changing health care system. This article purposes a teaching model to empower both the nurse educator and the student. As graduates have gained locus of control, National Council Licensure Examination pass rates have increased from 82 percent to 93 percent. The discussion examines a variety of strategies to facilitate nurse graduate success.
Caring for the Deaf: Nursing Students’ Knowledge and Awareness
Authors: Diaz Sandra , Goyal Deepika
Published: June 2020

Navigating an increasingly complex health care system is challenging for marginalized populations, including the Deaf and hard of hearing who rely heavily on nurses’ and hospital-provided interpreters’ knowledge of the American Sign Language. This study examined Deaf culture knowledge and awareness among undergraduate and graduate nursing students in the United States. Study findings indicated low knowledge regarding cochlear implants, use of interpreters, and parental newborn hearing test rights. Integrating care of the deaf into all levels of nursing education will serve to promote patient health literacy and health outcomes while advancing the science of nursing education.
Procedural sedation outside the operating room
Authors: Hinkelbein Jochen , Schmitz Jan , Lamperti Massimo , Fuchs-Buder Thomas
Published: June 2020

Purpose of review

The present review provides an overview of the different fields of procedural sedation and analgesia (PSA), describing the evidence from recently published studies concerning anxiety and moderate pain, cardiac interventions, gastrointestinal interventions, and PSA use in infants. It also provides guidance for practitioners of both unscheduled and scheduled procedural sedation, and a summary of the current guideline for PSA.

Recent findings

Safety always has to be first priority. Recently published literature is focusing on the combination of different well established drugs such as dexmedetomidine, remifentanil, propofol, and ketamine. These traditional and well known drugs are commonly used for PSA. The combinational use of multiple drugs seems to have benefits for both the provider and patient. Furthermore, there is growing interest into specific protocols and adaption for special circumstances. The preferred medications used for PSA should be both effective and well tolerated.

Procedural sedation deserves to have high degree of attention for potential adverse events. New combinations of well established drugs provide a better pharmacokinetic profile, fit to different indications and offer multiple benefits for both provider and patient.
Variation in Fluid and Vasopressor Use in Shock With and Without Physiologic Assessment: A Multicenter Observational Study
Authors: Chen Jen-Ting , Roberts Russel , Fazzari Melissa J. , Kashani Kianoush , Qadir Nida , Cairns Charles B. , Mathews Kusum , Park Pauline , Khan Akram , Gilmore James F. , Brown Anne Rain T. , Tsuei Betty , Handzel Michele , Lee Chang Alfredo , Duggal Abhijit , Lanspa Michael , Herbert James Taylor , Martinez Anthony , Tonna Joseph , Ammar Mahmoud A. , Hammond Drayton , Nazer Lama H. , Heavner Mojdeh , Pender Erin , Chambers Lauren , Kenes Michael T. , Kaufman David , Downey April , Brown Brent , Chaykosky Darlene , Wolff Armand , Smith Michael , Nault Katie , Sevransky Jonathan , Gong Michelle N. ,   on behalf of the VOLUME-CHASERS Study Group and Society of Critical Care Medicine Discovery Network
Published: June 2020

Objectives:

To characterize the association between the use of physiologic assessment (central venous pressure, pulmonary artery occlusion pressure, stroke volume variation, pulse pressure variation, passive leg raise test, and critical care ultrasound) with fluid and vasopressor administration 24 hours after shock onset and with in-hospital mortality.

Design:

Multicenter prospective cohort study between September 2017 and February 2018.

Settings:

Thirty-four hospitals in the United States and Jordan.

Patients:

Consecutive adult patients requiring admission to the ICU with systolic blood pressure less than or equal to 90 mm Hg, mean arterial blood pressure less than or equal to 65 mm Hg, or need for vasopressor.

Interventions:

None.

Measurement and Main Results:

Of 1,639 patients enrolled, 39% had physiologic assessments. Use of physiologic assessment was not associated with cumulative fluid administered within 24 hours of shock onset, after accounting for baseline characteristics, etiology and location of shock, ICU types, Acute Physiology and Chronic Health Evaluation III, and hospital (beta coefficient, 0.04; 95% CI, −0.07 to 0.15). In multivariate analysis, the use of physiologic assessment was associated with a higher likelihood of vasopressor use (adjusted odds ratio, 1.98; 95% CI, 1.45−2.71) and higher 24-hour cumulative vasopressor dosing as norepinephrine equivalent (beta coefficient, 0.37; 95% CI, 0.19−0.55). The use of vasopressor was associated with increased odds of in-hospital mortality (adjusted odds ratio, 1.88; 95% CI, 1.27−2.78). In-hospital mortality was not associated with the use of physiologic assessment (adjusted odds ratio, 0.86; 95% CI, 0.63−1.18).

