bluuebunny/crossref_metadata_2025 huggingface dataset:
Chromosomal Abnormalities and Other Common Pediatric Syndromes
Authors: Batakji Mariam , Diaz Christina D.
Published: March 2023

A syndrome is an association of phenotypical traits that occur together due to a specific genetic abnormality. Diagnosis of genetic disorders is usually done through karyotyping, chromosomal microarray (CMA), or fluorescence in situ hybridization (FISH). Due to medical advancements in the management of these children and their increased life span, more of these children are presenting for anesthesia for diagnostic and therapeutic procedures. Therefore, it is important to understand the specifics of each syndrome and the anesthetic considerations and challenges in order to provide a safe anesthetic. Trisomy disorders other than trisomy 21 include trisomy 13 (Patau syndrome) and trisomy 18 (Edwards syndrome). Even though trisomy 13 and 18 infants generally have a shortened life span (many less than a year), they can still present for diagnostic and therapeutic procedures and pose certain anesthetic risks. Other major syndromes that result in anesthesia challenges in the pediatric population include micrognathia syndromes (Pierre Robin, Treacher Collins, and Goldenhar syndrome), CHARGE syndrome, VACTREL association, metabolic syndromes, and muscular dystrophies. This chapter summarizes the clinical manifestations of the most common pediatric chromosomal abnormalities and syndromes that require unique considerations from the pediatric anesthesiologist.
Anesthesia for Pediatric Ophthalmologic Surgeries
Authors: Dua Nupur , Nguyen Wendy
Published: March 2023

Commonly performed pediatric ophthalmologic procedures performed under anesthesia include eye examination for tonometry, fundoscopy, and assessment of visual evoked potentials, cryotherapy or laser therapy for retinopathy of prematurity or retinoblastoma, strabismus repair, lens extraction in cataracts, and enucleation, which are predominantly performed in the ambulatory setting. However, special considerations are needed in premature infants with congenital disorders associated with pathology of the eye. An understanding of oculocardiac reflex (OCR) and postoperative nausea and vomiting (PONV) is more pertinent to pediatric ophthalmic surgeries. Differing from adult ophthalmic surgeries, use of regional blocks are not commonly used. Therefore, perioperative pain management needs to be considered, especially with more invasive procedures. This chapter describes the anatomy and physiology of the eye and the perioperative anesthetic management of commonly performed ophthalmic procedures in the pediatric population.
Systemic Medications and Routes of Administration
Authors: Saklayen Samiya L. , Graul Thomas
Published: March 2023

A comprehensive approach to pediatric pain management aims to address the multidimensional, biopsychosocial components of pain. Pharmacological measures to treat postoperative pain in children are often combined in a multimodal approach and may include regional anesthesia, and opioids as well as nonopioid analgesics. Many small studies have demonstrated beneficial opioid-sparing effects with the use of nonopioid adjuncts in children. Opioids continue to be predominant in providing adequate pain control for surgeries associated with significant postoperative pain, but not without risk. Certain medications, including codeine and tramadol, are now contraindicated by the Food and Drug Administration for treatment of postoperative pain following tonsillectomy in children.
Amniotic Fluid
Authors: Urness James , Attali Ami
Published: March 2023

Amniotic fluid is a complex, free-flowing fluid that surrounds the developing fetus and changes in function, composition, and volume as the pregnancy progresses to term. This medium supports the developing fetus in various ways, by forming a protective environment preventing injury from the outside, allowing free movements, serving as a means of nutrient and signaling transfer, and working as a defense system against foreign microbes. The production and maintenance of amniotic fluid balance rely on a number of sources depending on the stage of fetal development, maternal hydration, hormonal status, and placental perfusion. During routine antenatal visits, the amniotic fluid volume is measured and expressed as an objective amniotic fluid index compared to expected volumes. If there is less or more amniotic fluid than expected, it is termed oligohydramnios and polyhydramnios, respectively, and the timing of volume irregularities correlate to various problems in development of the fetus. During delivery, an amniotic fluid embolism (AFE) is one of the most feared and devastating obstetric complications for maternal prognosis, which can present with respiratory distress, cardiovascular collapse, and coagulopathy.
Spontaneous Abortion
Authors: Younger Joshua D. , Prasad Monica
Published: March 2023

Abortion can occur both spontaneously and electively. An abortion can be performed either medically or surgically. Medical abortions are usually managed with medications such as methotrexate, mifepristone, and misoprostol. Surgical abortions are performed with a manual vacuum aspirator (MVA), metal curette, a suction device, or any combination of these. Of note, 5% of all pregnancy-related maternal deaths are associated with either an elective or a spontaneous abortion. These maternal deaths are usually linked to sepsis and/or hemorrhage. The anesthetic considerations are dependent on the active issues that present when the patient enters the operating suite. The most concerning of them is the rapid management of hemorrhage and infection.
Endocrine Disorders
Authors: Zhou Eric P. , Chung Kevin W.
Published: March 2023

