bluuebunny/crossref_metadata_2025_split huggingface dataset:
Practical Considerations for Initiating and Utilizing Flash Continuous Glucose Monitoring in Clinical Practice
Authors: Wysham Carol H , Kruger Davida F 
Published: April 2021

Abstract
Use of continuous glucose monitoring (CGM) has been shown to improve clinical outcomes in patients with type 1 diabetes (T1D) and type 2 diabetes (T2D), including improved glycemic control, better treatment adherence, and an increased understanding of their treatment regimens. Retrospective analysis of CGM data allows clinicians and patients to identify glycemic patterns that support and facilitate informed therapy adjustments. There are currently 2 types of CGM systems: real-time CGM (rtCGM) and flash CGM. The FreeStyle Libre 2 (FSL2) is the newest flash CGM system commercially available. Because the FSL2 system was only recently cleared for use in the US, many endocrinologists and diabetes specialists may be unfamiliar with the strengths, limitations, and potential of the FSL2 system. This article focuses on practical approaches and strategies for initiating and using flash CGM in endocrinology and diabetes specialty practices.
Outcomes of Sleep Apnea Surgery in Outpatient and Inpatient Settings
Authors: Rosero Eric B. , Joshi Girish P. 
Published: April 2021

BACKGROUND:
Upper airway surgery is an alternative treatment for patients with severe obstructive sleep apnea (OSA). However, there is controversy regarding selection criteria for outpatient versus inpatient settings for these surgical procedures. The aim of this retrospective study was to compare postoperative outcomes of patients undergoing airway surgery in outpatient and inpatient settings based on length of stay at the facility.

METHODS:
The 2011–2017 American College of Surgeons National Surgical Quality Improvement databases were used to select adult patients with a diagnosis of OSA undergoing elective airway surgery procedures. Single-level (eg, uvulopalatopharyngoplasty [UPPP]) or multilevel surgery (eg, concomitant procedures on base of tongue, maxilla, palate, nose/turbinate, or tracheotomy) was identified using appropriate current procedural terminology (CPT) codes. Surgery setting was classified as outpatient (length of hospital stay = 0 days) or inpatient (length of stay ≥1 day). Propensity scores derived from logistic regression models were used to match inpatient to outpatient cases at a ratio of 1:1. Primary outcome was a composite of 30-day readmissions, reoperations, and/or postoperative complications. Outcomes between the matched groups were compared with McNemar’s tests and generalized mixed linear regression analyses.

RESULTS:
A total of 3208 cases were identified (1049 [32.7%] outpatient and 2159 [67.3%] inpatient). Inpatients were older, had more comorbidities, larger body mass index, and more multilevel procedures. UPPP was performed in about 96% of both inpatients and outpatients. The overall rate of composite of readmission, reoperations, and/or complications in the whole unmatched sample was 6.4% (6.8% and 5.5% in inpatients and outpatients, respectively). The propensity-matching algorithm produced a sample of 987 patients per surgical setting well balanced on available baseline characteristics. The incidence of the composite primary outcome was not significantly different between the groups (6.2% and 5.9% in inpatients and outpatients, respectively; odds ratio [OR] [95% confidence interval {CI}], 1.06 [0.73–1.53]; P = .77).

CONCLUSIONS:
This retrospective study found that the complications and 30-day readmission rates after airway surgery for OSA are low. There were no significant differences in the composite outcome of 30-day readmissions, reoperations, or complications between inpatient and outpatient settings. Adequately designed prospective studies are necessary to confirm the retrospective observations of this study.
Effect of Intravenous Acetaminophen on Mean Arterial Blood Pressure: A Post Hoc Analysis of the EFfect of Intravenous ACetaminophen on PosToperative HypOxemia After Abdominal SurgeRy Trial
Authors: Bravo Mauro , Bakal Omer , Rivas Eva , Mascha Edward J. , Pu Xuan , Mosteller Lauretta , Rodriguez-Patarroyo Fabio , Essber Hani , AlGharrash Ahmed , Turan Alparslan 
Published: April 2021

BACKGROUND:
Acetaminophen is commonly used as part of multimodal analgesia for acute pain. The intravenous formulation offers a more predictable bioavailability compared to oral and rectal acetaminophen. There have been reports of hypotension with intravenous acetaminophen attributable to centrally mediated and vasodilatory effects. We tested the hypothesis that in adults having abdominal surgery the use of intravenous acetaminophen versus placebo for postoperative pain management is associated with a decrease in mean arterial pressure (MAP) after its administration.