Conclusions:

The use of physiologic assessment in the 24 hours after shock onset is associated with increased use of vasopressor but not with fluid administration.
Acute Kidney Injury in Acute Ischemic Stroke Patients in Clinical Trials
Authors: Qureshi Adnan I. , Aslam Hunain , Zafar Werdah , Huang Wei , Lobanova Iryna , Naqvi Syed H. , Malhotra Kunal , Arora Niraj , Chandrasekaran Premkumar N. , Siddiq Farhan , French Brandi R. , Gomez Camilo R.
Published: June 2020

Objectives:

Acute ischemic stroke patients are at risk of acute kidney injury due to volume depletion, contrast exposure, and preexisting comorbid diseases. We determined the occurrence rate and identified predictors associated with acute kidney injury in acute ischemic stroke patients.

Setting:

Multiple specialized ICUs within academic medical centers.

Design:

Post hoc analysis of pooled data from prospective randomized clinical trials.

Patients:

Acute ischemic stroke patients recruited within 3 hours or within 5 hours of symptom onset.

Interventions:

IV recombinant tissue plasminogen activator, endovascular treatment, IV albumin, or placebo.

Measurements and Main Results:

Serum creatinine levels from baseline and within day 5 or discharge were used to classify acute kidney injury classification into stages. Any increase in serum creatinine was seen in 697 (36.1%) and acute kidney injury was seen in 68 (3.5%) of 1,931 patients with acute ischemic stroke. Severity of acute kidney injury was grade I, II, and III in 3.1%, 0.4%, and 0.05% patients, respectively. Patients with albumin (5.5% compared with 2.6%; p = 0.001), preexisting hypertension (4.3% compared with 1.5%; p = 0.0041), and preexisting renal disease (9.1% compared with 3.0%; p < 0.0001) had higher risk of acute kidney injury. The risk of acute kidney injury was lower between those who either underwent CT angiography (2.0% compared with 4.7%; p = 0.0017) or endovascular treatment (1.6% compared with 4.2%; p = 0.0071). In the multivariate analysis, hypertension (odds ratio, 2.6; 95% CI, 1.2–5.6) and renal disease (odds ratio, 3.5; 95% CI, 1.9–6.5) were associated with acute kidney injury. The risk of death was significantly higher among patients with acute kidney injury (odds ratio, 2.7; 95% CI, 1.4–4.9) after adjusting for age and National Institutes of Health Stroke Scale score strata.

Conclusions:

The occurrence rate of acute kidney injury in acute ischemic stroke patients was low and was not higher in patients who underwent CT angiogram or those who received endovascular treatment. Occurrence of acute kidney injury increased the risk of death within 3 months among acute ischemic stroke patients.
A Prospective, Split-Face, Randomized Study Comparing Picosecond to Q-Switched Nd:YAG Laser for Treatment of Epidermal and Dermal Pigmented Lesions in Asians
Authors: Ungaksornpairote Chanida , Manuskiatti Woraphong , Junsuwan Natchaya , Wanitphakdeedecha Rungsima
Published: June 2020

BACKGROUND

Whether picosecond lasers outperform Q-switched lasers in treating pigmented lesions has not been clearly evaluated.

OBJECTIVE

To compare the efficacy and safety of picosecond and Q-switched lasers in treating epidermal and dermal pigmented lesions in Asians.

METHODS

Eight subjects with lentigines and 6 subjects with acquired bilateral nevus of Ota-like macules were enrolled. Subjects was randomly treated with a picosecond laser on one side of the face and a Q-switched laser on the other side. Subjective assessments on pigment clearance, and adverse effect were obtained at Weeks 0, 4, 12, and 24 after the final treatment.

