bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevention of Tendon Subluxation in Dequervain’s Tenosynovitis Release Using Retinacular Repair
Authors: Horn Brandon J. , Zondervan Robert , Shafer-Crane Gail , Hornbach Erich
Published: February 2021

This study compared the incidence of tendon subluxation in patients of a single surgeon undergoing Dequervain’s release with and without retinacular repair. The study reviewed 31 patients that underwent standard Dequervain’s release without retinacular repair and 49 that underwent Dequervain’s release with retinacular repair. Each subject’s functional status was assessed using the Patient-Rated Wrist/Hand Evaluation. Subjects were compared against age, gender, handedness, tendon subluxation, return to work duration, and surgical laterality. Tendon subluxation is an infrequent complication affecting patients undergoing Dequervain’s release. This complication has a higher incidence in younger females and demonstrates no predilection for hand dominance. The efficacy of retinacular repair is suggested by good Patient-Rated Wrist/Hand Evaluation outcome scores and should be considered as an adjunct to prevent tendon subluxation. This is a level 4 study.
The Relationship between In-Training Examinations and Simulation Assessments in an Emergency Medicine Residency Program
Authors: Clarke Sheri L. , Eydgahi Ali
Published: February 2021

CONTEXT

Historically, the assessment of medical resident knowledge and skill has occurred through annual in-training examinations and faculty observation during real patient encounters. To improve patient care and the learning environment, medical educators have begun creating simulation experiences for medical residents to perform procedures without using real patients. However, simulation curricula and accompanying assessment techniques have not been standardized. Using a longitudinal record review, in-training examination scores were compared to annualized simulation assessment scores to see if there is any relationship between the assessment types.

METHODS

This project was a retrospective eight-year study from a single residency program. The scores were collected from 102 resident academic records from 2007 to 2015 for the annual American Board of Emergency Medicine in-training examination and the resident’s annual simulation assessment. Complete data sets were analyzed to determine if a relationship exists between the assessment methods. Then the averages were compared for only the first three years for all students and for all four years for osteopathic residents as they have an additional fourth year of training.

RESULTS

This study showed a lack of relationship between the two assessment types when reviewing three years of data. When the fourth year data is considered, there was a significant relationship between the assessment types.

CONCLUSIONS

The performance scores for both types of assessment provide independent information on the resident progress in training. Therefore, they should both be reviewed and considered to appropriately measure the resident’s performance. The significance of the fourth year of training for osteopathic residents requires further study.
Submandibular Gland Epithelial-Myoepithelial Carcinoma with Osseous Metastasis: A First Reported Case and Review of the Literature
Authors: Manteghi Alexander , Centric Aaron , Zwillenberg Seth , Minimo Corrado
Published: February 2021

Epithelial-myoepithelial carcinoma (EMC) is a low grade tumor that comprises 1% of all salivary tumors. Local recurrence is not uncommon, but rarely does this tumor demonstrate distant metastasis. We describe a case of a 53-year old female presenting with an asymptomatic, slowly enlarging left submandibular neck mass. Excision of the left submandibular gland (SMG) revealed epithelial-myoepithelial carcinoma with extensive perineural invasion and microscopically positive margins. A subsequent left supraomohyoid neck dissection demonstrated no residual tumor. The patient was stable for one year until a magnetic resonance imaging (MRI) workup for low back pain revealed multiple sclerotic lesions in the iliac crest and lumbar spine, with an iliac crest biopsy demonstrating metastasis. 2.5 year post-operative positron emission tomography-computed tomography (PET-CT) revealed increased [18F]-fluorodeoxyglucose (FDG) avidity in the right iliac crest, pubic symphysis, thoracic and lumbar spine, 9th rib, and sternum concerning for local recurrence and further osseous metastasis. We report the first known case of a submandibular gland EMC with osseous metastasis and highlight the need for prolonged tumor surveillance.
Malignant Dysrhythmias – Brugada Type 1 Pattern Formation in the Presence of Fever
Authors: Liroff Joshua , Gilbert Karyn , Kim Brian S.
Published: February 2021

Brugada is a malignant cardiac dysrhythmia characterized by ST elevations in precordial leads V1 to V3. It is an autosomal dominant disease, and patients are usually asymptomatic. Often the initial presenting symptom of this syndrome is syncope or sudden cardiac death (SCD). In patients with this syndrome, the only definitive treatment is the implantation of a cardioverter-defibrillator device (ICD). Previously it has been reported that Brugada type EKG patterns have been observed in patients who have used sodium channel blocking medications/drugs and in patients who are febrile. In this case, a 58 year-old male presented to our emergency department with a fever of five days duration and a non-productive cough. The patient was initially diagnosed with bilateral pneumonia, however during the initial workup his EKG demonstrated a Brugada type EKG pattern. The patient did not have any history of cardiac disease, nor was there any history of syncope or SCD in his family. The patient was eventually discharged from the hospital four days after his initial presentation and instructed to follow up with cardiology. Brugada type EKG patterns are known to occur in patients in febrile states and in those patients using certain types of medications. In those patients who present under the above mentioned conditions who are otherwise asymptomatic, the literature does not support the implantation of an ICD.
Transient Hyperammonemia Seen in Post Seizure Activity: A Series of Six Case Reports
Authors: Daughtry Justin T. , Boehm Kevin M.
Published: February 2021