Endocrine disorders have an important impact on maternal morbidity and mortality. Due to the multisystemic nature of these diseases, significant effects on electrolyte balance and hemodynamic stability can occur. Diabetes and thyroid disease are the most common endocrine disorders in the parturient. According to the Centers for Disease Control and Prevention, approximately 1% to 2% of pregnant women have type 1 or 2 diabetes, while the prevalence of gestational diabetes is between 6% and 9%. The most common thyroid disorders encountered during pregnancy are hyperthyroidism and hypothyroidism. Both can lead to an increased risk of perinatal morbidity and preterm delivery. Pheochromocytoma is a rare disease but one with profound medical and anesthetic implications. An understanding of the pathology and management of these disorders during pregnancy is crucial for the anesthesiologist in caring for pregnant patients.
Fetal Monitoring
Authors: Jain Shuchi , Younger Joshua D.
Published: March 2023

The goal of fetal assessment and monitoring is to improve neonatal outcomes by reducing neonatal mortality and neurologic morbidity. A knowledge of electronic fetal monitoring (EFM) allows one to anticipate problems and communicate concerns regarding fetal well-being. Fetal monitoring allows for the detection of poor fetal oxygenation and acid-base abnormalities for prompt interventions. Even though fetal monitoring technology has improved over the past 50 years, accurate fetal assessment in labor remains challenging. High surgical delivery rates and persistent cases of fetal/neonatal neurologic injuries demonstrate a need to further optimize fetal assessment tools. Anesthetics can have direct effects on the fetal heart rate and, knowledge of these complications is important when selecting appropriate anesthetics for the population.
Maternal Cardiopulmonary Resuscitation
Authors: Zhou Steven , Hussain Nasir
Published: March 2023

Cardiac arrest during pregnancy is a relatively rare phenomenon, as the majority of parturients tend to be younger with fewer comorbidities. While rare, cardiac arrest in pregnancy must be promptly recognized to avoid harm or even death of the mother or fetus. Etiologies are broad, ranging from pathologies related to heart disease or pulmonary embolism and to pregnancy specific-diseases such as preeclampsia or amniotic fluid embolism. While basic life support/advanced cardiac life support protocols should always be followed, the gravid patient always poses challenges. Thus, cardiopulmonary resuscitation must be initiated by an interdisciplinary team familiar with the physiologic changes of pregnancy and the specialized interventions necessary to mitigate harm.
Fever and Infection
Authors: Pappas Helen , Lange Elizabeth
Published: March 2023

Maternal fever, defined as temperature of 38°C (100.4°F) or greater, can result from a number of infectious and noninfectious etiologies and complicates up to one-third of all labors. The most common infectious causes include intra-amniotic infection, urinary tract infection, respiratory tract infections (both bacterial and viral), and sepsis. Noninfectious etiologies include epidural fever, high ambient temperatures, and drug fever. Maternal fever is associated with a number of maternal and neonatal complications, so it is aggressively managed to minimize the risk to both. The association between neuraxial labor analgesia and maternal fever has been well established, with women receiving epidural analgesia having a significantly higher incidence of fever. Research continues to evaluate proposed mechanisms for this association and targets for prevention and therapeutic intervention.
Airway Endoscopy, Microlaryngeal Surgery, and Laser Surgery
Authors: Naftalovich Rotem , Schiffenhaus James
Published: March 2023

Endoscopic airway surgery includes procedures performed on the tongue base, pharynx, larynx, and proximal esophagus. Microlaryngeal surgery refers to surgery of the larynx and vocal cords and generally requires aid of a microscope. These surgeries are unique in that they require the surgeon and anesthesiologist to share the surgical field (“shared airway”). Additionally, they require the anesthesiologist to employ unique techniques of airway management to ensure safe oxygenation, and surgical exposure, such as jet ventilation, intermittent or spontaneous ventilation, apneic oxygenation, or conventional ventilation via microlaryngeal tubes. Endoscopic airway surgery may also employ the use of lasers, which produce focused beams of electromagnetic energy and offer precise surgical control and minimal collateral damage to airway structures. The anesthesiologist must be prepared for the various complications associated with laser surgery, the most feared of them being an airway fire. It is imperative for the anesthesia provider to be familiar with the components of the fire triad, common operating room objects that can constitute the triad, precautions that can minimize the risk of airway fires, and steps to take should an airway fire occur. Patients requiring ear, nose, and throat (ENT) surgery can present anesthesiologists with challenges and unique airway management considerations.
Anesthesia for Laparoscopic Surgery
Authors: Ramirez Maria F. , Cata J. P.
Published: March 2023

Laparoscopic surgery is considered a common procedure that is performed around the world every day. Its advantages compared to conventional open abdominal surgery include the reduction of (1) postoperative pain and ileus, (2) respiratory complications, (3) blood loss, and (4) reduction of hospital stays, which allows a rapid return to normal activities. Laparoscopic surgery requires insufflation of the intraperitoneal cavity with carbon dioxide (CO2) to create space for visualization and surgical manipulation. Anesthetic concerns for patients undergoing laparoscopic surgery include cardiopulmonary effects of pneumoperitoneum, systemic absorption of CO2, venous air embolism, unintentional injuries to intraperitoneal structures, and patient positioning. Laparoscopic surgery is routinely performed under balanced general anesthesia with controlled ventilation. Appropriate anesthesia techniques and monitoring improve surgical conditions and allow early detection of fatal complications. Prevention of cardiovascular complications may be accomplished by a deep understanding of the hemodynamic consequences of pneumoperitoneum and by close communication with surgical colleagues.
Anesthesia for the Trauma Patient
Authors: Rothkrug Alexander , Fikry Karim
Published: March 2023

