bluuebunny/crossref_metadata_2025 huggingface dataset:
Climate-smart forestry—potential and practicalities
Authors: Yousefpour Rasoul
Published: February 2022

Climate smart forestry (CSF) integrates ecological, economic and social dimensions in forest decision process under climate change. CSF aims to develop adaptive response to global change and optimally contribute to mitigation goals. CSF projects are ecologically effective and economically efficient in reaching the goals and involve society in the process.

Definition

The potential to simultaneously adapt to and mitigate climate change in the managed forest ecosystems is defined as climate-smart forestry (CSF). CSF strategies aim to develop adaptive response to global change and enhance the provision of ecosystem services and optimally contribute to mitigation goals. Recent attention to socio-economic implications of CSF search for comprehensive approaches integrates social dimensions and engages stakeholders in the process.

Review Methodology

After a systematic assessment in the Web of Science database, combinations of three keywords “Climate” AND “Smart” and “Forest*” were used to explore the wealth of knowledge regarding CSF. Finally, the five most cited and most relevant publications were selected for the purpose of this minireview (limited to max. five papers). However, the nature of this minireview is a hybrid of review and opinion paper.
Yolk sac steps up to the plate
Authors: Mikkola Hanna K.A.
Published: February 2022

Atkins et al. (2022. J. Exp. Med.https://doi.org/10.1084/jem.20211924) create a PSC differentiation model for human yolk sac hematopoiesis and discover multipotent progenitors with erythro-myeloid and T lymphoid potential. The multipotent progenitors emerge via hemogenic endothelium and share origin with primitive erythroid wave in KDR+CD235a/b+ mesoderm.
Memristive synaptic device based on a natural organic material—honey for spiking neural network in biodegradable neuromorphic systems
Authors: Sueoka Brandon , Zhao Feng
Published: February 2022

Spiking neural network (SNN) in future neuromorphic architectures requires hardware devices to be not only capable of emulating fundamental functionalities of biological synapse such as spike-timing dependent plasticity (STDP) and spike-rate dependent plasticity (SRDP), but also biodegradable to address current ecological challenges of electronic waste. Among different device technologies and materials, memristive synaptic devices based on natural organic materials have emerged as the favourable candidate to meet these demands. The metal–insulator-metal structure is analogous to biological synapse with low power consumption, fast switching speed and simulation of synaptic plasticity, while natural organic materials are water soluble, renewable and environmental friendly. In this study, the potential of a natural organic material—honey-based memristor for SNNs was demonstrated. The device exhibited forming-free bipolar resistive switching, a high switching speed of 100 ns set time and 500 ns reset time, STDP and SRDP learning behaviours, and dissolving in water. The intuitive conduction models for STDP and SRDP were proposed. These results testified that honey-based memristive synaptic devices are promising for SNN implementation in green electronics and biodegradable neuromorphic systems.
The Role of Comparative Law in Political Science
Authors: Tiede Lydia Brashear
Published: February 2022

Comparing laws cross-nationally elucidates how they restrain political and societal actors and how actors may use law instrumentally to reach their goals. The Article analyzes the extant use of comparative law in political science and describes areas where a more in-depth comparative study of law may enhance understandings of how law shapes politics, particularly in the areas of governance, judicial behavior, rights protection, and democratic transitions and breakdowns. For meaningful use of comparative law in the study of politics, scholars must use causal research designs for cross-country analysis and rigorously choose cases for more detailed within-country qualitative analyses. Understanding how laws vary cross-nationally and what differences matter has the potential to shape theories and explanations of the explosive and sometimes subtle political changes witnessed in the twenty-first century.
Mean decrease accuracy for random forests: inconsistency, and a practical solution via the Sobol-MDA
Authors: Bénard Clément , Da Veiga Sébastien , Scornet Erwan
Published: February 2022

Variable importance measures are the main tools used to analyse the black-box mechanisms of random forests. Although the mean decrease accuracy is widely accepted as the most efficient variable importance measure for random forests, little is known about its statistical properties. In fact, the definition of mean decrease accuracy varies across the main random forest software. In this article, our objective is to rigorously analyse the behaviour of the main mean decrease accuracy implementations. Consequently, we mathematically formalize the various implemented mean decrease accuracy algorithms, and then establish their limits when the sample size increases. This asymptotic analysis reveals that these mean decrease accuracy versions differ as importance measures, since they converge towards different quantities. More importantly, we break down these limits into three components: the first two terms are related to Sobol indices, which are well-defined measures of a covariate contribution to the response variance, widely used in the sensitivity analysis field, as opposed to the third term, whose value increases with dependence within covariates. Thus, we theoretically demonstrate that the mean decrease accuracy does not target the right quantity to detect influential covariates in a dependent setting, a fact that has already been noticed experimentally. To address this issue, we define a new importance measure for random forests, the Sobol-mean decrease accuracy, which fixes the flaws of the original mean decrease accuracy, and consistently estimates the accuracy decrease of the forest retrained without a given covariate, but with an efficient computational cost. The Sobol-mean decrease accuracy empirically outperforms its competitors on both simulated and real data for variable selection.
Trends in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Seroprevalence in Massachusetts Estimated from Newborn Screening Specimens
Authors: Ma Kevin C , Hale Jaime E , Grad Yonatan H , Alter Galit , Luzuriaga Katherine , Eaton Roger B , Fischinger Stephanie , Kaur Devinder , Brody Robin , Siddiqui Sameed M , Leach Dylan , Brown Catherine M , Klevens R Monina , Madoff Lawrence , Comeau Anne Marie
Published: February 2022

Background

Estimating the cumulative incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is essential for setting public health policies. We leveraged deidentified Massachusetts newborn screening specimens as an accessible, retrospective source of maternal antibodies for estimating statewide seroprevalence in a nontest-seeking population.

