bluuebunny/crossref_metadata_2025 huggingface dataset:
National assessment of emergency staff level of practice in the management of forensic evidence
Authors: Albishri Saad B , Albednah Fahed A , Alenazi Nawaf S , Alsubaie Nahaa E , Elserafy Osama S
Published: August 2023

The emergency room is the most likely location where victims of violent crime would be encountered by the healthcare system, as the emergency staff is the first to evaluate the victim or culprit, exposing them to a range of forensic evidence. Forensic evidence can help exclude, identify, and prosecute a suspect and is classified as informational or physical evidence. Emergency staff must be proficient and knowledgeable in gathering, preserving, and documenting forensic evidence in their practice. To our knowledge, this is the first study that assesses the emergency staff’s level of practice in managing forensic evidence. The aims of this study are to assess the level of practice of emergency staff in managing forensic evidence and observe an association between emergency experience and the level of practice in managing forensic evidence, study a connection between forensic education/training and the level of practice in the management of forensic evidence. This observational cross-sectional analytical study in Saudi Arabia was conducted from January 2022 to December 2022. Participants completed a self-administered online survey. Measuring the level of practice was implemented through a researcher-designed questionnaire based on a paper that provided guidelines for forensic evidence collection in the emergency department. Most emergency healthcare workers had a good level of practice in managing forensic evidence (64.7%). Those with excellent practice scored the lowest in documentation, whereas participants in the poor practice category scored the lowest in the trace evidence and clothes domains. Emergency workers who encountered less number of forensic cases per month, i.e. less than two or three to five cases, were found to be more likely to have poor management of forensic evidence. Emergency personnel with no prior education or training are more likely to engage in poor practice in forensic evidence collection. Furthermore, those who had acquired forensic education/training had higher percentages of excellent forensic practice (56.52%) compared to poor practice (7.14%). Those who claimed that their institution had issued guidelines were more likely to have excellent practice (75.36%), whilst those who did not receive guidelines were more likely to have poor forensic evidence management (85.71%). More research is required involving local hospitals and utilizing consistently validated methods in evaluating forensic evidence collection.

Key points
Access challenges for patients with limited English proficiency: a secret-shopper study of in-person and telehealth behavioral health services in California safety-net clinics
Authors: Uscher-Pines Lori , Kapinos Kandice , Rodriguez Claudia , Pérez-Dávila Samantha , Raja Pushpa , Rodriguez Jorge A , Rabinowitz Maya , Youdelman Mara , Sousa Jessica L
Published: August 2023

The recent growth of telehealth may be impacting access to care for patients, including those with limited English proficiency (LEP). Using a secret-shopper design, simulated patients contacted 386 safety-net clinics in California in both Spanish and English from February–March 2023. Callers stated that they were new patients seeking medication for depression, and they documented time to an appointment and available visit modalities (telehealth and in-person). Multinomial logistic regression models examined associations between clinic characteristics and available modalities. English-speaking callers were more likely to speak with a live scheduler and to obtain appointment information from a scheduler who could engage with them in their preferred language. Among Spanish-speaking callers who reached a live scheduler, 22% reached someone who did not engage (eg, were hung up on) and, as a result, could not obtain appointment information. The mean estimated time to a prescribing visit was 36 days and did not differ by language. Sixty-four percent of clinics offered both telehealth and in-person visits, 14% only offered in-person visits, and 22% only offered telehealth visits. More attention and resources are needed to support patients with LEP at the point of scheduling and to ensure choice of visit modality for all patient populations.
A Riemannian Plane With Only Two Injective Geodesics
Authors: Bangert Victor , Suhr Stefan
Published: August 2023

We present an example of a complete Riemannian plane with precisely two injective geodesics—up to reparameterization. The example arises as a perturbation of a surface of revolution with contracting end. The last section is devoted to open problems.
Cultural challenges to competition law enforcement in Latin America
Authors: Peña Julián
Published: August 2023

The internationalization of competition law in recent decades has been very successful. A very large number of jurisdictions have now adopted competition laws and apply them in marked similarity. And yet, at times, these laws, despite the similarity in wording and theory, lead to substantial differences when enforced. Differences in the meaning attributed to various concepts, to the goals of competition laws and to the methods of implementation, may result in inconsistency in the enforcement. The Latin American experience reveals a certain level of mutation process from the model laws through the flexibilization in their competition law enforcement, influenced by their own social values and beliefs, as well as their economic, political, institutional, and legal cultures. These cultural challenges need to be solved internally in each jurisdiction to allow competition law enforcement to further develop. Those jurisdictions where competition law enforcement has evolved the most are those that have adapted their competition laws to their cultural realities, while at the same time learning from the international experience. An interdisciplinary debate, at the local and regional levels, has showed to be an essential tool to help find possible solutions to the different challenges Latin American enforcers face.
Parental effects on offspring sex ratio in the Numbat (Myrmecobius fasciatus): does captivity influence paternal sex allocation?
Authors: Firman Renée C , Ellis Connor M , Thorn Sian , Mawson Peter R
Published: August 2023