RESULTS

Clinical improvement differed between the 2 laser systems at Week 4 (p = .034), Week 12 (p = .039), and Week 24 (p = .027), with 85.7% of picosecond and 57.2% of Q-switched laser sites showing >50% improvement at 6 months. There was no significant difference in the incidence of side effect and healing time, but picosecond laser was significantly associated with a lower treatment discomfort (p = .05).

CONCLUSION

The picosecond laser seems to be more effective and better tolerated than Q-switched laser for the treatment of pigmented lesions in Asians.
Optimizing septal perforation repair techniques
Authors: Dedhia Raj D. , Davis Seth J. , Stephan Scott J.
Published: June 2020

Purpose of review

Multiple successful techniques and approaches for nasal septal perforation repair have been described, yet consistency in perforation and outcome metrics is required to identify the optimal approach to repair. The present article will review the recent literature.

Recent findings

Computational fluid dynamic studies continue to expand our understanding of the airflow dynamics in nasal septal perforation and after repair. Combining rhinoplasty and nasal septal perforation repair in appropriately selected patients can be safely done with excellent results. There has been a rise in utilization of a temporoparietal fascia with polydiaxonone plate construct for septal perforation repair with excellent outcomes.

The present review provides the reconstructive surgeon with an update on nasal septal perforation repair and describes a recently popularized technique of temporoparietal fascia-polydiaxonone plate for perforation reconstruction.
Measures of Stress Exposure for Hospitalized Preterm Infants
Authors: Nist Marliese Dion , Harrison Tondi M. , Pickler Rita H. , Shoben Abigail B.
Published: June 2020

Background

Extended hospitalization in neonatal intensive care units subjects preterm infants to multiple stress exposures that affect long-term cognitive functioning, motor development, and stress reactivity. Measurement of stress exposure is challenging with multiple measures of stress exposure in use, including counts of skin-breaking or invasive procedures or counts of noxious sensory exposures.

Objectives

The purpose of this analysis was to compare measures of stress exposure commonly used by researchers and to determine the predictive validity of these measures for early neurobehavior. We accomplished this objective through the following specific aims: (a) describe the stress exposures of preterm infants in the first 2 weeks of life, (b) determine the correlations among measures of stress exposure, and (c) compare the predictive validity of measures of stress exposure for early neurobehavior.

Methods

Very preterm infants born between 28 and 31 weeks postmenstrual age were enrolled from four neonatal intensive care units in a large Midwest city. We measured stress exposure over the first 14 days of life for each infant as a count of skin-breaking procedures, a count of invasive procedures, and cumulative scores derived from the Neonatal Infant Stressor Scale. Neurobehavior was assessed at 35 weeks postmenstrual age using the motor development and vigor and alertness/orientation subscales from the Neurobehavioral Assessment of the Preterm Infant. We used Spearman’s rho to determine correlations among the measures of stress exposure and multiple linear regression to determine the predictive validity of each stress exposure measure for neurobehavioral outcomes.

Results

Seventy-one preterm infants were included in the analysis. We found marked variance across individuals in all measures of stress exposure. There were moderate–high correlations among the measures of stress exposure. No measure of stress exposure was associated with early neurobehavior.

Discussion

The stress experiences of hospitalized preterm infants vary. This variance is reflected in all measures of stress exposure. Because measures of stress exposure are highly correlated, the most objective measure requiring the least interpretation should be used. However, the currently available measures of stress exposure used in this analysis may not reflect the infant’s physiological stress responses and fail to associate with early neurobehavior.
Feasibility Case Series of Environment and Sleep in Infants With Congenital Heart Disease
Authors: Kalvas Laura Beth , Harrison Tondi M.
Published: June 2020

Background

Developmental delay is a significant concern for infants born with complex congenital heart disease (CCHD). Environmental exposures (e.g., excessive light and sound exposure, sleep disruption) in neonatal intensive care are associated with poor developmental outcomes. However, the environmental experience of newborn infants in cardiac care is unknown.

Objectives

The aim of the study was to examine the feasibility of continuous environmental data collection (i.e., light and sound exposure, sleep pattern) in pediatric cardiac care units and describe the environmental experience of three hospitalized infants with CCHD.

