bluuebunny/crossref_metadata_2025 huggingface dataset:
Icelandic Cinema
Authors: Norðfjörð Björn
Published: May 2023

Icelandic cinema is comprised of both familiar features common to all national cinemas and unique ones that make it stand out among all the others. In fact, with its single distinct language, official state religion, government-sponsored cultural production (including cinema), “natural” island borders, and a mostly homogenous population, it comes close to capturing the essence of the concept of national cinema that is so rarely borne out by actuality. Conversely, what makes Icelandic cinema different from the “typical” national cinema is its extreme smallness—arguably the smallest one in all of world cinema. The year 1980 marks the most important turning point in the history of Icelandic cinema since it was then that the first films funded by the newly established Icelandic Film Fund were released in cinemas. Before then, and all the way back to the early twentieth century, pioneering filmmakers made numerous documentaries, the occasional narrative feature or even experimental film. But without state support and lacking infrastructure, such efforts were intermittent and lacking in consistency. That all changed during the 1980s as a new generation of filmmakers began the work of establishing a national cinema that privileged local talent and stories and was often inspired by canonical Icelandic literature. After some striking box-office successes in its early years the fledgling industry found itself in financial crisis as the decade drew to a close. The problem was solved through an increase in international partnership and the garnering of financial support from pan-Nordic and European film funds, resulting in a shift from a national to transnational emphasis during the 1990s. Another global turn emerged in the first decade of the twenty-first century as foreign runaway productions—led by Hollywood—increasingly made Iceland their home. In a very short span of time a tiny local cinema had developed into a complex industry, well integrated into the circuits of world cinema. Certainly, smaller nations (including ones lacking official statehood) have produced the occasional film, but a multidimensional film industry producing both a variety of local films and participating in the making of global blockbusters is not found among a smaller national population. It is in this sense that Iceland is the smallest of all national cinemas.
Flora Annie Steel
Authors: Nielsen Danielle
Published: May 2023

During her lifetime, Flora Annie Webster Steel (b. 1847–d. 1929) was one of the most popular Anglo-English writers of the fin de siècle. She was born in Harrow, England, the sixth child and second daughter of George Webster, a government employee, and Isabella MacCallum, an heiress to a fortune derived from Jamaican plantation holdings. When George Webster’s financial mismanagement required the family to move to Scotland, it prevented the young Flora from having any formal educational opportunities. She was largely self-taught and highly valued education. She married Indian Civil Service member Henry Steel when she was twenty years old and spent the next twenty-two years in India, primarily in the northern Punjab region. While living in the subcontinent, she served as the first female Inspector of Schools, organized girls’ and women’s secular education, worked with John Lockwood Kipling to preserve Indian handcrafts, and collected Indian folk tales. These folktales were first published in Anglo-Indian periodicals for readers in the subcontinent and later collected and published in Britain in the collections Tales from the Punjab and Wide Awake Stories with Richard Carnac Temple. While in India, she and Grace Gardiner co-authored The Complete Indian Housekeeper and Cook, a domestic manual intended to help newly-arrived British women manage their households. After returning permanently to Scotland in 1889, Steel used her Indian experiences to support what would become a prolific writing career, publishing short story collections such as In the Permanent Way, and Other Stories; newspaper columns on The Woman Question, marriage, and late in life, suffrage; novels; and histories of India. Referred to, often derisively, as “the female Kipling,” she continues to be most recognized for her novel On the Face of the Waters, which portrayed the Indian Uprising of 1857, though scholarly interest in her other writing is increasing. Her interest in Indian history is also evident in her series of novels, Prince of Dreamers, King-errant, Mistress of Men, and The Builder, detailing specific moments in the Mughal Dynasty, Dramatic History of India: 29 playlets, and non-fiction work like India, illustrated by Mortimer Menpes, and India Through the Ages: A Popular and Picturesque History of Hindustan. Her posthumously published autobiography, The Garden of Fidelity: Being the Autobiography of Flora Annie Steel, 1847–1929, concluded her writing career.
Correspondence Analysis in Psychology
Authors: Greenacre Michael
Published: May 2023

Correspondence analysis (CA) is a statistical method of multivariate analysis, which applies to a rectangular table of categorical data, with a wide range of applications in the social sciences, as well as in ecology, archaeology, and linguistics. This bibliography focuses primarily on its development and applications in the field of psychology, where it is often difficult to grasp the interrelationships between observed variables that are generally on categorical scales. The method has several historical origins and equivalent definitions. One of the earliest, due to the eminent British statistician Ronald A. Fisher, defines the method as a way of quantifying the categories of two categorical variables, that is, assigning scale values to the categories, with the objective of maximizing their discriminatory power, equivalent to maximizing their correlation. This idea was generalized to quantifying more than two categorical variables by the psychologist Louis Guttman. The same idea formed the basis of two research schools, led by Chikio Hayashi in Japan, and Jan de Leeuw in the Netherlands. The French linguist and mathematician Jean-Paul Benzécri realized the geometric interpretation of CA and developed the method as a tool for visualizing categorical data, which is its most popular application today. Simple CA visualizes the rows and columns of a two-way table as points in a spatial map, where the association between the row and column categories can be directly interpreted. When the table is a cross-tabulation called a contingency table, CA thus goes beyond the typical measurement and test of row–column association (e.g., the chi-square test) by explicitly showing what the main features of that association are. The generalization of the method, called multiple correspondence analysis (MCA), analyzes more than two categorical variables simultaneously and is routinely used to understand patterns of response in questionnaire surveys that involve many questions with categorical responses. All forms of CA are variants of principal component analysis (PCA), with two important generalizations of the regular way PCA is defined and used: (i) the distance function used to measure differences between the categories, called the chi-square distance, and (ii) the weighting of the categories proportional to their marginal sums. CA has been developed in a similar way to PCA, for example by introducing linear restrictions, where it is called canonical correspondence analysis (CCA), similarly to redundancy analysis (RDA) for PCA. Categorical PCA (CatPCA) is also a special restricted case of MCA.
Race and American Judaism
Authors: Imhoff Sarah
Published: May 2023

