bluuebunny/crossref_metadata_2025 huggingface dataset:
Why Are Donors More Generous with Time Than Money? The Role of Perceived Control over Donations on Charitable Giving
Authors: Costello John P , Malkoc Selin A
Published: March 2022

Solicitation of time and money donations are central to the success of nonprofit organizations like charities and political groups. Although nonprofits tend to prefer money, experimental and field data demonstrate that donors prefer to donate time, even when doing so does less good for the cause. However, despite the importance of this asymmetry, little is known about its psychological underpinnings. In the current investigation, we identify a previously unexplored difference between time and money, which we argue can explain the preference to donate time over money. Specifically, we propose that potential donors feel more personal control over their time (vs. money) donations, leading to greater interest in donating and donation amount. We test this framework across seven studies using incentive-compatible and hypothetical behaviors, utilizing both mediation and moderation approaches. Our results show that when donors’ sense of control is threatened, donations of time might be used as a compensatory strategy and that simple linguistic interventions can increase perceived control and donations for money, which we find to typically lag behind time. We conclude by discussing the implications of these results for marketing theory and practice.
The Association Between Antibiotic Use and Outcome Among Metastatic Melanoma Patients Receiving Immunotherapy
Authors: Poizeau Florence , Kerbrat Sandrine , Balusson Frédéric , Tattevin Pierre , Revest Matthieu , Cattoir Vincent , Luque-Paz David , Lesimple Thierry , Pracht Marc , Dinulescu Monica , Russo David , Oger Emmanuel , Dupuy Alain
Published: March 2022

Background

Several observational studies have reported a decreased response to immune checkpoint inhibitors (ICI) following antibiotic use. ICI activity has been hypothesized to be impaired by antibiotic-induced gut dysbiosis.

Methods

Patients with advanced melanoma receiving an anti-PD-1 antibody as a first-line therapy between 2015 and 2017 in France were selected using the French Health Insurance database. We compared overall survival and time-to-treatment discontinuation according to antibiotic exposure in the 3 months prior to the initiation of anti-PD-1 antibody. To disentangle a causal effect of antibiotics from a confounding bias, we balanced characteristics of patients exposed and nonexposed to antibiotics using an overlap weighting method based on a propensity score. We also evaluated a control cohort of patients with advanced melanoma receiving first-line targeted therapy, as there is no rationale for decreased efficacy of targeted therapy following antibiotic treatment.

Results

The anti-PD-1 antibody cohort comprised 2605 individuals. Antibiotic exposure in the 3 months prior to anti-PD-1 antibody initiation was not associated with shorter overall survival (weighted hazard ratio = 1.01, 95% confidence interval = 0.88 to 1.17) or time-to-treatment discontinuation (weighted hazard ratio = 1.00, 95% confidence interval = 0.89 to 1.11). Consistent results were observed when the time frame of antibiotics was narrowed to 1 month prior to anti-PD-1 initiation or when exposure was restricted to antibiotics leading to more profound gut dysbiosis. Similar results were observed in the targeted therapy cohort.

Conclusions

In a large cohort of advanced melanoma patients, we showed that antibiotic use preceding anti-PD-1 antibody was not associated with worse outcome. Physicians should not delay immunotherapy for patients who have recently received antibiotics.
Leaf traits of Chinese fir (Cunninghamia lanceolata) do not support the well-accepted ‘flux trait network’ hypothesis
Authors: Peng Xi , Zhao Meifang , Liu Shuguang , Yan Wende
Published: March 2022

Widely accepted universal models and hypotheses such as ‘high vein density-faster growth and higher productivity’ hold that high leaf vein density may promote higher coupling efficiency of carbon and water, indicating that rapid individual growth and high stand productivity, have attracted huge interest. However, these models and hypotheses do not include enough gymnosperm samples, especially conifers cultivated in subtropics. We here examined the values and scaling relationships between leaf vein density and leaf functional traits sampled from center region of the distribution range of Cunninghamia lanceolate, which has been well known for rapid growth. We also retrieved an empirical dataset that included photosynthetic, biochemical, anatomical and hydraulic traits of Cunninghamia lanceolata. The leaf vein density (ranging from 0.34 to 1.09 mm mm−2) is extremely low compared to the reported global range (1 to 25 mm mm−2), whereas C. lanceolata is famous for both fast-growing and high-yielding in China for a long time. We further verified that higher vein densities were associated with smaller leaves (r = −0.71, P < 0.001), which is consistent with that found in angiosperms. However, we found that vein density–thickness correlations and leaf lifespan plasticity showed opposite trends for C. lanceolate (negative) when compared with global species (positive), and such relationships may indicate the tradeoffs between functional efficiency and productivities. Our results provide an effective complementary assessment of general growth rules, including evaluation of the influence of regional plant trait characterization, configuration of plant species, and traits efficiency for hydraulic potential.
Variability in evapotranspiration shifts from meteorological to biological control under wet versus drought conditions in an alpine meadow
Authors: Xu Mingjie , An Tingting , Zheng Zhoutao , Zhang Tao , Zhang Yangjian , Yu Guirui
Published: March 2022