Sex allocation theories predict that under different ecological conditions the production of sons and daughters will affect parental fitness differently. Skewed offspring sex ratios often occur under captive conditions where individuals are exposed to nutritional and social conditions that differ from nature. Here, we analyzed 29 years of offspring sex ratio data from a captive population of an endangered marsupial, the Numbat (Myrmecobius fasciatus). We partitioned variation in offspring sex ratio based on parental origin (captive- vs. wild-bred), parental weight, maternal age, and maternal reproductive history. Our analyses revealed no effect of parental weight or maternal origin on offspring sex ratio—however, there was a significant effect of paternal origin. Data visualization indicated that captive-bred males tended to produce male-biased litters. We discuss the result in relation to recent studies that have shown that male mammals have the capacity to be arbiters of sex allocation and highlight candidate mechanisms, but consider it with caution due to the small sample size from which the result was derived. We performed a population viability analysis (PVA) to explore the potential impact of a sex ratio skew on the sustainability of the captive Numbat population under hypothetical scenarios. Our PVA revealed that supplementation with wild individuals is critical to the persistence of the captive Numbat population and that a biased sex ratio will lead to extinction of the captive colony under certain conditions. Overall, our study demonstrates that covert sex ratio skews can persist undetected in captive populations, which have the potential to become impactful and compromise population sustainability under changed management processes.
Antimicrobial Susceptibility Among Gram-Negative Isolates in Pediatric Patients in Latin America, Africa-Middle East, and Asia From 2016–2020 Compared to 2011–2015: Results From the ATLAS Surveillance Study
Authors: Yang Qiwen , Kamat Shweta , Mohamed Naglaa , Valdez Rafael Ricardo , Lin Stephen , Su Ming , Quintana Alvaro , Kiratisin Pattarachai , Rodríguez-Zulueta Ana Patricia , Brink Adrian
Published: August 2023

Background

Antimicrobial resistance (AMR) data in the pediatric population are limited, particularly in developing countries. This study assessed the AMR profile and key resistance phenotypes and genotypes for Gram-negative bacteria (GNB) isolates collected as part of the Antimicrobial Testing Leadership and Surveillance program from pediatric patients in Latin America, Africa-Middle East, and Asia in 2016–2020 versus 2011–2015.

Methods

Minimum inhibitory concentrations by broth microdilution methodology were interpreted per the Clinical and Laboratory Standards Institute. European Committee on Antimicrobial Susceptibility Testing breakpoints were used for interpreting colistin activity. β-lactamase genes were screened by polymerase chain reaction and sequencing.

Results

For Acinetobacter baumannii, low susceptibility (<60.0%) was observed for all antimicrobials, except colistin (≥92.9%), across regions and year periods. Ceftazidime-avibactam, amikacin, colistin, and meropenem were mostly active (78.6%–100.0%) against Enterobacter cloacae, Escherichia coli, and Klebsiella pneumoniae. For Pseudomonas aeruginosa, susceptibility to ceftazidime-avibactam, amikacin, and colistin was ≥85.9%. Among resistance phenotypes, carbapenem-resistant (CR, ≥44.8%) and difficult-to-treat resistant (DTR, ≥37.1%) rates were the highest in A. baumannii. A consistent increase in CR and DTR K. pneumoniae was noted across regions over time. Extended-spectrum β-lactamases (ESBL)-producing K. pneumoniae (32.6%–55.6%) were more frequent than ESBL-producing E. coli (25.3%–37.1%). CTX-M was the dominant ESBL among Enterobacterales. NDM-positive Enterobacterales species and VIM-positive P. aeruginosa were identified across regions.

Conclusions

This study identified high susceptibility to few agents for key GNB in pediatric patients. Continued surveillance of resistance phenotypes and genotypes at regional levels may help to guide appropriate treatment decisions.
Internalism and the Determinacy of Mathematics
Authors: Picollo Lavinia , Waxman Daniel
Published: August 2023

A major challenge in the philosophy of mathematics is to explain how mathematical language can pick out unique structures and acquire determinate content. In recent work, Button and Walsh have introduced a view they call ‘internalism’, according to which mathematical content is explained by internal categoricity results formulated and proven in second-order logic. In this paper, we critically examine the internalist response to the challenge and discuss the philosophical significance of internal categoricity results. Surprisingly, as we argue, while internalism arguably explains how we pick out unique mathematical structures, this does not suffice to account for the determinacy of mathematical discourse.
Impact of socioeconomic status and chemotherapy on neurocognitive performance in children with brain tumors
Authors: Chang Leslie , Patel Palak P , Zhang Yifan , Cohen Alan , Cohen Kenneth , Jacobson Lisa , Ladra Matthew , Peterson Rachel K , Acharya Sahaja
Published: August 2023

Background

Although the relationship between radiation and neurocognition has been extensively studied in the pediatric brain tumor population, it is increasingly recognized that neurocognitive impairment is multifactorial. Therefore, we quantified the effect of socioeconomic status (SES) and chemotherapy on neurocognitive impairment and decline post-treatment.

Methods

Eligible patients included those diagnosed with a brain tumor at < 22 years of age with ≥1 neurocognitive assessment. Neurocognitive impairment was defined as performance 1.5 standard deviations below the normative mean using age-standardized measures of intellectual function. Neurocognitive decline was defined as a negative slope. Neurocognitive outcomes included Wechsler indices of Full-Scale Intelligence Quotient (IQ). Logistic regression identified variables associated with neurocognitive impairment. Longitudinal data was analyzed using linear mixed models.