Several perennial questions animate the study of race and American Judaism. One is about how to understand Jewishness: it is race, ethnicity, religion, nation, something else, or none of the above? How have Jews in different times and places expressed their ideas, how have those shifted over time and space, and what happens when scholars use one or more of these as their own analytical categories for conceiving Jewishness? The answers are neither fixed nor exclusive, but the process of investigating both historical actors and contemporary scholarship is illuminating. Scholars and community members alike have wrestled with the question of whether Jews are white. But the better question, as Matthew Frye Jacobson argues, is “how have they been both white and other?” The answers will vary according to historical moment, economic situation, religious dynamics, and geography. But some generalization is still possible. From the 1790s onward, Jews were able to enter the United States and become citizens. And going even farther back into colonial history, unless they were Black or multiracial, Jews could not be enslaved. So, by many salient measures, they were white. This did not mean, however, that Jews would never face race-based prejudice or exclusion. Additional questions revolve around internal Jewish difference. Jews of color make up a substantial and growing percentage of Jewish communities across the Americas. Through descent, intermarriage, adoption, and conversion, the Jewish community is multiracial—and yet the discourse of whiteness still pervades. Moreover, Judaism also contains other descent-groups, which are sometimes racialized. How do Ashkenazi (descended from Central or Eastern Europe), Sephardi (descended from the Iberian Peninsula and its environs), and Mizrahi (descended from North Africa or the Middle East) Jews describe themselves and each other? And what is the place of Jews who do not seem to fit one of these categories easily? The following resources center on Judaism and the United States, but they also include some discussions and analyses from other countries in the Americas. Ethical questions about belonging and Jewish difference also remain pertinent. What claims can and should Jews make about the ethics of race and racial difference? How does Judaism provide resources—or stumbling blocks—for anti-racism or racial justice? Finally, a note on Judaism versus Jewishness: our key term here is Judaism, and so the works listed in this bibliography are those that either center religious analysis or lend themselves to such analysis even though it is not explicit in the work.
Women Poets and Authors in Late Imperial China
Authors: Qian Nanxiu , Wright Tim
Published: May 2023

One of the most exciting developments in the study of Chinese literature in late twentieth century has been the rediscovery of an extremely rich and diverse tradition of women’s writing of the imperial period (221 bce–1911 ce). Only recently has the enormous literary output of women writers of the Ming and Qing periods (1368–1911) been rediscovered. That women’s writing in traditional China has needed to be rediscovered is caused by two problems. The first lies in its controversial nature: although women found a great venue in writing, poetry especially, to communicate their inner feelings and thoughts, publishing and leaving their writings to later generations did violate the Confucian gender demarcation that confined their voices to within the domestic domain. The second reflected their marginalization by late Qing reformists and the New Culture Movement. Proponents of both views stubbornly adhered to a rigid scheme of historical evolution, and designated late imperial women as oppressed or silenced, thus neglecting and/or suppressing women’s writing. The late imperial period alone left more than four thousand collections of women’s literary works. Together they provide us with moving insights into the lives and feelings of a surprisingly diverse group of women living in Confucian China, a society that perhaps more than any other is known for its patriarchal tradition. Many of these writings are of considerable literary quality. These poets include imperial ladies, gentry women, courtesans, Buddhist and Daoist nuns, as well as commoners such as farm wives. Some women wrote out of isolation and despair, finding in words a mastery that otherwise eluded them. Others were recruited into poetry by family members, friends, or sympathetic male advocates. Some dwelt on intimate family matters and cast their poems as addresses to husbands and sons at large in the wide world of men’s affairs. Each woman had her own reasons for writing poetry and her own ways of appropriating, and often changing, the conventions of both men’s and women’s verse. The primary purpose of this article is to put before the English-speaking reader evidence of the poetic talent that flourished, against all odds, among women in premodern China. It is also designed to spur reflection among specialists in Chinese poetry, inspiring new perspectives on both the Chinese poetic tradition and the canon of female poets within that tradition. The history of women writers in late Imperial China both connects with and departs from the established patterns for women’s writing in the West, thus complementing current discussions of “feminine writing.” This article looks into this grand matter in four sections, namely: General Overviews, Primary Sources on Women Authors, Studies of Women Authors, and Studies on Women and Gender as Historical Background. This bibliographical entry tries to provide in-depth perspectives into the study of late imperial Chinese women poets and authors through recent scholarship.
A Bundle of the Top 10 OPAT Publications in 2022
Authors: Childs-Kean Lindsey M , Beieler Alison M , Coroniti Ann-Marie , Cortés-Penfield Nicolás , Keller Sara C , Mahoney Monica V , Rajapakse Nipunie S , Rivera Christina G , Yoke Leah H , Ryan Keenan L
Published: May 2023

