bluuebunny/crossref_metadata_2025 huggingface dataset:
What is behind multiple institutional affiliations in academia?
Authors: Hottenrott Hanna , Lawson Cornelia
Published: November 2021

Multiple institutional affiliations (or co-affiliations) occur when an academic belongs to more than one organisation. Recent research shows an increase in academics with multiple affiliations, but evidence on how these are organised and on academics’ motivations is mainly anecdotal. In this study we develop a typology of co-affiliations, which identifies four types based on their purpose and origin. We draw on results from a unique international survey of academics in three major science nations (the UK, Germany, and Japan) to study the different factors that could explain the four types of co-affiliations. The analysis shows that academics’ motivations (networking/prestige, resources, teaching, or personal income) correlate with the observed co-affiliation type. Researcher-initiated and research-focussed co-affiliations are often motivated by networking and resource access while co-affiliations that serve other than research purposes are more often income-motivated.
Deconstructing Racism, Hierarchy, and Power in Medical Education: Guiding Principles on Inclusive Curriculum Design
Authors: Green Kaye-Alese , Wolinsky Rebecca , Parnell Sabreea J. , del Campo Daniela , Nathan Ajay S. , Garg Priya S. , Kaplan Samantha E. , Dasgupta Shoumita
Published: November 2021

In the context of current U.S. racial justice movements, analysis of racism in medicine within medical education is a critical task for all institutions. To educate the next generation of physicians about racism in medicine and out of concern that the curriculum required critical assessment and change, a group of students and faculty at Boston University School of Medicine (BUSM) initiated a longitudinal curricular analysis through a vertical integration group, commissioned by the Medical Education Committee, from May 2019 to June 2020. The curriculum analysis and the major outcomes and guiding principles that emerged from it are described as a path forward, toward a more inclusive curriculum. The major elements of this analysis included a comprehensive internal curricular assessment and an external assessment of peer institutions that led to the development of key curricular recommendations and overarching equity and specific racially focused equity competencies. The curricular recommendations fall into the following domains: (1) challenging the persistence of biological/genetic notions of race, (2) embedding structural practices in medical education to dismantle racism in medicine, and (3) promoting institutional climate change. Initial steps to implement these recommendations are described. The authors believe that the historic and present reality of racism in America and in medicine has impacted medical education specifically, and more broadly, the practice of medicine, trainee experience, and patient outcomes. The key findings of the BUSM analysis are transferable to other medical education institutions, and the described review process can support peer institutions as they engage in the imperative work of institutional reflection and addressing the salient ideas and practices that uphold racism in medicine.
The Impact of the COVID-19 Pandemic on Pediatric Graduate Medical Education: Lessons Learned and Pathways Forward
Authors: Blankenburg Rebecca , Gonzalez del Rey Javier , Aylor Megan , Frohna John G. , McPhillips Heather , Myers Ross E. , Waggoner-Fountain Linda A. , Degnon Laura , Poitevien Patricia
Published: November 2021

In this article, the authors describe the impact of the COVID-19 pandemic on pediatric graduate medical education (GME), including the impact on clinical experiences for trainees, teaching methods used, trainee wellness, GME leader wellness and support, and the traditional interview process. A thorough literature review was done to identify impacts of the COVID-19 pandemic on pediatric GME. In addition, information was collected through Association of Pediatric Program Directors virtual cafes and conferences. Positive changes for GME from the COVID-19 pandemic included: the rapid transition to telehealth; asynchronous learning allowing for increased cross-program collaboration; innovative online teaching modalities; increased flexibility and decreased cost of online recruitment; and shared innovations across pediatric GME. Challenging aspects of the COVID-19 pandemic included: decreased learning about common childhood illnesses, such as bronchiolitis, acute otitis media, and influenza; decreased patient volumes and patient complexity in clinics and inpatient wards, leading to less practice developing efficiency, time management, and triaging skills; and an increased burden on trainees, including moral distress and decreased support from one another and other social supports. The COVID-19 pandemic has highlighted important opportunities in U.S. educational systems. As medical educators move forward, it will be important to learn from these while mitigating the negative impacts.
Exploring the Effect of COVID-19 on Graduate Nursing Education
Authors: O’Keefe Rachael , Auffermann Kristin
Published: November 2021

Graduate nursing students are both nurses and adult learners. During the COVID-19 pandemic, many found themselves working on the frontlines while maintaining their studies and confronting challenges in their professional, educational, and personal lives. Changes in work environments, including redeployments, increased hours, and furloughs, challenged their work–study balance. The rapid pivot to virtual instruction allowed graduate nursing students to continue their coursework, but asynchronous delivery of course content increased their isolation and stress. Academic institutions supported graduate nursing students through innovations such as regular town hall meetings and flexible attendance policies, while the widespread closure of clinical learning sites became one of their biggest challenges. A minimum of 500 hours of supervised direct patient care is required to prepare a student to practice as a nurse practitioner, but there is no formal, financed clinical placement system for nurse practitioner students—leaving this clinical learning requirement particularly vulnerable to disruption during the pandemic. Some of the clinical learning alternatives employed included occupational health work, tele-precepting, and simulation. Since telehealth will be a part of the future of health care delivery, tele-precepting practices should be further developed, but simulation was underused and not an acceptable replacement for supervised direct patient care. A postpandemic future needs to limit gaps in the development of safe, competent health care providers by viewing graduate nursing students as essential workers and ensuring their access to the robust didactic and clinical learning opportunities that will best position them as leaders in health care.
Evidence of Buprenorphine-precipitated Withdrawal in Persons Who Use Fentanyl
Authors: Varshneya Neil B. , Thakrar Ashish P. , Hobelmann J. Gregory , Dunn Kelly E. , Huhn Andrew S.
Published: November 2021

Objectives

Buprenorphine can precipitate withdrawal in opioid-dependent persons with recent fentanyl use. However, the prevalence of this phenomenon is not clinically established. We sought to evaluate the incidence of buprenorphine-precipitated withdrawal in persons who use fentanyl.