Elevations in serum ammonia levels (i.e., hyperammonemia) have often been interpreted as signs of liver failure or errors in metabolism. The purpose of this series of case studies is to evaluate a trend in both the markedly elevated levels of ammonia, along with its rapid clearance in patients with seizures. These patient cases each occurred in a community-based, academic emergency department in the metropolitan Detroit area that provided care to approximately 70,000 patients during a four-year period. These six patient cases had each been found with observed seizure activity in which an initial and repeat ammonia in the emergency department was ordered. In all six cases, there was an initial elevation in ammonia with rapid subsequent clearance of ammonia. As demonstrated in this series of case studies, transient hyperammonemia levels may occur within the clinical context of seizure activity. With further research, it may be confirmed to be a differential diagnostic marker to delineate new onset or recurrent seizures in the ED.
The Use of Magnetic Resonance Cholangiopancreatography (MRCP) in the Setting of Acute Pancreatitis: When is it Most Useful?
Authors: Sevensma Karlin , Allen Miranda , Harden Rebecca , Corser William
Published: February 2021

CONTEXT

The usefulness of MRCP in the workup of acute pancreatitis has long been debated.

METHODS

2013-2016 chart review data were collected by the authors from adult patients with acute pancreatitis who also had received Magnetic Resonance Cholangiopancreatography (MRCP). Those patients were categorized by diagnosis and according to whether or not the MRCP changed healthcare services.

RESULTS

Changes in care were significantly correlated with diagnosis and elevated liver function tests (LFT). The patients who benefitted most from MRCP were those with acute gallstone pancreatitis (r = 0.298, n = 109, p = 0.002) and patients with elevated LFT (r = 0.219, n = 89, p= 0.040). The most common way that MRCP influenced the care of patients with acute gallstone pancreatitis was by allowing providers to forego intraoperative cholangiogram (IOC) when MRCP results were negative (r = 0.335, n = 109, p < 0.001).

CONCLUSIONS

The authors conclude that this was not the most cost effective management practice since the cost of intraoperative cholangiogram was about one quarter that of MRCP. Limiting MRCP use in patients with acute gallstone pancreatitis and preferentially using IOC at the time of surgery can likely decrease hospital costs without compromising care.
A Fatal Case of Neuroinvasive West Nile Virus Infection in an Immunocompromised Host
Authors: Allen Justin , Conard Jennifer , Wang Michael
Published: February 2021

The neuroinvasive form of West Nile disease is an uncommon manifestation of the viral infection. To date, documented cases in Michigan of neuroinvasive decompensation from this virus have been rare. Evaluation requires a broad differential diagnosis and treatment options are still quite limited. Objective evaluations entailing physical exam and radiographic and laboratory changes are nonspecific. Serologic testing of cerebrospinal fluid by enzyme immunoassay remains the gold standard for diagnosis. However, IgM antibodies typically do not develop until after the fourth to seventh day of symptom onset. This retrospective case report presents an immunocompromised male patient in his mid-70s in whom neuroinvasive West Nile virus was diagnosed postmortem. All information was obtained from the patient’s electronic health record. This patient’s immunocompromised state at the time of West Nile exposure made him more susceptible to neuroinvasive disease progression and ultimately influenced the outcome. Prior to withdrawing care, the patient was treated for methicillin sensitive staphylococcus aureus (MSSA) cellulitis and Type 1 Herpes Simplex virus. In this case, neuroinvasive West Nile virus was a less likely diagnosis given the patient’s physical exam findings and the context of more likely alternative explanations for his cognitive decline. Treatment options for neuroinvasive forms of West Nile virus are still supportive and would not have altered the patient’s hospital course. This case report demonstrates that clinicians must maintain an ongoing index of suspicion for infection in warmer climates where West Nile is becoming more prevalent. Given some patients’ obscure physical exam findings and radiographic imaging results, a thorough history with laboratory conformation is required for a more conclusive diagnosis
Comparison of Acute Kidney Injury During Treatment with Vancomycin and either Piperacillin-Tazobactam or Meropenem
Authors: Cannon John M. , Douce Richard W. , Grubbs Erin R. , Wills Christopher B. , Khan Asam , Schmidt Elizabeth M. , Wang Michael S.
Published: February 2021

CONTEXT

Empiric antibiotics are often required in hospitalized patients with serious infections who may be septic and at risk for drug resistant organisms. The purpose of this study was to evaluate the observed incidence of acute kidney injury (AKI) in a sample of adult patients receiving either piperacillin-tazobactam and vancomycin or meropenemvancomycin for at least 72 hours.

METHODS

Single-center, retrospective matched cohort at a 200-bed Regional Community Medical Center. Adult patients were included in the sample if they were without preexisting renal dysfunction and admitted over an 18-month time period to receive either the combination of piperacillin-tazobactam and vancomycin or meropenem-vancomycin. Sample patients were evaluated for AKI. This condition was defined by the authors as an increase in serum creatinine of 0.5mg/ml or an increase of 50% above baseline during the duration of antibiotic treatment.

