bluuebunny/crossref_metadata_2025 huggingface dataset:
Testing for clomiphene in keratinous matrices (hair and nail)
Authors: Kintz Pascal , Gheddar Laurie , Blanchot Adeline , Ameline Alice , Raul Jean-Sébastien
Published: July 2023

Clomiphene or clomifene is a selective estrogen receptor modulator used to treat female fertility in case of ovulatory dysfunction. In sport, clomiphene is prohibited at all times for use by athletes and is listed in the section S4.2 (hormone and metabolic modulators) by the World Anti-Doping Agency. Indeed, clomiphene can indirectly increase testosterone levels in the body and can mitigate some side effects of synthetic steroid abuse. Despite its prescription to millions of subjects, its detection in human hair or nail clippings has never been reported. The aim of this study was to develop a specific method to identify clomiphene in hair and nail clippings by liquid chromatography–quadrupole tandem mass spectrometry. The procedure was then applied in a case of challenged doping results. The method involves sonication/incubation for 1 h of 30 mg of pulverized material in 1 mL of methanol in the presence of 2 ng diazepam-d5 used as internal standard. The chromatographic separation was performed using a HSS C18 column with a 15 min gradient elution. After spiking blank hair and nail with the corresponding amounts of clomiphene, linearity was verified from 1 to 500 pg/mg (r2 = 0.9994 and 0.9995 for hair and nail, respectively). The limit of detection was estimated at 0.3 pg/mg for both matrices. No interference was noted from endogenous compounds, particularly steroids. Clomiphene was identified at 85 and 20 pg/mg in the pubic hair and the fingernail clippings, respectively, of a male athlete challenging an adverse analytical finding.
Prosecuting the Crime against Humanity of Apartheid
Authors: Kemp Gerhard , Nortje Windell
Published: July 2023

Apartheid is a crime against humanity, yet no person has ever been prosecuted for this crime. In 2021 two individuals were indicted in South Africa for the crime of apartheid. This is an historic first in the country which gave the policy of apartheid its name and material content. The indictment is, however, also a reminder that the non-prosecution of apartheid is a legal and moral issue to be understood in the context of South Africa’s transition from apartheid to democracy. Furthermore, the indictment, while historic and of international significance, concerns constitutional, procedural and prosecutorial issues that illustrate the complexities of the application of international criminal law in domestic criminal justice systems. This contribution argues that all these factors should be acknowledged and analysed. Ultimately, and despite the many obstacles and complexities, it is submitted that it is right to indict individuals who, through their crimes, made the apartheid system possible even if they were not in positions of leadership.
Individualized risk assessment of distant metastases in oral cavity carcinoma: a validated predictive-score model
Authors: Id Said Badr , Alfaraj Fatimah A , Marta Gustavo N , Kowalski Luiz P , Kohler Hugo F , Huang Shao H , Su Jie , Xu Wei , Eng Lawson , de Moraes Fabio Y , Hahn Ezra , Kim John J , O’Sullivan Brian , Ringash Jolie , Waldron John , Matos Leandro L , Prisman Eitan , Irish Jonathan C , Yao Christopher M K L , de Almeida John R , Goldstein David P , Hope Andrew , Hosni Ali
Published: July 2023

Background

We aimed to develop and validate a risk-scoring system for distant metastases (DMs) in oral cavity carcinoma (OCC).

Methods

Patients with OCC who were treated at 4 tertiary cancer institutions with curative surgery with or without postoperative radiation/chemoradiation therapy were randomly assigned to discovery or validation cohorts (3:2 ratio). Cases were staged on the basis of tumor, node, and metastasis staging according to the eighth edition of the American Joint Committee on Cancer/Union for International Cancer Control guidelines. Predictors of DMs on multivariable analysis in the discovery cohort were used to develop a risk-score model and classify patients into risk groups. The utility of the risk classification was evaluated in the validation cohort.

Results

Overall, 2749 patients were analyzed. Predictors (risk score coefficient) of DMs in the discovery cohort were the following: pathological stage (p)T3-4 (0.4), pN+ (N1: 0.8; N2: 1.0; N3: 1.5), histologic grade (G) 3 (G3, 0.7), and lymphovascular invasion (0.4). The DM risk groups were defined by the sum of the following risk score coefficients: high (>1.7), intermediate (0.7-1.7), and standard risk (<0.7). The 5-year DM rates (high/intermediate/standard risk groups) were 30%/15%/4% in the discovery cohort (C-index = 0.79) and 35%/16%/5% in the validation cohort, respectively (C-index = 0.77; both P < .001). In the whole cohort, this predictive model showed excellent discriminative ability in predicting DMs without locoregional failure (29%/11%/1%), later (>2 year) DMs (11%/4%/2%), and DMs in patients treated with surgery (20%/12%/5%), postoperative radiation therapy (34%/17%/4%), and postoperative chemoradiation therapy (39%/18%/7%) (all P < .001). The 5-year overall survival rates in the overall cohort were 25%/51%/67% (P < .001).