Results

Eligible patients (n = 152, median age at diagnosis = 9.6 years) had a mean neurocognitive follow-up of 50.2 months. After accounting for age and receipt of craniospinal irradiation, patients with public insurance had 8-fold increased odds of impaired IQ compared to private insurance (odds ratio [OR]: 7.59, P < .001). After accounting for age, change in IQ was associated with chemotherapy use (slope: −0.45 points/year with chemotherapy vs. 0.71 points/year without chemotherapy, P = .012).

Conclusions

Public insurance, an indicator of low SES, was associated with post-treatment impairment in IQ, highlighting the need to incorporate SES measures into prospective studies. Chemotherapy was associated with change in IQ. Further work is needed to determine whether impairment associated with low SES is secondary to baseline differences in IQ prior to brain tumor diagnosis, brain tumor/therapy itself, or some combination thereof.
Safety, Reactogenicity, Immunogenicity, and Dose Selection of 10-Valent Extraintestinal Pathogenic Escherichia coli Bioconjugate Vaccine (VAC52416) in Adults Aged 60–85 Years in a Randomized, Multicenter, Interventional, First-in-Human, Phase 1/2a Study
Authors: Fierro Carlos A , Sarnecki Michal , Doua Joachim , Spiessens Bart , Go Oscar , Davies Todd A , van den Dobbelsteen Germie , Poolman Jan , Abbanat Darren , Haazen Wouter
Published: August 2023

Background

ExPEC10V is a bioconjugate vaccine containing O-antigen polysaccharides of 10 extraintestinal pathogenic Escherichia coli (ExPEC) serotypes. This phase 1/2a study (NCT03819049) assessed the safety, reactogenicity, and immunogenicity of ExPEC10V (VAC52416) to prevent invasive E coli disease in elderly adults.

Methods

The observer-blind, active-controlled design included a 28-day screening, vaccination, 181-day follow-up, and 1-year follow-up. Participants (60–85 years of age) were randomized to ExPEC10V low dose (antigen dose range, 4–8 µg), ExPEC10V medium dose (4–16 µg), or ExPEC10V high dose (8–16 µg); 4-valent ExPEC vaccine (ExPEC4V); or 13-valent pneumococcal conjugate vaccine (PCV13). The incidence of adverse events (AEs; solicited, day 15; unsolicited, day 30; serious AEs, day 181) and immunogenicity (electrochemiluminescent-based assay [ECL] and multiplex opsonophagocytic assay [MOPA]) were assessed. Optimal ExPEC10V dose was determined from safety data through day 30 and an immunogenicity dose selection algorithm based on day 15 ECL and MOPA results.

Results

A total of 416 participants were included (median age, 64.0 years; 54.8% female). The incidences of solicited local and systemic AEs were, respectively, 44.2% and 39.4% for low-dose, 52.9% and 46.1% for medium-dose, 57.7% and 45.2% for high-dose ExPEC10V, and 74.1% and 48.1% for PCV13. Five serious AEs, not vaccine related, were reported. The ECL revealed a robust antibody response to ExPEC10V through year 1. Opsonophagocytic killing activity was detected against all but serotype O8; this lack of response against serotype O8 was linked to low assay sensitivity. Based on the totality of data, high-dose ExPEC10V was considered optimal.

Conclusions

ExPEC10V was well tolerated and immunogenic in elderly adults against all but serotype O8.
The Utility of Metagenomic Next-Generation Sequencing (mNGS) in the Management of Patients With Bronchiectasis: A Single-Center Retrospective Study of 93 Cases
Authors: Zhang Hui , Shen Dongfeng , Zhou Jiaqi , Yang Qingyue , Ying Ying , Li Na , Cao Linfeng , Wang Wenmin , Ma Xiaolong
Published: August 2023

Background

Bronchiectasis is a chronic inflammatory respiratory disease mainly caused by pathogenic infections. However, standard methods of pathogen detection show prolonged cycle durations and unsatisfactory sensitivity and detection rates. Macrogenomic next-generation sequencing (mNGS) emerges as a promising technique for swift, effective, and unbiased pathogen detection and subsequent data interpretation.

Methods

Here, a retrospective analysis of 93 patients with suspected bronchiectasis was performed to assess the clinical applicability of mNGS. Bronchoalveolar alveolar lavage fluid (BALF) samples were collected from these subjects, followed by standard assays and mNGS separately. The turnaround time, detection rate, and pathogen identification using mNGS were compared with those of standard methods.

Results

mNGS identified a greater number of bacteria (72 vs 16), fungi (26 vs 19), and viruses (14 vs 0) than standard methods. Specifically, the commonly identified bacteria were Haemophilus, Mycobacterium intracellulare, Pseudomonas, and Streptococcus pneumoniae, while the most detected fungi were Aspergillus and the most prevalent viruses were human herpesviruses. Of note, 29 out of 30 patients (96.67%) who received optimized treatment strategies based on mNGS results experienced recovery.