RESULTS

A total of 266 patients receiving either combination of antibiotics were evaluated for AKI. The incidence of AKI was significantly higher in the piperacillin-tazobactam and vancomycin group (n = 74/292, 25%) compared with the meropenem-vancomycin group (n=8/74, 9.5%, p=0.008).

CONCLUSIONS

The results of this study suggest that the combination of piperacillin-tazobactam and vancomycin is associated with an increased incidence of AKI. Higher vancomycin trough concentrations were associated with increased risk for development of AKI.
Improving Pneumococcal Vaccination Rates in a Community-Based Internal Medicine Resident Clinic
Authors: Sebald Cale , Joubert Lana , Novakosky Marcella , Rosel MaryEllen
Published: February 2021

CONTEXT

Despite proven benefits of vaccination such as reduced morbidity and mortality, many patients remain out of date on their recommended vaccines. The goal of this pilot project was to develop and test a systematic vaccination review and ordering protocol aimed to increase the percentage of patients who were assessed under current pneumococcal vaccine recommendations by 5%.

METHODS

The study location was set in a community-based internal medicine resident clinic in Muskegon, Michigan, with the patient population coming from the same setting. Data from 50 patients who had completed office visit appointments at a resident clinic from January 2016 through April 7th, 2017 were randomly extracted before implementation of the protocol. Two months post-implementation, the authors obtained office visit data from another randomly selected 50 clinic patients for comparison. The nurses and medical assistants in the office had been educated on the pneumonia vaccine protocol based on CDC (United States Centers for Disease Control and Prevention) vaccination guidelines and state registry records. They were also provided copies of the seven-step vaccine assessment and ordering protocol that included obtaining MCIR (Michigan Care Improvement Registry) data to update the patient’s chart for a possible provider order set. Clinic residents were also educated on CDC pneumonia vaccine guidelines, and the authors posted several guideline related posters on clinic walls.

RESULTS

The authors initially compared the percentage of patients who providers had assessed regarding their vaccination status before protocol implementation to the percentage of patients after protocol implementation. There was a 10% post-implementation increase in pneumonia vaccination assessment.

CONCLUSIONS

Although the results of this pilot project are obviously limited by methodological and sample size characteristics, the initially measured improvements in vaccination status suggests that this type of systematic protocol approach may warrant further testing in similar settings.
Chief Resident Skills: A Study on Resident Perceptions of Skill Importance and Confidence
Authors: VanOrder Tonya , Wisniewski Samuel J.
Published: February 2021

CONTEXT

Chief residents (CRs) generally play a pivotal role in the graduate medical education mission to facilitate the professional development of resident physicians. Courses designed to prepare CRs for their new role previously have primarily focused on developing their teaching, evaluation and interpersonal communication skills. What remains unclear is how different types of residents (CRs versus Non-CRs and men versus women) may vary in their perception of how important particular skills are, and their confidence in performing these same skills. The purpose of this cross-sectional descriptive correlational study was to investigate the potential differences in sample respondents’ perceived importance of CR skills and respondents’ perceived confidence to perform these skills.

METHODS

The authors administered a 28-item survey questionnaire to a population of 457 CR and Non-CR respondents from 20 clinical specialties regarding their perceived importance of 11 skills, as well as their self-assessed confidence in performing each skill. This study also sought to examine whether gender-based differences existed for the perceived importance and confidence of these same CR skills.

RESULTS

Statistically significant differences in perceived importance and confidence levels between sample subgroups for the majority of key CR skills were observed. When asked about importance of CR skills, both CR and Non-CR respondents identified administrative and time management skills as most important, contrary to the other types of skills (e.g., teaching skills) the authors had generally expected to be most highly rated. As expected, the largest overall gap in perceived importance and self-reported confidence as either a CR or Non-CR was in the area of conflict management. Males reported higher confidence than females in each of the CR skills, with differences for five items found to be statistically significant. (p < 0.05) CR respondents also reported higher confidence in performing 10 of 11 skills at statistically significant levels. (p < 0.05)

CONCLUSIONS

Although this project contributes baseline data from a relatively large sample, further studies are still required to replicate these results in other resident populations to further examine the perceptions of contemporary resident physicians concerning this vital role.
Cardiovascular Factors Associated with Septic Shock Mortality Risks
Authors: Arnautovic Jelena , Mazhar Areej , Souther Britni , Mikhijan Gary , Boura J. , Huda Najia
Published: February 2021

CONTEXT

The presence of at least one underlying chronic health condition, such as long-term care facility residence, malnutrition, immunosuppression, or prosthetic device use, are well known factors increasing infection risks and progression to severe sepsis. Furthermore, some degree of cardiovascular dysfunction occurs in the majority of septic patients and this prognostic significance has become increasingly recognized. Since septic shock carries the highest mortality risk on the sepsis spectrum, it is important to evaluate the cardiovascular risk impact on mortality in this subset of patients.

METHODS

The retrospective parent study contributing these electronic health record data was IRB approved and conducted across four hospital intensive care units within the authors’ Michigan healthcare system. Patients with cardiopulmonary arrest or transfers from an outside facility were excluded. The authors evaluated the presence of modifiable and non-modifiable cardiovascular risk factors in septic shock patients upon admission to an emergency department.