The Tibetan Plateau is generally referred to as the Chinese water tower, and evapotranspiration (ET) affects the water budget and stability of alpine meadows on the Tibetan Plateau. However, its variability and controlling mechanisms have not been well documented under the drier conditions induced by global warming. Therefore, this study aimed to clarify whether meteorological or biological factors primarily affected the variability in ET under contrasting water conditions in the alpine meadow ecosystem on the Tibetan Plateau. Based on 6-year (2013–2018) eddy covariance observations and the corresponding meteorological and biological data, linear perturbation analyses were employed to isolate the contributions of meteorological and biological factors to the variability in evapotranspiration (δET). The results showed that δET was mainly driven by meteorological factors in wet peak seasons (July and August), and was dominated by net radiation (Rn) and air temperature (Ta), indicating that the inadequate available energy is the factor limiting ET. However, the dominant factors affecting δET shifted from meteorological to biological in dry peak seasons when the canopy stomatal conductance (gs) and leaf area index were dominant. At this point, the ecosystem was limited by the water conditions. These results provide empirical insights into how meteorological and biological factors regulate variability in ET under contrasting water conditions. These findings can further improve our understanding of water cycle processes and can help effectively manage water resources in alpine meadow ecosystems under future climate change conditions.
Correction of leaf nutrient resorption efficiency on the mass basis
Authors: Zhang Meixia , Luo Yan , Meng Qingquan , Han Wenxuan
Published: March 2022

Nutrient resorption is a crucial mechanism for plant nutrient conservation, but most previous studies did not consider the leaf-mass loss during senescence due to lack of measured data. This would lead to an underestimation of nutrient resorption efficiency (NuRE), or calculating NuRE of various species based on the average mass loss at plant-functional-group level in the literature, thus affecting its accuracy. Here we measured the leaf-mass loss to correct NuRE with the species-specific mass loss correction factor (MLCF), so as to foster a more accurate calculation of the nutrient fluxes within and between plants and the soil. Green leaves and senesced leaves were collected from 35 dominant woody plants in northern China. Mass of green and senesced leaves were measured to calculate the MLCF at species level. The MLCF was reported for each of the 35 dominant woody plants in northern China. These species averagely lost 17% of the green-leaf mass during leaf senescence, but varied greatly from 1.3% to 36.8% mass loss across the 35 species, or 11.7% to 19.6% loss across the functional types. Accordingly, the MLCF varied from 0.632 to 0.987 across the 35 species with an average value 0.832. The NuRE corrected with MLCF was remarkably increased on the whole (e.g. both the average nitrogen and phosphorus NuRE became about 9% higher, or more accurate), compared with the uncorrected ones, especially in the case of low resorption efficiencies. Our field data provide reliable references for the MLCF of plants in related regions at both species and functional-type levels, and are expected to promote more accurate calculations of NuRE.
The Other Little House: The Brothel as a Colonial Institution on the Canadian Prairies, 1880–93
Authors: Bertram L K
Published: March 2022

What role did settler bawdy houses play in Canadian colonial expansion in the 1880s? The trial of “Big Nelly” Webb, a white bawdy house madam and sex worker who shot a Mounted Police constable on the doorstep of her brothel in 1888, offers critical insight into the world of these seldom acknowledged colonial institutions and the women who ran them. Far from simply “women on the margins,” Canadian officials in the North-West Territories permitted many white madams and sex workers to operate bawdy houses in emerging prairie settlements because they viewed them as essential workers. Drawing from the archives of the North-West Mounted Police, memoirs and testimonies of bawdy house sex workers and madams, and newspaper and court reports, this article explores the networks of influence that supported these houses, including local police and high-ranking colonial officials. Beyond personal ties, the influence of women like Big Nelly reflected the colonial function of the settler brothel. The waves of migrating bawdy house madams and workers who flocked to Canada’s “Last Best West” during this period could serve a very real role in the growth and biopolitical regulation of new Canadian settlements in Indigenous territory. These workers were tasked with protecting and regulating settler sexual and reproductive health, retaining white bachelor migrants in isolated settlements, and fostering urban growth. Settler bawdy houses on the Prairies were also bastions of racial segregation and containment, built to displace (and expose) workers of color and stop the growth of Black, Indigenous, and mixed-race populations and resistance in the 1880s. Indeed, race-based hierarchies did not just exist within the settler brothel economies of Canada’s North-West Territories, they were one of the foundational justifications for their existence.
The governance of civil nuclear power in France: advantages and disadvantages of deep state involvement
Authors: Andrews-Speed Philip
Published: March 2022

France’s civil nuclear power industry emerged from the earlier military nuclear programme as a programme owned and controlled by the state. This was in line with the nation’s longstanding style of economic and industrial governance. Such an approach had the advantage that the capacity of nuclear power grew rapidly, with generous funding and close coordination by the state. During the 1980s and 1990s, the nuclear power industry succeeding in resisting broader moves to reduce the role of the state in French industry. Links between the government, the regulator and the industry remained close, aided by longstanding informal networks between key individuals. The first decade of the 2000s saw the start of significant reform of the nuclear regulatory infrastructure. However, by this time the disadvantages of long-term state control of the nuclear industry were becoming increasingly apparent. These included deficiencies in policy making, industry regulation and corporate management which have brought France’s nuclear industry to a crisis. This analysis applies institutional theory to show how the nation’s longstanding approach to economic and industrial governance has shaped the development of its nuclear industry and thus provides a salutary example for other countries pursuing a similar path.
Bryophyte ultraviolet-omics: from genes to the environment
Authors: Martínez-Abaigar Javier , Núñez-Olivera Encarnación
Published: March 2022