Methods

We collected self-report data on opioid withdrawal symptoms after buprenorphine use, and, as a comparator, after methadone use, in 1679 individuals seeking treatment for opioid use disorder across 49 addiction treatment centers in the United States.

Results

The odds of developing severe withdrawal symptoms significantly increased when taking buprenorphine within 24 hours after fentanyl use (OR = 5.202, 95% CI = 1.979–13.675, P = 0.001), and within 24 to 48hours after fentanyl use (OR = 3.352, 95% CI =1.237–9.089, P = 0.017). As expected, patients did not report significantly higher rates of withdrawal when taking methadone after fentanyl use. Of those who waited less than 24hours after fentanyl before using buprenorphine or methadone, 22.19% (n = 152 of 685) and 11.56% (n = 23 of 199), respectively, reported severe opioid withdrawal.

Conclusions

This study supports previous anecdotal reports of buprenorphine-precipitated withdrawal from fentanyl. The odds of withdrawal symptoms significantly increased when taking buprenorphine after recent (within 48 hours) fentanyl use, however, this relationship was not observed in persons taking methadone, suggesting that this effect is specific to buprenorphine. Further research is urgently needed to describe the pharmacokinetics of non-medical fentanyl use to improve buprenorphine inductions strategies.
A Tale of Two Pulmonary Artery Catheters
Authors: Durack Jeremy C. , Chen Leon L. , Imran Saira , Halpern Neil A.
Published: November 2021

Innovative catheter-based therapies are increasingly being used for the treatment of patients with submassive pulmonary embolism. These patients may be monitored in the intensive care unit following insertion of specialized pulmonary artery catheters. However, the infusion catheters utilized in catheter-based therapies differ greatly from traditional pulmonary artery catheters designed for hemodynamic monitoring. As such, the critical care team will have to be familiar with the monitoring and management of these novel catheters. Important distinctions between the catheters are illustrated using a clinical case report.
The Effect of the Nursing Care Based on the Roy Adaptation Model on the Level of the Quality of Life and Fatigue in the Patients Undergoing Coronary Artery Bypass Graft Surgery
Authors: Esmaili Mojtaba , Salehi-Tali Shahriar , Mazaheri Elaheh , Hasanpour-Dehkordi Ali , Kheiri Soleiman
Published: November 2021

This article reports the findings of a study designed to investigate the effectiveness of the Roy Adaptation Model, as it relates to improvements in nursing care outcomes for patients undergoing coronary bypass graft surgery. Results revealed that the implementation of a training program based on this model enhanced staff education and led to decreases in the level of fatigue and improved the quality of life for this group of patients.
A Quality Improvement Initiative to Evaluate the Effectiveness of the ABCDEF Bundle on Sepsis Outcomes
Authors: Loberg Rachel A. , Smallheer Benjamin A. , Thompson Julie A.
Published: November 2021

Sepsis affects 1.7 million Americans annually and often requires an intensive care unit (ICU) stay. Survivors of ICU can experience long-term negative effects. This quality improvement initiative was designed to increase compliance with ABCDEF bundle elements and improve clinical outcomes. A significant improvement was seen in the completion of spontaneous awakening and breathing trials (P = .002), delirium assessment (P = .041), and early mobility (P = .000), which was associated with a reduction in mortality and 30-day readmission rates. Findings were consistent with other research that demonstrated an improvement in care delivery and some clinical outcomes.
A New Patient Acuity Tool to Support Equitable Patient Assignments in a Progressive Care Unit
Authors: Eastman Debra , Kernan Kristine
Published: November 2021

Making fair and equitable staffing decisions and patient assignments created complexities and undue nursing dissatisfaction on a 20-bed progressive care unit. Common themes shared by the nursing staff included inadequate staffing ratios, increased workload, and unease for patient safety. On the basis of these concerns, a unit-based needs assessment provided insight into what perceived and actual barriers exist preventing nurses from providing excellent care. Information gathered helped determine what could be done to overcome some barriers, and performing a comprehensive unit profile assessment allowed for better insight into how the unit was currently functioning. A comprehensive review of literature was undertaken to examine articles related to patient acuity utilizing the electronic databases CINAHL, PubMed, and MEDLINE. Key words and phrases included the following: acuity, patient acuity, acuity tools, progressive care acuity, nurse-patient assignment, workload, nursing assignments, and equitable staffing. Utilizing the results of the nurse survey, and information gained from articles gathered during the literature review, a patient acuity tool was created. The tool was believed to be an accurate representation of the patients' acuity, and the majority of charge nurses reported that they utilized the patient acuity tool score when making nurse-patient assignments. Overall staff satisfaction and perceptions of nurse-patient assignment equity were improved.
The Attitude of Iranian Critical Care Nurses Toward Euthanasia
Authors: Emami Zeydi Amir , Ghazanfari Mohammad Javad , Fast Olive , Maroufizadeh Saman , Heydari Keyvan , Gholampour Mohammad Hashem , Karkhah Samad
Published: November 2021