Conclusions

Collectively, these findings suggest that mNGS has the potential to improve the diagnosis and treatment of bronchiectasis patients by enabling rapid and precise pathogen detection, which can lead to timely and effective treatment strategies.
Spontaneous periodic polarization wave in helielectric fluids
Authors: Zhou Junchen , Zou Yu , Li Jinxing , Huang Mingjun , Aya Satoshi
Published: August 2023

By analogy with spin waves in ferromagnetic systems, the polarization (or dipole) wave is the electric counterpart that remains elusive. Here, we discover that the helielectricity, i.e. a polarization field with helicoidal helices that corresponds to a quasi-layered chiral nematic environment, causes a spontaneous formation of large-scale polarization waves in the form of the sinusoidal function. Both experimental and theoretical analyses reveal that the polarization ordering over a threshold polarization strength violates the inherent periodicity of the polarization helices, thus penalizing the compression energy. It drives a second-order structural transition to a periodically modulated polarization wave state. The roles of chirality and confinement condition are discussed.
Measuring the impact of intellectual capital performance management indicators through the lens of organizational capital: A Police Agency case study
Authors: Al Ramahi Ahmed M , Davies Amanda , Al Kaabi Faisal
Published: August 2023

As the changing dynamics of the 21st-century workplace is influenced by societal demands and expectations, understanding the influence of organizational capital strategic indicators on employee performance is pivotal for competitive advantage and establishing best practice. There is a wealth of knowledge developed as to the influence of employee performance on organizational capital and, by association, intellectual capital. What is less known is the reverse influence—how do strategic management indicators of organizational capital influence employee performance? This study, conducted within a United Arab Emirates police agency explored the influence of six such indicators through interviews and a questionnaire. Results indicate middle-ranked positions placed the highest level of importance on risk management and crime prevention, with 97% of all study participants identifying this as an important/very important influencing indicator. Command (Administration) employees place marginally lower importance on an organizational clear vision and key performance indicators compared with core (operational) and services units (community-based services). A total of 89% of participants agreed that information technology/automated software influences employee and organizational performance. Models of excellence were perceived (57%) as having limited influence, however, acknowledging the capacity for influence on overall organizational performance. The variation in employee perception of the organizational capital indicators offers valuable insight for leadership decisions associated with aligning intellectual and organizational capital with the reality of employee, in this case, police officer, performance. Reviewing approaches to performance management supports police agencies to meet the continually evolving demands of the communities they serve.
Downsizing and recovery: Perceived quality of police services in Finland before, during, and after three major police management reform programs
Authors: Vuorensyrjä Matti
Published: August 2023

This study analyses the effects of three major police management reform programs on the perceived quality of police services in Finland. Downsizing in the early 2010s, and recovery of the number of personnel of the police towards the end of the 2010s, were notable over the police management reform years. The study is based on the analysis of three quality indicators from cross-sectional Police Citizen Surveys (1999–2020). We find that the reform period had a significant impact on the perceived quality of police services: negative in the early 2010s, and positive in the late 2010s. Respondents’ emergency response time estimates as well as perceived effectiveness of crime reporting deteriorated during the police management reform period. Since then, they have recovered. Policy-wise we conclude that in labor-intensive services such as policing management reform programs associated with downsizing constitute a real hazard, reducing, almost inevitably, the volume and the accessibility of services.
Flavor structure from ‘canonical’ Yukawa interactions and ‘emergent’ kinetic terms
Authors: Kawamura Yoshiharu
Published: August 2023

We study the flavor structure of quarks in the standard model from a viewpoint of a canonical type of Yukawa interactions and an emergence of kinetic terms. A realistic structure can be generated based on the emergence proposal that quark kinetic terms appear in the infrared region, as a result of radiative corrections involving towers of massive states.
Cross-Selling in Bank-Household Relationships: Mechanisms and Implications for Pricing
Authors: Basten Christoph , Juelsrud Ragnar
Published: August 2023

We show that banks cross-sell future deposits and loans to existing household depositors. A bank is 20-percentage-points more likely to sell a loan to an existing depositor than to an otherwise comparable household. Existing depositors pay a premium when borrowing, and we find no indication that banks obtain an informational advantage on such borrowers, suggesting that the cross-selling is driven more by demand than by supply complementarities. These demand complementarities are in turn driven more by stickiness rather than by unobserved persistent preferences. Finally, banks internalize future cross-selling potential when setting deposit rates.

Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online
E66 Arthropathy as the initial presentation of HIV
Authors: Musyoki D K , Okong’o L O
Published: August 2023

Background

Human immunodeficiency virus (HIV) has been associated with musculoskeletal disorders which has been estimated to occur in 11–72% of infected patients. Most of these reports however have been in adults with few published cases of HIV associated arthritis in children. The articular manifestations of HIV, especially overt arthritis, can occur at any stage of the disease but are more prevalent in advanced immunosuppression. With the increased access to early diagnosis and highly active antiretroviral therapy (HAART), such complications have increasingly become rare. However, HIV diagnosis may often be missed or delayed in slow progressors, and in such circumstances, these patients may manifest with arthritis as the initial manifestation of HIV. Therefore, there’s need for consideration of HIV associated arthritis in children presenting with arthropathy of undetermined cause. We hereby present a case of arthritis as the initial manifestation of HIV in a child with missed diagnosis of HIV.