METHODS:
This is a substudy of eFfect of intravenous ACetaminophen on posToperative hypOxemia after abdominal surgeRy (FACTOR) trial (NCT02156154). FACTOR trial randomly assigned adults undergoing abdominal surgery to either 1 g of acetaminophen or placebo every 6 hours during the first postoperative 48 hours. Continuous monitoring of blood pressure was obtained by noninvasive ViSi Mobile device (Sotera Wireless, Inc, San Diego, CA) at 15-second intervals during initial 48 hours postoperatively. We excluded patients without continuous monitoring data available. The primary outcome was the MAP difference between MAP 5 minutes before study drug administration (baseline) and MAP 30 minutes poststudy drug administration initiation. We used a linear mixed effects model to assess the treatment effect on MAP change. The secondary outcome was MAP area under baseline (AUB) during the 30 minutes after treatment. In a sensitivity analysis of change in MAP from predrug to postdrug administration, we instead used postdrug MAP as the outcome adjusting for the baseline MAP in the model.

RESULTS:
Among 358 patients analyzed, 182 received acetaminophen and 176 placebo. The mean (standard deviation [SD]) of average MAP change was −0.75 (5.9) mm Hg for the treatment and 0.32 (6.3) mm Hg for the placebo. Acetaminophen was found to decrease the MAP from baseline more than placebo after drug administration. The estimated difference in mean change of MAP was −1.03 (95% confidence interval [CI] −1.60 to −0.47) mm Hg; P < .001. The sensitivity analysis showed postoperative MAP in the acetaminophen group was 1.33 (95% CI, 0.76-1.90) mm Hg lower than in the placebo group (P < .001). The median of MAP AUB was 33 [Q1 = 3.3, Q3 = 109] mm Hg × minutes for the treatment and 23 [1.6, 79] mm Hg × minutes for the placebo. Acetaminophen was found to increase the AUB with an estimated median difference of 15 (95% CI, 5-25) mm Hg × minutes (P = .003).

CONCLUSIONS:
Intravenous acetaminophen decreases MAP after its administration. However, this decrease does not appear to be clinically meaningful. Clinicians should not refrain to use intravenous acetaminophen for acute pain management because of worries of hypotension.
Identification of Sleep Medicine and Anesthesia Core Topics for Anesthesia Residency: A Modified Delphi Technique Survey
Authors: Berezin Linor , Nagappa Mahesh , Wong Jean , Clivatti Jefferson , Singh Mandeep , Auckley Dennis , Charchaflieh Jean G. , Jonsson Fagerlund Malin , Gali Bhargavi , Joshi Girish P. , Overdyk Frank J. , Margarson Michael , Mokhlesi Babak , Moon Tiffany , Ramachandran Satya K. , Ryan Clodagh M. , Schumann Roman , Weingarten Toby N. , Won Christine H.J. , Chung Frances 
Published: April 2021

BACKGROUND:
Sleep disorders affect up to 25% of the general population and are associated with increased risk of adverse perioperative events. The key sleep medicine topics that are most important for the practice of anesthesiology have not been well-defined. The objective of this study was to determine the high-priority sleep medicine topics that should be included in the education of anesthesia residents based on the insight of experts in the fields of anesthesia and sleep medicine.

METHODS:
We conducted a prospective cross-sectional survey of experts in the fields of sleep medicine and anesthesia based on the Delphi technique to establish consensus on the sleep medicine topics that should be incorporated into anesthesia residency curricula. Consensus for inclusion of a topic was defined as >80% of all experts selecting “agree” or “strongly agree” on a 5-point Likert scale. Responses to the survey questions were analyzed with descriptive statistical methods and presented as percentages or weighted mean values with standard deviations (SD) for Likert scale data.