Anesthesiologists play a crucial role in management of the trauma patient. Understanding the priorities of the management of this patient population is critical to a holistic approach for effective care. Caring for the trauma patient can be challenging as there may be multiple, and sometimes undiagnosed, injuries. The evaluation of the trauma patient has to be carried out in a systematic and consistent fashion, prioritizing life-threatening conditions first. Evaluation always starts with ABC (airway, breathing, circulation). All trauma patients should be evaluated for cervical spine injury. They should all be assumed to have a full stomach unless proven otherwise. In unstable patients, damage control surgery (DCS) should always be considered. In patients with massive trauma, adequate intravenous access and proper hemodynamic monitoring is necessary, as massive blood loss should be expected and prepared for.
Hemorrhagic Shock
Authors: Tanner Colby B. , Boydston Elaine A.
Published: March 2023

Hemorrhagic shock is a significant cause of morbidity and mortality in trauma and surgical patients. Hemodynamically significant hemorrhage, when coupled with the physiologic derangements associated with trauma and surgery, results in oxygen debt, acidosis, organ dysfunction, coagulopathy, and ultimately death if not treated aggressively. Early detection of hemorrhagic shock allows for the prompt initiation of resuscitation and supportive care, mitigating these risks. Volume expansion via transfusion of whole blood or a balanced ratio of blood products is the intervention proven to have the most significant impact toward improving patient outcomes and should be employed to prolong life while patients await definitive surgical, endoscopic, or angiographic control of hemorrhage. Careful physical examination coupled with use of available laboratory tests and imaging techniques can aid in the development of a plan for resuscitation.
Mass Casualty Events
Authors: Manepalli Ashok Kumar , Watt Stacey
Published: March 2023

No hospital system is immune to mass casualty events and as such should be adequately prepared with disaster plans and personnel trained to act in crises. Anesthesiologists are well suited for the role of triage leaders and coordinators due to their experience in a wide array of hospital environments and ability to take care of critically ill patients. One of the most important aspects of mass casualty events is categorizing patients according to the severity of their injuries and allocating resources appropriately. This allows staff to prioritize patients who are salvageable from those with nonrecoverable injuries or not critically ill.
Anesthesia for Outpatient Surgery
Authors: Anthony Cometa M. , Giordano Christopher
Published: March 2023

Outpatient surgery is the most common setting to perform surgical procedures in the United States. It started as a way to overcome limited resources and financial constraints. As outpatient surgery has expanded and become more frequently used, ambulatory anesthesia has become a recognized subspecialty through the guidelines that were developed by the Society for Ambulatory Anesthesia (SAMBA). Important considerations must be taken into account when selecting the appropriate surgical procedures and the patient population that will undergo surgery on an outpatient basis. The anesthesiology provider is pivotal to ensure a safe and efficient perioperative outcome. This is achieved through appropriate communication, planning, preoperative assessment, intraoperative surgical and anesthetic management, and postoperative recovery and readiness for a safe discharge home.
Shock States
Authors: Eden Nikki , Rajan Shobana
Published: March 2023

Shock is hypoperfusion of tissues and vital organs, which may then result in organ failure and death. Shock is caused by many different mechanisms, broadly defined as hypovolemic, cardiogenic, distributive, and obstructive shock states. These states have defining factors that illustrate the underlying pathophysiology; however, there are often overlaps seen between them, and a patient may present in mixed states of shock. Septic shock due to infection and overwhelming systemic immune response is the most common form of shock. Given the serious morbidity and mortality associated with shock, quickly and correctly identifying this disease and beginning treatment is vital. The sequential organ failure assessment (SOFA) score can be useful in emergency settings for risk stratifying the mortality based on degree of organ damage.
Postoperative Headache
Authors: Osmani Feroz , Chung Kevin W.
Published: March 2023

Postoperative headaches are a relatively common phenomenon. It is important to conduct a thorough evaluation to rule out more serious etiologies. Postoperative headaches may be related to the patient’s prior medical history, the surgical procedure, or the anesthetic. Treatment options include intravenous hydration, adequate oxygenation, caffeine supplementation, and tighter blood pressure control. In the case of a postdural puncture headache, an epidural blood patch is the gold standard of treatment after more conservative options have failed. It is important to recognize which patients have a history of headache disorder and to treat them accordingly. Effective preoperative assessment and planning can reduce the incidence and morbidity of a common yet incredibly uncomfortable patient condition.
Electroconvulsive Therapy
Authors: Burnett Garrett W.
Published: March 2023