RESULTS

The authors’ final analytic sample included n = 109 adults who were discharged alive compared to those who died during hospitalization. Those patients who died were more often male with an underlying history of hypertension, congestive heart failure, coronary artery disease, or peripheral arterial diseases, were taking pre-admission beta-blocker medications, and had higher APACHE II scores at admission compared to the patients who survived to discharge. Significantly higher mortality risks were found in sample patients with increased troponin levels on admission and atrial fibrillation.

CONCLUSIONS

Appropriate triage and prompt treatment of these patient groups with tailored therapy to stabilize and improve cardiac dysfunction in the emergency department could potentially lead to improved survival outcomes. Clinicians need more studies to determine therapeutic targets most impacting underlying pathophysiologic mechanisms such as elevated troponin and atrial fibrillation that greatly increase mortality risks.
Retro-Odontoid Pseudotumor with Cervical Medullary Compression: A Case Report
Authors: Elfallal Wissam , Elfallal Samer
Published: February 2021

A retro odontoid pseudo tumor is a mass lesion lying posterior to the odontoid process along the dura. It is a disease process seen in inflammatory and non-inflammatory conditions causing chronic atlanto-axial instability. This type of mass has the potential to enlarge causing cervicomedullary compression and symptoms of myelopathy. In the past, authors have relied on a more invasive, direct approach to decompress the mass including an anterior trans oral odontoidectomy and a posterior trans-dural resection. The objective of this case report is to describe the use of an indirect approach, cervical fusion with decompressive laminectomy, to successfully treat a retro odontoid pseudo tumor in a geriatric patient. A male patient in his late 90’s presented with inability to ambulate, global paresis, and long tract signs in the upper extremities. He was found to have a large odontoid mass with compression at the cranio-cervical junction. He underwent cervical fusion with instrumented fixation from C1-6 and decompressive laminectomy from C4-6. Over a follow-up period of two years, there was improvement in the patient’s motor weakness and ambulation. Radiographic evaluation at the two-year mark showed marked reduction in pannus size. Indirect approaches to decompression in patients with retro odontoid pseudo tumor using techniques such as cervical fusion may be a safe for effective treatment in patients of advanced age, with multiple co-morbidities, and inability to tolerate lengthy surgical procedures.
Are Emergency Medicine Residents Provided Adequate Training in Patient-Centered Communication?: A Resident Survey
Authors: Stillman Kimberly , Kellar Jesse
Published: February 2021

CONTEXT

Emergency Medicine residents frequently face challenging communication situations. Little is known regarding resident comfort level and amount of training received in managing these types of patient care scenarios. The purpose of this study was to measure the relationships between Emergency Medicine resident comfort levels, reported amount of patient-centered communication training received and correlation between amount of GME training and comfort levels when handling difficult situations in emergency departments.

METHODS

In 2016, the authors used the Council of Emergency Medicine Residency Directors (CORD) listserv to disseminate an online survey to Emergency Medicine residents. Survey content came from the Patient Centered Communication subsection of The American Board of Emergency Medicine Milestones. This survey included five different patient scenarios.

RESULTS

There were a total of 306 completed surveys. Residents rated their comfort level as most comfortable in scenarios regarding exhibiting empathy and least comfortable when providing bad news to patients or dealing with drug-seeking patients and difficult family members. Training was most prevalent in the areas of exhibiting empathy and giving bad news and lowest in managing drug-seeking patients and difficult patients.

CONCLUSIONS

This survey revealed that Emergency Medicine residents do not consider themselves generally comfortable in multiple communication scenarios and that the amount of training received in these areas is often lacking during residency. A statistically significant positive correlation existed between comfort level and amount of graduate medical training in most areas. Results suggest that increasing the amount of communication training during residency may be of benefit in influencing how comfortably residents handle difficult patient scenarios.
Observed Clinical, Laboratory, and Echocardiographic Parameters in Takotsubo Syndrome Patients with Mortality and Decreased Ejection Fraction During Initial Hospital Admission
Authors: Hinojos Andrew , Vanhecke Thomas E. , Manning Stephen
Published: February 2021

CONTEXT

Approximately 1-2% of patients with suspected acute coronary syndrome also develop Takotsubo syndrome (TTS). This syndrome is characterized by transient systolic dysfunction of the apical and/or mid segments of the left ventricle that mimics myocardial infarction in the absence of obstructive coronary artery disease. Up to 21.8% of TTS patients develop serious complications, including death. Currently, there is no consensus on management of these patients and their complications. Thus, identifying TTS patients at higher risk for complications becomes valuable in managing their hospital course. The aim of this study was to examine the predictive significance of laboratory, echocardiographic, and clinical parameters on in-hospital mortality in a sample subgroup of TTS patients. Secondary analyses were performed on patients with reduced (i.e., <35%) ejection fractions.

METHODS

This retrospective study at a community hospital identified patients from October 1, 2009 to August 31, 2015 who presented with ACS and underwent cardiac catheterization. Patients were diagnosed with TTS by features of cardiomyopathy on cardiac catheterization or echocardiogram.

RESULTS

The authors analyzed data from a total of 177 eligible patients identified with TTS. The in-hospital mortality rate was 5.65%. Compared to the non-mortality subgroup, patients who suffered in-hospital mortality had significantly lower diastolic blood pressure on admission (p < 0.050), lower hemoglobin levels (p < 0.001), lower sodium (p = 0.020), higher blood urea nitrogen (p = 0.009), lower glomerular filtration rate (p = 0.016), and lower albumin levels (p < 0.001). Cox regression analyses demonstrated admission hemoglobin was significant, yielding a mortality hazard ratio of 0.760 (95% CI of 0.594-0.972, p = 0.029).