Conclusions

Patients at higher risk for DMs were identified by use of a predictive-score model for DMs that included pT3-4, pN1/2/3, G3, and lymphovascular invasion. Identified patients may be evaluated for individualized risk-adaptive treatment escalation and/or surveillance strategies.
Ex vivo repair and autotransplantation for a complex renal artery aneurysm
Authors: Chui Juanita N , Wang Kejia , Puttaswamy Vikram
Published: July 2023

Renal artery aneurysms (RAA) are rare, occurring with an incidence of <0.1%. Open repair remains the mainstay of treatment for anatomically complex aneurysms. Here, we present a case of a large hilar RAA managed with ex vivo reconstruction and heterotopic renal autotransplantation. In this case, the complex anatomy and location of the aneurysm precluded the use of an endovascular approach. In situ repair was deemed unfavorable because of the technical difficulty of the repair with the numerous arterial branches involved, risk of parenchymal injury from prolonged warm ischemic time, restricted surgical field and risk of aneurysm rupture. This case contributes to the literature on laparoscopic nephrectomy, ex vivo repair and autotransplantation as a safe and viable treatment strategy for patients with complex RAA.
Middleness: Provincial Fiction and the Aesthetics of Dull Life
Authors: Livesey Ruth
Published: July 2023

This article argues that the rise of the provincial novel in Britain during the 1860s set loose a radically democratizing aesthetic of everyday discriminations. The article suggests – through examples from the works of Elizabeth Gaskell and George Eliot – that provincial fiction embodies an aesthetics of what is termed ‘middleness’: a means of reading in which the social, cultural and geographical middle became an object of careful evaluative judgment. The article examines the aesthetic affordances of this form in relation to Sianne Ngai’s exploration of the category of the ‘interesting’. It places this practice of attention to the common and the dull in contrast to Matthew Arnold’s contemporaneous critique of provincialism as the chief weakness at the heart of English culture as it moved towards democracy. If Arnold’s mission in his critical essays was to establish a global standard of taste – collective agreement grounded in the judgement of what was ‘the best that has been thought and known in the world’ – then provincial fiction effected another sort of aesthetic community: one that valued the common and the dull.
An empirical approach to model selection: weak lensing and intrinsic alignments
Authors: Campos A , Samuroff S , Mandelbaum R
Published: July 2023

In cosmology, we routinely choose between models to describe our data, and can incur biases due to insufficient models or lose constraining power with overly complex models. In this paper, we propose an empirical approach to model selection that explicitly balances parameter bias against model complexity. Our method uses synthetic data to calibrate the relation between bias and the χ2 difference between models. This allows us to interpret χ2 values obtained from real data (even if catalogues are blinded) and choose a model accordingly. We apply our method to the problem of intrinsic alignments – one of the most significant weak lensing systematics, and a major contributor to the error budget in modern lensing surveys. Specifically, we consider the example of the Dark Energy Survey Year 3 (DES Y3), and compare the commonly used non-linear alignment (NLA) and tidal alignment and tidal torque (TATT) models. The models are calibrated against bias in the Ωm–S8 plane. Once noise is accounted for, we find that it is possible to set a threshold Δχ2 that guarantees an analysis using NLA is unbiased at some specified level Nσ and confidence level. By contrast, we find that theoretically defined thresholds (based on, e.g. p-values for χ2) tend to be overly optimistic, and do not reliably rule out cosmological biases up to ∼1–2σ. Considering the real DES Y3 cosmic shear results, based on the reported difference in χ2 from NLA and TATT analyses, we find a roughly $30{{\ \rm per\ cent}}$ chance that were NLA to be the fiducial model, the results would be biased (in the Ωm–S8 plane) by more than 0.3σ. More broadly, the method we propose here is simple and general, and requires a relatively low level of resources. We foresee applications to future analyses as a model selection tool in many contexts.
Distinct characteristics of two types of alternative lengthening of telomeres in mouse embryonic stem cells
Authors: Sung Sanghyun , Kim Eunkyeong , Niida Hiroyuki , Kim Chuna , Lee Junho
Published: July 2023

Telomere length must be maintained in actively dividing cells to avoid cellular arrest or death. In the absence of telomerase activity, activation of alternative lengthening of telomeres (ALT) allows the maintenance of telomeric length and prolongs the cellular lifespan. Our previous studies have established two types of ALT survivors from mouse embryonic stem cells. The key differences between these ALT survivors are telomere-constituting sequences: non-telomeric sequences and canonical telomeric repeats, with each type of ALT survivors being referred to as type I and type II, respectively. We explored how the characteristics of the two types of ALT lines reflect their fates using multi-omics approaches. The most notable gene expression signatures of type I and type II ALT cell lines were chromatin remodelling and DNA repair, respectively. Compared with type II cells, type I ALT cells accumulated more mutations and demonstrated persistent telomere instability. These findings indicate that cells of the same origin have separate routes for survival, thus providing insights into the plasticity of crisis-suffering cells and cancers.
Longitudinal Assessment of Association Between Tobacco Use and Tobacco Dependence Among Adults: Latent Class Analysis of the Population Assessment of Tobacco and Health Study Waves 1–4
Authors: Li Lihua , Yang Chen , Zhan Serena , Wilson Karen M , Taioli Emanuela , Mazumdar Madhu , Liu Bian
Published: July 2023

Introduction

With increasing tobacco product varieties, understanding tobacco use (TU) profiles and their associations with tobacco dependence (TD) has also become increasingly challenging.