Today, one of the major ethical challenges facing the world's health care system, and in particular nurses in the intensive care unit, is euthanasia or death out of pity. The aim of this study was to investigate the attitude of Iranian nurses in the intensive care unit toward euthanasia. This was an analytical cross-sectional study using census sampling. The data collection tool was the Euthanasia Attitude Scale. A total of 206 nurses working in the intensive care unit in 4 hospitals in the Mazandaran province of Iran were included in this study. The mean of total Euthanasia Attitude Scale score in intensive care unit nurses was 2.96. The mean euthanasia dimensions were ethical consideration, practical considerations, treasuring life, and naturalistic beliefs, 3.03, 2.92, 2.98, and 2.99, respectively. There was significant but low negative correlation between age and total Euthanasia Attitude Scale score, ethical considerations, and practical considerations. Male nurses exhibited significantly higher Euthanasia Attitude Scale scores, specifically in regard to ethical and practical considerations compared with female nurses. The most Iranian nurses in the intensive care unit had a negative attitude toward euthanasia for patients in the later stages of the disease. However, this opposition was less than similar studies in Iran in the past.
The Effect of Early Mobilization on Respiratory Parameters of Mechanically Ventilated Patients With Respiratory Failure
Authors: Rezvani Hamid , Esmaeili Maryam , Maroufizadeh Saman , Rahimi Besharat
Published: November 2021

The effect of early mobilization on hemodynamic parameters of patients under mechanical ventilation has been associated with positive results and yet its effect on specific respiratory parameters is less well appreciated. This article reports the results of a study of a randomized clinical trial of intensive care unit patients receiving mechanical ventilation. The findings of this study confirmed that a 4-step protocol for early mobilization can improve Pao
2, O2 saturation, Pao
2/Fio
2 (fraction of inspired oxygen) ratio, and pulmonary compliance. The value of interdisciplinary collaboration supporting early mobilization was confirmed.
Development, Implementation, and Evaluation of an Early Mobility Protocol in a Regional Level II Trauma Center
Authors: McCarty Catherine A. , Renier Colleen M. , Conway Pat G. , Vogel Linda , Woehrle Theo A. , Anderson Leslie A. , Hanson Eric J. , Benrud Lisa M. , Gerchman-Smith Mary
Published: November 2021

The purpose of this project was to develop and evaluate a collaborative nursing/therapist protocol for early mobility in a medical-surgical intensive care unit (MICU) in a regional level II trauma center. Data for patients in the MICU were compared for the periods August 3, 2015-August 2, 2016, and August 3, 2014-August 2, 2015. Semistructured interviews were conducted with 10 nurses and 1 therapist. Average MICU length of stay decreased from 3.81 to 3.50 days (P = .057). Mean time in mobility chairs did not change (0.12 days vs 0.11 days, P = .389). Mean number of days to first documented level 2-5 activity decreased significantly, from 1.81 to 1.51 days (P = .036). The percentage of hospitalizations with any documented level 3 or 4 activity increased significantly (from 3.8% to 7.4% and from 61.5% to 66.7%, P = .003 and P = .031, respectively). Barriers/challenges to implementation included having enough people to assist, space, documentation, having to coax the physician to place order for upright mobility, availability of therapists for later stages of protocol, patient variability, fear of patient falls, availability of therapy chairs, staff changes, time, and patient refusal. A multidisciplinary approach to protocol development for early mobility in an intensive care unit was successfully implemented at a regional level II trauma center.
Pharmacokinetics of Cefepime in Children on Extracorporeal Membrane Oxygenation
Authors: Thibault Céline , Moorthy Ganesh S. , Vedar Christina , Naim Maryam Y. , DiLiberto Mary Ann , Zuppa Athena F.
Published: November 2021

Background:

Cefepime is a first-line therapy for Gram-negative infections in children on extracorporeal membrane oxygenation. Cefepime pharmacokinetics (PK) in children on extracorporeal membrane oxygenation still needs to be better established.

Methods:

This was a prospective single-center PK study. A maximum of 12 PK samples per patient were collected in children <18 years old on extracorporeal membrane oxygenation who received clinically indicated cefepime. External validation of a previously published population PK model was performed by applying the model in a new data set. The predictive performance of the model was determined by calculating prediction errors. Because of poor predictive performance, a revised model was developed using NONMEM and a combined data set that included data from both studies. Dose-exposure simulations were performed using the final model. Optimal dosing was judged based on the ability to maintain free cefepime concentrations above the minimal inhibitory concentration (MIC) for 68% and 100% of the dosing interval.

Results:

Seventeen children contributed 105 PK samples. The mean (95% CI) and median (interquartile range) prediction errors were 33.7% (19.8–47.7) and 17.5% (−22.6 to 74.4). A combined data set was created, which included 33 children contributing 310 PK samples. The final improved 2-compartment model included weight and serum creatinine on clearance and oxygenator day and blood transfusion on volume of the central compartment. At an MIC of 8 mg/L, 50 mg/kg/dose every 8 hours reached target concentrations.