RESULTS:
The topics that were found to have 100% agreement among experts were the influence of opioids and anesthetics on control of breathing and upper airway obstruction; potential interactions of wake-promoting/hypnotic medications with anesthetic agents; effects of sleep and anesthesia on upper airway patency; and anesthetic management of sleep apnea. Less than 80% agreement was found for topics on the anesthetic implications of other sleep disorders and future pathways in sleep medicine and anesthesia.

CONCLUSIONS:
We identify key topics of sleep medicine that can be included in the future design of anesthesia residency training curricula.
Frequency and Temporal Distribution of Postoperative Respiratory Depressive Events
Authors: Driver C. Noelle , Laporta Mariana L. , Bergese Sergio D. , Urman Richard D. , Di Piazza Fabio , Overdyk Frank J. , Sprung Juraj , Weingarten Toby N. 
Published: April 2021

BACKGROUND:
The frequency and temporal distribution of postoperative respiratory depression (RD) events are not completely understood. This study determined the temporal distribution and frequency of RD episodes in postsurgical patients continuously monitored by bedside capnography and pulse oximetry.

METHODS:
This was a post hoc study of a subset of postsurgical patients enrolled in The PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) trial from 2 sites in the United States. These patients had undergone continuous bedside monitoring on general care wards. These data were adjudicated for potential RD episodes. The number of RD episodes per patient and the time of each RD episode were determined. The first RD episode experienced by a patient was classified as an “initial” episode, and the initial and all subsequent RD episodes experienced by a patient were classified as “all” episodes. A PRODIGY risk score was calculated.

RESULTS:
Data analyzed from 250 patients contained 2539 RD episodes in 155 (62.0%, 95% confidence interval, 55.7-68.0) patients with median 2 [0–8], range of 0–545 RD episodes per patient, with a PRODIGY risk score distribution of 100 (40.0%) low, 79 (31.6%) intermediate, 70 (28.0%) high (missing data from 1 patient). Median time to the initial RD episode was 8.8 [5.1–18.0] hours postoperatively. There was a peak occurrence of initial RD events between 14:00 and 20:00 on the day of surgery, and these were associated with a large number of subsequent events in the same timeframe. The peak time of all RD episodes occurred from 02:00 to 06:00. Patients with high PRODIGY risk scores had higher incidence and greater number of RD episodes per patient (P < .001, overall comparisons between groups for both incidence [χ2] and number of episodes [Kruskal-Wallis test]).

CONCLUSIONS:
Continuous monitoring of surgical patients demonstrates that RD episodes are common, and risk increases with higher PRODIGY scores. In this patient cohort, the rate of initial RD episodes peaked in the afternoon to early evening, while peak rate of all RD episodes occurred in early morning. Further, among patients with RD episodes, the number of episodes increased with higher PRODIGY scores.
Integrating Sleep Knowledge Into the Anesthesiology Curriculum
Authors: Singh Mandeep , Gali Bhargavi , Levine Mark , Strohl Kingman , Auckley Dennis 
Published: April 2021

There is common ground between the specialties of anesthesiology and sleep medicine. Traditional sleep medicine curriculum for anesthesiology trainees has revolved around the discussion of obstructive sleep apnea (OSA) and its perioperative management. However, it is time to include a broader scope of sleep medicine–related topics that overlap these specialties into the core anesthesia residency curriculum. Five main core competency domains are proposed, including SLeep physiology; Evaluation of sleep health; Evaluation for sleep disorders and clinical implications; Professional and academic roles; and WELLness (SLEEP WELL).
The range of topics include not only the basics of the physiology of sleep and sleep-disordered breathing (eg, OSA and central sleep apnea) but also insomnia, sleep-related movement disorders (eg, restless legs syndrome), and disorders of daytime hypersomnolence (eg, narcolepsy) in the perioperative and chronic pain settings. Awareness of these topics is relevant to the scope of knowledge of anesthesiologists as perioperative physicians as well as to optimal sleep health and physician wellness and increase consideration among current anesthesiology trainees for the value of dual credentialing in both these specialties.
How Nearby Homicides Affect Young Women's Pregnancy Desires: Evidence From a Quasi-Experiment
Authors: Weitzman Abigail , Barber Jennifer S. , Heinze Justin , Zimmerman Marc 
Published: April 2021