Methods

We analyzed 72 117 newborn specimens collected from November 2019 through December 2020, representing 337 towns and cities across Massachusetts. Seroprevalence was estimated for the Massachusetts population after correcting for imperfect test specificity and nonrepresentative sampling using Bayesian multilevel regression and poststratification.

Results

Statewide seroprevalence was estimated to be 0.03% (90% credible interval [CI], 0.00–0.11) in November 2019 and rose to 1.47% (90% CI: 1.00–2.13) by May 2020, following sustained SARS-CoV-2 transmission in the spring. Seroprevalence plateaued from May onward, reaching 2.15% (90% CI: 1.56–2.98) in December 2020. Seroprevalence varied substantially by community and was particularly associated with community percent non-Hispanic Black (β = .024; 90% CI: 0.004–0.044); i.e., a 10% increase in community percent non-Hispanic Black was associated with 27% higher odds of seropositivity. Seroprevalence estimates had good concordance with reported case counts and wastewater surveillance for most of 2020, prior to the resurgence of transmission in winter.

Conclusions

Cumulative incidence of SARS-CoV-2 protective antibody in Massachusetts was low as of December 2020, indicating that a substantial fraction of the population was still susceptible. Maternal seroprevalence data from newborn screening can inform longitudinal trends and identify cities and towns at highest risk, particularly in settings where widespread diagnostic testing is unavailable.
Measurement of Severe Acute Respiratory Syndrome Coronavirus 2 Antigens in Plasma of Pediatric Patients With Acute Coronavirus Disease 2019 or Multisystem Inflammatory Syndrome in Children Using an Ultrasensitive and Quantitative Immunoassay
Authors: Sigal George B , Novak Tanya , Mathew Anu , Chou Janet , Zhang Yubo , Manjula Navaratnam , Bathala Pradeepthi , Joe Jessica , Padmanabhan Nikhil , Romero Daniel , Allegri-Machado Gabriella , Joerger Jill , Loftis Laura L , Schwartz Stephanie P , Walker Tracie C , Fitzgerald Julie C , Tarquinio Keiko M , Zinter Matt S , Schuster Jennifer E , Halasa Natasha B , Cullimore Melissa L , Maddux Aline B , Staat Mary A , Irby Katherine , Flori Heidi R , Coates Bria M , Crandall Hillary , Gertz Shira J , Randolph Adrienne G , Pollock Nira R ,   Overcoming COVID-19 Investigators
Published: February 2022

Background

Detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antigens in blood has high sensitivity in adults with acute coronavirus disease 2019 (COVID-19), but sensitivity in pediatric patients is unclear. Recent data suggest that persistent SARS-CoV-2 spike antigenemia may contribute to multisystem inflammatory syndrome in children (MIS-C). We quantified SARS-CoV-2 nucleocapsid (N) and spike (S) antigens in blood of pediatric patients with either acute COVID-19 or MIS-C using ultrasensitive immunoassays (Meso Scale Discovery).

Methods

Plasma was collected from inpatients (<21 years) enrolled across 15 hospitals in 15 US states. Acute COVID-19 patients (n = 36) had a range of disease severity and positive nasopharyngeal SARS-CoV-2 RT-PCR within 24 hours of blood collection. Patients with MIS-C (n = 53) met CDC criteria and tested positive for SARS-CoV-2 (RT-PCR or serology). Controls were patients pre–COVID-19 (n = 67) or within 24 hours of negative RT-PCR (n = 43).

Results

Specificities of N and S assays were 95–97% and 100%, respectively. In acute COVID-19 patients, N/S plasma assays had 89%/64% sensitivity; sensitivities in patients with concurrent nasopharyngeal swab cycle threshold (Ct) ≤35 were 93%/63%. Antigen concentrations ranged from 1.28–3844 pg/mL (N) and 1.65–1071 pg/mL (S) and correlated with disease severity. In MIS-C, antigens were detected in 3/53 (5.7%) samples (3 N-positive: 1.7, 1.9, 121.1 pg/mL; 1 S-positive: 2.3 pg/mL); the patient with highest N had positive nasopharyngeal RT-PCR (Ct 22.3) concurrent with blood draw.