Conclusions:

Dosing intervals of 8 hours were needed to reach adequate concentrations at an MIC of 8 mg/L. Longer dosing intervals were adequate with higher serum creatinine and lower MICs.
Management of late in-the-bag IOL dislocation with exchange and scleral fixation of IOL with the transfixion technique
Authors: Pineda-Fernández Angel A. , Chen Yan
Published: November 2021

Introduction:

Late in-the-bag intraocular lens (IOL) dislocation is a serious complication of cataract surgery.

Patient and clinical findings:

A 70-year-old woman with a history of left eye cataract surgery presented with progressively decreasing vision that had worsened over the past 6 months. In the left eye, the uncorrected distance visual acuity (UDVA) was counting fingers at 5 m, the corrected distance visual acuity (CDVA) was 20/25 (+12.25 −1.25 × 180), and the intraocular pressure was normal. An anterior segment examination revealed severe inferior dislocation of the IOL-capsular bag complex.

Diagnosis, intervention, and outcomes:

The patient was diagnosed with late in-the-bag IOL dislocation and underwent IOL–capsular bag complex explantation with sulcus-sutured IOL implantation using a new scleral fixation technique that included transfixion of a foldable acrylic IOL with polytetrafluoroethylene suture. The postoperative outcome was good; the UDVA was 20/70, and the CDVA was 20/25, and there were no postoperative complications such as infection, suture erosion, iritis, uveitis, vitreous hemorrhage, or retinal detachment.

Conclusions:

Late in-the-bag IOL dislocation was safely managed with IOL–capsular bag complex explantation and scleral fixation of a foldable posterior chamber IOL. This transfixion technique can be used for scleral fixation in patients with late in-the-bag IOL dislocation.
Labor Participation of Retirement-Aged Workers
Authors: Yuan Bocong , Li Jiannan , Lan Junbang
Published: November 2021

Background:

Delayed retirement initiative is taken as one of the proposed solutions to population aging. Rare research attention has been paid to determinants in decisions-making of late retirement.

Method:

This study applies data from CHARLS survey (2018) that traces the health status among older adults in China, and implements the stepwise multiple regression analysis adjusted with robust standard errors on individual level.

Results:

The difficulty in instrumental activities of daily living (IADLs) and chronic conditions could increase the intention of retirement-aged workers to withdraw from late career participation; and the overlay of both would interact to reinforce such intention. Besides, the employment-related social pension participation could further strengthen the jointly contributing effect of both on withdrawal from late career participation.

Conclusion:

The triple interaction mechanism in retirement-aged workers’ decisions of late retirement needs considering in the policy formulation of delayed retirement initiative.
Deterioration of Lipid Metabolism Despite Fitness Improvements in Wildland Firefighters
Authors: Rosales Alejandro M. , Dodds Patrick S. , Hailes Walter S. , Sol Joseph A. , Coker Robert H. , Quindry John C. , Ruby Brent C.
Published: November 2021

Objective:

Determine serum lipid and general health/fitness alterations following a 5-month wildfire suppression season.

Methods:

We recruited 100 wildland firefighters (WLFFs) to a 5-month pre- to post-season observational study. Nude body mass, blood pressure (BP), grip strength, and steptest heart rate (HR) were recorded. Blood samples were collected for lipid panel analysis (total cholesterol, high density lipoproteins (HDL)-cholesterol, low density lipoproteins-cholesterol, very low density lipoproteinscholesterol, triglycerides, triglyceride:HDL-cholesterol ratio). Two-tailed dependentttests determined statistical significance (P < 0.05).

Results:

There were pre- to post-season changes in nude body mass (+2 ± 4%,P = 0.001), systolic BP (−2 ± 10%,P = 0.01), step-test HR (−5 ± 10%,P < 0.001), and all serum lipids (total cholesterol: +5 ± 14%,P = 0.02, HDL-cholesterol: = 1 ± 17%,P = 0.04, low density lipoproteins-cholesterol: +8 ± 22%,P = 0.02, very low density lipoproteins-cholesterol: +31 ± 49%,P < 0.001, triglycerides: +30 ± 49%,P < 0.001, triglyceride:HDL-cholesterol ratio: +37 ± 58%,P < 0.001). Pre- to post-season diastolic BP (P = 0.12) and grip strength (P = 0.60) remained stable.

Conclusions:

WLFFs demonstrate maladaptive serum lipids and body mass alterations despite subtle aerobic fitness improvements.
Impact of Peer-Assisted Learning on Ultrasound
Authors: Garvick Sarah , Smith Ian , Carter Jason , El Tannir Ziad , Gentile Anthony , Jones Geoff , Rogers Lauren , Gillette Chris
Published: November 2021

Purpose

The aim of this study was to understand how peer-assisted learning (PAL) could be utilized by physician assistant (PA) students in an ultrasound student interest group (USIG) as a means of developing cognitive confidence and practical competence with the imaging modality.

Methods

An observational study that included 3 USIG workshops was designed. Pre- and postworkshop surveys were administered. All first-year PA students, regardless of participation in the USIG workshops, were asked to complete the voluntary and anonymous surveys.