Ultraviolet (UV) radiation has contributed to the evolution of organisms since the origins of life. Bryophytes also have evolutionary importance as the first clearly identified lineage of land plants (embryophytes) colonizing the terrestrial environment, thus facing high UV and water scarcity, among other new challenges. Here we review bryophyte UV-omics, the discipline relating bryophytes and UV, with an integrative perspective from genes to the environment. We consider species and habitats investigated, methodology, response variables, protection mechanisms, environmental interactions, UV biomonitoring, molecular and evolutionary aspects, and applications. Bryophyte UV-omics shows convergences and divergences with the UV-omics of other photosynthetic organisms, from algae to tracheophytes. All these organisms converge in that UV damage may be limited under realistic UV levels, due to structural protection and/or physiological acclimation capacity. Nevertheless, bryophytes diverge because they have a unique combination of vegetative and reproductive characteristics to cope with high UV and other concomitant adverse processes, such as desiccation. This interaction has both evolutionary and ecological implications. In addition, UV effects on bryophytes depend on the species and the evolutionary lineage considered, with mosses more UV-tolerant than liverworts. Thus, bryophytes do not constitute a homogeneous functional type with respect to their UV tolerance.
On the precision of full-spectrum fitting of simple stellar populations – IV. A systematic comparison with results from colour–magnitude diagrams
Authors: Asa’d Randa , Goudfrooij Paul , As’ad A M
Published: March 2022

In this fourth paper of a series on the precision of ages of stellar populations obtained through the full-spectrum fitting technique, we present a first systematic analysis that compares the age, metallicity, and reddening of star clusters obtained from resolved and unresolved data [namely colour–magnitude diagrams (CMDs) and integrated-light spectroscopy] using the same sets of isochrones. We investigate the results obtained with both Padova isochrones and MIST isochrones. We find that there generally is a good agreement between the ages derived from CMDs and integrated spectra. However, for metallicity and reddening, the agreement between results from analyses of CMD and integrated spectra is significantly worse. Our results also show that the ages derived with Padova isochrones match those derived using MIST isochrones, both with the full-spectrum fitting technique and the CMD fitting method. However, the metallicity derived using Padova isochrones does not match that derived using MIST isochrones using the CMD method. We examine the ability of the full-spectrum fitting technique in detecting age spreads in clusters that feature the extended main-sequence turnoff (eMSTO) phenomenon using two-population fits. We find that three out of five eMSTO clusters in our sample are best fitted with one single age, suggesting that eMSTOs do not necessarily translate to detectable age spreads in integrated-light studies.
Standardized incidence ratios of malignant neoplasms among patients with pneumoconiosis
Authors: Michibata Tatsuya , Yorifuji Takashi
Published: March 2022

Background

Patients with pneumoconiosis, such as silicosis and asbestosis, have a high risk of lung cancer. However, whether these patients are at high risk for neoplasms other than lung cancer and mesothelioma remains inconclusive.

Aims

To examine whether patients with pneumoconiosis have a higher incidence of malignant neoplasms other than lung cancer.

Methods

We conducted a cohort study using the medical records of patients with pneumoconiosis who visited our two hospitals from 1 January 1991 through 31 December 2017. We identified the occurrence of malignant neoplasms and calculated the incidences and standardized incidence ratios (SIRs) compared with those of the general population.

Results

One hundred and seventy patients with pneumoconiosis (163 men, 7 women) including 142 patients with silicosis, 24 with asbestosis and 4 with pneumoconiosis were identified. The mean age was 66.8 years. The proportion of smokers was 79%. Forty-seven malignant neoplasms occurred. Most malignant neoplasms were lung cancer (n = 22), while some were digestive cancers such as gastric cancer (n = 9), oesophageal cancer (n = 3) and colorectal cancer (n = 3). Participants presented increased risks for lung cancer (SIR: 10.86, 95% confidence interval [CI]: 7.15–16.49), gastric cancer (SIR: 2.55, 95% CI: 1.22–5.35) and oesophageal cancer (SIR: 5.78, 95% CI: 1.86–17.92).

Conclusions

Compared with the general population, patients with pneumoconiosis had an increased risk of malignant neoplasms of the digestive system in addition to lung cancer. Clinicians should consider testing for digestive system cancers as well as for lung cancers in these patients.
Arguing About Extraterrestrial Intelligence
Authors: Cowie Christopher
Published: March 2022

Avi Loeb has defended the hypothesis that the interstellar object, ‘Oumuamua, detected in 2017, is in fact an extraterrestrial artefact. His hypothesis has been widely rejected by the scientific community. On examination however it is not clear why. The puzzle is at the level of argument structure. The scientific community's responses to Loeb's hypothesis appear to point to explanations of ‘Oumuamua's properties that are mere possibilities. Yet this is something that Loeb does not contest. I appeal to broadly philosophical considerations to understand and bolster the response to Loeb. These considerations concern the structure of his argument, the role of prior confidences within it, and the presence of ‘unconceived alternative’ explanations. I then generalise. ‘Oumuamua will surely not be the last object that does not admit of straightforward natural explanation and that is claimed to be evidence of an extraterrestrial artefact. I use the preceding discussion of Loeb's argument and the scientific community's response to make some general remarks for future debate about similar cases.
Agency Costs and Strategic Speculation in the U.S. Stock Market
Authors: Pasquariello Paolo
Published: March 2022