Conclusions

Ultrasensitive blood SARS-CoV-2 antigen measurement has high diagnostic yield in children with acute COVID-19. Antigens were undetectable in most MIS-C patients, suggesting that persistent antigenemia is not a common contributor to MIS-C pathogenesis.
Don’t stop me now, I’m having such a good time! Czechoslovakian wolfdogs renovate the motivation to play with a bow
Authors: Maglieri Veronica , Zanoli Anna , Mastrandrea Fosca , Palagi Elisabetta
Published: February 2022

Dogs engage in play behavior at every age and the play bow is their most iconic playful posture. However, the function of this posture is still under debate. Here, we selected the Czechoslovakian Wolfdog (CWD) as a model breed to clarify the function of the play bow. We analyzed frame-by-frame 118 sessions of 24 subjects and recorded 76 play bow events. We found that all the play bows were performed in the visual field of the playmate suggesting that the sender takes into account the attentional state of the receiver when releasing the signal. By drawing survival curves and using log-rank test we found that play bow was mainly performed during a short pause in an ongoing session and that its performance triggered the playmate’s reaction again. These findings show that play bow functions in restoring the partner motivation to play. Finally, by using a sequential analysis and a generalized mixed model, we found no evidence supporting the metacommunicative function of the play bow. The signal did not necessarily precede a contact offensive behavior (e.g., play biting and play pushing) and it was not affected by the level of asymmetry of the play session. In conclusion, in CWDs play bow can be considered a visual signal useful to maintain the motivation to play in the receiver. Therefore, we suggest that the mismatched number of play bows emitted by the 2 players in a given session can be predictive of their different motivations to play.
P2Y12 inhibitor adherence trajectories in patients with acute coronary syndrome undergoing percutaneous coronary intervention: prognostic implications
Authors: Turgeon Ricky D , Koshman Sheri L , Dong Yuan , Graham Michelle M
Published: February 2022

Aims

Post-acute coronary syndrome (ACS) P2Y12 inhibitor non-adherence is common and associated with greater risk of major adverse cardiovascular events (MACEs). Non-adherence can follow different trajectories from an inability to initiate, implement, or continue therapy for the intended duration. We aimed to evaluate P2Y12 inhibitor adherence trajectories among ACS patients treated with percutaneous coronary intervention (PCI), their frequency, and association with MACE.

Methods and results

We conducted a cohort study of adults discharged alive after PCI for ACS (2012–16) using the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease registry linked with administrative data. The primary outcome was P2Y12 inhibitor adherence trajectory in the year after PCI assessed using group-based trajectory modelling. We used logistic regression and Cox proportional-hazards regression to assess associations of trajectories with risk factors and MACE, respectively. We included 12 844 patients (mean age 62.4 years, 23.6% female). Five trajectories were identified: early consistent non-adherence (11.0%), rapid decline (7.7%), delayed initiation (6.0%), gradual decline (20.5%), and persistent adherence (54.8%). Compared with persistent adherence, rapid decline [hazard ratio (HR) 1.23, 95% confidence interval (CI) 1.01–1.49] and delayed initiation (HR 1.41, 95% CI 1.12–1.78) were associated with higher MACE in the overall cohort, whereas early consistent non-adherence was associated with higher MACE only in the subgroup receiving a drug-eluting stent (HR 2.44, 95% CI 1.60–3.71).

Conclusion

After PCI for ACS, patients followed one of five distinct P2Y12 inhibitor adherence trajectories. Rapid decline and delayed initiation were associated with a higher risk of MACE, whereas early consistent non-adherence was only associated with higher MACE risk in patients with a drug-eluting stent.

Key questions

Key findings

Take-home message
From Particularism to Mass Murder: Nazi Morality, Antisemitism, and Cognitive Dissonance
Authors: Kauders Anthony D
Published: February 2022

Scholars of the Third Reich have recently begun to study the ethical standards of National Socialist antisemites. Literature on Nazi morality frames German antisemitism as an attempt to reshape the country’s mores, but it pays insufficient attention to the psychological processes at work in replacing universalism with particularism. The author argues that cognitive dissonance theory could account for the uses and abuses of morality after 1933. He addresses three inter-related questions: did the regime utilize morality primarily to reduce cognitive dissonance?; did Germans invoke morality mainly to reduce cognitive dissonance?; and how successful was the appeal to morality in cognitive dissonance reduction? The first question makes us think about how morality can pre-empt feelings of cognitive dissonance prior to the implementation of certain policies or actions; the second explores how morality decreases dissonance afterward; and the third suggests that new moral frameworks replace older ones, eliminating cognitive dissonance altogether.
Transfer of Characters for Discrete Series Representations of the Unitary Groups in the Equal Rank Case via the Cauchy–Harish-Chandra integral
Authors: Merino Allan
Published: February 2022

As conjectured by Przebinda, the transfer of characters in the Howe’s correspondence should be obtained via the Cauchy–Harish-Chandra integral. In this paper, we prove that the conjecture holds for the dual pair $(\textrm{G} = \textrm{U}(p, q), \textrm{G}^{\prime} = \textrm{U}(r, s))$, $p+q = r+s$, starting with a discrete series representation $\Pi $ of $\widetilde{\textrm{U}}(p, q)$.
Heritability and genetic correlation estimates of semen production traits with litter traits and pork production traits in purebred Duroc pigs
Authors: Ogawa Shinichiro , Kimata Makoto , Tomiyama Masamitsu , Satoh Masahiro
Published: February 2022