Outpatient parenteral antimicrobial therapy (OPAT) has become more common in clinical settings. Correspondingly, OPAT-related publications have also increased; the objective of this article was to summarize clinically meaningful OPAT-related publications in 2022. Seventy-five articles were initially identified, with 54 being scored. The top 20 OPAT articles published in 2022 were reviewed by a group of multidisciplinary OPAT clinicians. This article provides a summary of the “top 10” OPAT publications of 2022.
The ameliorative effects of quercetin and curcumin against subacute nephrotoxicity of fipronil induced in Wistar rats
Authors: Uzunhisarcikli Meltem , Apaydin Fatma Gokce , Bas Hatice , Kalender Yusuf
Published: May 2023

Fipronil is a phenylpyrazole insecticide that is widely used in agricultural, veterinary, and public health fields for controlling a wide variety of insect species and it is an environmentally potent toxic substance. Curcumin and quercetin, which are well-known natural antioxidants, are widely used to prevent the harmful effects of free radicals on biological systems. The present study aimed to determine the potential ameliorative effects of quercetin and/or curcumin on fipronil-induced nephrotoxicity in rats. Curcumin (100 mg/kg of body weight), quercetin (50 mg/kg of body weight), and fipronil (3.88 mg/kg of body weight) were administered to male rats by intragastric gavage for 28 consecutive days. In the present study, body weight, kidney weight, the renal function markers (blood urea nitrogen, creatinine, and uric acid levels) in the blood, antioxidant enzyme activities, and malondialdehyde level as markers of oxidative stress, and histological changes of the renal tissue were evaluated. The levels of serum blood urea nitrogen, creatinine, and uric acid were significantly increased in fipronil-treated animals. Additionally, while superoxide dismutase, catalase, glutathione-S-transferase, and glutathione peroxidase activities were decreased in the kidney tissue of rats treated with fipronil, malondialdehyde level was significantly increased. Histopathological analyses showed that the glomerular and tubular injury occurred in the renal tissue of fipronil-treated animals. Also, the supplementation of quercetin and/or curcumin with fipronil significantly improved fipronil-induced alterations in renal function markers, antioxidant enzyme activities, malondialdehyde levels, and histological features of renal tissue.
TRPA1deficiency aggravates dilated cardiomyopathy by promotingS100A8expression to induceM1macrophage polarization in rats
Authors: Zhao Mengmeng , Zheng Zihui , Pan Wei , Zhang Jishou , Yin Zheng , Wei Cheng , Xu Yao , Wan Jun , Wang Menglong
Published: May 2023

Transient receptor potential ankyrin 1 (TRPA1) plays an important role in different cardiovascular diseases. However, the role of TRPA1 in dilated cardiomyopathy (DCM) remains unclear. Here, we aimed to investigate the role of TRPA1 in DCM induced by doxorubicin (DOX) and explore its possible mechanisms. GEO data were used to explore the expression of TRPA1 in DCM patients. DOX (2.5 mg/kg/week, 6 weeks, i.p.) was used to induce DCM. Bone marrow‐derived macrophages (BMDMs) and neonatal rat cardiomyocytes (NRCMs) were isolated to explore the role of TRPA1 in macrophage polarization, cardiomyocyte apoptosis, and pyroptosis. In addition, DCM rats were treated with the TRPA1 activator, cinnamaldehyde to explore the possibility of clinical translation. TRPA1 expression was increased in left ventricular (LV) tissue in DCM patients and rats. TRPA1 deficiency aggravated the cardiac dysfunction, cardiac injury, and LV remodeling in DCM rats. In addition, TRPA1 deficiency promoted the M1 macrophage polarization, oxidative stress, cardiac apoptosis, and pyroptosis induced by DOX. RNA‐seq results showed that TRPA1 knockout promoted the expression of S100A8, an inflammatory molecule that belongs to the family of Ca2+‐binding S100 proteins, in DCM rats. Furthermore, S100A8 inhibition attenuated M1 macrophage polarization in BMDMs isolated from TRPA1 deficiency rats. Recombinant S100A8 promoted the apoptosis, pyroptosis, and oxidative stress in primary cardiomyocytes stimulated with DOX. Finally, TRPA1 activation via cinnamaldehyde alleviated the cardiac dysfunction and reduced S100A8 expression in DCM rats. Taken together, these results suggested that TRPA1 deficiency aggravates DCM by promoting S100A8 expression to induce M1 macrophage polarization and cardiac apoptosis.
Characteristics and Outcomes of Very Elderly Patients Admitted to Intensive Care: A Retrospective Multicenter Cohort Analysis*
Authors: Rai Sumeet , Brace Charlotte , Ross Paul , Darvall Jai , Haines Kimberley , Mitchell Imogen , van Haren Frank , Pilcher David
Published: May 2023

OBJECTIVES:

To characterize and compare trends in ICU admission, hospital outcomes, and resource utilization for critically ill very elderly patients (≥ 80 yr old) compared with the younger cohort (16–79 yr old).

