bluuebunny/crossref_metadata_2025_split huggingface dataset:
Positivity for the curvature of the diffeomorphism group corresponding to the incompressible Euler equation with Coriolis force
Authors: Tauchi Taito , Yoneda Tsuyoshi 
Published: April 2021

Abstract
We investigate the geometry of the central extension $\widehat{\mathcal D}_{\mu}(S^{2})$ of the group of volume-preserving diffeomorphisms of the 2-sphere equipped with an $L^{2}$-metric, for which geodesics correspond to solutions of the incompressible Euler equation with Coriolis force. In particular, we calculate the Misiołek curvature of this group. This value is related to the existence of a conjugate point and its positivity directly implies the positivity of the sectional curvature.
Salt Stress Enhances Early Symbiotic Gene Expression in Medicago truncatula and Induces a Stress-Specific Set of Rhizobium-Responsive Genes
Authors: Chakraborty Sanhita , Driscoll Heather E. , Abrahante Juan E. , Zhang Fan , Fisher Robert F. , Harris Jeanne M. 
Published: April 2021

Salt stress is a major agricultural concern inhibiting not only plant growth but also the symbiotic association between legume roots and the soil bacteria rhizobia. This symbiotic association is initiated by a molecular dialogue between the two partners, leading to the activation of a signaling cascade in the legume host and, ultimately, the formation of nitrogen-fixing root nodules. Here, we show that a moderate salt stress increases the responsiveness of early symbiotic genes in Medicago truncatula to its symbiotic partner, Sinorhizobium meliloti while, conversely, inoculation with S. meliloti counteracts salt-regulated gene expression, restoring one-third to control levels. Our analysis of early nodulin 11 (ENOD11) shows that salt-induced expression is dynamic, Nod-factor dependent, and requires the ionic but not the osmotic component of salt. We demonstrate that salt stimulation of rhizobium-induced gene expression requires NSP2, which functions as a node to integrate the abiotic and biotic signals. In addition, our work reveals that inoculation with S. meliloti succinoglycan mutants also hyperinduces ENOD11 expression in the presence or absence of salt, suggesting a possible link between rhizobial exopolysaccharide and the plant response to salt stress. Finally, we identify an accessory set of genes that are induced by rhizobium only under conditions of salt stress and have not been previously identified as being nodulation-related genes. Our data suggest that interplay of core nodulation genes with different accessory sets, specific for different abiotic conditions, functions to establish the symbiosis. Together, our findings reveal a complex and dynamic interaction between plant, microbe, and environment. [Formula: see text] Copyright © 2021 The Author(s). This is an open access article distributed under the CC BY 4.0 International license .
Healing the Index Tibial Nonunion: Risk Factors for Development of a Recalcitrant Nonunion in 222 Patients
Authors: Wiss Donald A. , Garlich John , Sherman Randy 
Published: April 2021

Objectives:
To compare and stratify the healing rates after our index nonunion surgery using contemporary methods of fixation, report the prevalence of recalcitrant non-union, and identify specific demographic, injury, and treatment-related risk factors for the development of a recalcitrant nonunion.

Design:
Retrospective analysis of a prospectively collected database.

Setting:
Academic Level 1 Trauma Center.

Patients/Participants:
Two hundred twenty-two tibial nonunions treated with internal fixation by a single surgeon.

Intervention:
Bivariate and multivariate regression analysis were performed to compare healing rates by the type of fixation and graft augmentation and to identify specific demographic, injury, and treatment-related risk factors for the development of a recalcitrant nonunion.

Results:
Of the 222 patients, 162 (73%) healed as intended and 51 (23%) required 1 or more subsequent interventions to achieve union (96%). Nine fractures (4%) failed to unite. The 60 fractures (27%) that required a subsequent intervention(s) or failed to consolidate were defined as recalcitrant nonunions. There were no statistically significant differences in the recalcitrant rate when we compared plates versus nails or types of bone graft. Risk factors for developing a recalcitrant nonunion were multifactorial and included grade III open fractures, compartment syndrome, deep infection, and 2 or more prior surgical procedures.