Methods

A case series of three infants undergoing cardiac surgery for CCHD within the first month of life was performed. Measures of light, sound, and sleep were collected in 24-hour periods on three to four separate hospital days. For each day, light and sound meters were attached to the hospital bed, and an actigraphy band was placed on the infant’s lower leg to measure sleep/wake states. Feasibility of continuous environmental data collection was assessed through acceptability of data collection for families and clinical staff, usability of data collection equipment for research staff, and study protocol adherence. Descriptive statistics were used to calculate the count and duration of episodes of excessive light and sound exposure, hourly levels of light and sound exposure, total sleep time, duration of individual sleep episodes, and number of arousals from sleep.

Results

Although continuous environmental data collection was generally acceptable to families and clinical staff, multiple usability issues were identified by research staff, and study protocol adherence was variable. Missing data were a major limitation. User error during equipment setup was a main contributor to missing data. Infants experienced frequent episodes of sound exposure above recommended maximum levels, whereas light exposure generally remained below recommended maximum levels. Infant sleep patterns were highly fragmented, with frequent arousals and short duration of individual sleep episodes.

Discussion

Lessons learned during preliminary data collection with the infants in this case series will inform methods and prevent missing data in future, large-scale studies of this vulnerable, hard-to-recruit population. Data reflect a cardiac care environment characterized by excessive sound exposure and highly disrupted sleep. These environmental stressors may affect developmental outcomes in infants with CCHD.
Head and Brain Postmortem Computed Tomography—Autopsy Correlation in Hospital Deaths
Authors: Serinelli Serenella , Richardson Timothy E. , Destian Sylvie , Mirchia Kanish , Williams Michael , Medina-Perez Mariangeles , Gitto Lorenzo
Published: June 2020

The use of postmortem computed tomography (PMCT) to support autopsy pathology has increased in recent decades. To some extent, PMCT has also been contemplated as a potential alternative to conventional postmortem examination. The purpose of this study was to investigate the ability of PMCT to detect specific pathologic findings in the head and brain in natural hospital deaths.

We examined postmortem CT images and autopsy data from 31 subjects who died at SUNY (State University of New York) Upstate University Hospital between 2013 and 2018. Each subject underwent a noncontrast PMCT and a traditional autopsy. A neuroradiologist analyzed PMCT images for head and brain abnormalities. The autopsies were performed by pathologists who were aware of the radiology results.

In our series, PMCT was able to detect the majority of the significant space-occupying lesions, although it was not always reliable in ascertaining their nature. Postmortem computed tomography revealed findings usually challenging to detect at autopsy. Unfortunately, there were also situations in which PMCT was misleading, showing changes that were difficult to interpret, or that could be related to postmortem events. Therefore, we conclude PMCT should be used as an adjunct rather than a substitute to autopsy.
The Width of Invasion in Malignant Melanoma Is a Novel Prognostic Feature That Accounts for Outcome Better Than Breslow Thickness
Authors: Saldanha Gerald , Khanna Aarushi , O’Riordan Marie , Bamford Mark
Published: June 2020

Breslow thickness (BT) is the cornerstone of malignant melanoma staging. However, to our knowledge no-one has ever assessed the horizontal width of invasion, measured microscopically, as a prognostic feature. This was investigated as a prognostic feature in this study. A retrospective cohort of 1329 melanoma cases was collected from patients presenting to a UK teaching hospital from January 1, 2004, to December 31, 2014. The main outcome was overall survival (OS). We found that width was associated with OS in multivariable analysis (hazard ratio=1.05, 95% confidence interval: 1.03-1.07, P<0.001) and was similarly significant for melanoma-specific survival and metastasis-free survival. Its presence rendered BT nonsignificant. The width was significantly associated with OS after adjustment for American Joint Committee on Cancer (AJCC), version 8 clinical tumor stage (hazard ratio=1.05, 95% confidence interval: 1.03-1.07, P<0.001), and bootstrap validation showed only slight model optimism. Similar associations were seen for melanoma-specific survival and metastasis-free survival. However, the combination of invasive width and BT did not account for the outcome as well as another novel histologic feature, tumor area, which was measured using the calculated tumor area method. In conclusion, this study is the first investigation of a novel histologic feature, invasive melanoma width, and demonstrates its strong independent association with outcome.
Development of a New Emergency Medicine Spinal Immobilization Protocol for Pediatric Trauma Patients and First Applicability Test on Emergency Medicine Personnel
Authors: Nolte Philip C. , Liao Shiyao , Kuch Matthias , Grützner Paul A. , Münzberg Matthias , Kreinest Michael
Published: June 2020

Objectives

The purpose of this study was to (i) develop a protocol that supports decision making for prehospital spinal immobilization in pediatric trauma patients based on evidence from current scientific literature and (ii) perform an applicability test on emergency medicine personnel.