DESIGN:

A retrospective multicenter cohort study.

SETTING:

One-hundred ninety-four ICUs contributing data to the Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation Adult Patient Database between January 2006 and December 2018.

PATIENTS:

Adult (≥ 16 yr) patients admitted to Australian and New Zealand ICUs.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Very elderly patients with a mean ± sd age of 84.8 ± 3.7 years accounted for 14.8% (232,582/1,568,959) of all adult ICU admissions. They had higher comorbid disease burden and illness severity scores compared with the younger cohort. Hospital (15.4% vs 7.8%, p < 0.001) and ICU mortality (8.5% vs 5.2%, p < 0.001) were higher in the very elderly. They stayed fewer days in ICU, but longer in hospital and had more ICU readmissions. Among survivors, a lower proportion of very elderly was discharged home (65.2% vs 82.4%, p < 0.001), and a higher proportion was discharged to chronic care/nursing home facilities (20.1% vs 7.8%, p < 0.001). Although there was no change in the proportion of very elderly ICU admissions over the study period, they showed a greater decline in risk-adjusted mortality (6.3% [95% CI, 5.9%–6.7%] vs 4.0% [95% CI, 3.7%–4.2%] relative reduction per year, p < 0.001) compared with the younger cohort. The mortality of very elderly unplanned ICU admissions improved faster than the younger cohort (p < 0.001), whereas improvements in mortality among elective surgical ICU admissions were similar in both groups (p = 0.45).

CONCLUSIONS:

The proportion of ICU admissions greater than or equal to 80 years old did not change over the 13-year study period. Although their mortality was higher, they showed improved survivorship over time, especially in the unplanned ICU admission subgroup. A higher proportion of survivors were discharged to chronic care facilities.
Attitudes and Beliefs Toward Thymectomy in the Myasthenia Gravis Patient Registry
Authors: Hamedani Ali G. , McPherson Tarrant O. , Aban Inmaculada , Lee Ikjae , Kupersmith Mark J. , Wolfe Gil I. , Kaminski Henry J.
Published: May 2023

Objectives:

To evaluate patient attitudes and beliefs toward thymectomy for myasthenia gravis (MG).

Methods:

The Myasthenia Gravis Foundation of America administered a questionnaire to the MG Patient Registry, an ongoing longitudinal survey of adult MG patients. Questions assessed reasons for or against thymectomy and how hypothetical scenarios would have affected their decision.

Results:

Of 621 respondents, 190 (31%) reported a history of thymectomy. Of those who underwent thymectomy for nonthymomatous MG, 97 (51.6%) ranked symptom improvement as most important and 100 (53.2%) ranked reducing medication as least important. Among 431 nonthymectomy patients, the most frequent reason for not undergoing thymectomy was that their doctor did not discuss it (152 of 431 = 35.2%) and 235 (56.8%) said that they would have considered it more strongly if their doctor spent more time discussing it.

Conclusions:

Thymectomies are motivated more by symptoms than by medication, and a lack of neurologist discussion is the most common barrier to thymectomy.
Neonatal Fc Receptor Inhibitor Therapeutics in Neuromuscular Disease
Authors: Jaffry Mustafa , Menkes Daniel L. , Shaikh Anam , Mandava Kranthi , Kothari Om , Jaffry Kazim , Souayah Nizar
Published: May 2023

The Neonatal Fc Receptor (FcRn) is integral to a wide variety of processes including IgG recycling, serum albumin turnover, and bacterial opsonization. Thus, targeting FcRn will increase antibody degradation including pathogenic IgGs. FcRn inhibition provides a novel therapeutic mechanism by which autoantibody titers are reduced resulting in clinical improvement and disease abatement. The FcRn targeting mechanism is similar to that of intravenous immunoglobulin (IVIg) in which saturated FcRn facilitates accelerated pathogenic IgG degradation. Recently, the FcRn inhibitor efgartigimod was approved for the treatment of myasthenia gravis. Subsequently, clinical trials of this agent have been conducted for numerous inflammatory conditions involving pathogenic autoantibodies. These disorders include the Guillain–Barre syndrome, chronic inflammatory demyelinating polyneuropathy, and inflammatory myositis. Other disorders traditionally treated with IVIg may also benefit from FcRn inhibition in certain contexts. This manuscript discusses the mechanism of FcRn inhibition, preclinical data, and the results of clinical trials of this agent for a wide range of neuromuscular diseases.
Exploring the Interprofessional Contributions of Spiritual Health Practitioners to Prevent Compassion Fatigue in Nurses
Authors: Hildebrand Amy , Reimer-Kirkham Sheryl , Quinn Barry
Published: May 2023

Background

Few studies in academic literature involve the application of a spiritual health intervention for the purpose of mitigating compassion fatigue in nurses.

Objectives

The purpose of this qualitative study was to explore the perspectives of Canadian spiritual health practitioners (SHPs) in their support for nurses to prevent compassion fatigue.

Method

Interpretive description was utilized for this research study. Sixty-minute interviews with 7 individual SHPs were conducted. Data were analyzed with NVivo 12 software (QSR International, Burlington, Massachusetts). Thematic analysis identified common themes that allowed data from interviews, a pilot project on psychological debriefing, and a literature search to be compared, contrasted, and compiled.