We estimated heritabilities of semen production traits and their genetic correlations with litter traits and pork production traits in purebred Duroc pigs. Semen production traits were semen volume, sperm concentration, proportion of morphologically normal sperms, total number of sperm, and total number of morphologically normal sperm. Litter traits at farrowing were total number born, number born alive, number stillborn, total litter weight at birth, mean litter weight at birth, and piglet survival rate at birth. Litter traits at weaning were litter size at weaning, total litter weight at weaning, mean litter weight at weaning, and piglet survival rate from birth to weaning. Pork production traits were average daily gain, backfat thickness, and loin muscle area. We analyzed 45,913 semen collection records of 896 boars, 6,950 farrowing performance records of 1,400 sows, 2,237 weaning performance records of 586 sows, and individual growth performance records of 9,550 animals measured at approximately 5 mo of age. Heritabilities were estimated using a single-trait animal model. Genetic correlations were estimated using a 2-trait animal model. Estimated heritabilities of semen production traits ranged from 0.20 for sperm concentration to 0.29 for semen volume and were equal to or higher than those of litter traits, ranging from 0.06 for number stillborn and piglet survival rate at birth to 0.25 for mean litter weight at birth, but lower than those of pork production traits, ranging from 0.50 for average daily gain to 0.63 for backfat thickness. In many cases, the absolute values of estimated genetic correlations between semen production traits and other traits were smaller than 0.3. These estimated genetic parameters provide useful information for establishing a comprehensive pig breeding scheme.
Danger in the Mirror
Authors: Hensel Max , Wolfe Carmen
Published: February 2022

Self-harm, also known as non-suicidal self-injury (NSSI), is quite common, although only a minority of patients present to the emergency department for acute care. Methods of intended harm often involve cutting, burning, scratching, or otherwise harming the exterior skin, but self-harm may also include more drastic methods such as caustic ingestion or self-amputation. Care must be taken to balance medical resuscitation of acute injury with urgent psychiatric evaluation, and to determine a safe disposition for patients.
Patient Is “Out of Control!”
Authors: Springer Brian L.
Published: February 2022

Excited delirium syndrome is a medical emergency that must be recognized and treated quickly to prevent significant morbidity and high rates of mortality. This chapter reviews the clinical features of the syndrome and discusses the most current consensus definitions. It discusses the suspected underlying pathophysiologic processes that lead to this syndrome, including the links to stimulant abuse and psychiatric illness. It reviews how these patients appear in the prehospital and emergency department environment, discusses the association between the syndrome and sudden in-custody deaths, and provides options for aggressive supportive care and treatment.
“My Neighbors Are Harassing Me”
Authors: Lawrence Ryan E.
Published: February 2022

Schizophrenia onset usually happens during early adulthood. The illness often includes positive symptoms (delusions, hallucinations), negative symptoms (social withdrawal, avolition), and a disorganized thought process. Currently there are no definitive tests or biomarkers for schizophrenia, so the medical workup should focus on excluding neurologic, metabolic, infectious, autoimmune, and other causes of psychosis. Brain imaging is not routinely performed. The most important goals of the emergency department evaluation are to assess for safety and to engage the patient in treatment. Framing the treatment plan around the patient’s own goals can facilitate engagement. Antipsychotic medication usually improves positive symptoms. Medication selection is based on the side-effect profile; olanzapine is not recommended for patients with a first episode of psychosis due to high rates of metabolic side effects. While not all patients will want to discuss the diagnosis, clinicians should be prepared for this conversation, especially if it will facilitate engagement.
The Deadly D’s of the Elderly
Authors: Cullison Jennifer
Published: February 2022

The deadly D’s of geriatric psychiatric emergencies—delirium, dementia, depression, and bipolar disorder—all present a challenging diagnosis for the emergency medicine physician. Delirium is often difficult to diagnose in the elderly and itself is an independent risk factor for morbidity and mortality. Dementia also affects the steadily increasing population of older adults and is associated with delirium, depression, and failure to thrive. It is well known to medicine that the prevalence of depression increases with increasing age; however, it should not be forgotten that a major depressive episode can coincide with decompensation of existing or new cases of bipolar disorder. These syndromes can exist simultaneously in the same patient and often can synergistically increase risk for each other, especially in the geriatric population. Early identification, classification, differential diagnosis, and disposition are all important in the emergency department for the timely management for these potentially life-threatening illnesses found in the complex cases of the older population.
Things Are Not Always What They Seem
Authors: Reinbold Alexandra , McCoin Nicole
Published: February 2022

The emergency physician must be thorough in the clinical approach to the patient with cognitive impairment, intellectual disability, developmental and behavioral challenges, and autism spectrum disorder. The physician must make a concerted effort to obtain history from all possible resources, including the patient, the patient’s family and friends, caregivers, and emergency medical services. The clinician should involve those who are familiar with the care of the patient, as well as staff (e.g., child life services), to support the patient throughout the workup, given that it is an unfamiliar and stressful environment for the patient. The physician should perform a comprehensive physical exam in order to glean as many clues as possible to work toward a diagnosis. A broad differential should be established, as missed or delayed diagnosis is not uncommon in this population. The physician should err on the side of caution during workup and disposition planning.
The Refeeding Dilemma
Authors: Gorgas Diane L.
Published: February 2022