This study investigates the notion that agency-driven information asymmetry may affect a firm’s stock liquidity. I postulate that less uncertainty about managerial agency problems may enhance liquidity provision by lowering dealers’ perceived adverse selection risk from trading with better-informed speculators. Consistent with my conjecture, I find that the staggered adoption of antitakeover provisions across U.S. states in the 1980s and 1990s — a plausibly exogenous shock unambiguously reducing the threat of (and speculators’ information advantage about) value-enhancing intervention — robustly improves the stock liquidity of affected firms relative to peer firms, especially at prior high fundamental or agency uncertainty and with poor governance. (JEL D22, G14, G34)

Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online.
A participatory approach to tracking system transformation in clusters and innovation ecosystems—Evolving practice in Sweden’s Vinnväxt programme
Authors: Wise Emily , Eklund Moa , Smith Madeline , Wilson James
Published: March 2022

For decades, cluster initiatives and funding programmes have been used as instruments of industrial and innovation policy—addressing system failures by strengthening linkages among actors, fostering innovation, and developing more effective innovation systems. More recently, a growing segment of these initiatives are also focused on driving system-level transformation and contributing to broader societal benefits. This segment is characterized by larger-scale and longer-term strategic efforts involving a variety of stakeholders across different parts of society, aimed at contributing to addressing societal challenges. These characteristics are shared with the emerging frame of transformative innovation policy, which highlights the importance of embedded practices of learning and reflexivity to enable continuous monitoring of progress and inform and adapt the direction of systemic change processes—requiring new approaches to governance and evaluation. Despite deep experience with implementing cluster programmes and other systemic innovation policy instruments, practitioners still struggle with monitoring and evaluation. Current approaches focus on evidencing strengthened innovation (and economic effects) on the level of firms and research actors, and fail to capture contributions on the level of the broader system. This article presents an evolving approach for tracking system transformation in clusters and collaborative innovation initiatives. Through an interactive, co-development process with initiatives in the Swedish Vinnväxt programme, this research proposes a definition and set of system effect categories for cluster initiatives. It tests a participatory approach for tracking their contribution to system-level change over time, providing an initial case on which to build and apply in other transformative innovation programmes.
Gas in the Musculoskeletal System: The Good and the Bad
Authors: Madson Samuel Leathen , Mansfield Liem T.
Published: March 2022

Gas in the musculoskeletal system is frequently encountered in clinical practice and can indicate either a benign or nefarious process. Anaerobic infection is capable of producing gas in the musculoskeletal system; however, nonaggressive processes accounting for gas are much more common. In some instances, the presence of gas can be used to exclude a diagnosis of infection. Nitrogen gas bubble may be formed with joint manipulation,1–3 in volume loss and degeneration,4 and in traumatic dislocation/diastasis. The presence of gas with fracture is consistent with open fractures, which affect clinical management, and is associated with future complications.5 The referring or treating physician may also introduce gas through arthrocentesis, injection, or surgery. However, infection must always be considered with scrutiny of the radiologic records and correlation with the clinical history and physical examination so that proper treatment is not delayed. Therefore, it is important for the radiologist to recognize the presence of gas on imaging studies and have the expertise to appropriately raise clinical suspicion of infection or assign a typically benign cause to avoid unnecessary diagnostic evaluation and therapeutic procedures.
Work-Life Balance of Nursing Faculty: A Scoping Review
Authors: Moyer Susan M.
Published: March 2022

AIM

This scoping review examined the work-life balance (WLB) of nursing faculty.

BACKGROUND

The nursing faculty shortage has resulted in increasing workloads that make it challenging for faculty to achieve WLB. Understanding WLB may be important for strengthening the nursing faculty workforce.

METHOD

This study used Arksey and O’Malley’s scoping review methodology to examine articles published between January 2000 and December 2020 that reported on the WLB of nursing faculty. All articles were eligible for inclusion, including those that used quantitative, qualitative, or mixed-method research approaches, as well as editorials and other summary articles.

RESULTS

Thirty-three articles were included in the review. Three major categories emerged: perceptions of WLB, characteristics associated with WLB, and strategies to achieve WLB among nursing faculty.

CONCLUSION

Research on the WLB of nursing faculty is limited. Further research on strategies that improve WLB may play an integral role in the recruitment and retention of nursing faculty.
Phakic intraocular lens explantation: series of 175 surgeries
Authors: Marques João Heitor , Baptista Pedro Manuel , Abreu Ana Carolina , Monteiro Sílvia , Pinto Maria do Céu
Published: March 2022

Purpose:

To evaluate the indications for pIOL explantation, pIOL survival time, and visual outcomes and access endothelial cell loss (ECL) after explantation.

Setting:

Ophthalmology Department, Centro Hospitalar Universitário do Porto, Portugal.

Design:

Retrospective longitudinal study.

Methods:

A chart review was performed for all consecutive patients who underwent pIOL explantation from January 2010 to December 2019 in a single center.