Results

The 3 main themes were found. The first theme highlighted the underlying issue of how spirituality is ranked or viewed within health care and the impact of leadership integrating spirituality in their practice. The second theme related to SHPs' perception of nurses' compassion fatigue and lack of connection to spirituality. The final theme explored the nature of SHP support to mitigate compassion fatigue before and during the COVID-19 pandemic.

Discussion

Spiritual health practitioners are positioned in a unique role to be facilitators of connectedness. They are professionally trained to provide a type of in situ nurturing for patients and health care staff through spiritual assessments, pastoral counseling, and psychotherapy. The COVID-19 pandemic has revealed an underlying desire for in situ nurturing and connectedness in nurses due to an increase in existential questioning, unusual patient circumstances, and social isolation leading to disconnectedness. Organizational spiritual values are recommended to be exemplified by those in leadership to create holistic, sustainable work environments.
Twenty Years of an Institutional Chest Pain Pathway: What’s Come and What’s Yet to Come
Authors: Zilinyi Robert S. , Stant Jennifer A. , Sayan Osman R. , Collins Michael B. , Rabbani LeRoy E.
Published: May 2023

Acute coronary syndromes (ACS) remain one of the leading causes of cardiovascular morbidity and mortality in the United States and around the world. Because of the acute nature of ACS presentations, timely identification, risk stratification, and intervention are of the utmost importance. Twenty years ago, we published the first iteration of our institutional chest pain clinical pathway in this journal, which separated patients presenting with chest pain into one of the 4 levels of decreasing acuity, with associated actions and interventions for providers based on the level. This chest pain clinical pathway has undergone regular review and updates under a collaborative team of cardiologists, emergency department physicians, cardiac nurse practitioners, and other associated stakeholders in the treatment of patients presenting with chest pain. This review will discuss the key changes that our institutional chest pain algorithm has undergone over the last 2 decades and what the future holds for chest pain algorithms.
The Outcome of Patients with Pulmonary Arterial Hypertension and Chronic Thromboembolic Pulmonary Hypertension during the COVID-19 Pandemic
Authors: Serati Alireza , Keshmiri Mohammad Sadegh , Shafaghi Shadi , Mohammad Majid Malek , Kashani Babak Sharif , Naghashzadeh Farah , Mohamadifar Arezoo , Shafaghi Masoud , Noorali Sima , Hajimoradi Maryam , Astani Bahamin , Aghdasi Sina , Riahi Mahsa , Alavi Sima , Malek Rayka , Movahed Mohammad Reza
Published: May 2023

Background:

The coronavirus 2019 (COVID-19) has affected the lives of many people worldwide. Patients with chronic underlying morbidities are vulnerable to get the severe form of the infection. The goal of this study was to evaluate the outcome of patients with pulmonary arterial hypertension during the COVID-19 pandemic in Iran.

Methods:

This cross-sectional study was conducted at a large tertiary center for pulmonary artery hypertension (PAH) patients. The primary end point was the prevalence of SARS-CoV-2 infection in PAH patients. The secondary end points were investigating the severity and mortality of COVID-19 infection in PAH patients during the COVID-19 pandemic.

Results:

Totally 75 patients were enrolled in the study from December 2019 to October 2021 and 64% were female. The mean ± SD age was 49 ± 16 years. The prevalence of COVID-19 in PAH/chronic thromboembolic pulmonary hypertension patients was 44%. About 66.7% of patients had comorbidities, which was a prognostic factor for COVID-19 infection in PAH patients (P < 0.001). Fifty-six percent of infected patients were asymptomatic. The most reported symptoms in symptomatic patients were fever (28%) and malaise (29%). Twelve percent of patients were admitted with severe symptoms. The mortality rate in infected individuals was 3.7%.

Conclusions:

COVID-19 infection in PAH/chronic thromboembolic pulmonary hypertension patients seems to be associated with high mortality and morbidity. More scientific proof is needed to clarify different aspect of COVID-19 infection in this population.
Comparison of 1-year Follow-up Echocardiographic Outcomes of Sapien 3 Versus Evolut R Bioprosthetic Transcatheter Aortic Valves: A Single-center Retrospective Iranian Cohort Study
Authors: Sahebjam Mohammad , Zoroufian Arezou , Hajizeinali Alimohammad , Salarifar Mojtaba , Jalali Arash , Ayati Aryan , Farmanesh Mahkameh
Published: May 2023

Objective:

The current study aimed to compare 1-year echocardiographic outcomes of the new generations of self-expanding (Evolut R) versus balloon-expandable (Sapien 3) bioprosthetic transcatheter aortic valves.

Methods:

In this study, gradients and flow velocities obtained from transthoracic Doppler-echocardiography were retrospectively collected from patients who underwent 2 new generations of transcatheter aortic valve implantation interventions with Sapien 3 and Evolut R valves. Patients underwent echocardiography before the procedure and at discharge, 6 months, and 1-year follow-up.