CONCLUSIONS

Patients who present with TTS and hypotension, anemia, low albumin levels, elevated lactic acid and renal dysfunction were associated with higher rates of in-hospital mortality in this study’s sample population. Further, admission hemoglobin had the strongest association with death. Every unit decrease in hemoglobin increased mortality risk by 24%.
Delivering the AAMC “Teaching for Quality” Program through a Community-Based GME Collaborative: Lessons Learned to Date
Authors: Church Brandy , Corser William , Rohrer Jonathan , Hortos Kari , Harrison Angela
Published: February 2021

CONTEXT

To address scholarly activity (SA) accreditation standards, the Michigan State University’s College of Osteopathic Medicine Statewide Campus System has offered the Association of American Medical Colleges’ (AAMC) Teaching for Quality Program for two cohorts of community-based faculty. The purpose of this paper was to describe the design and delivery of the customized program, the authors’ initial lessons learned, and their plans for further evaluation and dissemination.

METHODS

The authors customized the program to overcome the barriers typically faced by community-based program faculty learners through a graduate medical education (GME) consortium model. This was the first time this program was delivered in this manner

RESULTS

The authors’ initial cohort of 19 learners successfully developed 15 projects, with two pairs of learners collaborating on projects. The second cohort of 15 learners developed 11 projects, with one pair of learners collaborating. The authors present a series of principles for community-based GME leaders striving to develop SA projects in their respective GME environments.

CONCLUSIONS

The “consortium advantage” derived from entities such as the SCS may prove integral to efficiently coordinating SA project resources and knowledge across diverse GME systems.
An Atypical Case of Transverse Diverticulitis and the Changing Management of Diverticular Disease
Authors: Ostosh Andrew C. , Saleh Adeeb , Boehm Kevin M.
Published: February 2021

Diverticulitis is an inflammation of an out pouching of the lower gastrointestinal tract, particularly in the large intestine. Although the condition is taught to medical students as typically occurring in the left lower quadrant of the abdomen, right-sided and transverse forms diverticulitis can occur. Uncomplicated, e.g., non-perforated, diverticulitis is usually treated with antibiotics. Complicated, e.g. perforated, is usually treated with surgery. The purpose of this case report is to present an atypical case of perforated diverticulitis and review current recommendations for this condition. This was a case of transverse diverticulitis in a man in his late 40’s who recovered with non-operative treatment. The widespread use of computerized tomography (CT) scans makes diagnosing diverticular disease relatively simple, but treatment is evolving. The case summarized here shows that less invasive measures can be used in treating both complicated and uncomplicated diverticular disease. After an uncomplicated in-patient admission for intravenous antibiotics, the patient was discharged in stable condition with a prescription for oral antibiotics and clinic follow-up. Classic medical school teaching concerning treatments for complicated and uncomplicated forms of diverticulitis have been updated but require further research testing.
Correlation of Clinical Factors and Audiometric Characteristics with MRI Findings in Patients with Asymmetric Sensorineural Hearing Loss
Authors: Vu Quynh-Nhu , Ko Ellen , Wisniewski Samuel J. , Carpenter Garrett , Laur Hannah , Shermetaro Carl
Published: February 2021

CONTEXT

To identify the presence of any correlative factors between presenting symptoms and characteristics of asymmetrical sensorineural hearing loss on audiogram, and if retrocochlear pathology was identified on MRI in patients presenting in a private practice setting.

METHODS

A retrospective study of patients meeting inclusion criteria who underwent MRI for asymmetric hearing loss between March 2014 to March 2017 was reviewed using Allscripts electronic health records. This data was then compiled in an excel spreadsheet and submitted for statistical analysis.

RESULTS

Of the initial 687 study patients, N = 303 patients met the inclusion criteria for review. Of these 303, 48 patients (15.8%) had abnormal MRI findings. Chi-square analysis performed showed no significant association of varied clinical variables (e.g. uni and bi-lateral tinnitus, vertigo, etc.) with abnormal MRI. Point Biserial Correlation analysis revealed no statistically significant correlations, with the exception of that between AS (Left Ear) 6 kHz and MRI lesions (r = -0.115, p = 0.045). Logistic and multinomial logistic regression analysis used to calculate odds ratios showed that for patients with hearing loss at the 6 kHz (dB) level, there is a very slightly lower, statistically significant likelihood of lesions showing up on MRI (OR, 0.984 (95% CI, 0.970-0.998), p = 0.0251).

CONCLUSIONS

The results lead to the conclusion that there may be an association between experiencing hearing loss at the level of 6 kHz and a slightly lower chance of the presence of retrocochlear lesion noted on MRI.
Inverted Papilloma of the Middle Ear and Mastoid Cavity: A Case Report, Literature Review, And Surveillance Proposal
Authors: Metz Christopher M. , Standring Robert T. , Babu Seilesh C. , Keller Christian E.
Published: February 2021

INTRODUCTION TO THE TOPIC

Inverted papilloma is a rare condition of the middle ear. In this paper, the authors present a case report of a patient at a Midwestern health system with inverted papilloma. To supplement the case report, a literature review was also performed to identify clinical trends predisposing such cases to recurrence, malignant transformation, and response to radiation. In addition, the authors also propose a surveillance algorithm derived from this case and previously published surveillance strategies.