Aims and Methods

We aimed to identify TU profiles and their associations with TD over time, and to identify subgroups with high risk of TD. We included 3463 adult recent tobacco users who had complete TU and TD data across waves 1–4 of the Population Assessment of Tobacco and Health (PATH) study. We used a composite index of TD and a summed TD score from an established 16-item TD measure. We applied a latent class analysis to identify TU profiles based on participants’ usage of eight common tobacco product groups at each survey wave and to check the stability of the TU profiles over time. We then used generalized estimating equations regressions to evaluate the longitudinal TU–TD association, adjusting for potential confounders.

Results

We identified three distinct TU profiles that remained consistent across four survey waves: Dominant cigarette users (62%–68%), poly users with high propensity of using traditional cigarettes, e-cigarettes, and cigars (24%–31%), and dominant smokeless product users (7%–9%). Covariate-adjusted models showed that TD was significantly lower among the poly users and the dominant smokeless users, compared to that among the dominant cigarette users.

Conclusions

Both TU profiles and their associations with TD were stable over time at the population level. Poly users and smokeless product users were consistently associated with lower TD than cigarette-dominant users, suggesting the need for tailored tobacco cessation interventions for users with different TU profiles.

Implications

The finding of consistent TU profiles across four survey waves extends the current literature in capturing TU patterns in an evolving tobacco product landscape. The finding of the overall higher level of TD among the cigarette-dominant users compared to the other TU latent profiles (the Cig+eCig+Cigar dominant poly users and the dominant smokeless product users) can help identify high-risk groups for potential interventions. Our application of innovative statistical methods to high-quality longitudinal data from the PATH study helps improve the understanding of the dynamic TU–TD relationship over time.
Opioid Risk Mitigation Practices of Interprofessional Oncology Personnel: Results From a Cross-Sectional Survey
Authors: McNally Gretchen A , McLaughlin Eric M , Ridgway-Limle Emily , Rosselet Robin , Baiocchi Robert
Published: July 2023

Background

This study explored the risk mitigation practices of multidisciplinary oncology health-care personnel for the nonmedical use of opioids in people with cancer.

Methods

An anonymous, cross-sectional descriptive survey was administered via email to eligible providers over 4 weeks at The Ohio State University’s Arthur G. James Cancer Hospital. The survey asked about experiences and knowledge related to opioid use disorders.

Results

The final sample of 773 participants included 42 physicians, 213 advanced practice providers (APPs consisted of advanced practice nurses, physician assistants, and pharmacists), and 518 registered nurses. Approximately 40% of participants responded feeling “not confident” in addressing medication diversion. The most frequent risk reduction measure was “Checking the prescription drug monitoring program” when prescribing controlled medications, reported by physicians (n = 29, 78.4%) and APPs (n = 164, 88.6%).

Conclusion

People with cancer are not exempt from the opioid epidemic and may be at risk for nonmedical opioid use (NMOU) and substance use disorders. Implementing risk reduction strategies with every patient, with a harm reduction versus abstinence focus, minimizes harmful consequences and improves. This study highlights risk mitigation approaches for NMOU, representing an opportunity to improve awareness among oncology health-care providers. Multidisciplinary oncology teams are ideally positioned to navigate patients through complex oncology and health-care journeys.
Contributions from ClpS surface residues in modulating N-terminal peptide binding and their implications for NAAB development
Authors: Callahan Nicholas , Siegall William B , Bergonzo Christina , Marino John P , Kelman Zvi
Published: July 2023

Numerous technologies are currently in development for use in next-generation protein sequencing platforms. A notable published approach employs fluorescently-tagged binding proteins to identity the N-terminus of immobilized peptides, in-between rounds of digestion. This approach makes use of N-terminal amino acid binder (NAAB) proteins, which would identify amino acids by chemical and shape complementarity. One source of NAABs is the ClpS protein family, which serve to recruit proteins to bacterial proteosomes based on the identity of the N-terminal amino acid. In this study, a Thermosynechococcus vestitus (also known as Thermosynechococcus elongatus) ClpS2 protein was used as the starting point for direct evolution of an NAAB with affinity and specificity for N-terminal leucine. Enriched variants were analyzed and shown to improve the interaction between the ClpS surface and the peptide chain, without increasing promiscuity. Interestingly, interactions were found that were unanticipated which favor different charged residues located at position 5 from the N-terminus of a target peptide.
Development and testing of a bespoke cultural intervention to support healthcare professionals with patients from a diverse background
Authors: Deshmukh Ashwini , Roberts Lisa , Adebajo Adewale , Kamal Atiya , Armitage Christopher J , Evison Felicity , Bunting Helen , Dubey Shirish , Moorthy Arumugam , Reehal Joti , Dogra Nisha , Kumar Kanta
Published: July 2023

Objective

Development and test of a culturally sensitive intervention for rheumatology healthcare professionals (HCPs).

Methods

Using a before and after study design, 15 HCPs were recruited to undertake the bespoke intervention from four National Health Service sites across England, in areas serving a diverse population. The intervention was evaluated using two validated outcomes: (i) Patient Reported Physician Cultural Competency (PRPCC); and (ii) Patient Enablement Instrument (PEI), measuring patients’ perceptions of their overall healthcare delivery. Additionally, HCPs completed the COM-B questionnaire for capability (C), opportunity (O) and motivation (M) to perform behaviour (B), measuring behaviour change.