Results:

Of the 66 patients, 28 received Sapien 3 and 38 received Evolut R valves. Evolut R valve presented a lower mean gradient at all follow-up time points compared with Sapien 3 valves (14.4 mm Hg, 14.9 mm Hg, 15.5 mm Hg compared with 10.1 mm Hg, 11.6 mm Hg, 11.8 mm Hg, respectively; all P-values <0.001). Small valve sizes of Evolut R, including 23 and 26, had higher echocardiographic mean gradient or peak gradient at the time of discharge compared with larger valves, including sizes 29 and 34 (11.1 mm Hg and 11.2 mm Hg vs. 10.2 mm Hg, 9.1 mm Hg) and 1-year follow-up (11.0 mm Hg, 11.0 mm Hg vs. 9.9 mm Hg, 8.4 mm Hg; all P-values = 0.001). Although Sapien 3 valves demonstrated a higher peak gradient in smaller sizes at discharge (18.44 mm Hg in size 23 vs. 17.9 mm Hg, 16.5 mm Hg in size 26 and 29, respectively; P = 0.001), the peak gradients did not show a statistically significant difference in the 1-year follow-up.

Conclusions:

The current study detected significantly lower mean and peak gradients in Evolut R compared with Sapien 3 at all follow-up time points. Furthermore, smaller valve sizes were associated with significantly higher gradients at all follow-ups, regardless of the valve type.
Unmet Clinical Needs in the Management of Idiopathic Multicentric Castleman Disease: A Consensus-based Position Paper From an ad hoc Expert Panel
Authors: Zinzani Pier Luigi , Paulli Marco , Arcaini Luca , Della Torre Emanuel , Ferrero Simone , Figuera Amalia , Frigeri Ferdinando , Martelli Maurizio , Sabattini Elena , Scarpa Riccardo , Barosi Giovanni
Published: May 2023

Castleman disease describes a group of heterogeneous clinicopathological disorders now included in the tumor-like lesions with B-cell predominance of the World Health Organization classification. Managing idiopathic multicentric Castleman disease (iMCD) is challenging, because few systematic studies or comparative randomized clinical trials have been conducted. International, consensus evidence-based guidelines for iMCD were published in 2018, but gaps in the therapeutic options for difficult-to-treat patients, who do not respond to siltuximab and other conventional therapies, still exist. This article presents the results of group discussion among an ad hoc constituted Panel of Italian experts to identify and address unmet clinical needs (UCNs) in managing iMCD. Recommendations on the appropriateness of clinical decisions and proposals for new research concerning the identified UCNs were issued through formalized multiple-step procedures after a comprehensive analysis of the scientific literature. The following key UCNs were addressed: strengthening the diagnostic certainty in iMCD patients before planning first-line therapy; management of siltuximab therapy; choice and management of immune-modulating, or chemotherapy agents in patients resistant/intolerant to siltuximab therapy. While most of the conclusions reached by the Panel are consistent with the existing guidelines, some alternative therapeutic options were stressed, and the discussion contributed to bringing forth the issues that need further investigation. Hopefully, this comprehensive overview will improve the practice of iMCD and inform the design and implementation of new studies in the field.
Improving the screening process for obstructive sleep apnea in the primary care setting
Authors: Soni Sarah J.
Published: May 2023

Background:

There is a high prevalence of obstructive sleep apnea (OSA) in the primary care setting that is underdiagnosed and underreported in 75–80% of the population. If untreated, OSA has implications for long-term cardiovascular, cerebrovascular, and metabolic health.

Local problem:

At a primary care clinic in New Jersey, patients at high risk for OSA were not being routinely screened for the condition.

Methods:

This project intended to address the administration of the STOP-Bang Questionnaire among asymptomatic high-risk patient populations with hypertension and/or obesity. In addition to determining each participant's level of risk for OSA, and in turn, facilitating referrals and diagnostic testing per a provider's discretion.

Interventions:

The STOP-Bang Questionnaire, a validated screening tool for OSA, was implemented in a primary care practice to measure levels of risk for OSA among eligible participants.

Results:

A total of 32 out of the 100 patients assessed were identified as high risk for OSA. After screening, 36 participants were referred for confirmatory testing.

Conclusions:

The STOP-Bang Questionnaire, a validated screening tool for OSA, is recommended for all asymptomatic high-risk patients, specifically for those with obesity and/or hypertension, at least annually. The use of a screening tool evaluates a level of risk, promotes detection of disease in the primary stages, delays disease progression, and improves treatment initiatives.
Excess Mortality at Veterans Health Administration Facilities During the COVID-19 Pandemic
Authors: Tenso Kertu , Strombotne Kiersten L. , Feyman Yevgeniy , Auty Samantha G. , Legler Aaron , Griffith Kevin N.
Published: May 2023

Importance:

The COVID-19 pandemic resulted in excess mortality among the general US population and at Veterans Health Administration (VHA) facilities. It is critical to understand the characteristics of facilities that experienced the highest and lowest pandemic-related mortality to inform future mitigation efforts.

Objective:

To identify facility-level excess mortality during the pandemic and to correlate these estimates with facility characteristics and community-wide rates of COVID-19 burden.

Design:

We used pre-pandemic data to estimate mortality risk prediction models using 5-fold cross-validation and Poisson quasi-likelihood regression. We then estimated excess mortality and observed versus expected (O/E) mortality ratios by the VHA facility from March to December 2020. We examined facility-level characteristics by excess mortality quartile.

Participants:

Overall, there were 11.4 million VHA enrollees during 2016 and 2020.

Main Measures:

Facility-level O/E mortality ratios and excess all-cause mortality.