Electroconvulsive therapy (ECT) involves the induction of a generalized tonic-clonic seizure to treat various psychiatric disorders, including treatment-resistant depression, catatonia, psychosis, and more. General anesthesia is provided for patient comfort and safety. Medications commonly used in anesthesia affect seizure quality and duration; therefore, it is vital that anesthesiologists prepare a tailored anesthetic for each patient undergoing ECT. ECT is often performed in non–operating room locations, and it is necessary to ensure all monitoring and emergency equipment are available. ECT is associated with an initial parasympathetic surge followed by a longer lasting sympathetic surge, which may lead to prolonged hypertension and tachycardia. Depending on each patient’s comorbidities, prophylaxis or intraoperative treatment of parasympathetic and sympathetic symptoms may be required.
Ethics
Authors: Siddiqui Shahla
Published: March 2023

Advance directives preserve patient autonomy and preferences. A do not resuscitate (DNR) order is placed in a patient’s chart after discussing at length their wishes regarding futility and comfort care in the event of the need for resuscitation. If the patient is unable to participate in the discussion, a healthcare proxy or surrogate is asked regarding their perceived wishes. Such discussions occur prior to the need for such resuscitation. In the case of a patient requiring surgery, usually, such DNR orders are voided for the length of the perioperative period. This is because administering anesthesia may trigger instability in a critically ill or palliative patient who may require such resuscitation. A living will defines treatment by establishing parameters under which patients want to be treated. A durable power of attorney for healthcare establishes a surrogate for patients if they are unable to make decisions for themselves.
Safety Practices
Authors: Saad Ramsey , Hanna Joseph Salama
Published: March 2023

Promoting safety in the operating room is a process that involves adequate review of sentinel events and the development of system improvements to identify vulnerabilities within the system to detect and prevent predictable human failings in the context of poorly designed systems. These can be developed to minimize the occurrence of complications and also to prevent future sentinel events. A key concept with the culture of safety is transparency and reporting with the goal of process and system improvement, as opposed to a culture of blame and fear. This is crucial to encourage reporting of adverse events and near misses.
Shakespeare
Authors: Berman Carol W.
Published: March 2023

In Shakespeare’s world, we have Othello, the tale of a jealous king who believes his innocent queen, Desdemona, has betrayed him sexually. In psychiatry, this type of paranoia is called the Othello complex. Hamlet is a Shakespearean character who illustrates the Oedipus complex at work. Hamlet is indecisive and passive, rather than active in avenging his father’s death because unconsciously he wished for his father’s death. His “to be or not to be” monologue is a brilliant display of his passivity. King Lear is an example of a narcissistic personality who needs his three daughters to prove their love for him. Two do so insincerely, and the third, Cordelia, speaks truthfully and simply. King Lear, stuck in a rigid personality, winds up forfeiting everything, including his kingdom, his life, and his children due to his foolishness and narcissism. Richard III is a portrait of a sociopathic personality who kills everyone on his path to the throne.
Jungian Concepts
Authors: Berman Carol W.
Published: March 2023

Carl Gustav Jung broke away from Freudian concepts and went deeper into the unconscious with his “collective unconscious,” archetypes, and the anima and animus. Jung was fascinated by mythology, and not just Greek mythology. Myth revealed the collective unconscious to the conscious mind; second, dreams for him were analogues of myth. Myth was also a way of thinking, which was the opposite of directed and logical thinking. He also introduced the ideas of extraversion and introversion of character. Two extraverted characters are Strindberg’s Miss Julie or Judge Brack in Hedda Gabler. More introverted characters include Chekhov’s Ivanov and Laura in The Glass Menagerie.
Adlerian Complexes
Authors: Berman Carol W.
Published: March 2023

Alfred Adler was another doctor who had studied with Freud but decided to break away from him. Adler’s innovations of individual psychology emphasized aggression and the inferiority complex. He wrote about the aggression drive, the neurotic disposition, and masculine protest. According to Adler, the neurotic person lacks confidence, is oversensitive, is guilty, and inhibits aggression. His concentration on other factors besides the Freudian libido led to the work of Karen Horney, Harry Stack Sullivan, and Erich Fromm. In Mamet’s Glengarry Glen Ross, characters aggressively struggle for power. New neural networks can be induced according to Adler, although he did not know of or use these modern terms, by watching theater like that of Mamet.
Head and neck tumours
Authors: Ajithkumar Thankamma
Published: March 2023

Clinical management of head and neck cancers depends on the site of the primary tumour, the stage of disease and expected function outcome. Radiotherapy has a well-established role in the curative, adjuvant, and palliative management of head and neck cancers. Patients with early-stage disease are cured with single modality treatment whereas those with locally advanced disease are treated with combined modality treatment. This chapter discusses the clinical and imaging features of different sites of head and neck tumours, the role of radiotherapy, the optimal integration of systemic therapies, and practical details on radiotherapy planning. It also summarizes the evidence underpinning current clinical practice.
Breast cancer
Authors: Ajithkumar Thankamma
Published: March 2023

Breast cancer is the commonest malignancy in women, affecting one in eight in their life time. It is uncommon in men. Most breast cancers are of ductal in type and approximately twenty percent of screen-detected cancers and ductal carcinoma in situ. Clinical management of breast cancer and ductal carcinoma in situ, particularly radiotherapy, has evolved significantly in recent years. Radiotherapy has a well-established role in the curative, adjuvant, and palliative management of breast cancer. This chapter discusses the clinical and imaging features of breast cancer, the role of radiotherapy, and practical details on radiotherapy planning. It also summarizes the evidence underpinning current clinical practice.
Urological cancers
Authors: Ajithkumar Thankamma
Published: March 2023