Results:

This study included 175 eyes of 112 patients (77% women). The mean pIOL survival was 12.9 ± 4.8 (3.7 to 28.6) years, and the mean follow-up period after explantation was 4.1 ± 3.0 (0.3 to 9.9) years. The most frequent causes for explantation were cataract formation (44.0%, n = 77) and ECL (50.3%, n = 88). During the follow-up period after explantation, the mean ECL rate was 2.27 ± 9.32%/year in the cataract group and −2.14 ± 10.24%/year in the ECL group, reflecting a positive change in cell density in the latter. 8 eyes (4.6%) required a corneal transplant during the follow-up. The mean corrected distance visual acuity was 0.17 ± 0.24 logMAR at the last visit.

Conclusions:

This study demonstrated that pIOL explantation, after a mean survival time of 13 years, was a safe procedure. The main causes for explantation were cataract formation and ECL. Most patients showed a sustained improvement in visual acuity and endothelial cell density after pIOL explantation, and yet its timing should be ideal to avoid irreversible complications.
Clinical features, management, and outcomes of expulsive choroidal hemorrhage during cataract surgery: 13-year experience of a tertiary eye center
Authors: Shekhar Madhu , Menon Ramya P. , Rajendran Janani , Kannan Naresh Babu , Das Mano Ranjan , Rajendrababu Sharmila , Balakrishnan Logesh , Mishra Chitaranjan
Published: March 2022

Purpose:

To study the risk factors, clinical features, management, and outcomes of intraoperative expulsive choroidal hemorrhage (ECH) during cataract surgery.

Setting:

Aravind Eye Hospital, Madurai, Tamil Nadu, India.

Design:

Retrospective hospital-based study.

Methods:

Of the 1 167 250 patients who underwent cataract surgery between 2008 and 2020, patients diagnosed with intraoperative ECH were included. Demography, ocular and systemic risk factors, visual acuity, type of ocular anesthesia, intraoperative and postoperative records, management, and surgical outcomes were analyzed.

Results:

52 eyes (0.004%) of 1 167 250 patients had ECH. Of the 52 cases, 43 cases (incidence rate 0.006%) were reported in the years 2008 to 2015 and 9 cases (incidence rate 0.002%) in the years 2016 to 2020. The change in the ocular anesthesia from peribulbar and retrobulbar anesthesia (2008 to 2015) to sub-Tenon anesthesia (2016 to 2020) was associated with a reduced rate of ECH (P = .002). 28 eyes (53.8%) experienced limited ECH and 24 eyes (46.2%) full-blown ECH. The visual outcome was better in eyes with limited ECH compared with full-blown suprachoroidal hemorrhage in all follow-up visits. The median vision (interquartile range) before the cataract surgery and at postoperative day 1 were 1.30 (0.78 to 2.60) and 2.45 (1 to 2.75), respectively. The median final vision (interquartile range) after the secondary surgical intervention was 2.2 (0.60 to 2.60).

Conclusions:

This series included 52 eyes with ECH, recognized associations of ECH with different types of anesthesia and with different cataract surgical procedures, and described management of ECH. Postoperative visual outcome was poor.
The Situated Information, Motivation, and Behavioral Skills Model of HIV Antiretroviral Therapy Adherence Among Persons Living With HIV in Haiti: A Qualitative Study Incorporating Culture and Context
Authors: Puttkammer Nancy , Emmanuel Demes Joseph Adrien , Dervis Witson , Chéry Jean Marcxime , Elusdort Josette , Haight Elizabeth , Balan Jean Gabriel , Simoni Jane M.
Published: March 2022

To inform a clinic-based adherence-promotion intervention, this qualitative study applied the Situated Information, Motivation, and Behavioral Skills Model of Care Initiation and Maintenance to elucidate cultural and contextual factors affecting antiretroviral therapy adherence in Haiti. From the 23 focus group discussions with patients (n = 58) and health care workers (n = 57), culturally specific themes emerged relating to Information (e.g., conflicts with allopathic medicine and heuristics about how treatment failure occurs), Motivation (e.g., protecting family members, health and physical appearance, material advantages, and relationships with health workers), and Behavioral Skills (e.g., managing food intake and side effects, navigating health services utilization, accessing medication, and advocating for care needs). Recommendations include: provide therapeutic education on HIV drug resistance; promote the concept of “undetectable = untransmittable”; develop treatment buddy relationships; invest in training and enforcement of patient privacy, transparency, and fairness in access to services and resources; and provide patient-centered behavioral skills counseling.
Risk Factor and Treatment of Vaginal Intraepithelial Neoplasia After Hysterectomy for Cervical Intraepithelial Neoplasia
Authors: Kim Ju-Hyun , Kim Jooyoung , Kim Kidong , No Jae Hong , Kim Yong Beom , Suh Dong Hoon
Published: March 2022

Objectives

The aim of the study were to identify the risk factors for recurrent vaginal intraepithelial neoplasia (VaIN)1+ and to evaluate the efficacy of laser vaporization in patients who underwent hysterectomy for the treatment of cervical intraepithelial neoplasia (CIN).

Methods

Medical records of 374 women who underwent hysterectomy for the treatment of CIN were retrospectively reviewed. Recurrence was defined as VaIN1+ diagnosis by colposcopy-directed biopsy.