Results

Two hundred patients were recruited before HCPs undertook the intervention (cohort 1), and 200 were recruited after (cohort 2) from 15 HCPs; after exclusions 178 patients remained in cohort 1 and 186 in cohort 2. Sixty percent of patients identified as white in both recruited cohorts, compared with 29% and 33% of patients (cohorts 1 and 2, respectively) who identified as being of South Asian origin. After the intervention, the COM-B scores indicated that HCPs felt more skilled and equipped for consultations. No significant differences were noted in the average overall cultural competency score between the two cohorts in white patients (57.3 vs 56.8, P = 0.8), however in the South Asian cohort there was a statistically significant improvement in mean scores (64.1 vs 56.7, P = 0.014). Overall, the enablement score also showed a statistically significant improvement following intervention (7.3 vs 4.3, P < 0.001) in the white patients and in the South Asian patients (8.0 vs 2.2, P < 0.001).

Conclusion

This novel study provides evidence for improving cultural competency and patient enablement in rheumatology settings.
Authoritarian Populism and Social Discomfort in Everyday Life
Authors: Gemici Basak
Published: July 2023

Sociology brings cultural and performative explanations to studies of populism and democracy. My research contributes to this trend by introducing feminist ethnomethodology into studying authoritarian populism and explaining its interactional mechanisms. I find that authoritarian populism unfolds as intensified boundary work in everyday life. Based on 96 in-depth interviews and ten months of urban bus ethnography in Istanbul, Turkey, I explain how this intense boundary work produces social discomfort in daily life through orienting toward, assessing in terms of, and enforcing conformity against a normative and binary populist mentality. Revealing this process explicates why civilian disciplinary actions intensify along with formal state repression. Regime loyalists and ethnic majorities experience and manage social discomfort more leniently than regime opponents and marginalized communities who are also dealing with the fear of state and civilian threats. There are three ways of negotiating social discomfort. Distancing from previously taken-for-granted interactions is widespread; marginalized communities censor the presentation of self, and regime loyalists display symbols of power reflecting the “native and national” mentality. The findings of this article suggest that social discomfort is a common denominator for prolonged authoritarian populism(s).
Intestinal parasitic infections and risk analysis among urban refugees in the Klang Valley, Malaysia
Authors: Mohd Hanapi Izzah Ruzana , Behnke Jerzy M , Sahimin Norhidayu , Saifulazmi Nur Fadlin , Golam Mohammad Khan Ashah Sara Jehan , Abdul Mutalib Raisya Nur Syazmeen , Lau Yee Ling , Mohd Zain Siti Nursheena
Published: July 2023

Background

Global studies show intestinal parasitic infections (IPIs) have been introduced and spread with refugee inflows from low to high socio-economic countries. However, there is relatively limited information on the prevalence of infections among the community.

Methods

A 2-year cross-sectional study was conducted to determine the prevalence and associated risk factors for infections among urban refugees in the Klang Valley, Malaysia. A total of 418 faecal samples were collected and examined by microscopy.

Results

Faecal screening revealed moderate levels (32.3%) of infections in the community. Three nematode (Ascaris lumbricoides, Trichuris trichiura and hookworm) and three protozoan species (Entamoeba, Giardia and Cryptosporidium) were recorded, with the highest prevalence being A. lumbricoides (20.6%) followed by T. trichiura (10.3%), while other infections were <5%. Statistical analysis found that young males with less education were more likely to be infected with helminths. Additionally, living near waste disposal sites, the presence of stray animals, eating with bare hands, bare footedness, poor handwashing practices and no anthelmintic treatment constituted significant risk factors for helminth infections. Protozoan infections were linked to drinking tap water or from water dispensers and poor handwashing practices.

Conclusions

These findings emphasize the importance of health education in addition to introduction of biannual anthelmintic treatment to promote community health and well-being.
Employment Mismatches Drive Expectational Earnings Errors among Mozambican Graduates
Authors: Jones Sam , Santos Ricardo , Xirinda Gimelgo
Published: July 2023

Biased beliefs about future labor-market earnings are commonplace. Based on a longitudinal survey of graduate work transitions in Mozambique, this study assesses the contribution of employment mismatches to a large positive gap between expected (ex ante) and realized (ex post) earnings. Accounting for the simultaneous determination of pecuniary and non-pecuniary work characteristics, employment mismatches are found to be material and associated with large earnings penalties. A decomposition of these expectational errors shows that around two-thirds are attributable to employment mismatches, suggesting job seekers systematically overestimate the ease of securing “good jobs.”
Female Education and Brideprice: Evidence from Primary Education Reform in Uganda
Authors: Nagashima Masaru , Yamauchi Chikako
Published: July 2023

Universal primary education (UPE) policies have been shown to improve educational attainment and delay marriage and childbearing, particularly among rural girls. This disproportionate improvement in female relative to male education can change the bargaining structure between the wife and the husband. Furthermore, with the expectation of this change, decisions about marriage-market entry, matching, and marital arrangements, such as brideprice, can change. In particular, greater female bargaining power can increase the share of marriages without a brideprice in settings where husbands may demand a refund upon divorce. Using first-hand data on marital transfers and exploiting Uganda’s UPE, which abolished primary school fees in 1997, this study shows that longer UPE exposure is associated positively with female education and negatively with brideprice practice. The results imply that UPE policies can affect women’s marital lives by empowering them in household decisions. The study also discusses the consistency of the results with other potential mechanisms, such as selective marriage-market entry, marital squeeze, and assortative matching.
Evaluation of Bait Crops for the Integrated Management of White Rot (Sclerotium cepivorum) in Allium Crops
Authors: Hoang Hua Gia Khuong , Wilson Robert , Dung Jeremiah
Published: July 2023