Result:

VHA-enrolled veterans experienced 52,038 excess deaths from March to December 2020, equating to 16.8% excess mortality. Facility-specific rates ranged from −5.5% to +63.7%. Facilities in the lowest quartile for excess mortality experienced fewer COVID-19 deaths (0.7–1.51, P<0.001) and cases (52.0–63.0, P=0.002) per 1,000 population compared with the highest quartile. The highest quartile facilities had more hospital beds (276.7–187.6, P=0.024) and a higher percent change in the share of visits conducted via telehealth from 2019 to 2020 (183%–133%, P<0.008).

Conclusions:

There was a large variation in mortality across VHA facilities during the pandemic, which was only partially explained by the local COVID-19 burden. Our work provides a framework for large health care systems to identify changes in facility-level mortality during a public health emergency.
Can History Change Our Future Course? Lessons From Case Managers Across Time
Authors: Moreo Kathleen , Llewellyn Anne , Sands Judith , Luttrell Jody , Prince Melanie , Owen Mindy
Published: May 2023

Purpose/Objectives:

History can tell us a lot. Through the lens of case management history, we can appreciate how our practice has evolved and what have been the sticking points along the way. We can better understand how our practice became knitted into the fabric of the health care system, and why we apply certain functions and processes of case management across different practice settings. Historical lessons captured by national case management organizations or found in the literature can help us think about how to improve the future, as well as the care we deliver today. Higher education is another good resource for honing our skills. As the complex care of patients has evolved over time, there has been growth in advanced case management education (P. Stark, 2020). Yet, not everyone has access to formal education.

Primary Practice Settings(s):

Practical knowledge gained from the experiences of other case managers is not only free but also valuable. When we are exposed to the practical experiences and advice of seasoned case managers, we create an opportunity for knowledge sharing and reverse mentoring, which can result in leadership development (S. Powell, 2013). This article provides a historical glance into the evolution of today's case management practice, as well as provides salient lessons and advice from senior case managers who share practical tips and stories for tomorrow's case management leaders. Mentors share their career-long experiences in hospital case management, rehabilitation case management, pediatric case management, military case management, and hospice case management.

Findings/Conclusions:

Valuable lessons can be learned from reviewing case management's history that can be applied to improve current and future case management practice. Sources of information can be obtained from national organizations as well as from a review of the literature. Senior case managers who have dedicated their careers to case management can also be a vital resource, lending insights into pitfalls to avoid and best practices to implement in everyday practice.

Implications for Case Management Practice:

The case management mentors in this article have imparted the following key points to assist tomorrow's case management experts in maximizing their value:
To All the Physicians Advisors
Authors: Powell Suzanne K.
Published: May 2023

Over the years, the physician advisor has become a regulatory and revenue integrity force. This Editorial discusses the evolution and roles of the physician advisor and how case managers can work more effectively with them.
Effectiveness of psychological interventions delivered by physiotherapists in the management of neck pain: a systematic review with meta-analysis
Authors: Farrell Scott F. , Edmunds Devon , Fletcher John , Martine Harry , Mohamed Hashem , Liimatainen Jenna , Sterling Michele
Published: May 2023

Physiotherapists are increasingly using psychological treatments for musculoskeletal conditions. We assessed the effects of physiotherapist-delivered psychological interventions on pain, disability, and quality of life in neck pain. We evaluated quality of intervention reporting. We searched databases for randomized controlled trials (RCTs) comprising individuals with acute or chronic whiplash-associated disorder (WAD) or nontraumatic neck pain (NTNP), comparing physiotherapist-delivered psychological interventions to standard care or no treatment. Data were extracted regarding study characteristics and outcomes. Standardised mean difference (SMD) was calculated by random-effects meta-analysis. We evaluated certainty of evidence using Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) and intervention reporting using TIDieR. Fourteen RCTs (18 articles—4 detail additional outcome/follow-up data) were included comprising 2028 patients, examining acute WAD (n = 4), subacute/mixed NTNP (n = 3), chronic WAD (n = 2), and chronic NTNP (n = 5). Treatment effects on pain favoured psychological interventions in chronic NTNP at short-term (SMD −0.40 [95% CI −0.73, −0.07]), medium-term (SMD −0.29 [95% CI −0.57, 0.00]), and long-term (SMD −0.32 [95% CI −0.60, −0.05]) follow-up. For disability, effects favoured psychological interventions in acute WAD at short-term follow-up (SMD −0.39 [95% CI −0.72, −0.07]) and chronic NTNP at short-term (SMD −0.53 [95% CI −0.91, −0.15]), medium-term (SMD −0.49 [95% CI −0.77, −0.21]), and long-term (SMD −0.60 [95% CI −0.94, −0.26]) follow-up. GRADE ratings were typically moderate, and intervention reporting often lacked provision of trial materials and procedural descriptions. Psychological interventions delivered by physiotherapists were more effective than standard physiotherapy for chronic NTNP (small-to-medium effects) and, in the short term, acute WAD.
Wise-Pattern versus Transverse Pattern Mastectomy in Two-Stage Implant-Based Breast Reconstruction: A Propensity Score-Matched Analysis
Authors: Escandón Joseph M. , Butterfield James A. , Christiano Jose G. , Gooch Jessica C. , Olzinski Ann Therese , Prieto Peter A. , Skinner Kristin A. , Langstein Howard N. , Manrique Oscar J.
Published: May 2023

Background:

The wise pattern adapted to the mastectomy incisions has become a valuable asset for breast reconstruction in patients with large and ptotic breasts. Herein, we compared the time for exchange, time to initiate postmastectomy radiotherapy (PMRT) and complications rate between reconstructions performed with wise pattern versus a transverse incision pattern.