Anorexia nervosa is the most common eating disorder and is a common psychiatric disorder, especially among adolescent girls. Cognitive behavioral therapy is the mainstay of treatment, associated with programs that focus on increasing body mass index through gradual refeeding. The process of refeeding can be fraught with complications, because of both the underlying marked changes in physiology associated with malnutrition and the psychiatric overlay of the disease itself. This chapter focuses on gastric complications of refeeding, specifically gastric rupture and superior mesenteric artery syndrome, but also on appropriate fluid management of the severely volume-contracted patient with anorexia nervosa and the potential cardiac complications of the disease.
Discovery of extreme, roughly daily superflares on the recurrent nova V2487 Oph
Authors: Schaefer Bradley E , Pagnotta Ashley , Zoppelt Seth
Published: February 2022

V2487 Oph is a recurrent nova with detected eruptions in 1900 and 1998. Startlingly, V2487 Oph shows flares, called ‘Superflares’, with up to 1.10 mag amplitude, fast rises of under one-minute, always with an initial impulsive spike followed by a roughly exponential tail, typically one-hour durations, and with random event times averaging once-per-day. The typical flare energy E is over 1038 erg, while the yearly energy budget is 1041 erg. V2487 Oph Superflares obey three relations; the number distribution of flare energies scales as E−2.34 ± 0.35, the waiting time from one flare to the next is proportional to E of the first event, and flare durations scale as E0.44 ± 0.03. Scenarios involving gravitational energy and nuclear energy fail to satisfy the three relations. The magnetic energy scenario, however, can explain all three relations. This scenario has magnetic field lines above the disc being twisted and amplified by the motions of their footprints, with magnetic reconnection releasing energy that comes out as Superflare light. This exact mechanism is already well known to occur in white light solar flares, in ordinary M-type flare stars, and in the many Superflare stars observed all across the H-R diagram. Superflares on Superflare stars have rise times, light-curve shapes, and durations that are very similar to those on V2487 Oph. So we conclude that the V2487 Oph Superflares are caused by large-scale magnetic reconnection. V2487 Oph is now the most extreme Superflare star, exhibiting the largest known flare energy (1.6 × 1039 erg) and the fastest occurrence rate.
New low mass ratio contact binaries in the Catalina Sky Survey
Authors: Christopoulou Panagiota-Eleftheria , Lalounta Eleni , Papageorgiou Athanasios , Ferreira Lopes C E , Catelan Márcio , Drake Andrew J
Published: February 2022

We present the identification and photometric analysis of 30 new low mass ratio (LMR) totally eclipsing contact binaries found in Catalina Sky Survey data. The LMR candidates are identified using Fourier coefficients and visual inspection. We perform a detailed scan in the parameter plane of mass ratio (q) versus inclination (i) using phoebe -0.31 scripter to derive the best (q, i) pair for the initial models. The relative physical parameters are determined from the final model of each system. A Monte Carlo approach was adopted to derive the parameter errors. The resulting parameters confirm the identification. The approximate absolute physical parameters of the systems are estimated based on the light-curve solutions and Gaia Early Data Release 3 distances. 12 out of 30 new systems have fill-out factors $f\gt 50{{\ \rm per\ cent}}$ and q ≤ 0.25 (deep contact LMR systems), and eight of them, to within errors, are extreme LMR deep systems with q ≤ 0.1. We discuss the evolutionary status of the 30 LMR systems in comparison with the most updated catalogue of LMR systems from the literature. The scenario of the LMR systems as pre-merger candidates forming fast rotating stars is investigated for all systems, new and old, based both on Hut’s stability criteria and critical instability mass ratio (qinst) relation. CSS$\_$J075848.2+125656, with q/qinst = 1.23 ± 0.23, and CSS$\_$J093010.1−021624, with q/qinst = 1.25 ± 0.23, can be considered as merger candidates. $$\begin{eqnarray} \_ \end{eqnarray}$$
Probe strings on anti-de Sitter accelerating black holes
Authors: Nagasaki Koichi
Published: February 2022

In this work we consider a spacial kind of spacetime called an anti-de Sitter accelerating black hole. This is a kind of black hole that contains a stringlike singularity along polar axes attached to the black hole that accelerates it. By using a string as a probe, we study the properties of the complexity growth of black holes following the complexity–action duality. We find that the growth in the Einstein–Hilbert action is independent of the acceleration but the string probe detects the effects of acceleration.
Social Service Providers’ Knowledge of and Practice with LGBTQ+ People at Risk of Sex Trafficking
Authors: Gerassi Lara B , Pederson Anna C
Published: February 2022

Despite growing evidence suggesting that LGBTQ+ people are at risk of sex trafficking (ST), the ways in which social service providers encounter and address this population remain understudied. This study uses a directed content analysis approach to understand providers’ perceived knowledge of and practice with LGBTQ+ people at risk of ST. Authors conducted 24 semistructured, in-depth interviews of social service providers who worked with people who were sex trafficked (predominantly youth and young adults) in a region of a midwestern state. Providers had a range of knowledge and practice strategies, which included using outdated LGBTQ+ terminology and problematic assumptions about ST risk among LGBTQ+ individuals and also about how experiences of trauma influenced LGBTQ+ people’s sexuality and gender. Those who did encounter LGBTQ+ people at risk of ST suggested that there were gaps in services, particularly for trans clients. In addition, providers’ knowledge and practice strategies generally reflected an outdated understanding of gender and sexuality as stagnant and binary. Social service providers have an important opportunity to provide inclusive and affirming services to LGBTQ+ people at risk of ST. The article concludes with a discussion of the implications for practice (e.g., language recommendations and provider trainings), organizations, and future research.
New Drug Treats Pediatric Achondroplasia
Authors: Aschenbrenner Diane S.
Published: February 2022

The Food and Drug Administration has granted accelerated approval to vosoritide (Voxzogo) to treat children ages five years and older with achondroplasia who still have open epiphyses.