White rot, caused by Sclerotium cepivorum, is a serious disease that causes significant yield losses in Allium production. The pathogen persists in soil as sclerotia, which germinate in response to sulfur compounds in Allium root exudates. This study was aimed at investigating the potential of early-terminated Allium bait crops to reduce densities of S. cepivorum sclerotia in soil. In growth chamber experiments with white onion (A. cepa cultivar ‘Southport White Globe’), red onion (A. cepa cultivar ‘Marenge’), sweet onion (A. cepa cultivar ‘Walla Walla’), and bunching onion (A. fistulosum cultivar ‘Parade’), termination of all four Alliums at the first- and second-leaf stages reduced soil sclerotia populations by up to 62 and 76%, respectively. Examination of soil samples collected 4 weeks after crop termination indicated that sclerotia populations in bait crop treatments remained low when seedlings were terminated at the first- and second-leaf stages. In contrast, crop termination at the third-leaf stage resulted in an increase in sclerotia counts due to the pathogen reproduction on the bait crops. The reduction in sclerotia populations in soil due to early crop termination was also observed in replicated field trials. Greater reductions in sclerotia counts were observed when plants in these experiments were terminated chemically as opposed to mechanically. In-furrow fungicides did not reduce sclerotia numbers under the conditions tested. This study demonstrates the potential for early termination of Allium bait crops to help reduce white rot inoculum in soil.
Acute Pain Management for Patients Maintained on Sublingual Buprenorphine as Medication for Opioid Use Disorder
Authors: Haines Alexander J. , Wood Katlyn C. , Costello Jennifer L. , Tawil Tara
Published: July 2023

Objective

The aim of this study was to compare morphine milligram equivalent (MME) requirements for acute pain management between patients admitted for medical or surgical diagnoses with opioid use disorder (OUD) who receive >12 mg of sublingual buprenorphine daily compared with those who receive ≤12 mg/d.

Design

This study was performed via retrospective chart review.

Setting

This study evaluated patient encounters between January 2017 and November 2021 from a single-center community teaching hospital in Lancaster, PA.

Methods

Patients were assessed according to daily dose of buprenorphine received while admitted (>12 mg/d vs ≤12 mg/d); patients who had buprenorphine held were included within the ≤12 mg/d study group. The primary outcome evaluated daily average MME requirements over the entirety of hospital length of stay. Key secondary outcomes were total MME requirements and daily average pain scores.

Subjects

Key inclusion criteria were sublingual buprenorphine therapy for at least 1 month prior to admission, presence of an acute pain diagnosis during hospital stay, and history of OUD.

Results

Seventy-eight (78) patients were included for analysis. Daily average MME requirements were similar between patients who received buprenorphine >12 mg/d and ≤12 mg/d (median, 7.5 vs 10.6; P = 0.350). Total MME and daily average pain scores were similar between study groups.

Conclusions

For OUD patients in need of acute pain management, the continuation of sublingual buprenorphine throughout hospitalization at a daily dose of >12 mg/d compared with ≤12 mg/d did not confer a significant difference in daily average MME requirements.
Father Groups in the Neonatal Intensive Care Unit
Authors: Lægteskov Tascha Ravn , Holm Kristina Garne , Petersen Mette , Lysdal Rasmus Klitbøl , Hjelvang Brian Rafn , Brødsgaard Anne
Published: July 2023

Background:

Parents' participation in the neonatal intensive care unit (NICU) reduces length of stay and positively affects infants' psychological, cognitive, and behavioural outcomes. Healthcare professionals in the NICU focus on both parents, but tend to have the main focus on the mother and the infant. Therefore, fathers may experience a lack of support and feel that they are being disregarded in the NICU.

Purpose:

To study fathers' experiences with father groups during NICU admission with their preterm infant. The father group is a 90-minute intervention based on dialogue between fathers and a male healthcare professional.

Methods:

A qualitative content analysis was conducted using 10 online semistructured interviews with fathers participating in a father group. The study was reported according to the Standards for Reporting Qualitative Research.

Results:

The overall theme emerging from our analysis was “Emotional support, encouragement, and an enhanced capacity to deal with the situation and with life in the NICU.” This theme emerged from the categories “Meeting with peers and sharing reflections” and “Fathers' territory” based on 5 subcategories.

Implications for Practice:

Participation in father groups gives fathers recognition for being important as parents in the NICU, improves fathers' mental well-being, and enhances their coping capacity. Father groups support fathers in the NICU and can be integrated into NICU practices and policies to enhance a family-centered approach.

Implications for Research:

This study revealed a need for further research to determine whether participation in a father group has a measurable effect on clinical outcomes.
A Qualitative Study of Nurses' Perspectives on Neonatologist Continuity of Care
Authors: Machut Kerri Z. , Gilbart Christie , Murthy Karna , Michelson Kelly N.
Published: July 2023

Background:

Families and staff in neonatal intensive care units (NICUs) value continuity of care (COC), though definitions, delivery, and impacts of COC are incompletely described. Previously, we used parental perspectives to define and build a conceptual model of COC provided by neonatologists. Nursing perspectives about COC remain unclear.