Conclusions:
Internal fixation remains a successful method of treatment for most tibial nonunions. However, 27% of patients required a subsequent intervention because of failure to heal our index nonunion procedure. Factors that are associated with recalcitrant nonunions were a grade III open fracture, compartment syndrome, deep infection, and 2 or more or more prior surgical procedures.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Surreal Becomes Real: Ethical Dilemmas Related to the COVID-19 Pandemic and Professional Identity Formation of Health Professionals
Authors: Wald Hedy S. , Ruddy Meaghan 
Published: April 2021

Abstract
Fundamental quandaries of clinical and biomedical ethics for health care professionals, committees, and systems have been raised into stark relief by the COVID-19 pandemic. The nature and extent of critical issues raised by this ongoing crisis, including challenging ethical dilemmas for the health care profession, is likely to have an indelible impact on the professional identity formation (PIF) of learners and practitioners across the trajectory of the professional lifecycle. The lifelong process of PIF for health care practitioners, from learner through independent practice, is supported in medical education by intentional reflection, relationships within community of practice include guidance from mentoring, as well as resilience, both emotional and moral. We consider how grappling with ethical dilemmas related to the COVID-19 pandemic can challenge, inform, and even potentially transform the PIF process, thereby supporting development of a morally resilient, humanistic professional identity in health care trainees and health care professionals.
Rapid Knowledge Mobilization and Continuing Professional Development: Educational Responses to COVID-19
Authors: Rowland Paula , Tavares Walter , Lowe Mandy , Tripp Tim , Richardson Juanita , Anderson Melanie , Oja Lori Anne , Paton Morag , Wiljer David , Woods Nicole , Ng Stella 
Published: April 2021

Introduction:
The field of Continuing Professional Development (CPD) has a role to play in supporting health care professionals as they respond to the COVID-19 pandemic. However, the evolving science of COVID-19, the need for quick action, and the disruption of conventional knowledge networks pose challenges to existing CPD practices. To meet these emergent and rapidly evolving needs, what is required is an approach to CPD that draws insights from the domain of knowledge mobilization (KMb).

Methods:
This short report describes a research protocol for exploring rapid KMb responses to COVID-19 at one Canadian academic teaching hospital. The proposed research will proceed as a case study using a mixed methods design collecting quantitative (surveys and Web site use metrics) and qualitative data (interviews) from individuals involved in developing, using, and supporting the KMb resources. Analysis will proceed in two phases: descriptive analysis of data to share insights and integrative analysis of data to build theory.

Results:
Results from this study will inform the immediate KMb and CPD contribution to the COVID-19 response.

Discussion:
Findings from this study will also make a broader contribution to the field of CPD, theoretically informing intersections between KMb and CPD and therefore contributing to an integrated science of CPD.
Measurement of the Lower Lid Margin Thickness by Oculus Keratograph
Authors: Yao Jie , Liu Xin-Quan , Zhu Yi , Wang Da-Hu 
Published: April 2021

Objectives:
To investigate the lower lid margin thickness (LLMT) from the posterior lash line to the anterior edge of tear meniscus with Oculus Keratograph 4 (K4).

Methods:
This was a prospective, single-center, observational study. A total of 90 volunteers aged 18 to 79 years with no ocular diseases were included in this study. The LLMT of 90 subjects was measured twice by the same person with K4. To determine the reliability of K4, measuring the LLMT of 30 normal subjects was separately performed by two operators.

Results:
The LLMT measurements with K4 between two operators demonstrated a good reproducibility (0.94±0.18 vs. 0.96±0.16 mm; intraclass correlation coefficient=0.88; P=0.18). The mean age of 90 volunteers (42 men and 48 women) was 45.5±14.1 years. The LLMT was 0.95±0.17 mm, which was a significant positive correlation with age (r
s=0.57; P<0.001). In addition, there was no significant difference in the LLMT between genders (0.97±0.16 vs. 0.93±0.18 mm; P=0.32).

Conclusions:
We found that K4 was a reliable tool in the LLMT measurements, and the LLMT seemed to be closely related to age but not to gender.
Effect of Eye Spray Phospholipid Concentration on the Tear Film and Ocular Comfort
Authors: Pult Heiko , Khatum Farzana S. , Trave-Huarte Sonia , Wolffsohn James S. 
Published: April 2021

Objectives:
To evaluate the effect of eye spray phospholipid concentration on symptoms and tear film stability.