Methodology/case presentation

A 12-year-old boy was admitted in the Kenyatta National Hospital (KNH) paediatric ward with a history of joint pain and swelling for three months. He had otherwise previously been well. He had no history of fever, trauma, preceding gastroenteritis or urine tract infection. He had no chorea, no erythematous rash and no cardiac complications of rheumatic fever. He was not wasted, and was able to walk with great difficulty. He had bilateral knee and right ankle swelling. The swollen joints were warm to touch with positive ballotment and fluid sweep test. Joint aspiration revealed straw coloured joint effusion. Investigations included a positive HIV rapid test with CD4% of 6, CRP 8.33 mg/l (n = <5), Elevated ESR (111 mm in first h) and negative ANA. Bilateral Knee -rays did not reveal any destructive or erosive changes. A diagnosis of HIV arthropathy was made and the patient was started on HAART, HCQ, prednisone and ibuprofen. He improved, with resolution of the joint swellings, was discharged home after 10 days and follow up in the rheumatology and comprehensive care clinics advised.

Conclusion

HIV arthropathy should be considered in patients manifesting with arthritis of unknown origin; and the patients evaluated for HIV as a strategy for identifying and including them in care. Highly active antiretroviral therapy, steroids, hydroxychloroquine and NSAIDS may be effective therapy for HIV arthropathy.

Disclosure statement: The authors have no conflict of interest to declare.
Association between inflammatory indexes and erectile dysfunction in U.S. adults: National Health and Nutrition Examination Survey 2001-2004
Authors: Liu Chunhui , Gao Yue , Ji Jie , Sun Chao , Chen Ming
Published: August 2023

Background

The association of inflammatory biomarkers with erectile dysfunction (ED) is still largely unknown.

Aim

The study sought to explore the association of inflammatory biomarkers with ED in U.S. adults.

Methods

Participant data for this study were extracted from the National Health and Nutrition Examination Survey, and individuals that lacked information on clinical variables were excluded. Dose-response curve analysis was applied to explore the association of inflammatory biomarkers with ED prevalence. The confounders were adjusted for with weighted logistic regression analysis. We employed 1:1 propensity score matching to eliminate the effects of clinical variables to confirm the reliability of the results.

Outcomes

ED prevalence was investigated with potential risk factors.

Results

A total of 2331 men ≥20 years of age who participated in the National Health and Nutrition Examination Survey 2001-2004 were included in this study. Compared with individuals without ED, ED cohort displayed higher levels of neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, systemic immune-inflammatory index, and systemic inflammation response index. Dose-response curve analysis indicated ED prevalence increased with the increase of platelet-to-lymphocyte ratio, systemic immune-inflammatory index, and systemic inflammation response index. Weighed logistic regression analysis revealed neutrophil-to-lymphocyte ratio was positively associated with ED. The reliability of the results was confirmed by 1:1 propensity score matching reanalysis.

Clinical Implications

Individuals with chronic inflammatory conditions should be alert for the development of ED.

Strengths and Limitations

It is a large controlled study to investigate the relationship between inflammatory indexes and ED. However, it is a cross-sectional study and it lacks an accurate assessment of the degree of ED.

Conclusion

Inflammatory biomarkers were associated with ED prevalence.
Platelet-rich plasma for erectile dysfunction: a review of the current research landscape
Authors: Fazekas Dylan , Campbell Katherine , Ledesma Braian , Masterson Thomas
Published: August 2023

Introduction

Erectile dysfunction (ED) is the inability to achieve or maintain erection for satisfactory sexual performance. ED drastically reduces the quality of life for men and their partners and is commonly linked to comorbid conditions such as diabetes and cardiovascular disease. As a result, clinicians and researchers are working to improve treatments for ED. Current guideline-approved ED treatments include oral phosphodiesterase type 5 inhibitors, intraurethral alprostadil, penile intracavernosal injections, and penile prosthesis surgery. Today, there is increasing interest in restorative therapies such as intracavernosal platelet-rich plasma (PRP) for the management of ED.

Objectives

This narrative review describes the current trials investigating intracavernosal PRP for ED and proposes future directions to increase the strength of evidence to support use of PRP in this population.

Methods

A comprehensive literature search of PubMed, Science Direct, and Scopus was performed to identify all randomized clinical trials using PRP for the treatment of ED.

Results

We identified 4 randomized clinical trials investigating the safety and efficacy of PRP for ED. We found significant heterogeneity among study protocols, including collection of PRP, dosing of PRP, and follow-up.

Conclusion

While intracavernosal PRP is considered safe, its efficacy for the management of ED remains unknown due to variability among clinical trials.
Poppers use and HIV infection—a literature review
Authors: Abdalla Kalil B , da Silveira Dartiu X , Fidalgo Thiago M
Published: August 2023

Introduction

During the HIV surge in the 1980s, inhaled volatile nitrites (poppers) were hypothesized as a possible cause of the AIDS. Later it was found that poppers use was not the cause but rather a marker associated with HIV acquisition and sexual behaviors without the use of prevention tools.

Objectives

This article reviews the available literature regarding the association between poppers use and newly acquired HIV, aiming to support the hypothesis that there is no causal association between nitrites use and HIV transmission and to discuss other contributing factors.