Purpose:

To describe nursing perspectives on neonatologist COC and revise our conceptual model with neonatal nurse input.

Methods:

This was a qualitative study interviewing NICU nurses. The investigators analyzed transcripts with directed content analysis guided by an existing framework of neonatologist COC. Codes were categorized according to previously described COC components, impact on infants and families, and improvements for neonatologist COC. New codes were identified, including impact on nurses, and codes were classified into themes.

Results:

From 15 nurses, 5 themes emerged: (1) nurses validated parental definitions and benefits of COC; (2) communication is nurses' most valued component of COC; (3) neonatologist COC impact on nurses; (4) factors that modulate the delivery of and need for COC; (5) conflict between the need for COC and the need for change. Suggested improvement strategies included optimizing staffing and transition processes, utilizing clinical guidelines, and enhancing communication at all levels. Our adapted conceptual model describes variables associated with COC.

Implications for Practice and Research:

Interdisciplinary NICU teams need to develop systematic strategies tailored to their unit's and patients' needs that promote COC, focused to improve parent–clinician communication and among clinicians. Our conceptual model can help future investigators develop targeted interventions to improve COC.
Using a Constructivist-Oriented Modified Grounded Theory Approach in the Study of Intrafamily Trauma Communication Process in War-Affected Families
Authors: Hoffman Sarah J. , Fredkove Windy M.
Published: July 2023

Grounded theory methodology is frequently applied in health research, yet studies contending with contextual constraints may require a more pragmatic approach, including potential methodologic divergence and modifications of method choice and application. Dissemination of a detailed documentation and justification of methodologic choices, and specific method modifications and/or innovations, are uncommon in extant literature; however, a more expansive approach to such reporting has the potential to enhance research practices, increase transparency, and contribute to the ongoing discourse around research approaches and rigor. Here, we articulate our methodologic decision-making and methods, including modifications, as applied to the qualitative strand of an explanatory mixed-methods study. The primary aim of this article is to contribute to the discourse and collective learning around methodology and method choices and modifications by presenting one approach to applying a constructivist-oriented, modified version of grounded theory analytic methods through a worked qualitative study example.
A Geospatial Analysis of Abortion Access in the United States after the Reversal of Roe v Wade
Authors: Alterio Maeve , Von Davies Robin , Tobias Michele , Koehl Arthur , Tang Jennifer H. , Kopp Dawn
Published: July 2023

INTRODUCTION:

To investigate current abortion access in the United States based on geographic location and to forecast access according to the landscape of abortion care in the year after the Dobbs v Jackson Women’s Health Organization decision.

METHODS:

Addresses of abortion-providing clinics were identified using web-based directories from Planned Parenthood, the National Abortion Foundation, Abortion Finder, and Power to Decide. Using geographic coordinates and the OpenStreetMap road network, Valhalla's Isochrone application programming interface was used to calculate the areas within a 30-, 60-, and 90-minute driving distance from these clinics. The population of reproductive-aged women (15–49 years) in the tracts inside or outside the accessible areas was determined using the U.S. Census American Community Survey for 2020. Review of legislative and judicial actions for 2023 determined at-risk states. Clinic locations and laws are accurate as of June 2, 2023.

RESULTS:

The addresses of 750 abortion facilities were geocoded. Currently, 41.4% (30.8 million) of women do not have access to an abortion clinic within a 30-minute drive, and 29.3% and 23.6% do not have access within a 60-minute and 90-minute drive, respectively. When accounting for the combined population with no access, severely limited access, and at-risk of losing access, 53.5% of women do not have access within a 30-minute drive, and 45.6% and 43.0% do not have access within a 60-minute and 90-minute drive, respectively.

DISCUSSION:

Two of every five American women do not have access to an abortion facility within a 30-minute drive, and one in four lack access within a 90-minute drive. These proportions could significantly increase if access is restricted further with state bans proposed in 2023.
Reconstruction of Achilles Tendon Skin Defect Using Single-Stage Reverse Sural Artery Island Flap
Authors: Patodia Gaurav
Published: July 2023

Wound complications following open repair of a ruptured Achilles tendon are common and require immediate skin cover. This study analyses the use of a reverse sural artery island flap to cover skin defects over an exposed intact Achilles tendon. Thirteen patients with postoperative wound complications over the tendoachilles were operated upon. All wounds were debrided and reconstructed with a single-stage reverse sural artery island flap. Within 5 weeks of flap cover, 12 wounds healed completely, while 1 flap had superficial necrosis at the margin in a diabetic patient. This eventually healed and did not compromise the final result. None of the flaps had venous congestion. In our hands, reconstructing skin defects following wound complications after Achilles tendon repair with islanded reverse sural artery flap is a reliable and safe option.

Level of Evidence: Level IV.
Ovarian stimulation and oocyte cryopreservation in females with cancer
Authors: Oktay Kutluk H. , Turan Volkan
Published: July 2023

Purpose of review

We reviewed the most recent developments including the safety and effectiveness data and success rates in individualized ovarian stimulation protocols for adult and postpubertal females with cancer.