AbstractLeveraging spatiotemporal variation in homicides that occurred during a 2.5-year weekly panel survey of 387 women ages 18–22 in Flint, Michigan, we investigate how young women's desires to become pregnant and to avoid pregnancy evolve in response to local homicides during the transition to adulthood. To address the endogeneity of exposure, we explore how the same woman's pregnancy desires (1) differed, on average, across weeks before and after the first homicide occurred within a quarter mile of her home; (2) evolved in the aftermath of this initial homicide exposure; and (3) changed in response to additional nearby homicides. One-fifth (22%) of women were exposed to a nearby homicide at least once during the study, and one-third of these women were exposed multiple times. Overall, the effects of nearby homicides were gradual: although average desires to become pregnant and to avoid pregnancy differed after initial exposure, these differences emerged approximately three to five months post-exposure. Repeated exposure to nearby homicides had nonlinear effects on how much women wanted to become pregnant and how much they wanted to avoid pregnancy. Together, our analyses provide a new explanation for why some young women—especially those who are socially disadvantaged—desire pregnancy at an early age.
Introduction
Authors: Snaza Nathan , Singh Julietta 
Published: April 2021

AbstractThis introduction to the special issue “Educational Undergrowth” proposes an ecological view of educational institutions and practices, one that foregrounds the porosity of borders so that entities and institutions that can sometimes seem distinct are thought of as always entangled. The editors elaborate this ecological view by drawing on theories of coloniality, especially the work of Sylvia Wynter (and her human/Man distinction) and Stefano Harney and Fred Moten (in The Undercommons). In this framing, the university appears as a specific, but not isolated, part of a colonial ecology structured around producing Man. This allows both for critical accounts of how coloniality shapes institutions such as schools and universities, always in relation to many other institutions and sites, and for speculative experiments in queer, decolonial, abolitionist education. The introduction intervenes in contemporary leftist debates about the university in particular and education more generally by offering a way of attuning to critical, abolitionist, and decolonial projects as specific but intraactive outgrowths of the colonial ecology and myriad disruptive projects (happening both in and outside of institutionalized schools). On the one hand, educational undergrowth accounts for how resources circulate unevenly in the colonial ecology so that the “growth” of some people, institutions, and projects is possible only because others are deprived, defunded, and disinvited. On the other hand, it draws on affect theory, new materialisms, and work in decolonial and critical ethnic studies to valorize otherwise marginal, bewildering, errant educational encounters that are always taking place in the undergrowth of the university.
Beyond Land Acknowledgment in Settler Institutions
Authors: Stewart-Ambo Theresa , Yang K. Wayne 
Published: April 2021

AbstractWhat does land acknowledgment do? Where does it come from? Where is it pointing? Existing literature, especially critiques by Indigenous scholars, unequivocally assert that settler land acknowledgments are problematic in their favoring of rhetoric over action. However, formal written statements may challenge institutions to recognize their complicity in settler colonialism and their institutional responsibilities to tribal sovereignty. Building on these critiques, particularly the writings of Métis cultural producer Chelsea Vowel, this article offers beyond as a framework for how institutional land acknowledgments can or cannot support Indigenous relationality, land pedagogy, and accountability to place and peoples. The authors describe the critical differences between Indigenous protocols of mutual recognition and settler practices of land acknowledgment. These Indigenous/settler differences illuminate an Indigenous perspective on what acknowledgments ought to accomplish. For example, Acjachemen/Tongva scholar Charles Sepulveda forwards the Tongva concept of Kuuyam, or guest, as “a reimagining of human relationships to place outside of the structures of settler colonialism.” What would it mean for a settler speaker of a land acknowledgment to say, “I am a visitor, and I hope to become a proper guest”? Two empirical examples are presented: the University of California, Los Angeles, where an acknowledgment was crafted in 2018; and the University of California, San Diego, where an acknowledgment is under way in 2020. The article concludes with beyond as a potential decolonial framework for land acknowledgment that recognizes Indigenous futures.
Stained University
Authors: Gonzalez Jaime Acosta , Meyerhoff Eli 
Published: April 2021