Methods:
High-concentration (Tears Again, Optima Pharma GmbH, Hallbergmoos, Germany) and low-concentration (Ocuvers, Innomedis AG, Germany) phospholipid eye sprays were sprayed onto the closed eyelids of 30 subjects (33.2±1.8 years; 20 women) in a multicentered, prospective, crossover study. Ocular comfort (visual analog scale) and noninvasive tear film stability (NIBUT) of each eye were evaluated before application (along with the Ocular Surface Disease Index), 10 min after application, and 30 min after application.

Results:
Comfort (high concentration: 68.5±16.4 vs. low concentration: 70.7±14.5 phospholipid) and NIBUT (high concentration: 11.5±4.6 sec vs. low concentration: 11.2±6.0 sec phospholipid) were not different (P>0.3) between sprays before application, but comfort (by 12 points, P=0.001) and NIBUT (by 5 sec, P=0.016) were significantly better with a high-concentration phospholipid spray at both 10 min and 30 min time points than those with the low-concentration phospholipid spray.

Conclusions:
The liposomal eye spray with higher concentration of phospholipids significantly improved ocular comfort and tear film stability in contrast to the eye spray with lower concentration of phospholipids, hence practitioners need to choose an appropriate eye spray to maximize the patient benefit.
Risk of Depression Associated With Finasteride Treatment
Authors: Pompili Maurizio , Magistri Carlo , Maddalena Stefano , Mellini Cristiano , Persechino Severino , Baldessarini Ross J. 
Published: April 2021

Abstract

Background
Finasteride is one of several inhibitors of the 5α-reductase that converts testosterone to dihydrotestosterone used to treat hair loss and benign prostatic enlargement. Emerging clinical observations indicate that such treatment may be associated with depression, anxiety, and possibly increased suicidal risks, in addition to sexual dysfunction, even after its discontinuation.

Methods
We carried out a systematic review of reports pertaining to association of finasteride treatment with clinical depression or other adverse psychiatric effects. We analyzed reported risks of depression by pooling of rates and by meta-analysis of comparisons of subjects treated with finasteride or not.

Findings
Crude pooled rates of depressive symptoms with versus without finasteride were 3.33% (confidence interval, 3.22%–3.44%) versus 2.54% (2.44%–2.64%); random-effects meta-analysis yielded an odds ratio of 2.14 (1.40–3.27) (both P < 0.0001). In addition, risk of suicidal ideation or behavior was greater with versus without finasteride (21.2% [21.0%–21.5%] vs 14.0% [13.8%–14.2%], P < 0.0001), and risk of sustained sexual dysfunction was high (60.1% [37.3%–82.9%]).

Conclusions
The findings support a growing impression that finasteride is associated with adverse psychiatric effects that can persist in association with sexual dysfunction after discontinuing finasteride treatment.
Association of Aripiprazole With Reduced Hippocampal Atrophy During Maintenance Treatment of First-Episode Schizophrenia
Authors: Wang John , Hart Kamber L. , Qi Wei , Ardekani Babak A. , Li Chenxiang , Marx Julia , Freudenreich Oliver , Cather Corinne , Holt Daphne , Bello Iruma , Diminich Erica D. , Tang Yingying , Worthington Michelle , Zeng Botao , Wu Renrong , Fan Xiaoduo , Zhao Jingping , Wang Jijun , Goff Donald C. 
Published: April 2021

Abstract

Purpose/Background
Hippocampal volume loss in early schizophrenia has been linked with markers of inflammation and oxidative stress, and with less response of negative symptoms. Aripiprazole has been reported to preserve hippocampal volume and to reduce inflammation.

Methods/Procedures
Study 1 was a 12-month multicenter randomized placebo-controlled trial of citalopram added to clinician-determined second-generation antipsychotic medication in 95 patients with first-episode schizophrenia (FES), 19 of whom received aripiprazole. We compared participants taking aripiprazole with those on other antipsychotics to determine whether those on aripiprazole had less hippocampal volume loss. We also examined peripheral biomarker data from medication-naive patients with schizophrenia receiving 8 weeks of antipsychotic treatment (n = 24) to see whether markers of inflammation and oxidative stress that previously predicted hippocampal volume differed between aripiprazole (n = 9) and other antipsychotics (study 2).

