bluuebunny/crossref_metadata_2025_split huggingface dataset:
Enhanced Recovery Pathway Reduces Hospital Stay and Opioid Use in Microsurgical Breast Reconstruction: A Single-Center, Private Practice Experience
Authors: Ochoa Oscar , Rajan Meenakshi , Garza Ramon , Chrysopoulo Minas , Pisano Steven , Ledoux Peter , Arishita Gary , Michalek Joel , Nastala Chet 
Published: May 2022

Background:
This study aimed to determine benefits of the Enhanced Recovery After Surgery (ERAS) pathway implementation in free flap breast reconstruction related to postoperative narcotic use and health care resource utilization.

Methods:
A retrospective analysis of consecutive patients undergoing deep inferior epigastric perforator flap breast reconstruction from November of 2015 to April of 2018 was performed before and after implementation of the ERAS protocol.

Results:
Four hundred nine patients met inclusion criteria. The pre-ERAS group comprised 205 patients, and 204 patients were managed through the ERAS pathway. Mean age, laterality, timing of reconstruction, and number of previous abdominal surgical procedures were similar (p > 0.05) between groups. Mean operative time between both groups (450.1 ± 92.7 minutes versus 440.7 ± 93.5 minutes) and complications were similar (p > 0.05). Mean intraoperative (58.9 ± 32.5 versus 31.7 ± 23.4) and postoperative (129.5 ± 80.1 versus 90 ± 93.9) morphine milligram equivalents used were significantly (p < 0.001) higher in the pre-ERAS group. Mean length of stay was significantly (p < 0.001) longer in the pre-ERAS group (4.5 ± 0.8 days versus 3.2 ± 0.6 days). Bivariate linear regression analysis demonstrated that operative time was positively associated with total narcotic requirements (p < 0.001) and length of stay (p < 0.001).

Conclusions:
ERAS pathways in microsurgical breast reconstruction promote reduction in intraoperative and postoperative narcotic utilization with concomitant decrease in hospital length of stay. In this study, patients managed through ERAS pathways required 46 percent less intraoperative and 31 percent less postoperative narcotics and had a 29 percent reduction in hospital length of stay.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Case Report
Authors: Barmatz Caroline , Barzel Oren , Reznik Jacqueline 
Published: May 2022

Background and Purpose:This case report describes the hydrotherapy sessions received in conjunction with a rehabilitation program designed for a patient recovering from coronavirus disease 2019 (COVID-19) with intensive care unit (ICU)–acquired muscle weakness. The primary purpose of this case report was to examine the effects of hydrotherapy in a patient recovered from COVID-19 with ICU-acquired muscle weakness in the absence of any cross-infection.Case Description:The subject was a 29-year-old man in recovery after contracting COVID-19 infection and ICU-acquired muscle weakness. On admission to the orthopedic rehabilitation ward at Sheba Medical Center, the patient tested negative for COVID-19 according to the polymerase chain reaction test.Intervention:The patient received 4 hydrotherapy sessions that involved exercising in warm water (31°C-35°C) to improve muscle strength in a non- or low–weight-bearing capacity. A standard physical therapy program was also provided to the patient.Outcome:Following 2 weeks of rehabilitation that included 4 hydrotherapy sessions combined with a standard physiotherapy regimen, the patient was discharged home and able to walk outdoors independently for at least 30 minutes. Aside from the inclusion of specific personal protective equipment and social distancing (2 m), no additional requirements were necessary to our standard pool hygiene and no adverse infections were reported.Discussion:The results of this case report showed that hydrotherapy is a useful modality in the rehabilitation of ICU-acquired muscle weakness developed as a result of COVID-19.
The Step-Count Accuracy of Activity Monitors on Land and in the Water: Revisited
Authors: Stevens Sandra , Michaels Natalie Norman , Noven Marnie Vanden , Caputo Jennifer , Johnson Samantha L. 
Published: May 2022

Background:
Activity monitors are used by people from all walks of life in the United States and elsewhere. Various companies boast their monitors can be used both on land and in the water, but the accuracy of these monitors when determining step count is unknown. This study is based on a pilot study published in 2019 by the same authors.

Methods:
Six popular water-resistant activity monitors were tested on 27 participants. Participants walked on a land treadmill for 3 minutes at a self-selected, comfortable walking speed while wearing 2 land/water activity monitors (one on each wrist) that were randomized across participants. This was repeated in the water on a HydroTrack (by HydroWorx) underwater treadmill. All walks were filmed so the actual step count could be determined for comparison with the counts from the monitors.

Results:
The accuracy of each monitor for step count on land and in the water was determined by comparing the monitor's calculation with the actual step count using correlation, mean step difference, Cohen's d calculation, paired t test for significance, and intraclass correlation.

Relevance:
This study provides further information regarding the accuracy of activity monitors in assessing step count on land and in the water. Continued research is recommended using a larger number of monitors, with individuals of varying ages and conditions.
The Effect of Aquatic Physical Therapy on Children With Down Syndrome
Authors: Hartlage Ashley , Nicholson Cody , Silvius Allison , Ennis Beth 
Published: May 2022

Purpose/Hypothesis:
Properties of water such as buoyancy, hydrostatic pressure, and fluid resistance when used with aquatic exercises have been shown to have a positive effect on balance and functional mobility. Previous literature has shown these improvements in children with cerebral palsy, spinal muscular atrophy (SMA) type II, and developmental coordination disorder, disorders that could present with similar impairments to children with Down syndrome. Therefore, the purpose of this study was to determine the effect of aquatic therapy on children with Down syndrome.