The role of radiotherapy for urological cancers depends on the site of the primary tumour and the stage of disease. Radiotherapy has an established role in the curative, adjuvant and palliative treatment of prostate cancer. Radiotherapy is part of the multimodality treatment of locally invasive urinary bladder cancers. Radiotherapy is seldom used in the management of testicular cancer, except in the palliative setting or in patients with early-stage cancer who are not candidates for cisplatin-based adjuvant chemotherapy. This chapter discusses the clinical and imaging features of cancers arising from the prostate, urinary bladder, testis, and penis, the role of radiotherapy, and practical details on radiotherapy planning. It also summarizes the evidence underpinning current clinical practice.
Subarachnoid haemorrhage
Authors: Harwood Rowan H. , Huwez Farhad Umer , Guyler Paul , Alam Sajid , Gaynor Catherine
Published: March 2023

This chapter provides an overview of subarachnoid haemorrhage (SAH), which behaves differently from stoke even if some of its symptoms are similar. Primary SAH happens when an artery ruptures and blood enters the subarachnoid space, while secondary SAH is the extension from a primary intracerebral haemorrhage or trauma. Blood in the subarachnoid space raises intracranial pressures, irritates the meninges, and triggers vasospasm. The chapter explains the symptoms and diagnosis of SAH. It also covers the initial management of SAH, which is preliminary to the process of imaging and surgery. Patients with ‘good grades’ require angiography, while patients with ‘poor grades’ often die but may subsequently recover enough to allow intervention.
Neuroimaging in stroke
Authors: Harwood Rowan H. , Huwez Farhad Umer , Guyler Paul , Alam Sajid , Gaynor Catherine
Published: March 2023

This chapter explores the role and techniques of brain imaging. The chapter explains the basic principles of CT and magnetic resonance imaging (MRI), and gives examples of appearances of different stroke syndromes and mimics. Perfusion scanning and vascular imaging are discussed.
Functional Morphology and Development of the Colleterial Glands in Non- and Egg-Laying Females of the Pest Termite Coptotermes gestroi (Blattaria, Isoptera, Rhinotermitidae)
Authors: da Silva Iago Bueno , Costa-Leonardo Ana Maria
Published: March 2023

Colleterial glands of female insects are accessory glands responsible for producing secretions associated with egg-laying. Within Dictyoptera, they synthesize compounds of the ootheca. However, their morphology and role in termites are poorly understood. Here, we compared the morphology, development, and secretory activity of the colleterial glands between non- and egg-laying females of the pest termite Coptotermes gestroi under light and transmission electron microscopy. We also provide the first description of these glands for Rhinotermitidae. The glands are paired, divided into anterior and posterior units, which join in a common duct via basal trunks. They are highly developed within egg-laying females, especially the posterior gland, secreting glycoproteins to lubricate the genital chamber and/or stick the eggs together. Ultrastructure revealed glandular epithelia composed of bicellular units of Class 3, whose secretory activity varied between groups and units. Posterior gland of egg-laying females showed richness of mitochondria, rough endoplasmic reticulum, and secretory vesicles, including electron-dense secretory granules, indicating synthesis and transport of contents, especially proteins. The basal trunks were enfolded by muscles, supporting their role in conducting secretion. Morphophysiological modifications occur in the colleterial glands as females mature and lay eggs, and the mechanisms underlying the secretory cycle of the glands are discussed.
Sulfur isotopic discrimination factors differ among avian tissues and diets: Insights from a case study in Gentoo Penguins
Authors: Rosciano Natalia G , Stahl Angela R , Polito Michael J
Published: March 2023

The use of stable isotopes of sulfur (δ34S) to infer avian diets, foraging habitats, and movements is relatively uncommon, resulting in a lack of information on patterns of δ34S incorporation in avian tissue. In a controlled study of Gentoo Penguins (Pygoscelis papua), we found that diet-tissue isotopic discrimination factors (Δ34Sdiet-tissue) differed among egg components and feathers synthesized from a common diet, ranging from –0.4 to –1.7‰. We also found that methodical choices such as lipid extraction and prey tissue selection influenced calculated Δ34Sdiet-tissue values. Specifically, Δ34Sdiet-tissue values were lower (i.e., more negative) when calculated using whole fish relative to fish muscle and lipid-extraction biased egg yolk, but not fish tissue, δ34S values. The Δ34Sdiet-tissue values obtained for Gentoo Penguins fed a marine fish diet were generally lower than those reported for freshwater fish consumption by Double-crested Cormorants (Phalacrocorax auritus), the only other bird species in which Δ34Sdiet-tissue has been quantified. We found support for the hypothesis that tissue Δ34Sdiet-tissue values are inversely related to dietary δ34S values in birds, similar to what has been observed in mammals. Given this relationship, the discrimination factors reported here for Gentoo Penguins may be broadly applicable to other avian species with a similar marine diet. Finally, we provide recommendations for future studies seeking to quantify Δ34Sdiet-tissue in avian tissues and guidance to allow for greater application of sulfur stable isotope analysis in ornithological research.
Targeting the next generation of gamblers? Gambling sponsorship of esports teams
Authors: Biggar Blair , Zendle David , Wardle Heather
Published: March 2023

Background

Esports fans are a target audience for gambling companies wanting to attract the next generation of bettors to their products. As with other sports, professional esports teams have commercial sponsorship arrangements. Our paper seeks to document the level of gambling sponsorship of the world’s top esports teams.