Results

A statistically significant difference between those who attended at least one workshop and those who did not attend any workshops on their postworkshop scores (p = 0.02) was seen. There was a statistically significant association between the number of workshops attended and the postworkshop difference (p = 0.03).

Conclusion

Results show that, in the context of social cognitive theory, PAL is an efficacious learning modality that enhances learner and tutor performance in ultrasound.
Multicenter Results With an Active Transcutaneous Bone Conduction Implant in Patients With Single-sided Deafness
Authors: Huber Alexander M. , Strauchmann Bernd , Caversaccio Marco D. , Wimmer Wilhelm , Linder Thomas , De Min Nicola , Hempel John-Martin , Pollotzek Marlene , Frenzel Henning , Hanke Frauke , Röösli Christof
Published: November 2021

Objective:

To evaluate the audiological and subjective benefit from hearing rehabilitation with an active bone conduction implant in subjects with single-sided sensorineural deafness (SSD).

Study Design:

Prospective, multicenter, single-subject repeated measures.

Setting:

Tertiary referral center, five clinics in Germany and Switzerland.

Patients:

Seventeen subjects aged 18 years and older with severe to profound unilateral sensorineural hearing loss and contralateral normal hearing were followed up for 24 months.

Intervention:

Active bone conduction implant.

Main Outcome Measures:

Speech understanding in noise was assessed in three situations: with signal from front, deaf, or normal hearing side (with noise from front in all set-ups). Subjective benefit was evaluated using the Speech, Spatial, and Qualities of Hearing (SSQ-B) and Bern Benefit in Single-Sided Deafness (BBSS) questionnaire.

Results:

When the signal was coming from the deaf side the mean improvement of the speech reception threshold in noise ranged from 1.5 up to 2.2 dB with the device and was statistically and clinically significant at all tested timepoints. No significant difference between the aided and unaided situation was found when signal and noise were coming from the front. With the signal from the normal hearing side no clinically significant difference, that is, greater than 1 dB between the aided and unaided situation was found. The SSQ-B and BBSS questionnaire showed an overall improvement with no significant difference between time points.

Conclusions:

The study demonstrates long-term efficacy and benefit of the device in adults with SSD. Patients reported substantial and persistent subjective benefit from the active bone conduction implant.
Facing Challenges, Creating Connections
Authors: Kingston Mary Beth
Published: November 2021

Mary Beth Kingston, PhD, RN, NEA-BC, FAAN, chief nurse executive of Advocate Aurora Health and past president of the American Organization for Nursing Leadership (AONL), interviews her mentor, Joanne Disch, PhD, RN, FAAN, who serves on the Advocate Aurora Health Board of Directors and was the inaugural chair. Dr Disch also serves as chair of the Chamberlain University Board of Trustees and is professor ad honorem at the University of Minnesota School of Nursing. This is an abridged version of the interview, which took place at the AONL Virtual Conference in 2020.
Perceptions of Live Streaming Compared With an In-Person Nursing Conference
Authors: Overbay Devorah , Bigand Teresa , Springer Gale
Published: November 2021

OBJECTIVE

The aim of this study was to understand registered nurses' (RNs') perceptions of attending a live streaming versus in-person continuing education event.

BACKGROUND

During the COVID-19 global pandemic, in-person continuing education events for healthcare providers required conversion to digital platforms. Literature is sparse regarding healthcare providers' perceptions on attending a live streaming continuing education event.

METHODS

Registered nurses completed a survey after a live streaming research conference from a large US healthcare system. Likert-scale survey items were analyzed using descriptive statistics and open-ended questions with content analysis and thematic coding.

RESULTS

A total of 219 RNs participated. The RNs reported an overall positive experience with the live streaming event and indicated a preference for this platform for the future. Three benefits emerged: savings, self-care and safety, and user-friendly. Perceived drawbacks were coded with 3 themes: technical issues, impaired focus, and social/networking challenges.

CONCLUSIONS

Despite challenges, live streaming conferences may be satisfying and preferable for nurses.
Arthroscopic Synovectomy of the Wrist in Patients With Rheumatoid Arthritis
Authors: d'Ailly Philip N. , Mulders Marjolein A. M. , Bisoendial Radjesh J. , Kuijper T. Martijn , Coert J. Henk , Schep Niels W. L.
Published: November 2021

Background

Rheumatoid arthritis (RA) of the wrist can lead to loss of wrist function and progressive joint destruction if inadequately treated. Arthroscopic synovectomy of the wrist may prove a valuable treatment for local inflammation.

Objective

The aim of this study was to perform a systematic review evaluating functional outcomes and pain following arthroscopic synovectomy of the wrist in RA patients.

Methods

A systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines. MEDLINE, EMBASE, The Cochrane Library, Web of Science, and Google Scholar were searched for studies describing pain or functional outcomes following arthroscopic synovectomy of the wrist in RA patients (CRD42021270846). Risk of bias was assessed using the Methodological Index for Non-Randomized Studies. Data collection included patient characteristics, pain scores, wrist function questionnaires, secondary surgery, and complications.