CASE REPORT

The authors present a rare case of inverted papilloma of the middle ear. To the authors’ knowledge, this is the youngest case presentation (mid-teenage years) of this condition to have been reported in the literature. The patient underwent surgical excision, had recurrence, and has been disease free since revision surgery.

SUMMARY OF THE EVIDENCE

Our literature review identified 25 cases previously published with ours being the 26th. An inadequate number of cases exist to abstract statically relevant clinical trends in presentation and tumor behavior. Additionally, no tumor characteristics have been identified that predispose tumors to future malignant transformation. No assessments can be made regarding the benefits of radiation therapy. Most cases to date have been surveyed with a combination of CT, MRI, and clinical follow-up.

CONCLUSIONS

Inverted papillomas of the middle ear space are rare. Although this case report adds to the literature, additional cases are needed to draw statistically relevant clinical characteristics and responses to medical and surgical therapy.
Anatomic Evaluation of the Quadriceps Tendon in Cadaveric Specimens: Application for Anterior Cruciate Ligament Reconstruction Graft Choice
Authors: Krebs Nathan , Yaish Amjad , O'Neill Nicholas
Published: February 2021

Purpose

The quadriceps tendon (QT) is an autograft option for primary and revision anterior cruciate ligament (ACL) reconstruction. Techniques for predicting the appropriate graft size are limited. The purpose of this study was to evaluate the morphologic features of the QT in cadaveric specimens and compare the findings to recent MRI studies.

Materials and Methods

Macroscopic dissections were performed on 10 cadaveric knees. Using the distal myotendinous junction of the rectus femoris and superior pole of the patella as anatomic landmarks, the QT was isolated. Tendon length, width, and thickness were recorded at 10 millimeter (mm) increments. A central 80 mm x 10 mm graft was harvested, after which the graft was measured in an identical fashion. Specimen anthropometric data was collected. Subgroup analysis and linear regression were then performed using Microsoft Excel 2011 Office Analysis ToolPak.

Results

The mean QT length was 83.3 +/- 14.4 mm, ranging from 63 to 108 mm. The mean percentage of remaining QT volume following graft harvesting was 63.3%. QT length showed significant correlation with patient height (correlation coefficient: 0.719, p = 0.027). QT thickness remained relatively constant, while the width is greatest at its patellar insertion and gradually decreases proximally towards the myotendinous junction.

Conclusion

The QT has the anatomical features to produce a robust autograft for ACL reconstruction. During preoperative evaluation of graft size and quality, patient height should be considered as it is strongly correlated with the length of the potential graft. Our findings support the use of MRI as a way to preoperatively assess the QT as an autograft when performing an ACL reconstruction.
Effectiveness of Hands-Only Cardiopulmonary Resuscitation Teaching on Lay Bystander Attitudes Toward Future Resuscitation
Authors: Nofzinger Jenna R. , Kakish Edward , Bahhur Nael O. , Ryno Joseph , Pillai Mahesh , DeBelly Jessica , Jones Corion
Published: February 2021

CONTEXT

It is estimated that there are approximately 1,000 sudden cardiac events occurring daily outside of the hospital setting in the US.

OBJECTIVES

The objectives of this pilot project were to determine lay participants’ ability to remember the steps of hands-only cardiopulmonary resuscitation (HOCPR) following a 30-minute instructional session regarding proper technique and their willingness to perform bystander CPR (BCPR) on victims of sudden cardiac arrest outside in the community.

SAMPLE AND SETTING

A nine-item survey questionnaire that was created by the authors was first administered to a sample of 75 adults who had volunteered at their institutions’ emergency department. Inclusion criteria included all adults over the age of eighteen years.

OUTCOME MEASURES

To gauge whether basic HOCPR training improved bystander preparedness and willingness to provide assistance to a victim of sudden cardiac event.

METHODS

After IRB approval, participants were shown a one-minute video by the American Heart Association (AHA) and provided a 30-minute demonstration of key HOCPR skills on a mannequin. A post-instruction nine-item survey was sent by mail/email or administered by phone at one month after training to assess participants’ retention of HOCPR knowledge and attitude.

RESULTS

The initial survey responses showed 75 (100%) were able to recall the basic steps of HOCPR, with 59 (79%) “very likely” to help provide BCPR. Not needing to provide breaths made 57 (76%) of lay participants more willing to assist a person in need. A subgroup of 31 (41%) of the initial 75 participants were lost to follow-up. Out of the 44 (59%) who completed the one-month survey, 44 (100%) of participants remembered the primary HOCPR steps and technique. A subgroup of 32 (73%) one-month respondents indicated that they were more likely to assist victims if rescue breathing was not required, and 11 (25%) had reportedly tried to teach family and friends about HOCPR.