Methods

A systematic review of the commercial arrangements between the top 20 esports clubs across three of the most followed esports titles was undertaken: Dota 2, League of Legends (LoL) and CS:GO. Data were scraped online relating to the top 20 teams competing at their respective major tournaments between October and November 2021.

Results

Half of the esports teams in Dota 2 and CS:GO’s world championship events in 2021 were sponsored by gambling companies. Teams sponsored by gambling companies have a combined total of 25 868 912 followers across three major social media channels. No LoL teams were sponsored by gambling companies, yet sibling teams within the CS:GO and Dota 2 competitions were.

Conclusion

The relationship between gambling companies’ sponsorship in esports should be considered in line with the calls for change in the relationship between football and gambling with gambling as a public health issue at its heart.
A new facet of cumulative advantage in higher education finance
Authors: Herberholz Lars
Published: March 2023

This paper studies the accumulation of financial resources in higher education. Its focus lies on the Quality Pact for Teaching (QPT), a large-scale funding programme that aimed to improve the quality of tertiary education in Germany. Starting in 2011, the QPT allocated almost 2 billion euros over a 10-year period. Yet, unlike prior national funding schemes, the QPT was strongly inspired by New Public Management measures and marked the first time that a substantial amount of teaching grants was awarded in a competitive manner. My estimations show that institutions with a successful history of acquiring third-party funds coped best under these novel circumstances, thus revealing a clear pattern of cumulative advantage. Although typically dedicated to research purposes, the level of previous third-party funding emerges as a strong predictor of QPT success. Therefore, it appears that the QPT unintentionally contributed to steeper financial gaps in Germany’s academic landscape.
Rapid-cycle designs to adapt interventions for COVID-19 in safety-net healthcare systems
Authors: Schlechter Chelsey R , Reese Thomas J , Wirth Jennifer , Gibson Bryan , Kawamoto Kensaku , Siaperas Tracey , Pruhs Alan , Dinkins Courtney Pariera , Zhang Yue , Friedrichs Michael , George Stephanie , Lam Cho Y , Pierce Joni H , Borsato Emerson P , Cornia Ryan C , Stevens Leticia , Martinez Anna , Bradshaw Richard L , Kaphingst Kimberly A , Hess Rachel , Del Fiol Guilherme , Wetter David W
Published: March 2023

Racial/ethnic minority, low socioeconomic status, and rural populations are disproportionately affected by COVID-19. Developing and evaluating interventions to address COVID-19 testing and vaccination among these populations are crucial to improving health inequities. The purpose of this paper is to describe the application of a rapid-cycle design and adaptation process from an ongoing trial to address COVID-19 among safety-net healthcare system patients. The rapid-cycle design and adaptation process included: (a) assessing context and determining relevant models/frameworks; (b) determining core and modifiable components of interventions; and (c) conducting iterative adaptations using Plan-Do-Study-Act (PDSA) cycles. PDSA cycles included: Plan. Gather information from potential adopters/implementers (e.g., Community Health Center [CHC] staff/patients) and design initial interventions; Do. Implement interventions in single CHC or patient cohort; Study. Examine process, outcome, and context data (e.g., infection rates); and, Act. If necessary, refine interventions based on process and outcome data, then disseminate interventions to other CHCs and patient cohorts. Seven CHC systems with 26 clinics participated in the trial. Rapid-cycle, PDSA-based adaptations were made to adapt to evolving COVID-19-related needs. Near real-time data used for adaptation included data on infection hot spots, CHC capacity, stakeholder priorities, local/national policies, and testing/vaccine availability. Adaptations included those to study design, intervention content, and intervention cohorts. Decision-making included multiple stakeholders (e.g., State Department of Health, Primary Care Association, CHCs, patients, researchers). Rapid-cycle designs may improve the relevance and timeliness of interventions for CHCs and other settings that provide care to populations experiencing health inequities, and for rapidly evolving healthcare challenges such as COVID-19.
Organizational trust, usability, and inclusivity are key implementation facilitators for a proposed assets-based mobile health intervention
Authors: White Michelle J , Xie Rujia , Lane Hannah , Rodriguez Javier , Gilchrist L’Tanya , Howard Janna , Perrin Eliana M , Skinner Asheley , Silberberg Mina
Published: March 2023

Assets-based interventions can address child health disparities by connecting families to existing community resources. Community collaboration when designing interventions may identify barriers and facilitators to implementation. The objective of this study was to identify crucial implementation considerations during the design phase of an asset-based intervention to address disparities in childhood obesity, Assets for Health. We conducted focus groups and semi-structured interviews with caregivers of children (<18 years) (N = 17) and representatives of community-based organizations (CBOs) which serve children and families (N = 20). Focus group and interview guides were developed based on constructs from the Consolidated Framework for Implementation Research. Data were analyzed using rapid qualitative analysis and matrices were used to identify common themes within and across groups of community members.