Results

Six noncomparative cohort studies were included, with a total of 153 arthroscopic synovectomies. Disease duration of RA ranged from 32 to 89 months, and radiographic progression was mild to moderate. The Methodological Index for Non-Randomized Studies scores ranged from 8 to 10 out of 16. Mean follow-up ranged from 21 to 95 months. Improvements were seen in pooled mean visual analog scale pain score (from 7.7 to 2.2, p < 0.05), pooled mean Modified Mayo Wrist Score (from 43.3 to 70.4, p < 0.05), and the Disability of the Arm, Shoulder, and Hand (from 67.5 to 36.5, p < 0.05). Two complications occurred, and 5 patients required secondary surgery.

Conclusions

There is limited evidence suggesting that arthroscopic synovectomy of the wrist improves wrist function and pain in patients with RA, with few complications. In centers with arthroscopic expertise, it can be considered as a treatment option.
Impact of Body Mass Index on Major Complications, Multiple Complications, In-hospital Mortality, and Failure to Rescue After Esophagectomy for Esophageal Cancer
Authors: Hirano Yuki , Kaneko Hidehiro , Konishi Takaaki , Itoh Hidetaka , Matsuda Satoru , Kawakubo Hirofumi , Uda Kazuaki , Matsui Hiroki , Fushimi Kiyohide , Itano Osamu , Yasunaga Hideo , Kitagawa Yuko
Published: November 2021

Objective:

To examine the association of BMI with mortality and related outcomes after oncologic esophagectomy.

Summary Background Data:

Previous studies showed that high BMI was a risk factor for anastomotic leakage and low BMI was a risk factor for respiratory complications after esophagectomy. However, the association between BMI and in-hospital mortality after oncologic esophagectomy remains unclear.

Methods:

Data for patients who underwent esophagectomy for esophageal cancer between July 2010 and March 2019 were extracted from a Japanese nationwide inpatient database. Multivariate regression analyses and restricted cubic spline analyses were used to investigate the associations between BMI and short-term outcomes, adjusting for potential confounders.

Results:

Among 39,406 eligible patients, in-hospital mortality, major complications, and multiple complications (≥2 major complications) occurred in 1069 (2.7%), 14,824 (37.6%), and 3621 (9.2%), respectively. Compared with normal weight (18.5–22.9 kg/m2), severe underweight (<16.0 kg/m2), mild/moderate underweight (16.0–18.4 kg/m2), and obese (≥27.5 kg/m2)were significantly associated with higher in-hospital mortality [odds ratio 2.20 (95% confidence interval 1.65–2.94), 1.25 (1.01–1.49), and 1.48 (1.05–2.09), respectively]. BMI showed U-shaped dose-response associations with mortality, major complications, and multiple complications. BMI also showed a reverse J-shaped association with failure to rescue (death after major complications).

Conclusions:

Both high BMI and low BMI were associated with mortality, major complications and multiple complications after esophagectomy for esophageal cancer. Patients with low BMI were more likely to die once a major complication occurred. The present results can assist with risk stratification in patients undergoing oncologic esophagectomy.
The Beirut Port Explosion Injuries and Lessons Learned
Authors: Gebran Anthony , Abou Khalil Elissa , El Moheb Mohamad , Albaini Obey , El Warea Mohamad , Ibrahim Rand , Karam Karin , El Helou Mohamad Othman , Ramly Elie P. , El Hechi Majed , Matar Ayah , Zeineddine Jana , Dabar George , Al Hajj Assem , Abi Saad George , Hoballah Jamal , Safadi Bassem , Kaafarani Haytham M. A.
Published: November 2021

Objective:

This multicenter study aims to describe the injury patterns, emergency management and outcomes of the blast victims, recognize the gaps in hospital disaster preparedness, and identify lessons to be learned.

Summary Background Data:

On August 4th, 2020, the city of Beirut, Lebanon suffered the largest urban explosion since Hiroshima and Nagasaki, resulting in hundreds of deaths and thousands of injuries.

Methods:

All injured patients admitted to four of the largest Beirut hospitals within 72 hours of the blast, including those who died on arrival or in the emergency department (ED), were included. Medical records were systematically reviewed for: patient demographics and comorbidities; injury severity and characteristics; prehospital, ED, operative, and inpatient interventions; and outcomes at hospital discharge. Lessons learned are also shared.

Results:

An estimated total of 1818 patients were included, of which 30 died on arrival or in the ED and 315 were admitted to the hospital. Among admitted patients, the mean age was 44.7 years (range: 1 week–93 years), 44.4% were female, and the median injury severity score (ISS) was 10 (5, 17). ISS was inversely related to the distance from the blast epicenter (r = -−0.18, P = 0.035). Most injuries involved the upper extremities (53.7%), face (42.2%), and head (40.3%). Mildly injured (ISS <9) patients overwhelmed the ED in the first 2 hours; from hour 2 to hour 8 post-injury, the number of moderately, severely, and profoundly injured patients increased by 127%, 25% and 17%, respectively. A total of 475 operative procedures were performed in 239 patients, most commonly soft tissue debridement or repair (119 patients, 49.8%), limb fracture fixation (107, 44.8%), and tendon repair (56, 23.4%). A total of 11 patients (3.5%) died during the hospitalization, 56 (17.8%) developed at least 1 complication, and 51 (16.2%) were discharged with documented long-term disability. Main lessons learned included: the importance of having key hospital functions (eg, laboratory, operating room) underground; the nonadaptability of electronic medical records to disasters; the ED overwhelming with mild injuries, delay in arrival of the severely injured; and the need for realistic disaster drills.