Methods

A structured search of the literature published between 1980 and 2019 was performed in MEDLINE using PubMed. Based on this literature search, a new Emergency Medicine Spinal Immobilization Protocol for pediatric trauma patients (E.M.S. IMMO Protocol Pediatric) was developed. Parameters found in the literature, such as trauma mechanism and clinical findings that accounted for a high probability of spinal injury, were included in the protocol. An applicability test was administered to German emergency medicine personnel using a questionnaire with case examples to assess correct decision making according to the protocol.

Results

The E.M.S. IMMO Protocol Pediatric was developed based on evidence from published literature. In the applicability test involving 44 emergency medicine providers revealed that 82.9% of participants chose the correct type of immobilization based on the protocol. A total of 97.8% evaluated the E.M.S. IMMO Protocol Pediatric as helpful.

Conclusions

Based on the current literature, the E.M.S. IMMO Protocol Pediatric was developed in accordance with established procedures used in trauma care. The decision regarding immobilization is made on based on the cardiopulmonary status of the patient, and life-threatening injuries are treated with priority. If the patient presents in stable condition, the necessity for full immobilization is assessed based upon the mechanisms of injury, assessment of impairment, and clinical examination.
Disproportionate burden of coronavirus disease 2019 among racial minorities and those in congregate settings among a large cohort of people with HIV
Authors: Meyerowitz Eric A. , Kim Arthur Y. , Ard Kevin L. , Basgoz Nesli , Chu Jacqueline T. , Hurtado Rocio M. , Lee Catherine K. , He Wei , Minukas Theresa , Nelson Sandra , Ojikutu Bisola O. , Robbins Greg , Sanchez Sarimer , Triant Virginia A. , Zachary Kimon , Gandhi Rajesh T.
Published: June 2020

Background:

Many people living with HIV (PLWH) have comorbidities which are risk factors for severe coronavirus disease 2019 (COVID-19) or have exposures that may lead to acquisition of severe acute respiratory distress syndrome coronavirus 2. There are few studies, however, on the demographics, comorbidities, clinical presentation, or outcomes of COVID-19 in people with HIV.

Objective:

To evaluate risk factors, clinical manifestations, and outcomes in a large cohort of PLWH with COVID-19.

Methods:

We systematically identified all PLWH who were diagnosed with COVID-19 at a large hospital from 3 March to 26 April 2020 during an outbreak in Massachusetts. We analyzed each of the cases to extract information including demographics, medical comorbidities, clinical presentation, and illness course after COVID-19 diagnosis.

Results:

We describe a cohort of 36 PLWH with confirmed COVID-19 and another 11 patients with probable COVID-19. Almost 85% of PLWH with confirmed COVID-19 had a comorbidity associated with severe disease, including obesity, cardiovascular disease, or hypertension. Approximately 77% of PLWH with COVID-19 were non-Hispanic Black or Latinx whereas only 40% of the PLWH in our clinic were Black or Latinx. Nearly half of PLWH with COVID-19 had exposure to congregate settings. In addition to people with confirmed COVID-19, we identified another 11 individuals with probable COVID-19, almost all of whom had negative PCR testing.

Conclusion:

In the largest cohort to date of PLWH and confirmed COVID-19, almost all had a comorbidity associated with severe disease, highlighting the importance of non-HIV risk factors in this population. The racial disparities and frequent link to congregate settings in PLWH and COVID-19 need to be explored urgently.
Is Small Fiber Neuropathy Induced by Gadolinium-Based Contrast Agents?
Authors: Radbruch Alexander , Richter Henning , Bücker Patrick , Berlandi Johannes , Schänzer Anne , Deike-Hofmann Katerina , Kleinschnitz Christoph , Schlemmer Heinz-Peter , Forsting Michael , Paulus Werner , Martin Louise F. , van Thriel Christoph , Karst Uwe , Jeibmann Astrid
Published: June 2020

Objectives

In recent years, complaints of patients about burning pain in arms and legs after the injection of gadolinium-based contrast agents (GBCAs) have been reported. In the current study, we investigated changes of small fibers in the epidermis as a potential cause of the patient complaints in a mouse model.