Children prescribed vosoritide should have a meal and 240 to 300 mL of fluid in the hour prior to drug administration to prevent hypotensive episodes.
Exploring the Ethics of a Nurses' Strike During a Pandemic
Authors: Murphy Michael J.
Published: February 2022

It's usually considered a violation of professional ethics for health care workers, including nurses, to refuse to work during mass medical emergencies, especially if their refusal is over concerns like compensation. Strikes and other forms of work stoppage may result in harm to patients and, therefore, violate professional obligations of beneficence. However, in rare circumstances a health care worker's choice to remain on the job despite risk or potential harm to themselves or even their family may be considered beyond their professional obligation. During a pandemic such as COVID-19, the ethical calculus (that is, finding the right balance between beneficence and harm before deciding on a course of action) must take account of a confluence of factors, including the risks to present patients, future patients, and health care workers; the severity and duration of the risks; and the availability of ameliorative or protective steps that reduce risk and harm. The principle of beneficence to both future patients and health care workers may be thwarted if the risk analysis is confined only to short-term concerns (that is, to concerns occurring within a narrow temporal window). If a significantly elevated risk has been demonstrated to affect nurses and other health care workers of color disproportionately, racial justice must also be considered. The purpose of this article is to assess the moral framework of a work stoppage by nurses during a pandemic.
When Is an Isolated Olecranon Fracture Pathognomonic for Osteogenesis Imperfecta?
Authors: VanEenenaam David P. , Houlihan Nathan , Heyer Jessica H. , Flynn John M. , Mitchell Stuart L.
Published: February 2022

Background:

Isolated fractures of the olecranon process of the ulna in pediatric patients with open physes are classically considered pathognomonic for osteogenesis imperfecta (OI). The purpose of this study was to distinguish the clinical manifestations of isolated olecranon fractures in patients with and without OI to help practitioners assess when further evaluation for OI may be necessary.

Methods:

All patients younger than 18 years old who were treated for an isolated olecranon fracture at a pediatric tertiary care center between 2009 and 2021 were identified. Patients without radiographs available for review, those with known skeletal dysplasia other than OI, and patients with multiple fractures (eg, polytraumas) or with concomitant dislocations were excluded. Of the 701 patients identified, 403 were included for analysis. Demographic variables, mechanism of injury, treatment type, and determination of OI diagnosis were collected. Patients with a previously confirmed diagnosis of OI or with genetic confirmation of OI following their fracture were designated as OI (+), and the remainder were designated OI (−). The Mann-Whitney U and χ2 tests were used to compare groups.

Results:

Of the 403 patients, the median age was 7.8 years (interquartile range 5.2 to 12.5), and 270 (67%) were male. There were 14 confirmed cases of OI (3.5%). The OI (+) and OI (−) groups did not differ significantly by age or sex (P>0.05). OI (+) patients were more likely to sustain an injury from low-energy mechanisms (86% vs. 32%, P<0.001), sustain displaced fractures (86% vs. 21%, P<0.001) and undergo operative treatment (86% vs. 20%, P<0.001), and to report a history of previous fracture (79% vs. 16%, P<0.001) than OI (−) patients. 36% of OI (+) patients sustained a second olecranon fracture during the study period; there were no subsequent olecranon fractures in the OI (−) group.

Conclusions:

Isolated olecranon fractures may not be pathognomonic for OI. However, orthopaedists must be vigilant about the possibility of OI in patients who sustain displaced, isolated olecranon fractures under low-energy mechanisms with a history of previous fracture(s).

Level of Evidence:

Level III.
Incidence, characteristics and predictors of mortality following cardiac arrest in ICUs of a German university hospital
Authors: Jansen Gerrit , Sauzet Odile , Borgstedt Rainer , Entz Stefanie , Holland Fee Oda , Lamprinaki Styliani , Thies Karl-Christian , Scholz Sean Selim , Rehberg Sebastian Wily
Published: February 2022

BACKGROUND

Cardiac arrest in intensive care is a rarely studied type of in-hospital cardiac arrest.

OBJECTIVE

This study examines the incidence, characteristics, risk factors for mortality as well as long-term prognosis following cardiac arrest in intensive care.

DESIGN

Retrospective cohort study.

SETTING

Five noncardiac surgical ICUs (41 surgical and 37 medical beds) at a German university hospital between 2016 and 2019.

PATIENTS

Adults experiencing cardiac arrest defined as the need for chest compressions and/or defibrillation occurring for the first time on the ICU.

MAIN OUTCOME MEASURES

Primary endpoint: occurrence of cardiac-arrest in the ICU. Secondary endpoints: diagnostic and therapeutic measures; risk factors and marginal probabilities of no-return of spontaneous circulation; rates of return of spontaneous circulation, hospital discharge, 1-year-survival and 1-year-neurological outcome.