Findings/Results
Aripiprazole was associated with a mean increase in hippocampal volume of 0.35% (SD, 0.80%) compared with a 0.53% decrease (SD, 1.2%) with other antipsychotics during the first year of maintenance treatment in patients with FES. This difference was significant after adjusting for age, sex, citalopram treatment, and baseline Brief Psychiatric Rating Scale score (B = 0.0079, P = 0.03). Aripiprazole was also associated with reduced concentrations of the inflammatory cytokines interleukin-8 and tumor necrosis factor (P < 0.01) during the first 8 weeks of treatment in medication-naive patients with FES.

Implications/Conclusions
These results suggest that aripiprazole may protect against hippocampal atrophy via an anti-inflammatory mechanism, but these results require replication in larger, randomized trials, and the clinical relevance of hippocampal volume loss is not established.
Systematic Literature Review of Pediatric Male and Female Genital Hair Thread Tourniquet Syndrome
Authors: Adjei Naomi N. , Lynn Anna Y. , Grimshaw Alyssa , Brault Marie A. , Dugan Katherine , Vash-Margita Alla 
Published: April 2021

Objective
The aim of this study was to describe genital hair thread tourniquet syndrome (HTTS) and its treatment by pediatric and adolescent health care providers through a systematic literature review.

Methods
We performed a systematic literature review on pediatric male and female genital HTTS. Studies were included if they involved genital HTTS in males or females 21 years and younger and were published in English. The main outcomes were body parts involved, symptoms, treatment, anesthetic type, providers involved in diagnosis and management, and implications of delayed or missed diagnosis.

Results
There were 38 female cases from 33 publications (1973–2020) and 147 male cases from 47 publications (1951–2019). The average age among females and males was 9.1 and 5.1 years, respectively. Among cases involving female patients, 93% of them were premenarchal; patients were circumcised in 90% of reviewed cases of male HTTS. The most commonly involved body parts were clitoris and labia minora in females, and penis and urethra in males. Males most commonly presented with edema and urinary symptoms, whereas females most commonly presented with edema and pain. General anesthesia was used for tourniquet excision in most cases. Male and female genital HTTS were mostly managed by urologists and emergency medicine physicians, respectively.

Conclusion
This systematic literature review of more than 150 cases of male and female genital HTTS describes evaluation and management of genital HTTS spanning 7 decades. The main treatment of genital HTTS remains prompt diagnosis and removal of the tourniquet, as well as education on prevention strategies. Delayed diagnosis due to lack of recognition of the HTTS can lead to serious sequelae. Development of national guidelines regarding best practices in management of genital HTTS disseminated to all providers taking care of pediatric and adolescent patients will lead to improved patient care.
Pediatric Emergency Medicine Training
Authors: Mota Curiel César , Yock-Corrales Adriana , Contreras Cristina , Corona Lisandra , Pavlichiv Viviana , Álvarez Eugenia , González del Rey Javier 
Published: April 2021

Pediatric emergency medicine (PEM) is a relatively new and rapidly evolving subspecialty in many countries. The purposes of this study were to describe the characteristics and to find common/shared practices in current available PEM fellowship programs across Latin America.

Methods
An electronic, multicenter survey was created and stored on Google forms. The survey was in Spanish language and included 30 questions about the characteristics of the pediatric emergency program, history of the program, and support expected from the Latin American Pediatric Emergency Society.