Methods

Six groups of 8 mice were intravenously injected with either a macrocyclic GBCA (gadoteridol, gadoterate meglumine, gadobutrol), a linear GBCA (gadodiamide or gadobenate dimeglumine) (1 mmol/kg body weight), or saline (NaCl 0.9%). Four weeks after injection, animals were euthanized, and footpads were assessed using immunofluorescence staining. Intraepidermal nerve fiber density (IENFD) was calculated, and the median number of terminal axonal swellings (TASs) per IENFD was determined.

Results

Nonparametric Wilcoxon signed-rank test revealed significantly lower IENFDs for all GBCAs compared with the control group (P < 0.0001) with the linear GBCAs showing significantly lower IENFDs than the macrocyclic GBCAs (P < 0.0001). The linear GBCAs presented significantly more TAS per IENFD than the control group (P < 0.0001), whereas no significant increase of TAS per IENFD compared with the control group was found for macrocyclic GBCAs (P < 0.237).

Interpretation

It is unclear whether or at what dosage the decrease of IENFDs and the increase of TAS per IENFD found in the current animal model will appear in humans and if it translates into clinical symptoms. However, given the highly significant findings of the current study, more research in this field is required.
Magnetic Resonance Imaging of Venous Stents at 1.5 T
Authors: Reiss Simon , Özen Ali Caglar , Lottner Thomas , Reichert Andreas , Massmann Alexander , Bock Michael
Published: June 2020

Purpose

The aims of this study were to assess radiofrequency (RF) shielding and susceptibility-induced imaging artifacts of venous stents with different designs at 1.5 T and to analyze the relationship between stent designs, that is, cell geometry and RF shielding.

Methods

Twelve dedicated venous stents and 1 stent used for venous pathologies with 8 different designs from 5 different manufacturers were tested: Blueflow (plus medica, Düsseldorf, Germany), Sinus Obliquus, Sinus Venous, Sinus XL (Optimed, Ettlingen, Germany), Vici (Veniti, St. Louis, MO), Zilver Vena (Cook, Bjaeverskov, Denmark), and Venovo (Bard, Tempe, AZ). Two versions with different lengths were available from all stents except the Venovo. For each stent, B
1 and frequency mapping was performed using the double angle method and gradient multiecho imaging. Each stent was measured in 3 different orientations: parallel, orthogonal, and at 45 degrees to B
0. A correlation analysis was performed between the induced B
1 field strength inside the stents and the geometries of the cells.

Results

Radiofrequency shielding was found to be strongly varying between different stent designs. The 120-mm-long Vici stent showed the lowest mean relative B
1 amplitude of (38% ± 16%) when oriented parallel to B
0. The highest mean B
1 amplitude was measured inside the 100-mm-long Blueflow stent with diagonal orientation (90% ± 20%). Averaged over all stents, the shielding was 18% stronger when the stents are oriented orthogonal to B
0 compared with a parallel orientation and the between-stent variation was lower for the orthogonal orientation (11%) compared with the parallel orientation (20%). For laser-cut stents, a linear correlation was found between the amount of RF shielding and the length of individual cells measured perpendicular to the stents’ long axes. The woven stents showed a strongly inhomogeneous intraluminal RF shielding pattern, whereas the laser-cut stents provided a more homogeneous shielding pattern. No substantial susceptibility-induced frequency shifts were measured near all stents with a maximum shift of ∆f = 96 Hz measured in the vicinity of the 150-mm-long Sinus Obliquus stent.

Conclusion

Magnetic resonance imaging in the vicinity of commercially available venous stents is feasible at 1.5 T with no substantial susceptibility-induced artifacts but reduced transmit and receive B
1 field strengths inside the stents. The strength and homogeneity of the intraluminal B
1 depend on the stents’ fabrication (woven or laser-cut) and cell geometry.
Mandibular Distraction in Robin Sequence With Multi-Level Airway Disease: Always Contraindicated?
Authors: Abu-Ghname Amjed , Davis Matthew J. , Davies Leslie W. , Masoumy Mohamad , Mehta Deepak K. , Heinle Jeffrey S. , Buchanan Edward P.
Published: June 2020