Conclusions:

We, therefore, describe the injury patterns, emergency flow and trauma outcome of patients injured in the Beirut port explosion. The clinical and system-level lessons learned can help prepare for the next disaster.
A Randomized Controlled Trial of the Effect of Repetitive Transcranial Magnetic Stimulation of the Motor Cortex on Lower Extremity Spasticity in Hereditary Spastic Paraplegia
Authors: Bastani Pouya B. , Kordjazi Mohsen , Oveisgharan Shahram , Abdi Siamak
Published: November 2021

Introduction:

Hereditary spastic paraplegia refers to a group of conditions characterized by a slow progression of spasticity in lower limbs resulting in gait abnormalities. Current treatment options have proven to be insufficient in terms of symptom alleviation. In this study, we tested the effectiveness of repetitive transcranial magnetic stimulation (rTMS) on lower limb spasticity in patients with hereditary spastic paraplegia.

Methods:

Eight patients were randomly assigned to receive either five sessions of active 5 Hz-rTMS (n= 4) or sham rTMS (n= 4). The primary outcome was a change in spasticity assessed by the modified Ashworth scale. Secondary outcomes were change in 10 m walking test, Fugl-Meyer assessment of lower extremity motor function, and quality-of-life short-form survey scores. Assessment of the outcomes was done before, upon completion, and 1 month after the intervention. We analyzed the data using repeated-measure analysis of variance.

Results:

Mean age of the participants was 38.5 (SD = 5.4) years, and 50% were women. Compared with sham rTMS, real rTMS was effective in decreasing modified Ashworth scale (rTMS × time: F [df = 2] = 7.44;P= 0.008). Real rTMS group had lower modified Ashworth scale scores at the end of rTMS sessions (estimate = −0.938; SE = 0.295;P= 0.019) and at the end of follow-up (estimate = −0.688; SE = 0.277;P= 0.048) compared with the sham rTMS group. Real and sham rTMS groups were not different in the secondary outcomes.

Conclusions:

Repetitive transcranial magnetic stimulation is an effective method in reducing lower limb spasticity of patients with hereditary spastic paraplegia.
Spike-Associated Networks Predict Postsurgical Outcomes in Children With Refractory Epilepsy
Authors: Bear Joshua J. , Sargent Jenifer L. , O'Neill Brent R. , Chapman Kevin E. , Ghosh Debashis , Kirsch Heidi E. , Tregellas Jason R.
Published: November 2021

Purpose:

Up to half of the children undergoing epilepsy surgery will continue to have seizures (szs) despite a cortical resection or ablation. Functional connectivity has shown promise in better identifying the epileptogenic zone. We hypothesized that cortical areas showing high information outflow during interictal epileptiform discharges are part of the epileptogenic zone.

Methods:

We identified 22 children with focal epilepsy who had undergone stereo electroencephalography, surgical resection or ablation, and had ≥1 year of postsurgical follow-up. The mean phase slope index, a directed measure of functional connectivity, was calculated for each electrode contact during interictal epileptiform discharges. The positive predictive value and negative predictive value for a sz-free outcome were calculated based on whether high information outflow brain regions were resected.

Results:

Resection of high outflow (z-score ≥ 1) and very high outflow (z-score ≥ 2) electrode contacts was associated with higher sz freedom (high outflow: χ2 statistic = 59.1; P < 0.001; very high outflow: χ2 statistic = 31.3; P < 0.001). The positive predictive value and negative predictive value for sz freedom based on resection at the electrode level increased at higher z-score thresholds with a peak positive predictive value of 0.86 and a peak negative predictive value of 0.9.

Conclusions:

Better identification of the epileptogenic zone has the potential to improve epilepsy surgery outcomes. If the surgical plan can be modified to include these very high outflow areas, more children might achieve sz freedom. Conversely, if deficits from resecting these areas are unacceptable, ineffective surgeries could be avoided and alternative therapies offered.
Ongoing decline in insect-pollinated plants across Danish grasslands
Authors: Ehlers Bodil K. , Bataillon Thomas , Damgaard Christian F.
Published: November 2021

Loss of habitat, eutrophication and reduced grazing intensity are known drivers of landscape-level changes in plant species composition; however, consequences of the massive decline in insect abundance are still to be understood. Pollinator decline can reduce seed set in plants relying on insects for successful reproduction. This may result in a reduced recruitment of insect-pollinated plant species with associated changes in species composition. So far, large-scale studies addressing this issue have relied on few data points—typically consisting of ‘historic’ records of numbers of insect-pollinated plants compared to present-day records. Such comparisons can provide information as to whether the diversity of insect-pollinated plants has changed, but not whether the process is still ongoing. Here, we use nationwide monitoring data of plant species richness in Danish grasslands from the period 2004–2014, covering 244 grassland sites and encompassing more than 790 flowering plant species. We show an ongoing decrease in insect-pollinated, but not wind-pollinated, plant species across different habitat types. In both dry calcareous andNardusgrasslands, loss of insect-pollinated plants was greatest at sites with low grazing intensity. However, insect-pollinated plants also declined from sites with higher grazing intensity, and plants requiring more specialized insect pollination tended to decline most. In addition to changes in plant diversity driven by land-use intensification, loss of pollinators may also play a role in reducing the richness of insect-pollinated plants. Ongoing reduction in floral richness could further increase the threat to insects relying on these plants as a food source.
Estimating disease vector population size from citizen science data
Authors: Tran Tam , Porter W. Tanner , Salkeld Daniel J. , Prusinski Melissa A. , Jensen Shane T. , Brisson Dustin
Published: November 2021