Results

Among 374 patients, 36 (9.6%) had VaIN1+ during a median follow-up of 32 (0–193) months: 13 (3.5%) had VaIN1, 6 (1.6%) VaIN2, 15 (4.0%) VaIN3, and 2 (0.5%) invasive cancer. Multivariate analysis showed that age of greater than 50 years was the only independent risk factor for VaIN1+ recurrence (odds ratio, 3.359; 95% CI, 1.60–7.07; p = .001). Among the 34 patients with VaIN, 21 (61.8%) were treated with laser vaporization and 11 (32.3%) were observed without treatment. Time to second recurrence was longer in the VaIN treated by laser vaporization group than that in the observation group (mean time to subsequent recurrence, 128.7 [95% CI, 101.4–156.0] vs. 41.8 [15.7–67.9] months; p = .003). Moreover, laser vaporization (hazard ratio, 0.125; 95% CI, 0.03–0.59; p = .009) was the only independent good prognostic factor for the second VaIN1+ recurrence.

Conclusions

Patients older than 50 years who underwent hysterectomy for the treatment of CIN might be highly at risk of VaIN1+. Laser vaporization is the only independent prognostic factor that might prevent the second VaIN1+ recurrence.
An Artificial Intelligence Computer-vision Algorithm to Triage Otoscopic Images From Australian Aboriginal and Torres Strait Islander Children
Authors: Habib Al-Rahim , Crossland Graeme , Patel Hemi , Wong Eugene , Kong Kelvin , Gunasekera Hasantha , Richards Brent , Caffery Liam , Perry Chris , Sacks Raymond , Kumar Ashnil , Singh Narinder
Published: March 2022

Objective:

To develop an artificial intelligence image classification algorithm to triage otoscopic images from rural and remote Australian Aboriginal and Torres Strait Islander children.

Study Design:

Retrospective observational study.

Setting:

Tertiary referral center.

Patients:

Rural and remote Aboriginal and Torres Strait Islander children who underwent tele-otology ear health screening in the Northern Territory, Australia between 2010 and 2018.

Intervention(s):

Otoscopic images were labeled by otolaryngologists to classify the ground truth. Deep and transfer learning methods were used to develop an image classification algorithm.

Main Outcome Measures:

Accuracy, sensitivity, specificity, positive predictive value, negative predictive value, area under the curve (AUC) of the resultant algorithm compared with the ground truth.

Results:

Six thousand five hundred twenty seven images were used (5927 images for training and 600 for testing). The algorithm achieved an accuracy of 99.3% for acute otitis media, 96.3% for chronic otitis media, 77.8% for otitis media with effusion (OME), and 98.2% to classify wax/obstructed canal. To differentiate between multiple diagnoses, the algorithm achieved 74.4 to 92.8% accuracy and an AUC of 0.963 to 0.997. The most common incorrect classification pattern was OME misclassified as normal tympanic membranes.

Conclusions:

The paucity of access to tertiary otolaryngology care for rural and remote Aboriginal and Torres Strait Islander communities may contribute to an under-identification of ear disease. Computer vision image classification algorithms can accurately classify ear disease from otoscopic images of Indigenous Australian children. In the future, a validated algorithm may integrate with existing telemedicine initiatives to support effective triage and facilitate early treatment and referral.
Cochlear Implant Electrode Misplacement: A Case Series and Contemporary Review
Authors: Shin Timothy J. , Totten Douglas J. , Tucker Brady J. , Nelson Rick F.
Published: March 2022

Objective:

To determine root causes leading to misplaced cochlear implant (CI) electrode arrays and discuss their management using a case series and contemporary literature review.

Study Design:

Retrospective case review and contemporary literature review.

Setting:

Single tertiary-referral center.

Patients:

Adult and pediatric patients who were diagnosed with a misplaced CI electrode array, excluding tip-foldover. Literature review was performed via a MEDLINE database PubMed query. All articles that described at least one case of extracochlear electrode array misplacement were included; partial insertions and extrusions were excluded.

Main Outcome Measure:

Extracochlear misplacement.

Results:

A total of 61 cases were reviewed, including 4 new cases and 57 cases from 29 previously published articles. We discuss management of CI arrays in the carotid canal, the vestibule, and the modiolus. The rate of CI misplacement is estimated to be 0.49%. The most frequent location of misplacement CI was the vestibular system (50.8%) followed by the internal carotid canal (11.5%). Normal cochlear anatomy was noted on preoperative computer tomography (CT) in 59.0% of patients; abnormalities were noted in 27.9%. The most common technical issue was misidentification or poor visualization of the round window.

Conclusion:

CI electrode misplacement is rare but can cause postoperative complications and may result in permanently diminished CI performance and hearing outcomes, even after revision surgery. Failure to identify the round window is the most common reason for CI misplacement, despite most patients having normal cochlear anatomy. Surgical strategies to localize the round window and basal turn are imperative for proper electrode placement.

Level of Evidence:

4.
A Novel Eustachian Tube Test: Preliminary Research of Sonotubometry With Nasopharynx Under Pressure
Authors: Li Jingyu , Ruan Kaian , Tan Songhua , Xie Lihong , Liu Lei , Liu Xinmiao , Tang Anzhou
Published: March 2022

Objectives:

The aim of this study was to develop a novel Eustachian tube (ET) test consisting of sonotubometry with nasopharynx under pressure to measure opening of the ET. We assessed the advantages of this novel approach compared with those of sonotubometry only or tubomanometry only and explored the possibility of quantifying ET patency.