Methods

We searched all studies published until March 2022 that discussed poppers use and HIV. We extracted relevant information, such as authors and publication year, country where the study was conducted, study design, characteristics of the population, number of participants, objectives of the study, methods, results, and limitations.

Results

The search identified 1956 abstracts, and 1915 were excluded after title review. Forty-one abstracts were assessed, and 17 studies met the inclusion criteria. The majority of the studies found an association between nitrites use and HIV transmission. Four studies associated HIV transmission with sexual behavior without the use of prevention tools, and 5 articles associated nitrites use with this kind of sexual behavior.

Conclusions

Our findings show a complex association among nitrites use, sexual behaviors without the use of prevention tools, and sexually transmitted infections; furthermore, it is impossible to make causal inferences between poppers use and HIV disease. The data suggest that it is vital to consider this substance use when planning health policies for specific populations, such as men who have sex with men, focusing on harm reduction strategies, psychoeducation, and orientations on sex with the use of prevention tools.

Clinical Trial Registration

PROSPERO CRD42020181437. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=181437.
Public perceptions of genomic studies and hereditary diseases in Aari community, South Omo Zone, Ethiopia
Authors: Tilahun Melaku , Gebresilase Tewodros Tariku , Aseffa Abraham , Haile Kassa , Wogayehu Teklu , Murale Moi Top , Yntiso Hailu , Munung Nchangwi Syntia , Bobosha Kidist , Kaba Mirgissa
Published: August 2023

Background

Genetic and genomic research is revolutionizing precision medicine; however, addressing ethical and cultural aspects is crucial to ensure ethical conduct and respect for community values and beliefs. This study explored the beliefs, perceptions and concerns of the Aari community in South Ethiopia regarding genetic concepts, hereditary diseases and ethical research practices related to sample collection, storage and sharing.

Methods

In-depth interviews and focus group discussions were conducted with community elders, health officials, tuberculosis patients and apparently healthy individuals. Data were thematically analysed using MAXQDA software.

Results

Participants identified diseases such as podoconiosis, leprosy, goitre and epilepsy as hereditary and perceived some as ‘curses’ due to generational impact and social stigma. Disease susceptibility was attributed to divine intervention or factors such as malnutrition and sanitation. Although hereditary diseases were considered unavoidable, in some cases environmental factors were acknowledged. Participants shared personal examples to demonstrate inheritance concepts. Blood held cultural significance, and concerns about its potential misuse resulted in scepticism towards giving samples.

Conclusions

This study emphasizes the significance of comprehending local beliefs and perceptions and stresses the need to establish effective communication, build trust and address underlying causes of hesitancy to improve recruitment and ensure ethical conduct.
Characteristics of Menstrual Suppression and Its Association With Mental Health in Transgender Adolescents
Authors: Moussaoui Dehlia , O'Connell Michele A. , Elder Charlotte V. , Grover Sonia R. , Pang Ken C.
Published: August 2023

OBJECTIVE:

To investigate the prevalence, nature, and effectiveness of menstrual suppression in transgender and gender-diverse (TGD) adolescents, and to explore whether there is an association between menstrual suppression and mental health in this population.

METHODS:

A cross-sectional study was performed of TGD adolescents assigned female at birth attending their first appointment at a specialist pediatric gender service between February 2017 and December 2021. Demographic and mental health data were collected using a questionnaire at the time of first visit, and information regarding menstrual suppression at this time was retrieved from the medical record.

RESULTS:

A total of 530 TGD individuals were included; 131 (24.7%) were on menstrual suppression at their initial visit, mainly to help alleviate gender dysphoria. Combined oral contraceptive pills were the most common agent used (n=61, 46.6%), followed by norethindrone (n=39, 29.8%) and intramuscular medroxyprogesterone (n=19, 14.5%). Rates of effectiveness (in stopping menstruation) and patient satisfaction were high. Among the 399 individuals not on menstrual suppression, there was strong interest in starting this treatment. No differences in the risk of gender dysphoria, depression, or anxiety were observed between those who were receiving menstrual suppression and those who were not.

CONCLUSION:

Effectiveness of and satisfaction with menstrual suppression were high in TGD adolescents receiving this treatment. These findings support the routine exploration and management of menstrual health in TGD adolescents. However, menstrual suppression was not associated with any difference in gender dysphoria, depression, or anxiety symptoms in this cross-sectional study, and longitudinal studies are required to better investigate this.
Social Media and Digital Footprints in Orthopaedic Trauma: An Analysis of 1465 Orthopaedic Trauma Association Members.
Authors: Richman Evan H. , Richman Owen T. , Lee Michael S. , Qubain LeeAnn , Heylmun Lauren , Awad Mohamed E , Alfonso Nicholas
Published: August 2023

Objectives:

The purpose of this study was to quantify social media usage among Orthopaedic Trauma Association (OTA) members.

Methods:

All active OTA members were searched for involvement among common social media platforms. Surgeons were then classified as “active” on any given social media site if they posted within the last 6 months. Surgeons were also identified by the region they practiced in, gender, and their practice setting (academic vs private). Lastly, a surgeon’s score and number of reviews from common physician review websites was examined.