CONCLUSIONS

These results indicate that of those involved in the survey, the majority could recall the correct steps and be willing to provide HOCPR. These results could help in shaping community outreach and training programs designed to improve the rate and quality of response to victims of sudden cardiac arrest.
A Case of Humoral Hypercalcemia of Malignancy Secondary to Hepatocellular Carcinoma with Fulminant Clinical Course
Authors: Castro-Camero Pamela , Park Bumsoo , Gupta Amit , Vemulapalli Raghavendra , Shreve Maria
Published: February 2021

Hepatocellular carcinoma is one of the most common liver malignancies in the United States. Poor prognosis is associated with paraneoplastic syndromes such as hypercalcemia, hypercholesterolemia, or hypoglycemia. Hypercalcemia as a paraneoplastic syndrome of hepatocellular carcinoma has been rarely reported. We report a mortality case of incidentally diagnosed hepatocellular carcinoma associated with humoral hypercalcemia of malignancy. The patient demonstrated a fulminant disease course with an unexpected fatal outcome within 40 days of initial diagnosis. Our case can suggest importance of early definitive treatment of hepatocellular carcinoma, extremely close monitoring, and aggressive medical treatment when it is associated with humoral hypercalcemia of malignancy.
Introducing Osteopathic Curriculum for Family Medicine Physicians in a Community-based Allopathic Residency Program
Authors: Turnbull Jacob , Merck Dan , MacMillan Karri
Published: February 2021

CONTEXT

Will increased exposure to osteopathic medicine improve allopathic resident and attending physicians’ support of implementing an osteopathic curriculum in graduate medical education? The overall goal of this quality improvement project was to examine the familiarity and interest of allopathically-trained residents and attendings with osteopathic medicine before, and after, a brief educational workshop.

METHODS

Setting: Mercy Health Saint Mary’s Hospital in Grand Rapids, MI. Participants included a sample of 27 Family Medicine (FM) residents and attendings who had been trained in allopathic medical schools. First, a one-hour lecture on “Foundations of Osteopathic Medicine” was given. The lecture included a PowerPoint presentation followed by a 15-minute hands-on demonstration of osteopathic diagnosis and treatment. A pre and post-workshop survey modified from another larger study was administered to all attendees. Primary selected outcomes included percentage of allopathic resident participation in attendance and pre-post-workshop response differences.

RESULTS

Of the 31 allopathic residents in this community-based FM program, 23 (74.2%) were present for the lecture and completed both a pre and post-workshop survey. A total of 24 (78%) of participants had never attended a previous lecture on osteopathic medicine. Respondents’ overall attitude regarding the implementation of an osteopathic curriculum was generally positive after the workshop. Of the 27 participants (23 residents and four attendings) surveyed before the lecture, 23 (85.2%) were initially interested in learning how to perform osteopathic manual treatment (OMT), this increasing to 25 (92.6%) after the workshop. The Mercy Health FM resident respondents were initially first supportive of osteopathic medicine at 59.3%, improving to 77.8% after completing the workshop.

CONCLUSIONS

These results suggest that many allopathically trained physicians may lack exposure to osteopathic medicine principles. In this allopathic-oriented residency sample setting, a relatively brief workshop increased attendees’ interest in osteopathic medicine. Results suggest that initial and refresher exposure to osteopathic medicine content and OMT practices during residency curricula can be used to elicit support from allopathically-trained resident physicians.
Penerapan Metode Unified Theory Of Acceptence And Use Of Technology (UTAUT) Dalam Memprediksi Behavioral Intentions Pada Penggunaan E-Commerce Shopee Dikalangan Mahasiswa (Studi Kasus Di Fakultas Tarbiyah Dan Keguruan UIN Ar-Raniry)
Authors: Hanifah Oktana Putri  , Bustami Yusuf
Published: February 2021

This study aims to determine the effect of performance expectancy, effort expectancy, social influence, facilitating conditions on Behavioral intentions among students Tarbiyah and Teacher Training Faculty (FTK), State Islamic University of Ar-Raniry (UIN Ar-Raniry), in using e-commerce Shopee. The sample used in this study were students who had used e-commerce Shopee. We used the Unified Theory of Acceptance and Use of Technology (UTAUT) methodology in this study by distributing questionnaires both in paper based and by utilizing the google form application. The results of this study indicate that the four factors studied has the positive effects on Behavioral Intention of FTK’s students by 42%.
Differentiation of coarse-mode anthropogenic, marine and dust
particles in the high Arctic Islands of Svalbard
Authors: Song Congbo , Dall’Osto Manuel , Lupi Angelo , Mazzola Mauro , Traversi Rita , Becagli Silvia , Gilardoni Stefania , Vratolis Stergios , Yttri Karl Espen , Beddows David C. S. , Schmale Julia , Brean James , Kramawijaya Agung Ghani , Harrison Roy M. , Shi Zongbo
Published: February 2021