Methods:

We retrospectively reviewed the record of patients who underwent immediate two-stage implant-based reconstruction (IBBR) between January 2011 and December 2020. Two cohorts were compared according to the incision pattern: wise versus transverse incision pattern. Complications were compared after propensity score matching.

Results:

We initially analyzed 393 two-stage immediate IBBR in 239 patients, 91 (23.2%) in the wise-pattern group and 302 (76.8%) in the transverse pattern group. The expansion time (53 days versus 50 days, p=0.9), the time for TE-to-implant exchange (154 versus 175 days, p=0.547), and the time to initiate PMRT (144 days versus 126 days, p=0.616) were not different between groups. Before propensity score matching, the 30-day rate of wound-related complications (32% versus 10%, p<.001) and 30-day rate of wound complications requiring E/D+C procedures (20% versus 7%, p<.001) were significantly higher in the wise-pattern group. After propensity score matching, the 30-day rate of wound-related complications persisted significantly higher (25% versus 10%, p=0.03) in the wise-pattern group.

Conclusion:

The wise pattern mastectomy independently increases the incidence of wound-related complications versus only transverse patterns during two-stage IBBR, even after propensity score matching. Delayed TE placement may improve the safety profile of this procedure.
Augmented Reality Microsurgery (ARM) - Proof of Concept for a Novel Approach to Microsurgical Field Visualization in Plastic Surgery
Authors: Falola Reuben , Lombana Nicholas , Rodriguez-Unda Nelson , Mehta Ishan , Webster Nicholas , Weber Robert , Altman Andrew , Saint-Cyr Michel
Published: May 2023

Background:

Microsurgery is conducted on tiny anatomical structures like blood vessels and nerves. Over the past few decades, little has changed in the way plastic surgeons visualize and interact with the microsurgical field. New advances in Augmented Reality (AR) technology present a novel method for microsurgical field visualization. Voice and gesture-based commands can be used in real-time to adjust the size and position of a digital screen. Surgical decision support and/or navigation may also be employed. The authors assess the use of AR in microsurgery.

Methods:

The video feed from a Leica Microsystems OHX surgical microscope was streamed to a Microsoft HoloLens2 AR headset. A fellowship-trained microsurgeon and 3 plastic surgery residents then performed a series of 4 arterial anastomoses on a chicken thigh model using the AR headset, a surgical microscope, a video microscope or “exoscope”, and surgical loupes.

Results:

The AR headset provided an unhindered view of the microsurgical field and peripheral environment. The subjects remarked on the benefits of having the virtual screen track with head movements. The ability of participants to place the microsurgical field in a tailored comfortable, ergonomic position was also noted. Points of improvement were the low image quality compared to current monitors, image latency, and the lack of depth perception.

Conclusion:

AR is useful tool that has the potential to improve microsurgical field visualization and the way surgeons interact with surgical monitors. Improvements in screen resolution, latency, and depth of field are needed.
Acellular dermal matrix cover improves skin growth during tissue expansion by affecting distribution of mechanical forces
Authors: Ledwon Joanna K. , Applebaum Sarah A. , Progri Bianka , Han Tianhong , Vignesh Oveyaa , Gutowski Kristof S. , Chang Alec B. , Reddy Narainsai K. , Tepole Adrian B. , Gosain Arun K.
Published: May 2023

Background

Biological cover over tissue expander prostheses has been introduced to provide soft tissue support for tissue expanders during breast reconstruction. However, its impact on mechanically induced skin growth remains unknown. This study will investigate the hypothesis that covering the tissue expander with acellular dermal matrix (ADM) affects mechanotransduction without compromising the efficacy of tissue expansion.

Methods

Tissue expansion, with and without use of ADM, was performed on a porcine model. The tissue expanders were inflated twice with 45 ml of saline and the full-thickness skin biopsies were harvested from expanded and control unexpanded skin one week and 8 weeks after the final inflation. Histological evaluation, immunohistochemistry staining, and gene expression analysis were performed. Skin growth and total deformation were evaluated using isogeometric analysis (IGA).

Results

Our results demonstrate that utilization of ADM as a biological cover during tissue expansion does not impede mechanotransduction that lead to skin growth and blood vessel formation. IGA revealed similar total deformation and growth of expanded skin with and without a biological cover, confirming that its use does not inhibit mechanically induced skin growth. In addition, we found that use of an ADM cover results in more uniform distribution of mechanical forces applied by the tissue expander.

Conclusions

These results suggest that ADM improves mechanically induced skin growth during tissue expansion by facilitating a more uniform distribution of mechanical forces applied by the tissue expander. Therefore, the use of a biological cover has potential to improve outcomes in tissue expansion-based reconstruction.

Clinical Relevance Statement.

Utilization of ADM during tissue expansion results in more uniform distribution of mechanical forces applied by the tissue expander and might improve clinical outcomes in patients undergoing breast reconstruction.