Desired intervention characteristics included an easy-to-use list of community programs that could be filtered based on caregiver preferences and local community health workers to promote trust and engagement among Black and Hispanic/Latino families. Most community members felt an intervention with these characteristics could be advantageous versus existing alternatives. Key outer setting characteristics which were barriers to family engagement included families’ financial insecurity and lack of access to transportation. The CBO implementation climate was supportive but there was concern that the intervention could increase staff workload beyond current capacity.

Assessment of implementation determinants during the intervention design phase revealed important considerations for intervention development. Effective implementation of Assets for Health may depend on app design and usability, fostering organizational trust and minimizing the costs and staff workload of caregivers and CBOs, respectively.
Protective mechanism of TCF7L1 against retinal photoreceptor cell injury following retinitis pigmentosa based on the GEO database
Authors: Yin Yuan , Wu Shuai , Niu Lingzhi , Huang Shiwei
Published: March 2023

Recent studies have reported the promising value of differential gene expression analysis and weighted gene coexpression network analysis (WGCNA) for identifying disease biomarkers. Based on this method, this study intends to characterize the hub genes and pathways related to retinal photoreceptor cell (PRC) injury in the context of retinitis pigmentosa (RP). A total of 53 coexpression modules were identified by WGCNA, among which lightpink4, darkolivegreen, tan4, blue2, skyblue2, and navajowhite2 ranked at the top. By analyzing the RP microarrays retrieved from the GEO database, 338 differentially expressed genes (DEGs) were identified in the RP samples. Forty‐five candidate genes were selected from these DEGs by intersection with the genes in the coexpression modules. These intersection genes were subjected to GO and KEGG analyses. Furthermore, the genes and pathways involved in PRC damage were identified based on analyses utilizing GeneCards and STRING tools. Transcription factor 7‐like 1 (TCF7L1, also called TCF3) was suggested to participate in the RP‐associated PRC damage through the Wnt signaling pathway. It was validated in a blue light‐irradiated cell model that TCF7L1 overexpression boosted PRC viability and repressed apoptosis. Inhibition of the Wnt signaling pathway also contributed to protective effects. Together, the data mentioned above supported the conclusion that either elevation of TCF7L1 or blockade of the Wnt signaling pathway could prevent RP progression by protecting PRCs from damage.
Sharps injuries with Lovenox and generic enoxaparin prefilled safety syringes
Authors: Grimmond Terry , Gruden Maryann , Hurst Bobbi Jo , Crutchfield Lydia F.
Published: March 2023

Purpose:

Investigate the incidence and mechanisms of sharps injuries (SI) to staff using Lovenox and generic enoxaparin prefilled syringes.

Methods:

Four national adverse event databases were examined over a 12-year period for incidence and brands involved with injury events to staff using enoxaparin prefilled syringes.

Results:

The search revealed 581 adverse events (including 20 sharps injuries) associated with device malfunction in 8 of 16 brands, with one brand mentioned significantly more frequently than others. No national alert had been issued.

Conclusions:

Use of certain brands of enoxaparin prefilled syringes poses a small but serious risk of injury to staff. Conducting root cause analyses on all SI is essential, as is the need for regularly evaluating safer devices, reporting all device incidents, enabling simpler reporting of adverse events, and establishing more effective intervention by FDA and manufacturers.
Retention and Overdose Risk among Patients Receiving Substance Use Disorder Treatment, Mental Health Care and Peer Recovery Support: A Longitudinal Analysis
Authors: Park Ju Nyeong , Agee Tracy , McCormick Sean , Felsher Marisa , Collins Karina , Hsu Jeffrey , Schweizer Nicholas , Lucas Gregory , Falade-Nwulia Oluwaseun
Published: March 2023

Background

Drug overdose remains a major crisis in the United States. Expanding substance use disorder (SUD) treatment and recovery support services is critical for reducing overdose risk during disasters such as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) pandemic. We evaluated the outcomes of an innovative multicomponent service, inclusive of medications for SUD, and peer support, colocated in an outpatient infectious disease clinic in Baltimore City. Our goal was to examine whether a multicomponent SUD program can support patients in recovery during a pandemic.

Methods

One hundred five patients in the RESTORE service between 2019–2020 completed baseline, 3-month, and 6-month surveys. Telemedicine and phone-based support groups were implemented in March 2020 after statewide restrictions on face-to-face services due to SARS-CoV2. Data from surveys and electronic medical records were integrated and analyzed using mixed-effects regression models.

Results

At baseline, most patients (88%) reported using drugs/alcohol in the preceding 30 days; 48% of patients reported a history of drug overdose, as well anxiety (23%) and depression (28%) symptoms. Despite pandemic-related disruptions and procedural changes, retention in RESTORE was high (83% after 3 months, 76% after 6 months). Mixed-effects regression models indicated decreased anxiety, alcohol use, heroin use, and nonfatal overdose after 6 months of enrollment (all P < 0.05).