RESULTS

A total of 114 cardiac arrests were observed out of 14 264 ICU admissions; incidence 0.8%; 95% confidence interval (CI) 0.7 to 1.0; 45.6% received at least one additional diagnostic test, such as blood gas analysis (36%), echocardiography (19.3%) or chest x-ray (9.9%) with a resulting change in therapy in 52%, (more frequently in those with a return of spontaneous circulation vs none, P 
= 0.023). Risk factors for no-return of spontaneous circulation were cardiac comorbidities (OR 5.4; 95% CI, 1.4 to 20.7) and continuous renal replacement therapy (OR 5.9; 95% CI, 1.7 to 20.8). Bicarbonate levels greater than 21 mmol 1 were associated with a higher mortality risk in combination either with cardiac comorbid-ities (bicarbonate <21 mmol I−1: 13%; 21 to 26 mmolI−1 45%; >26mmolI−1:42%)orwithaSOFA at least 2 (bicarbonate <21 mmolI−1 8%; 21 to 26 mmolI−1: 40%; >26mmolI−1: 37%). "In-hospital mortality was 78.1% (n = 89); 1-year-survival-rate was 10.5% (95% CI, 5.5 to 17.7) and survival with a good neurological outcome was 6.1% (95% CI, 2.5 to 12.2).

CONCLUSION

Cardiac arrest in ICU is a rare complication with a high mortality and low rate of good neurological outcome. The development of a structured approach to resuscitation should include all available resources of an ICU and adequately consider the complete diagnostic and therapeutic spectra as our results indicate that these are still underused. The development of prediction models of death should take into account cardiac and hepatic comorbidities, continuous renal replacement therapy, SOFA at least 2 before cardiac arrest and bicarbonate level. Further research should concentrate on identifying early predictors and on the prevention of cardiac arrest in ICU.
Immunochemotherapy and Maintenance With Obinutuzumab or Rituximab in Patients With Previously Untreated Marginal Zone Lymphoma in the Randomized GALLIUM Trial
Authors: Herold Michael , Hoster Eva , Janssens Ann , McCarthy Helen , Tedeschi Alessandra , Pocock Chris , Rosta Andras , Trněný Marek , Nielsen Tina G. , Knapp Andrea , Hiddemann Wolfgang , Marcus Robert
Published: February 2022

The aim of this study was to explore the efficacy and safety of obinutuzumab (G)- versus rituximab (R)-chemotherapy in a subgroup of patients with previously untreated marginal zone lymphoma (MZL) in the phase III GALLIUM trial (NCT01332968). Patients had stage III/IV (or stage II with bulky disease), splenic, nodal, or extranodal MZL requiring treatment. Patients were randomized 1:1 to receive G- or R-chemotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisone; cyclophosphamide, vincristine, and prednisone; or bendamustine, allocated at patient level). Patients with complete/partial response at the end of induction (EOI) received G/R maintenance. Investigator-assessed progression-free survival (PFS), other time-to-event endpoints, response, and safety were assessed. Overall, 195 patients with MZL were included in this analysis: G-chemotherapy (n = 99), R-chemotherapy (n = 96). Median observation time: 59.3 months. No meaningful difference was observed between arms for PFS (4-y PFS rates: G-chemotherapy, 72.6%; R-chemotherapy, 64.1%), other time-to-event endpoints, or EOI response rates (by computed tomography [CT; G-chemotherapy, 81.8%; R-chemotherapy, 81.3%] and positron emission tomography CT [G-chemotherapy, 79.2%; R-chemotherapy, 87.5%]). All patients experienced ≥1 adverse event (AE). G-chemotherapy was associated with a higher incidence of grade 3–5 (86.1% versus 77.4%), grade 5 (14.9% versus 9.7%), and serious (66.3% versus 51.6%) AEs versus R-chemotherapy. Both arms had a higher incidence of grade 3–5 and serious AEs than patients with follicular lymphoma (GALLIUM), with G-chemotherapy being less tolerable than R-chemotherapy. Based on the observed tolerability of G-chemotherapy versus R-chemotherapy, and the comparable efficacy of G-chemotherapy and R-chemotherapy in this analysis, G-chemotherapy cannot be recommended as first-line treatment for MZL.
Teledermatology
Authors: Nickles Melissa A. , Rustad Andrea M. , Lio Peter A.
Published: February 2022

Importance

Amidst widespread social distancing measures enacted during the COVID-19 pandemic, the Centers for Medicare & Medicaid Services expanded telehealth service coverage for beneficiaries. U.S. dermatologists and their patients have since transitioned toward billable video-based visits. Teledermatology continues to rapidly evolve, and dermatology providers should be aware and informed of systems, benefits, and barriers to effectively incorporate teledermatology into patient care.

Objective

The aim of this study was to review the history of teledermatology, its progression to the current state, and its use and expansion during the COVID-19 pandemic.