Results:

A total of 1,465 Orthopaedic Trauma Association (OTA) members were included in the analysis. Most surgeons were male [89.1% (n=1305)] and practiced in a private setting [54.5% (n = 799)]. A total of 590 (40.3%) surgeons had at least 1 form of social media account. Social media sites most used were LinkedIn with 48.7% (n = 713) and ResearchGate with 29.2% (n = 428). Academic surgeons were more likely to have a ResearchGate, LinkedIn, and Twitter account, while private surgeons were more likely to have a personal website (P<0.05). Lastly, there was no correlation between surgeons more active on social media and average scores on Vitals.com or Healthgrade.com (P>0.05).

Conclusion:

Most orthopaedic trauma surgeons do not have professional social media accounts. While social media may help spread scholarship, having a professional social media account does not correlate with better online physician reviews or increased online reviews among orthopaedic trauma surgeons.
Incidence of Spontaneous Resorption of Lumbar Disc Herniation
Authors: Zou Tao , Liu Xue-Yang , Wang Ping-Chuan , Chen Hao , Wu Pi-Gen , Feng Xin-Min , Sun Hui-Hui
Published: August 2023

Study Design:

A meta-analysis.

Objective:

This study aimed to analyze the incidence of spontaneous resorption of lumbar disk herniation (LDH) after conservative treatment.

Summary of Background Data:

The resorption of intervertebral disks has been more frequently reported, but there is a lack of reference to the probability of resorption.

Methods:

We strictly refer to the standard established in the PRISMA (Preferred Reporting Items for a Systematic Review and Meta-analysis) statement, comprehensively searched electronic databases using the terms related to the spontaneous resorption of LDH. Two reviewers independently evaluated the potential studies, extracted, and analyzed the enrolled data.

Results:

Thirty-one studies with 2233 patients who received conservative treatment were included for this analysis. We found that the pooled overall incidence of disk resorption was 70.39%, 87.77% for disk sequestration, 66.91% for disk extrusion, 37.53% for disk protrusion, and 13.33% for disk bugle, respectively. The resorption incidence in of 25%≤ reduction of disk herniation (RDH) 50%, RDH≥50%, and RDH=100% were 40.19%, 43.62, and 36.89%. The resorption incidence was 66.98% in Japan, 61.66% in the United States, 83.52% in Korea, 60.68% in China, 78.30% in the UK, 56.70% in Italy, and 83.68% in Turkey, respectively. Subgroup analysis showed that there was no significant difference in resorption incidence among prospective, retrospective studies and randomized controlled trials (P=0.77), and there was no significant difference in evaluation method among qualitative and quantitative studies (P=0.05).

Conclusions:

The existing evidence shows that the overall resorption incidence of LDH was 70.39%, the resorption incidence of ruptured LDH is higher than that of contained LDH. There are significant differences in the resorption incidence among countries. The resorption process mainly occurred within 6 months of conservative treatment.
Varying Degree of Overlap Following the Critical Steps of Lumbar Fusion and Short-term Outcomes
Authors: Borja Austin J. , Farooqi Ali S. , Gallagher Ryan S. , Detchou Donald K.E. , Glauser Gregory , Shultz Kaitlyn , McClintock Scott D. , Malhotra Neil R.
Published: August 2023

Study Design:

Retrospective cohort.

Objective:

The present study analyzes the impact of end-overlap on short-term outcomes after single-level, posterior lumbar fusions.

Summary of Background Data:

Few studies have evaluated how “end-overlap” (i.e., surgical overlap after the critical elements of spinal procedures, such as during wound closure) influences surgical outcomes.

Methods:

Retrospective analysis was performed on 3563 consecutive adult patients undergoing single-level, posterior-only lumbar fusion over a 6-year period at a multi-hospital university health system. Exclusion criteria included revision surgery, missing key health information, significantly elevated body mass index (>70), non-elective operations, non-general anesthesia, and unclean wounds. Outcomes included 30-day emergency department visit, readmission, reoperation, morbidity, and mortality. Univariate analysis was carried out on the sample population, then limited to patients with end-overlap. Subsequently, patients with the least end-overlap were exact-matched to patients with the most. Matching was performed based on key demographic variables—including sex and comorbid status—and attending surgeon, and then outcomes were compared between exact-matched cohorts.

Results:

Among the entire sample population, no significant associations were found between the degree of end-overlap and short-term adverse events. Limited to cases with any end-overlap, increasing overlap was associated with increased 30-day emergency department visits (P=0.049) but no other adverse outcomes. After controlling for confounding variables in the demographic-matched and demographic/surgeon-matched analyses, no differences in outcomes were observed between exact-matched cohorts.

Conclusions:

The degree of overlap after the critical steps of single-level lumbar fusion did not predict adverse short-term outcomes. This suggests that end-overlap is a safe practice within this surgical population.
Association Between Age-stratified Cohorts and Perioperative Complications and 30-day and 90-day Readmission in Patients Undergoing Single-level Anterior Cervical Discectomy and Fusion
Authors: Yeshoua Brandon J. , Singh Sirjanhar , Liu Helen , Assad Nima , Dominy Calista L. , Pasik Sara D. , Tang Justin E. , Patel Akshar , Shah Kush C. , Ranson William , Kim Jun S. , Cho Samuel K.
Published: August 2023

Study Design:

Retrospective analysis.