Conclusions

Multicomponent SUD services that are colocated within infectious disease specialty services could help patients to successfully manage their overdose risk and mental health even during future disasters. This model of care could be implemented in other specialty settings that see high rates of SUD.
Surgical and Health-related Quality of life Outcomes in Children With Congenital Scoliosis During 5-year Follow-up. Comparison to Age and Sex-matched Healthy Controls
Authors: Haapala Hermanni , Heiskanen Susanna , Syvänen Johanna , Raitio Arimatias , Helenius Linda , Ahonen Matti , Diarbakerli Elias , Gerdhem Paul , Helenius Ilkka
Published: March 2023

Background:

Congenital spinal anomalies represent a heterogeneous group of spinal deformities, of which only progressive or severe curves warrant surgical management. Only a limited number of studies have investigated the impact of surgery on the health-related quality of life and very limited data exists comparing these outcomes to healthy controls.

Methods:

A single surgeon series of 67 consecutive children with congenital scoliosis (mean age at surgery 8.0 y, range: 1.0 to 18.3 y, 28 girls) undergoing hemivertebrectomy (n = 34), instrumented spinal fusion (n = 20), or vertical expandable prosthetic titanium rib procedure (n = 13) with a mean follow-up of 5.8 years (range: 2 to 13 y). The comparison was made to age and sex-matched healthy controls. Outcome measures included the Scoliosis Research Society questionnaire both pre and postoperatively, radiographic outcomes, and complications.

Results:

The average major curve correction was significantly better in the hemivertebrectomy (60%) and instrumented spinal fusion (51%) than in the vertical expandable prosthetic titanium rib group (24%), respectively (P < 0.001). Complications were noted in 8 of 67 (12%) children, but all patients recovered fully during follow-up. Pain, self-image, and function domains improved numerically from preoperative to final follow-up, but the pain score was the only one with a statistically significant change (P = 0.033). The Scoliosis Research Society pain, self-image, and function domain scores remained at a significantly lower level at the final follow-up than in the healthy controls (P ≤ 0.05), while activity scores improved to a similar level.

Conclusions:

Surgery for congenital scoliosis improved angular spinal deformities with a reasonable risk of complications. Health-related quality of life outcomes improved from preoperative to final follow-up, but especially pain and function domains remained at a significantly lower level than in the age and sex-matched healthy controls.

Level of Evidence:

Level III, therapeutic.
Surgical Outcomes of Cerebral Palsy Patients With Scoliosis and Lumbar Hyperlordosis
Authors: Lau Darryl , Samdani Amer F. , Pahys Joshua M. , Miyanji Firoz , Shah Suken A. , Lonner Baron S. , Sponseller Paul D. , Yaszay Burt , Hwang Steven W. ,   Harms Study Group Investigators
Published: March 2023

Study Design.

Retrospective review of a prospectively collected multicenter database

Objective.

To compare outcomes of patients with cerebral palsy (CP) who undergo surgery for scoliosis with normal lordosis (NL) versus hyperlordosis.

Summary of Background Data.

Surgical correction of scoliosis with lumbar hyperlordosis is challenging. Hyperlordosis may confer higher perioperative morbidity, but this is not well understood.

Materials and Methods.

A multicenter database was queried for CP patients who underwent surgery from 2008 to 2017. The minimum follow-up was 2 years. Two groups were identified: lumbar lordosis <75° (NL) versus ≥ 75° hyperlordosis (HL). Perioperative, radiographic, and clinical outcomes were compared.

Results.

Two hundred seventy-five patients were studied: 236 NL and 39 HL (−75 to −125°). The mean age was 14.1 years, and 52.4% were male. Patients with hyperlordosis had less cognitive impairment (76.9% vs. 94.0%, P=0.008) and higher CPCHILD scores (59.4 vs. 51.0, P=0.003). Other demographics were similar between the groups. Patients with hyperlordosis had greater lumbar lordosis (-90.5 vs. −31.5°, P<0.001) and smaller sagittal vertical axis (−4.0 vs. 2.6 cm, P<0.001). Patients with hyperlordosis had greater estimated blood loss (2222.0 vs. 1460.7 mL, P<0.001) but a similar perioperative complication rate (20.5% vs. 22.5%, P=0.787). Significant correction of all radiographic parameters was achieved in both groups. The HL group had postoperative lumbar lordosis of -68.2° and sagittal vertical axis of −1.0 cm. At a 2-year follow-up, patients with hyperlordosis continued to have higher CPCHILD scores and gained the greatest benefit in overall quality of life measures (20.0 vs. 6.1, P=0.008). The reoperation rate was 10.2%: implant failure (3.6%), pseudarthrosis (0.7%), and wound complications (7.3%). There were no differences in the reoperation rate between the groups.

Conclusion.

Surgical correction of scoliosis with hyperlordosis is associated with greater estimated blood loss but similar radiographic results, perioperative morbidity, and reoperation rate as normal lordosis. Patients with hyperlordosis gained greater overall health benefits. Correction of ≥25% of hyperlordosis seems satisfactory.

Level of Evidence.

3