Recent findings

In women with breast cancer, aromatase inhibitor- and tamoxifen-supplemented stimulation protocols increase the margin of safety by limiting estrogen exposure. The outcomes of ovarian stimulation appear similar between cancer and noncancer populations, even with the recently developed random-start protocols, which allow initiation of ovarian stimulation anytime during the menstrual cycle. Based on lower anti-Mullerian hormone levels and primordial follicle density, carriers of BRCA pathogenic variants (BRCApv) have decreased ovarian reserve in comparison to women without those variants and may lose larger portion of their ovarian reserve post chemotherapy. Oocyte cryopreservation is also emerging as a suitable fertility preservation approach for selected postpubertal girls as young as 12 years of age.

Individualized ovarian stimulation approaches combined with improvements in cryopreservation techniques increased the success and safety margin to preserve fertility with oocyte freezing. Women with BRCApv, on the other hand, may be at disadvantage as they have lower ovarian reserve and may lose larger portion of their ovarian reserve post chemotherapy compared to women who do not carry these variants.
Rosacea Aggravated after Intracutaneous Injection of Poly-L-lactic Acid through a Stamp-type Microneedle
Authors: Yu Sa , Gong Ruicheng , Wang Lu
Published: July 2023

Injectable poly-L-lactic acid (PLLA) has been widely used for skin texture improvement, volume augmentations of the face or body, and other cosmetic or reconstructive treatment. Despite its significant efficacy, many side effects have also been reported. Here, we describe a case of rosacea aggravated by intracutaneous injection of PLLA using a mesogun injector with stamp-type microneedle. After the treatment, the patient exhibited aggravated rosacea symptoms, such as flushing and erythema. A possible mechanism for the exacerbations might be that PLLA stimulated subclinical inflammatory reaction in the skin. We suggest that PLLA injection should be administered more cautiously in patients with rosacea or other inflammatory skin lesions.
Staphylococcal Toxic Shock Syndrome after Autologous Breast Reconstruction: A Case Report and Literature Review
Authors: Nakamura Hideharu , Makiguchi Takaya , Hasegawa Yasuko , Yamatsu Yukie , Shoda Koki , Mori Yumi , Sakurai Kei , Shirabe Ken , Yokoo Satoshi
Published: July 2023

Staphylococcal toxic shock syndrome (TSS) is a rare but potentially life-threatening systemic bacterial intoxication. TSS is characterized by fever, hypotension, rash, digestive symptoms such as vomiting and diarrhea, multiorgan system involvement, and desquamation in the initial recovery period. We report a case of a 35-year-old woman who developed TSS caused by methicillin-resistant Staphylococcus aureus following deep inferior epigastric perforator flap breast reconstruction. Local findings are often not obvious in a case of TSS, which can make early diagnosis and appropriate initial treatment difficult. If a patient presents with characteristic symptoms of TSS after autologous breast reconstruction, TSS should be suspected and exploration of surgical wounds should be initiated as soon as possible.
Average Scleral Lens Replacement Period at a Tertiary Care Hospital
Authors: Pritikin Ethan , Rodman Jack , Chiu Gloria B.
Published: July 2023

Objective:

To evaluate the average scleral lens replacement period at a tertiary care hospital.

Methods:

Patients were identified retrospectively through electronic medical records. Inclusion criteria included scleral lens patients treated at the USC Department of Ophthalmology who had reordered a scleral lens at least once in one eye. Lens order histories were evaluated, and statistical analysis included a multivariable, mixed-methods, linear, regression model.

Results:

Two hundred fifty-one patients (120 men and 131 women; average age 57.1±17.4 years, range 9–93 years) and a total of 445 eyes (227 OD, 218 OS; 199 irregular corneas, 246 ocular surface disease) were included. The average replacement period for a scleral lens was 23.9±14.3 months (range 5–2,617 days). Patients with greater scleral lens experience had a statistically significant increase in their average scleral lens replacement period; for every one year of additional experience wearing scleral lenses, average replacement period increased by 30.7 days (P=0.001). There was no statistically significant correlation between average scleral lens replacement period and sex, diagnosis, prior outside scleral lens treatment, lens brand, or lens diameter.

Conclusion:

The average scleral lens replacement period in this patient cohort at a tertiary care hospital was 23.9±14.3 months (1.99±1.19 years). Further studies are needed to better understand the impact of scleral lens age on ocular health and vision. Certainly, proper scleral lens training and education are essential to ensure optimal lens condition and treatment outcomes.
Neonatal Physiotherapy Interventions in Reducing Acute Procedural Pain and Improving Neuromotor Development in a Preterm Neonate
Authors: Sharma Neha , Samuel Asir John
Published: July 2023

Background:

Repeated painful procedures are very common in neonatal intensive care unit (NICU). A combination of multisensory stimulation (MSS) and soft tissue therapy (STT) potentiates each other's analgesic effects and helps in reducing procedural pain.

Case Description:

Thirty-six weeks and 2 days old preterm neonate was undergoing venipuncture at right forearm for diagnostic purpose when admitted in NICU because of prematurity. MSS and STT were provided once in a day for 30 minutes, total for 5 days for pain relief and improvement in neuromotor outcomes.