Results
A total of 11 PEM programs in 6 countries were acknowledged in Latin America. All programs are placed in pediatric tertiary care hospitals. All PEM programs were approved by the local universities and the Ministries of Health in each country. Difficulties to start a PEM program included a lack of physicians properly trained in PEM who could direct the program, physician instructors in specific topics, places to complete rotations of the future fellows, and getting the local health authorities to acknowledge the importance of the program. With regard to the duration of the program, 72.7% (8) have a 2-year curriculum and 27.3% (3) have a 1-year curriculum. Four (36.4%) program directors mentioned an admission examination as a requirement, 4 (36.4%) needed an examination plus an interview, 3 (27.3%) mentioned that it is necessary just like an interview, and 2 (18.2%) mentioned that the physicians are admitted with a scholarship. With regard to the structure of the programs and rotations included, most of the programs have rotations that are compulsory in different pediatric subspecialties. In 80% of the programs, fellows are evaluated based on different technical skill procedures that they need to learn and perform during PEM fellowship training. The PEM fellowship is recognized by different societies in emergency medicine and pediatrics, except in Dominican Republic where it is only recognized by the Ministry of Health and the university. After completion of the program in 90% (10) of the programs, graduates are not guaranteed a job, and in half, there is no mechanism implemented for recertification of the pediatric emergency physicians by the local medical council.

Conclusions
In Latin America, postgraduate programs in pediatric emergencies are a response to a need for health systems. Being an innovative specialty, it surpassed each country's own challenges, until it was able to reach an internationally standardized level, with a great diversity of pedagogical methodology, which the product has been to offer a high quality of emergency care to children.
Point-of-Care Ultrasound Identification of Right-Sided Cardiac Chamber Collapse Associated With Pericardial Effusions Without Hypotension
Authors: Bergmann Kelly R. , Riera Antonio , Whitcomb Valerie , Toney Amanda G. , Tessaro Mark O. 
Published: April 2021

Abstract
We present a case series of 6 children in whom point-of-care ultrasound revealed a pericardial effusion with right atrial or ventricular collapse, and show how this may heighten concern for development of pericardial tamponade and expedite care.
Pediatric Emergency Department Return Visits Within 72 Hours
Authors: Smith Jaron A. , Fletcher Ashley , Mirea Lucia , Bulloch Blake 
Published: April 2021

Objectives
In the United States, approximately 2.2% to 5% of children discharged from the emergency department (ED) return within 72 hours. There is limited literature examining caregivers' reasons for return to the ED, and none among Hispanics and Spanish-speaking caregivers. We sought to examine why caregivers of pediatric patients return to the ED within 72 hours of a prior ED visit, and assess roles of ethnicity and primary language.

Methods
A previously validated survey was prospectively administered to caregivers returning to the ED within 72 hours of discharge at a freestanding, tertiary care, children's hospital over a 7-month period. Reasons for return to the ED, previous ED discharge processes, and events since discharge were summarized according to Hispanic ethnicity, and English or Spanish language preference, and compared using the Fisher exact test.

Results
Among 499 caregiver surveys analyzed, caregivers returned mostly because of no symptom improvement (57.5%) and worsening condition (35.5%), with no statistically significant differences between Hispanic/non-Hispanic ethnicity, or English/Spanish preference. Most (85.2%) caregivers recalled reasons to return to the ED. Recall of expected duration until symptom improvement was significantly higher among Hispanic (60.4%) versus non-Hispanic (52.1%) (P = 0.003), and for Spanish- (68.9%) versus English-speaking (54.6%) (P = 0.04), caregivers.

Conclusions
Most caregivers returned to the ED because their child's condition was not better or had worsened. Ethnicity and language were not associated with variations in reasons for return. Non-Hispanic and English-speaking caregivers were less likely to recall being informed of time to improvement and may require additional intervention.
Morel-Lavallee Lesion
Authors: Potocki Ronald , Deanehan J. Kate 
Published: April 2021

AbstractThis case describes an 18-year-old woman who presented to the pediatric emergency department with 2 days of worsening right knee pain and swelling. The patient's history was remarkable for a motor vehicle accident 12 days before presentation, as well as recent treatment for a gonococcal sexually transmitted infection 9 days before presentation. Her examination was notable for a large area of fluctuance of her right knee without overlying erythema or appreciable intraarticular effusion. Point-of-care-ultrasound (POCUS) revealed a large, subcutaneous fluid collection containing multiple, mobile septations. This was confirmed by radiology ultrasound, and the patient was seen by an orthopedic surgeon who recommended conservative management without aspiration of the fluid collection. To our knowledge, this is the first reported case of a Morel-Lavallee lesion being diagnosed by POCUS in a pediatric patient. This case demonstrates the utility of POCUS in facilitating the prompt recognition of shear injuries in children and guiding management in the emergency department.