AbstractDuke University was founded on tobacco wealth, and now it has a tobacco-free campus. How should we understand this change? How can communities around this university, and higher education broadly, reckon with our historical and ongoing complicities with tobacco capitalism? This article examines how the individualized subject has been historically constructed, in response to resistances, through supplementary relations between the university and tobacco industries. With abolitionist university studies, the authors focus on the postslavery university as a key site for these individualizing processes. They situate Duke as a nexus of new means of capitalist accumulation, including, on the one hand, the postslavery university as an institution for disciplining, individualizing, and differentiating wage laborers and, on the other, the tobacco industry's shift to monopolization and mass consumption of tobacco commodities. The long Black freedom movement continues in the post-WWII era with resistances that push capitalism into crisis, while simultaneously, capitalism's coping mechanism of tobacco use has the unintended consequence of mass death. This article explores how, at the site of Duke, part of capitalism's response to resistance movements has been to deepen the individualization processes, charging individuals with taking on responsibility for the costs of both tobacco use and higher education. The authors ask how narratives of smoke-free and tobacco-free campuses could interlink with postracial narratives to obscure how the tobacco companies and universities have accumulated capital through racism, deception, dispossession, and exploitation.
The lobster optic lamina IV: Glial cells
Authors: Hámori J. , Horridge G. A. 
Published: April 2021

Abstract
There are 3 distinct types of glial cells in the optic lamina of the lobster: dark, light, and sheet cells, all distinguished from the neurons by being multipolar and not having dictyosomes. Dark cells are surrounded by intercellular material and together with light cells constitute a structural support for the groups of nerve cells. Light cells are also sheath cells for the neuron somata. The sheet cells have numerous flat processes which together form the 2 glial layers in which the synaptic region is sandwiched. An extensive system of extracellular cisterns between the sheet processes may serve for fluid transport towards the fibres and synapses, and the numerous vesicles in the sheet cells may represent an extension of the extracellular transport system.
Growth inhibition of polyoma transformed cells by contact with static normal fibroblasts
Authors: Stoker M. G. P. , Shearer Moira , O’Neill C. 
Published: April 2021

Abstract
The growth of polyoma-transformed BHK21 cells was studied in mixed cultures with normal mouse fibroblasts. On coverslips in excess medium, normal fibroblasts undergo one or two divisions after the cells become contiguous. Py-cell growth was not inhibited by contact with confluent fibroblasts which were still dividing, but the Py cells were rapidly inhibited after contact with fibroblasts which had become static. Further experiments confirmed the earlier view that the inhibitory effect was not due to a general change in the medium but was only brought about when cells were in contact or close proximity.
Characterization of the Atrial Natriuretic Factor System in Lungs of the Toad Bufo Paracnemis
Authors: Glass Mogens L. , Branco Luiz G. S. , Antunes-Rodrigues José , Gutkowska Jolanta 
Published: April 2021

ABSTRACT
Blood pressure in the amphibian pulmonary circulation is relatively high because a single ventricle serves both the systemic and pulmonary circulation, creating a high degree of plasma filtration from pulmonary capillaries. Previous studies have shown that lung atrial natriuretic factor (ANF) may have an important physiological function in preventing edema in mammals. In this study, we report the presence of the complete ANF system in the lungs of the toad Bufo paracnemis. Radioimmunoassay of tissue homogenates revealed that toad lung ANF concentration was approximately twice as high (928.5±83.0 pg mg−1 protein) as that of lung tissue in mammals of a similar size. The amount of ANF was significantly higher in the left than in the right atrium (15.0±1.2 versus 1.9±0.8 ng mg−1 protein; N=4, P&lt;0.001), while the ventricle contained 488.3±41.8 pg mg−1 protein. In extracts of both lungs and atria, high-performance liquid chromatography revealed two forms of the peptide; prohormone and a carboxy-terminal peptide of low molecular mass, which is the biologically active form of peptide. The presence of the prohormone suggests that ANF is synthesized in toad lungs and atria. Characterization of toad lung receptors by a competitive binding assay demonstrated three different subtypes of ANF receptors: the guanylyl cyclase (GC) receptors, GC-A and GC-B, as well as clearance (C) receptors. We conclude that the toad Bufo paracnemis has a well-developed complete ANF system in the lung, suggesting that it has a role in toad lung physiology.