Results

Our findings suggest that teledermatology is a useful tool to address the dermatologic needs of those with limited mobility, critically ill patients, and remote communities. Teledermatology could decrease the burden of skin disease and improve the quality of life for many people, as well as empower patients to be more active in their own care. Certain conditions are more amenable to diagnosis and long-term management with teledermatology, such as acne, psoriasis, rosacea, and atopic dermatitis. Dermatologists should prioritize seeing patients with pigmented lesions in person, as melanoma may be more difficult to detect via telemedicine. Unified legislation for teledermatology is necessary as medicolegal protection, safety and privacy quality analysis, and The Health Insurance Portability and Accountability Act of 1996 (HIPAA)-approved security compliance have yet to be fully addressed.
Risk Assessment of Lingual Plate Perforation in Anterior Edentulous Mandibular Region: A Virtual Implant Placement Study Using Cone-Beam Computed Tomography
Authors: Taşdemir Ismail , Kalabalik Fahrettin , Aytuğar Emre
Published: February 2022

Background:

The aim of this study was to evaluate the prevalence of lingual cortical bone perforation caused by virtually placed implants on cone-beam computed tomography images in the edentulous mandibular canine region and determine the relationship between the morphological structure of the crest and the risk of perforation.

Methods:

Eight hundred dental implants were virtually inserted on 100 qualified cone-beam computed tomography scans. Crests were divided into 4 groups according to the crest morphology as Type U, Type L, Type P, and Type C. The distance between the implant tip and lingual plate was measured using a digital caliper. Incidence of lingual plate perforation and proximity of the implant tip to the lingual plate were measured for 4 types of the alveolar crest.

Results:

A total of 800 virtual implant applications were performed in 100 patients who met the inclusion criteria. The incidence of lingual plate perforation was found to be significantly higher in Type U crests than in the other types. It was also found to be statistically significantly higher in Type L crests than in Type P and Type C crests. When the relationship between implant length and perforation was evaluated, perforation in 14 mm implants was significantly higher than 8, 10, and 12 mm implants.

Conclusions:

According to the results of this study, it was determined that high rates of perforation occurred in the U and L type crests and 14 mm implants during implant surgery in the mandibular anterior edentulous region.
A Paradigm Shift in the Management of Thyroid Eye Disease How Teprotumumab Has Changed the Therapeutic Interface
Authors: Ugradar Shoaib , Kossler Andrea L. , Douglas Raymond , Cockerham Kimberly
Published: February 2022

Background:

Teprotumumab, a monoclonal antibody that blocks the insulin-like growth factor-1 receptor, has recently been approved by the US Food and Drug Administration (FDA) for the treatment of thyroid eye disease (TED). Since its approval, aside from data on the safety and clinical efficacy of teprotumumab from Phase-2 and Phase-3 trials, only a handful of reports have been published regarding its use in the wider population. In this review, we briefly describe the mechanism of action of teprotumumab and review the literature to provide an overview of published clinical experience. This information was used to provide recommendations for patient selection, management of patient expectations, infusion details and site options, tips to optimize the authorization process, and how to monitor and mitigate side effects.

Evidence Acquisition:

A systemic review of the literature was performed regarding teprotumumab, focusing on its mechanisms of action and published reports on its use on patients with TED. A review of Embase, Medline (PubMed), Web of Science, and Google Scholar was conducted.

Results:

Clinical experience following the approval of teprotumumab has confirmed its efficacy in reducing inflammation and proptosis in patients with acute TED (<2 years). The reduction in proptosis occurs due to a reduction in orbital fat and muscle volume. Furthermore, there is evidence for its use in patients with compressive optic neuropathy. There are also reports that show its efficacy in reducing proptosis, inflammation, and diplopia in patients with chronic TED (>2 years). Teprotumumab was associated with side effects, such as muscle spasm, hearing loss, and hyperglycemia. To date, 2 case reports have shown a possible association with flares of inflammatory bowel disease.

Conclusions:

Teprotumumab is a powerful therapeutic option for the treatment of TED. Clinical experience following FDA approval has demonstrated efficacy in treating patients with acute and chronic TED. It is the only therapeutic option that has been shown to reduce orbital soft tissue expansion in TED. However, it is expensive, and sometimes, obtaining insurance authorization can be time consuming and difficult. Further work will reveal its full side effect profile and help to establish its role in the armamentarium used to treat TED.
Using the forces of hydrodynamic countercurrent chromatography for the study of bacteriophages
Authors: Friedersdorff Jessica C. A. , Bright Colin , Rooke David , Creevey Christopher J. , Kingston Smith Alison H.
Published: February 2022

Bacteriophages (phages) are viruses that target bacteria, with the ability to lyse and kill host bacterial cells. Due to this, they have been of some interest as a therapeutic since their discovery in the early 1900s, but with the recent increase in antibiotic resistance, phages have seen a resurgence in attention. Current methods of isolation and purification of phages can be long and tedious, with caesium chloride concentration gradients the gold standard for purifying a phage fraction. Isolation of novel phages requires centrifugation and ultrafiltration of mixed samples, such as water sources, effluent or faecal samples etc, to prepare phage filtrates for further testing. We propose countercurrent chromatography as a novel and alternative approach to use when studying phages, as a scalable and high-yield method for obtaining phage fractions. However, the full extent of the usefulness and resolution of separation with this technique has not been researched; it requires optimization and ample testing before this can be revealed. Here we present an initial study to determine survivability of two phages, T4 and ϕX174, using only water as a mobile phase in a Spectrum Series 20 HPCCC. Both phages were found to remain active once eluted from the column. Phages do not fully elute from the column and sodium hydroxide is necessary to flush the column between runs to deactivate remaining phages.