Abstract. Understanding aerosol-cloud-climate interactions in the Arctic is key to predict the climate in this rapidly changing region. Whilst many studies have focused on submicron aerosol (diameter less than 1 μm), relatively little is known about the climate relevance of supermicron aerosol (diameter above 1 μm). Here, we present a cluster analysis of multiyear (2015–2019) aerodynamic volume size distributions with diameter ranging from 0.5 to 20 μm measured continuously at the Gruvebadet Observatory in the Svalbard archipelago. Together with aerosol chemical composition data from several online and offline measurements, we apportioned the occurrence of the coarse-mode aerosols to anthropogenic (two sources, 27 %) and natural (three sources, 73 %) origins. Specifically, two clusters are related to Arctic haze with high levels of black carbon, sulfate and accumulation mode (0.1–1 μm) aerosol. The first cluster (9 %) is attributed to ammonium sulfate-rich Arctic haze particles, whereas the second one (18 %) to larger-mode aerosol mixed with sea salt. The three natural aerosol clusters were: open ocean sea spray aerosol (34 %), mineral dust (7 %), and an unidentified source of sea spray-related aerosol (32 %). The results suggest that sea spray-related aerosol in polar regions may be more complex than previously thought due to short/long-distance origins and mixtures with Arctic haze, biogenic and likely snow-blowing aerosols. Studying supermicron natural aerosol in the Arctic is imperative for understanding the impacts of changing natural processes on Arctic aerosol.
Improvement in tropospheric moisture retrievals from VIIRS through the use of infrared absorption bands constructed from VIIRS and CrIS data fusion
Authors: Borbas E. Eva , Weisz Elisabeth , Moeller Chris , Menzel W. Paul , Baum Bryan A.
Published: February 2021

Abstract. An operational data product available for both the Suomi National Polar-orbiting Partnership (S-NPP) and National Oceanic and Atmospheric Administration-20 (NOAA-20) platforms provides high-spatial-resolution infrared
(IR) absorption band radiances for Visible Infrared Imaging Radiometer Suite (VIIRS) based on a VIIRS and Crosstrack
Infrared Sounder (CrIS) data fusion
method. This study investigates the use of these IR radiances, centered at
4.5, 6.7, 7.3, 9.7, 13.3, 13.6, 13.9, and 14.2 µm, to construct
atmospheric moisture products (e.g., total precipitable water and upper
tropospheric humidity) and to evaluate their accuracy. Total precipitable
water (TPW) and upper tropospheric humidity (UTH) retrieved from
hyperspectral sounder CrIS measurements are provided at the associated VIIRS
sensor's high spatial resolution (750 m) and are compared subsequently to
collocated operational Aqua Moderate Resolution Imaging Spectroradiometer (MODIS) and S-NPP VIIRS moisture products.
This study suggests that the use of VIIRS IR absorption band radiances will
provide continuity with Aqua MODIS moisture products.
Alkenone isotopes show evidence of active carbon concentrating mechanisms in coccolithophores as aqueous carbon dioxide concentrations fall below 7 µmol L−1
Authors: Badger Marcus P. S.
Published: February 2021

Abstract. Coccolithophores and other haptophyte algae acquire the carbon required for metabolic processes from the water in which they live. Whether carbon is actively moved across the cell membrane via a carbon concentrating mechanism, or passively through diffusion, is important for haptophyte biochemistry. The possible utilization of carbon concentrating mechanisms also has the potential to over-print one proxy method by which ancient atmospheric CO2 concentration is reconstructed using alkenone isotopes. Here I show that carbon concentrating mechanisms are likely used when aqueous carbon dioxide concentrations are below 7 µmol L−1. I compile published alkenone-based CO2 reconstructions from multiple sites over the Pleistocene and recalculate them using a common methodology, which allows comparison to be made with ice core CO2 records. Interrogating these records reveals that the relationship between proxy CO2 and ice core CO2 breaks down when local aqueous CO2 concentration falls below 7 µmol L−1. The recognition of this threshold explains why many alkenone-based CO2 records fail to accurately replicate ice core CO2 records, and it suggests the alkenone proxy is likely robust for much of the Cenozoic when this threshold was unlikely to be reached in much of the global ocean.
Temporal dynamics of tree xylem water isotopes:
In-situ monitoring and modelling
Authors: Seeger Stefan , Weiler Markus
Published: February 2021

Abstract. We developed a setup for a fully automated, high frequency in-situ monitoring system of the stable water isotopes Deuterium and 18O in soil water and tree xylem. The setup was tested for 12 weeks within an isotopic labelling experiment during a large artificial sprinkling experiment including three mature European beech (Fagus sylvatica) trees. Our setup allowed for one measurement every 12–20 minutes, enabling us to obtain about seven measurements per day for each of our 15 in-situ probes in the soil and tree xylem. While the labelling induced an abrupt step pulse in the soil water isotopic signature, it took seven to ten days until the isotopic signatures at the trees' stem bases reached their peak label concentrations and it took about 14 days until the isotopic signatures at 8 m stem height levelled off around the same values. During the experiment, we observed the effects of several rain events and dry periods on the xylem water isotopic signatures, which fluctuated between the measured isotopic signatures observed in the upper and lower soil horizons. In order to explain our observations, we combined an already existing root water uptake (RWU) model with a newly developed approach to simulate the propagation of isotopic signatures from the root tips to the stem base and further up along the stem. The key to a proper simulation of the observed short term dynamics of xylem water isotopes, was accounting for sap flow velocities and the flow path length distribution within the root and stem xylem. Our modelling framework allowed us to identify parameter values that relate to root depth, horizontal root distribution and wilting point. The insights gained from this study can help to improve the representation of stable water isotopes in trees within ecohydrological models and the prediction of transit time distribution and water age of transpiration fluxes.