Objective:

To assess perioperative complication rates and readmission rates after ACDF in a patient population of advanced age.

Summary of Background Data:

Readmission rates after ACDF are important markers of surgical quality and, with recent shifts in reimbursement schedules, they are rapidly gaining weight in the determination of surgeon and hospital reimbursement.

Methods:

Patients 18 years of age and older who underwent elective single-level ACDF were identified in the National Readmissions Database (NRD) and stratified into 4 cohorts: 18–39 (“young”), 40–64 (“middle”), 65–74 (“senior”), and 75+ (“elderly”) years of age. For each cohort, the perioperative complications, frequency of those complications, and number of patients with at least 1 readmission within 30 and 90 days of discharge were analyzed. χ2 tests were used to calculate likelihood of complications and readmissions.

Results:

There were 1174 “elderly” patients in 2016, 1072 in 2017, and 1010 in 2018 who underwent ACDF. Their rate of any complication was 8.95%, 11.00%, and 13.47%, respectively (P<0.0001), with dysphagia and acute posthemorrhagic anemia being the most common across all 3 years. They experienced complications at a greater frequency than their younger counterparts (15.80%, P<0.0001; 16.98%, P<0.0001; 21.68%, P<0.0001). They also required 30-day and 90-day readmission more frequently (P<0.0001).

Conclusion:

It has been well-established that advanced patient age brings greater risk of perioperative complications in ACDF surgery. What remains unsettled is the characterization of this age-complication relationship within specific age cohorts and how these complications inform patient hospital course. Our study provides an updated analysis of age-specific complications and readmission rates in ACDF patients. Orthopedic surgeons may account for the rise in complication and readmission rates in this population with the corresponding reduction in length and stay and consider this relationship before discharging elderly ACDF patients.
Perceived Needs Among Healthcare Providers Caring for Seriously Ill Adults Regarding Electronic Health Record Triggers for Palliative Care Referral
Authors: West Lori-Jeanne , Tomko Caitlin , Sessanna Loralee , Paplham Pamela , Austin-Ketch Tammy
Published: August 2023

Many healthcare facilities in the United States currently utilize electronic health record triggers to promote and facilitate palliative care referral. The purpose of this study was to explore perceived needs regarding electronic health record trigger criteria for palliative care referral among healthcare providers caring for seriously ill adult hospitalized patients in a teaching hospital in New York State. A qualitative descriptive approach was utilized with use of individual semistructured interviews. Braun and Clarke's Reflexive Thematic Analysis method was used to analyze data. Data analysis generated one overarching theme, I'm in Favor of an Electronic Health Record Automatic Trigger for Palliative Care, and three key themes, Build a Checklist Screening Tool Into Epic With Predefined Conditions and a Palliative Consult in the Admission Order Set, If Providers Call a Palliative Care Consult Sooner, We Give Patients a Better Quality of Life, and Providers Need to Be Aware of the Different Facets of What Palliative Care Actually Does. Findings revealed that all participants supported incorporating electronic health record palliative care triggers. Future research is needed exploring provider palliative care education approaches to promote understanding of palliative care services and to address personal and/or professional bias.
pSTAT5 is associated with improved survival in patients with thick or ulcerated primary cutaneous melanoma
Authors: Tan Samuel X. , Chong Sharene , Rowe Casey , Claeson Magdalena , Dight James , Zhou Chenhao , Rodero Mathieu P. , Malt Maryrose , Smithers B. Mark , Green Adele C. , Khosrotehrani Kiarash
Published: August 2023

Identifying prognostic biomarkers to predict clinical outcomes in stage I and II cutaneous melanomas could guide the clinical application of adjuvant and neoadjuvant therapies. We aimed to investigate the prognostic value of phosphorylated signal transducer and activator of transcription 5 (pSTAT5) as a biomarker in early-stage melanoma. This study evaluated all initially staged Ib and II melanoma patients undergoing sentinel node biopsy at a tertiary centre in Brisbane, Australia between 1994 and 2007, with survival data collected from the Queensland Cancer Registry. Primary melanoma tissue from 189 patients was analysed for pSTAT5 level through immunohistochemistry. Cox regression modelling, with adjustment for sex, age, ulceration, anatomical location, and Breslow depth, was applied to determine the association between pSTAT5 detection and melanoma-specific survival. Median duration of follow-up was 7.4 years. High pSTAT5 detection was associated with ulceration and increased tumour thickness. However, multivariate analysis indicated that high pSTAT5 detection was associated with improved melanoma-specific survival (hazard ratio: 0.15, 95% confidence interval: 0.03–0.67) as compared to low pSTAT5 detection. This association persisted when pSTAT5 detection was limited to immune infiltrate or the vasculature, as well as when sentinel node positivity was accounted for. In this cohort, staining for high-pSTAT5 tumours identified a subset of melanoma patients with increased survival outcomes as compared to low-pSTAT5 tumours, despite the former having higher-risk clinicopathological characteristics at diagnosis. pSTAT5 is likely an indicator of local immune activation, and its detection could represent a useful tool to stratify the risk of melanoma progression.