Study Design:

This was a prospective clinical study at a tertiary referral center.

Methods:

Sonotubometry, tubomanometry, and sonotubometry with nasopharynx under pressure were performed on a total of 106 ears. The ET-opening detection rates of the different test methods were compared with McNemar's test or Fisher's exact test. The correlation between the ET-opening latency index (R value) and nasopharyngeal pressure, as well as the correlation between the sound pressure of the external ear canal and the nasopharyngeal pressure, was assessed via Spearman's correlation coefficients.

Results:

ET openings were detected most frequently during sonotubometry with nasopharynx under pressure, with opening rates of 93.40, 98.10, and 98.10% at 30, 40, and 50 mbar, respectively, which were significantly higher than those of sonotubometry (80.20%) and tubomanometry (74.50, 86.80, and 90.60% at 30, 40, and 50 mbar, respectively). Both R values and sound pressures were significantly different at pressures of 30, 40, and 50 mbar; the R value decreased with the increase of nasopharyngeal pressure (r = −0.298, p 
= 0.000), while the sound pressure increased with nasopharyngeal pressure (r = 0.251, p 
= 0.000).

Conclusions:

Sonotubometry with nasopharynx under pressure represents a novel hybrid ET test that our findings suggest is superior to sonotubometry only and tubomanometry only in detecting ET openings in healthy ears. Sound pressure resulting from sonotubometry with nasopharynx under pressure may be useful for quantifying the degree of openness of the ET. However, further validation in both healthy subjects and patients with ET dysfunction is required before this novel ET test may be recommended for clinical use.
Evaluation of D-dimer levels measured by different analytical methods in COVID-19 patients
Authors: Arslan Fatma Demet , Başok Banu Işbilen , Terzioğlu Mustafa , Altan Tuba Kansu , Karaca Yeşer , Senger Suheyla Serin , Çolak Ayfer
Published: March 2022

Clinicians experience some challenges due to the lack of standardization of test, although D-dimer is a prognostic marker for COVID-19. We compared the clinical and analytical performances of D-dimer results obtained from different devices, kits and methods in patients with a diagnosis of COVID-19. Thirty-nine patients with a diagnosis of COVID-19 and 24 healthy individuals were included in the study. D-dimer levels were measured with Innovance D-DIMER kit (immunoturbidimetric method) on Sysmex CS-2500 and BCS XP and VIDAS D-Dimer Exclusion II kit (enzyme-linked fluorescence method) on mini VIDAS. The studies of precision, method comparison and clinic performance were performed. The variation coefficients in all systems were within the acceptable imprecision (7.8%). Bias%(12.5%) between BCS XP and Sysmex CS-2500 was lower than the acceptable Bias%(15.5%). Bias% values (19.2% and 33.3%, respectively) between Mini VIDAS with BCS XP and Sysmex CS-2500 were higher than the acceptable Bias%. The correlation coefficients among all systems were 0.89–0.98. For 500 ng/ml FEU, there was almost perfect agreement between BCS XP and Sysmex CS-2500, a moderate agreement between Mini VIDAS and BCS XP and Sysmex CS-2500. The cut-off values for distinguishing between individuals with and withoutCOVID-19 were Mini VIDAS, Sysmex CS-2500 and BCS XP 529, 380 and 390 ng/ml FEU, respectively. The immunoturbidimetric method can be used as an alternative to the enzyme-linked fluorescent method because of satisfactory agreement at the different thresholds proposed for venous thromboembolism. However, it is recommended to follow up COVID-19 with the D-dimer results obtained by the same assay system.
A Multi-site Case Study of Care Coordination Between Primary Care and Specialty Care
Authors: Charns Martin P. , Benzer Justin K. , McIntosh Nathalie M. , Mohr David C. , Singer Sara J. , Gurewich Deborah
Published: March 2022

Background:

Care coordination is critical for patients with multiple chronic conditions, but fragmentation of care persists. Providers’ perspectives of facilitators and barriers to coordination are needed to improve care.

Objectives:

We sought to understand providers’ perspectives on care coordination for patients having multiple chronic diseases served by multiple providers.

Research Design:

Based upon our earlier survey of patients with multiple chronic conditions, we selected 8 medical centers having high and low coordination. We interviewed providers to identify facilitators and barriers to coordination and compare them between patient-rated high sites and low sites and between primary care (PC)-mental health (MH) and PC-medical/surgical specialty care.

Subjects:

Physicians, nurses and other clinicians in PC, cardiology, and MH (N=102) in 8 Veterans Affairs medical centers.

Results:

We identified warm handoffs, professional relationships, and physical proximity as facilitators, and service agreements, reporting relationships and staffing as barriers. PC-MH coordination was reported as better than PC-medical/surgical specialty coordination. Facilitators were more prevalent and barriers less prevalent in sites rated high by patients than sites rated low, and between PC-MH than between PC-specialty care.