In patients with Pierre Robin sequence (PRS), understanding the mechanism of airway obstruction and the potential for concurrent airway lesions is important for determining appropriate intervention. When concomitant airway anomalies are present with PRS, mandibular distraction osteogenesis alone is often contraindicated and unsuccessful at alleviating the obstruction, mandating the need for tracheostomy. Herein, the authors present the second-reported case of PRS with concomitant complete tracheal rings and highlight the importance collaborative surgical efforts to avoid tracheostomy. Our patient was born with signs and symptoms of PRS and concomitant complete tracheal rings. At birth, he developed respiratory compromise that was resistant to invasive and noninvasive intervention and was transferred to our care. The severity of his airway compromise necessitated operative intervention. Due to the patient's complex medical condition, avoiding the long-term sequelae of a tracheostomy and performing mandibular distraction was favorable. However, due to his multi-level airway disease, a 2-staged approach was planned: sliding tracheoplasty to release the tracheal rings, followed by mandibular distraction to correct the micrognathia. The patient tolerated both procedures and was successfully distracted and eventually weaned into room air. When managing patients with PRS in the setting of severe respiratory distress, securing the airway and carefully evaluating for concomitant airway anomalies is crucial. Even in the setting of multi-level airway disease where mandibular distraction is typically contraindicated, by directly addressing each anatomic level of airway obstruction, the airway can be safely secured and the resultant consequences of tracheostomy can be avoided. Careful planning with a multidisciplinary team is essential.
Effects of Water-Circulating Cooling Mask on Postoperative Outcomes in Orthognathic Surgery and Facial Trauma
Authors: Santos Thiago de Santana , Osborne Patrick Rocha , Jacob Eduardo Santana , Araújo Rafael Tajra Evangelista , Nogueira Carlos Bruno Pinheiro , Martins-Filho Paulo Ricardo Saquete
Published: June 2020

The purpose of this study was to perform a systematic review and meta-analysis of randomized clinical trials (RCTs) investigating the efficacy of hilotherapy on postoperative pain, swelling, neurosensory impairment and patient satisfaction. The authors analyzed RCTs comparing the use of hilotherapy versus conventional cryotherapy or no cold treatment for orthognathic surgery and repair of facial trauma. The authors assessed the risk of bias and strength of evidence according to the Cochrane guidelines and GRADE rating system, respectively. Treatment effects were defined as weighted or standardized mean difference using the inverse variance method. Five RCTs were included. Postoperative pain and swelling in patients using hilotherapy were lower comparing to the control group in the postoperative day 2 (Pain: MD −1.75, CI 95% −2.69 to −0.81; Swelling: MD −21.16 mL, CI 95% −38.91 to −3.41) and in the final evaluation (Pain: MD −0.31, CI 95% −0.44 to −0.18; MD −4.45 mL, CI 95% −7.87 to −1.03). Patients reported higher satisfaction with hilotherapy, but no differences were found for neurosensory impairment. Current evidence suggests that hilotherapy is effective in reducing postoperative pain and swelling in orthognathic surgery and repair of facial fractures and may lead to improvements in patient satisfaction in the recovery phase.
Analysis of Orbital Morphology and its Relationship With Eyelid Morphology
Authors: Osaki Takeo , Murakami Hidetaka , Tamura Ryosuke , Nomura Tadashi , Hashikawa Kazunobu , Terashi Hiroto
Published: June 2020

Correct anatomical reconstruction of the orbital wall for function and cosmesis is important; however, this is difficult because of the structure's complexity. The authors aimed to analyze and classify orbital morphology from computed tomography (CT) images and examine the relationship between orbital morphology and eyelid morphology in the Japanese population. CT images of 60 men (right side, 29; left side, 31) and 44 women (each side, 22) were included. The lengths of the orbital medial wall and floor in the coronal plane at the anterior, middle, and posterior planes of the orbit; angle between them; simotic index; and the thickness of upper eyelid were measured. Additionally, the presence or absence of double eyelids was evaluated. Non-paired Student's t test and Pearson correlation coefficient test were used for analysis. Orbital morphology was symmetrical on both sides, and men had a larger orbit than women. Orbital morphology was classified into 2 groups according to the posterior angle, and there was a difference between the groups in the simotic index. The difference between groups may represent a genetic difference between the Jomon and Yayoi people and not only provide a new classification for the orbit of the population but also be useful in orbital reconstruction.