Outcomes:

Pain intensity was assessed with Preterm Infant Pain Profile-Revised (PIPP-R) and Neonatal Pain, Agitation and Sedation Scale (N-PASS). The neuromotor outcomes were also assessed with Infant Neurological International Battery (INFANIB) and Premie-Neuro Scale. All the measurements were taken at baseline and after 5 days of intervention. The pain scores, PIPP-R and N-PASS, were measured at 30 seconds, 60 seconds, 90 seconds, and 120 seconds before the intervention. The PIPP-R: 7, 7, 10, and 6, and N-PASS scores before the intervention were: 2, 9, 4, and 5, respectively. After 5 days of intervention, the pain scores were PIPP-R: 3, 9, 3, and 3, and N-PASS: 3, 3, 4, and 4, respectively. The neuromotor tests, INFANIB and Premie-Neuro, were measured at baseline and postintervention. The scores were INFANIB: 58 and 60, respectively, and Premie-Neuro: 90 and 92, respectively.

Discussion/Conclusion:

Neonatal physiotherapist may give importance to procedural pain management in NICU settings to promote good clinical practice along with other physiotherapy interventions. Along with pain scores, neuromotor scores were improved after the 5th day of intervention in the preterm neonate. MSS and STT might help in reducing procedural pain and improving neuromotor outcomes after 5 days of intervention among preterm neonates.
The Use of Impella 5.5 for Donor–Heart Hemodynamic Support in Heart Transplantation
Authors: Kawabori Masashi , David Brandon , Nordan Taylor , Chen Frederick Y. , Couper Gregory S.
Published: July 2023

Primary graft dysfunction is a feared complication and cause of mortality post–heart transplant. Primary graft dysfunction may require mechanical circulatory support, such as venoarterial extracorporeal membrane oxygenation, which carries its own risk for complications. We developed a new mechanical circulatory support method for patients who underwent heart transplant bridged with Impella 5.5, which was then placed into the donor heart. Among 12 heart transplants, four required Impella 5.5 support. The average age was 55.8 years. The mean duration for postoperative mechanical circulatory support was 3.8 days, ranging from 2 to 5 days. No patients developed severe right ventricular dysfunction. In our limited study, complications and mortality associated with the replanted Impella 5.5 were both 0%.
Treatment of strabismus and blepharospasm with Botox (onabotulinumtoxinA): Development, insights, and impact
Authors: Scott Alan B. , Fahn Stanley , Brin Mitchell F.
Published: July 2023

Strabismus, deviation of the ocular alignment, can adversely affect quality of life and activities of daily living. Surgery was the prior standard of care for strabismus, but up to 40% of patients required additional surgeries. This need for more effective and less invasive treatment, along with the convergence of other events such as the development of electromyography, purification of botulinum toxin A, and the finding that injection of botulinum toxin type A could paralyze the hind limbs of chicks, led Dr. Alan Scott to investigate injection of his formulation for strabismus. The positive results of initial trials in monkeys segued to human trials with observations of alignment improvements and few adverse events. The success of botulinum toxin type A in the treatment of strabismus led to interest in its use to treat other skeletal muscles, particularly in blepharospasm, a type of focal dystonia involving eyelid spasms and involuntary eye closure that lacked an effective pharmacological treatment. Patient groups helped to increase awareness of this novel treatment, and results from clinical trials confirmed its effectiveness. Dr. Scott’s formulation, then known as Oculinum, received its first Food and Drug Administration approvals in 1989 for strabismus and blepharospasm. Allergan acquired Oculinum in 1991, renaming it Botox. These initial uses led to its application in a myriad of other indications as outlined in other articles of this supplement.
Warm autoimmune hemolytic anemia: new insights and hypotheses
Authors: Branch Donald R.
Published: July 2023

Purpose of review

Warm autoimmune hemolytic anemia (wAIHA) is the most common of the immune hemolytic anemias. Although there are numerous case reports and reviews regarding this condition, some of the unusual and more recent findings have not been fully defined and may be contentious. This review will provide insight into the common specificity of the warm autoantibodies and hypothesize a novel mechanism of wAIHA, that is proposed to be linked to the controversial subject of red blood cell senescence.

Recent findings and hypotheses

It is now well established that band 3 on the red blood cell is the main target of autoantibodies in wAIHA. wAIHA targets the older red blood cells (RBCs) in about 80% of cases and, recently, it has been shown that the RBCs in these patients are aging faster than normal. It has been proposed that in these 80% of patients, that the autoantibody recognizes the senescent red blood cell antigen on band 3. It is further hypothesized that this autoantibody's production and potency has been exacerbated by hypersensitization to the RBC senescent antigen, which is processed through the adaptive immune system to create the pathogenic autoantibody. Recent publications have supported previous data that the senescent RBC antigen is exposed via a dynamic process, wherein oscillation of a band 3 internal loop flipping to the cell surface, creates a conformational neoantigen that is the RBC senescent antigen. It has also recently been shown that the cytokine profile in patients with wAIHA favors production of inflammatory cytokines/chemokines that includes interleukin-8 which can activate neutrophils to increase the oxidative stress on circulating RBCs to induce novel antigens, as has been postulated to favour exposure of the senescent RBC antigen.

This manuscript reviews new findings and hypotheses regarding wAIHA and proposes a novel mechanism active in most wAIHA patients that is due to an exacerbation of normal RBC senescence.