Discussion:

We noted that professional relationships were highly related to coordination and both affected other facilitators and barriers and were affected by them. We suggested actions to improve relationships directly, and to address other facilitators and barriers that affect relationships and coordination. Among these is the use of the Primary Care Mental Health Integration model.
“It Takes a Virtual Village” Achieving Magnet Redesignation Amidst the COVID-19 Pandemic
Authors: Jeffs Lianne , Amaral Nely , Mundle William , Amaral Caleb , Crook Katelyn , Fung Emily Y. Y. , Ronald Kara , Merkley Jane
Published: March 2022

This article outlines how a Canadian hospital achieved the American Nursing Credentialing Center Magnet Recognition Program redesignation after participating in a virtual site visit (VSV) appraisal process amidst the COVID-19 pandemic. Within our current COVID-19 landscape, being a resilient Magnet-designated organization is paramount. In this context, the American Nurses Credentialing Center (ANCC) has developed a VSV model that (1) extends the use of audio/video (A/V) conferencing technology to showcase nursing excellence; (2) maintains the integrity of the appraisal process; and (3) ensures the safety and well-being of staff, patients and their care partners, and the appraisers. Key narrative insights are highlighted around planning and on-site execution of a successful VSV. The redesignation is a culmination of several stakeholders' efforts who shared their sense of pride, inspiration, and accomplishment during the VSV. The redesignation status notification exemplifies resiliency and was welcomed amidst uncertainty with the evolving COVID-19 pandemic. The planning and on-site implementation plan may serve as a blueprint for others who will be engaged in a VSV as part of their designation or redesignation journey. Insights are shared around preparing for the VSV, hosting the VSV, and achieving the ANCC Magnet Recognition Program redesignation.
The Challenge of Advancing Health Equity During a Year of Pandemic and Crisis
Authors: Burnes Bolton Linda , Lee Harlem , Mitchell Nicole
Published: March 2022

Since its inception, Cedars-Sinai Health System has led with compassion to embody the principles of health equity and the fight against prejudice and racism. Founded in 1902 as Los Angeles' first Jewish hospital, Cedars-Sinai through the years has continued to serve the most vulnerable, disadvantaged, and marginalized communities. In this article, we share a part of our current journey toward advancing health equity during a challenging year of pandemic and crisis (2020-2021).
C-Reactive Protein in Bipolar Disorder and Unipolar Depression
Authors: Zhang Ximei , Li Xianyun , Tong Jinghui , Li Na , Zhang Fangfang
Published: March 2022

This study aimed to explore the role of C-reactive protein (CRP) in the pathological mechanism and differential diagnoses of bipolar disorder (BD) and unipolar depression (UD). We tested serum CRP levels of 176 BD and 86 UD patients, and 82 healthy controls (HCs), at acute and remission phases. In the acute phase, CRP levels were higher in BD than in UD patients and HC, and lower in UD patients than in HC. The CRP levels of BD patients in a manic episode were higher than those of HC; in a depressive or mixed episode, they were comparable to those of HC. The CRP levels of BD and UD patients during an acute depressive episode yielded an area under the curve of 0.676. CRP may be a state marker of acute manic episodes in BD and acute depressive episodes in UD, and a biomarker for distinguishing BD and UD.
Investigating Structure-Function Connectivity in a Patient With Locked-In Syndrome by 7 T Magnetic Resonance Imaging
Authors: Tan Xufei , Sun Yuan , Gao Jian
Published: March 2022

Introduction:

Functional neuroimaging studies have been conducted to investigate cognitive and behavioral dysfunctions in locked-in syndrome (LIS). This study, we used a multimodal neuroimaging approach to investigate functional and structural connectivity in a LIS patient.

Case Report:

A 39-year-old patient who was in a total locked-in state was admitted in our department. The Coma Recovery Scale-Revised score, event-related potential, and ultra–high-field 7 T magnetic resonance imaging (MRI) were used to investigate this patient. White matter connectometry and seed-based resting-state functional connectivity analysis were used to compare the patient with an age-matched, sex-matched healthy control. Diffusion MRI findings indicated that fibers in the brainstem significantly decreased, especially in the cross region of pons, whereas the fibers above the brainstem in the deep brain increased particularly in the posterior cingulate cortex (PCC), the left parietal lobe, and parts of the corpus callosum. Meanwhile, using the PCC as the seed region, the functional connectivity between PCC and left parietal and occipital lobes, right occipital and temporal lobes increased, respectively, especially in the area of left inferior parietal gyrus and the postcentral gyrus, which were in accordance with the most increased fiber density areas observed in diffusion MRI.

Conclusions:

These results provide tentative evidences to reveal the important role of PCC and corpus callosum in the LIS patient. These findings may be informative to the study of patients with LIS.
Harnessing the Synergy Between Mindfulness and Psychotherapy
Authors: Churchill Heather
Published: March 2022

This column explores mindfulness as one part of Buddhist teaching and practice that has attracted attention in the treatment of mental and substance use disorders. Cognitive neuroscientific correlates of mindfulness are presented. Mindfulness is offered as a potentially valuable technique that can not only help patients in individual psychotherapies endure the painful emotions that are part of psychotherapy sessions and of managing life between sessions but also help patients and clinicians across modalities move beyond adherence to particular techniques that focus primarily on symptom reduction, to better meet patient needs and improve treatment outcomes. This column explores elements of a mindfulness coping skills group used in a residential treatment setting that emphasizes intensive individual psychotherapy in a psychodynamic system of care.