Citizen science projects have the potential to address hypotheses requiring extremely large datasets that cannot be collected with the financial and labour constraints of most scientific projects. Data collection by the general public could expand the scope of scientific enquiry if these data accurately capture the system under study. However, data collection inconsistencies by the untrained public may result in biased datasets that do not accurately represent the natural world. In this paper, we harness the availability of scientific and public datasets of the Lyme disease tick vector to identify and account for biases in citizen science tick collections. Estimates of tick abundance from the citizen science dataset correspond moderately with estimates from direct surveillance but exhibit consistent biases. These biases can be mitigated by including factors that may impact collector participation or effort in statistical models, which, in turn, result in more accurate estimates of tick population sizes. Accounting for collection biases within large-scale, public participation datasets could update species abundance maps and facilitate using the wealth of citizen science data to answer scientific questions at scales that are not feasible with traditional datasets.
A short perinuclear amphipathic α-helix in Apq12 promotes nuclear pore complex biogenesis
Authors: Zhang Wanlu , Khan Azqa , Vitale Jlenia , Neuner Annett , Rink Kerstin , Lüchtenborg Christian , Brügger Britta , Söllner Thomas H. , Schiebel Elmar
Published: November 2021

The integral membrane protein Apq12 is an important nuclear envelope (NE)/endoplasmic reticulum (ER) modulator that cooperates with the nuclear pore complex (NPC) biogenesis factors Brl1 and Brr6. How Apq12 executes these functions is unknown. Here, we identified a short amphipathic α-helix (A
α
H) in Apq12 that links the two transmembrane domains in the perinuclear space and has liposome-binding properties. Cells expressing an
APQ12
(
apq12-ah
) version in which A
α
H is disrupted show NPC biogenesis and NE integrity defects, without impacting Apq12-ah topology or NE/ER localization. Overexpression of
APQ12
but not
apq12-ah
triggers striking over-proliferation of the outer nuclear membrane (ONM)/ER and promotes accumulation of phosphatidic acid (PA) at the NE. Apq12 and Apq12-ah both associate with NPC biogenesis intermediates and removal of A
α
H increases both Brl1 levels and the interaction between Brl1 and Brr6. We conclude that the short amphipathic α-helix of Apq12 regulates the function of Brl1 and Brr6 and promotes PA accumulation at the NE possibly during NPC biogenesis.
Carbon dioxide levels and ventilation inAcromyrmexnests: significance and evolution of architectural innovations in leaf-cutting ants
Authors: Bollazzi Martin , Römer Daniela , Roces Flavio
Published: November 2021

Leaf-cutting ant colonies largely differ in size, yet all consume O2and produce CO2in large amounts because of their underground fungus gardens. We have shown that in theAcromyrmexgenus, three basic nest morphologies occur, and investigated the effects of architectural innovations on nest ventilation. We recognized (i) serial nests, similar to the ancestral type of the sister genusTrachymyrmex, with chambers excavated along a vertical tunnel connecting to the outside via a single opening, (ii) shallow nests, with one/few chambers extending shallowly with multiple connections to the outside, and (iii) thatched nests, with an above-ground fungus garden covered with plant material. Ventilation in shallow and thatched nests, but not in serial nests, occurred via wind-induced flows and thermal convection. CO2concentrations were below the values known to affect the respiration of the symbiotic fungus, indicating that shallow and thatched nests are not constrained by harmful CO2levels. Serial nests may be constrained depending on the soil CO2levels. We suggest that inAcromyrmex, selective pressures acting on temperature and humidity control led to nesting habits closer to or above the soil surface and to the evolution of architectural innovations that improved gas exchanges.
Geometric and topological approaches to shape variation in
Ginkgo
leaves
Authors: Hang Haibin , Bauer Martin , Mio Washington , Mander Luke
Published: November 2021

Leaf shape is a key plant trait that varies enormously. The range of applications for data on this trait requires frequent methodological development so that researchers have an up-to-date toolkit with which to quantify leaf shape. We generated a dataset of 468 leaves produced by
Ginkgo biloba
, and 24 fossil leaves produced by evolutionary relatives of extant
Ginkgo
. We quantified the shape of each leaf by developing a geometric method based on elastic curves and a topological method based on persistent homology. Our geometric method indicates that shape variation in modern leaves is dominated by leaf size, furrow depth and the angle of the two lobes at the leaf base that is also related to leaf width. Our topological method indicates that shape variation in modern leaves is dominated by leaf size and furrow depth. We have applied both methods to modern and fossil material: the methods are complementary, identifying similar primary patterns of variation, but also revealing different aspects of morphological variation. Our topological approach distinguishes long-shoot leaves from short-shoot leaves, both methods indicate that leaf shape influences or is at least related to leaf area, and both could be applied in palaeoclimatic and evolutionary studies of leaf shape.