Materials/Methods:
Ten children aged 2 to 8 years with a diagnosis of Down syndrome received 1:1 (student therapist:child) therapy sessions, with some children requiring a 2:1 ratio. Prior to aquatic intervention, each child was evaluated using the Pediatric Balance Scale (PBS) and the Water Orientation Test Alyn (WOTA-1). For 8 consecutive weeks, each child received personalized interventions lasting about 45 minutes based upon their needs. After the 8-week aquatic intervention sessions, each child was then reevaluated with both outcome measures.

Results:
The study began with 10 participants, with 9 completing the 8-week program. Eight of the 9 children made clinically significant improvements in their WOTA-1 scores, and 7 of the 9 children made clinically significant improvements in their PBS score.

Conclusions:
The use of aquatic physical therapy for children with Down syndrome displayed quantitative improvements in balance, as well as comfort and mobility in the water. Using individualized treatment plans, each child was able to improve in each of the aforementioned areas.

Clinical Relevance:
This small study demonstrates that children with Down syndrome can gain functional benefits from aquatic therapy similar to previous research in children with hypertonia. As physical therapists, we need to be aware of how aquatic therapy can benefit different subgroups of children so that we can refer and treat as appropriate in order to give children the best functional outcome.
A Specialized Program for Prevention and Surveillance of Skin Abrasions During Aquatic Therapy for Patients With Spinal Cord Injury: A Successful Quality Assurance Initiative With Sustained Impact
Authors: Recio Albert C. , Kakitis-Fawley Amy , Mertins Rachel , Sachs Christy , Stiens Steven A. 
Published: May 2022

Background and Purpose:
The primary objective of this research was to continuously improve the quality of aquatic therapy for patients with spinal cord injury (SCI) while reducing the incidence of skin abrasions using the PDCA (Plan, Do, Check, Act) system. The specific aim was to reduce the incidence of skin abrasions revealed by quality surveillance.

Methods:
Using the PDCA format for continuous improvement, a 3-phase program was designed and implemented. Phase I consisted of data mining. Phase II entailed the development of policy and procedures, and phase III consisted of education and implementation of the new policies and procedures.

Results:
Between 2010 and 2018, only 1.08% of all patients (N = 1203) were identified as having skin abrasions acquired during their aquatic therapy sessions. Of the total number of aquatic therapy appointments during that same time period, the incidence of skin abrasions was even lower, at only 0.08% (16 804).

Discussion:
During aquatic therapy sessions, patients were experiencing scrapes and abrasions predominantly affecting their limbs. Initial verbal reporting by therapists and nursing staff led to a paper tracking system starting in 2010. In phase II, we implemented policy and procedures outlining appropriate steps to prevent skin abrasions during aquatic therapy sessions. In phase III, therapists received additional training and education to lessen potential abrasions for patients and protective footwear became obligatory for ambulatory patients.

Conclusion:
Consistent communication, reporting, and tracking, combined with education and effective preventive measures, dramatically lessened the incidence of skin abrasions during aquatic therapy and using the PDCA system these outcomes can be sustained.
The Benefits of Group Aquatic Therapy for Young Children With Down syndrome
Authors: Milligan Helen , Glanzman Allan , Waasdorp Ilana , Kinslow Tricia , Hagenbaugh Michelle , Pipan Mary , Harrington Ann , Palombaro Kerstin 
Published: May 2022

Background and Purpose:
To describe the implementation of an aquatic-based exercise program for young children with Down syndrome (DS). The aquatic setting is particularly motivating for children with DS. Swimming can be a safe and effective way to promote lifetime physical activity for individuals with DS. Caregivers often feel unprepared to assist their children in swimming activities, limiting participation in community programs.

Case Series:
Twenty children with DS participated in an aquatic-based program to facilitate transition to a community swim programs.

Intervention:
The Trisomy 21 Aquatic Group, an 8-week group-based exercise program, was developed that included aquatic skills, water acclimation, fitness activities, and caregiver instruction. A pre- and postparticipation evaluation included the establishment of goals and standardized assessments including the Gross Motor Function Measure (GMFM), a parent questionnaire, and the Water Orientation Test Alyn (WOTA-1). The aquatic-based exercise program was piloted with 20 children between the ages of 1 and 5 years and included caregiver participation. Interventions consisted of respiratory control, water orientation, swim skills, balance and strengthening activities, and functional skills. Instruction promoted caregiver confidence and carryover in the community with consistent routines, repetition, and scaffolding of skills.

Outcomes:
Both WOTA and GMFM were analyzed using pre- and postgroup paired t tests. Statistically significant changes from pre- to postgroup tests were noted. The mean GMFM improved from 154 to 179.45 or 24.65 points (P < .00001 ± 18.93) and the mean WOTA improved from 25.53 to 37.33 or 12.2 points (P < .00001 ± 8.13). The parent questionnaire revealed significant changes in the child's ability to follow simple directions and take turns (Z = 2.157, P = .030) and blow bubbles (Z = 2.50, P = .0124) and an increase in the number of signs (mean change of 6.8 signs). Parents reported having confidence supporting their children in the water, improvements in strength, improved respiratory control, and readiness for swim lessons.

Discussion:
A standardized aquatics program for individuals with DS is presented. This is a step toward the establishment of effective treatment strategies regarding aquatic therapy for those with DS.
Natural processes influencing pollinator health
Authors: Stevenson Philip C. , Koch Hauke , Nicolson Susan W. , Brown Mark J. F. 
Published: May 2022

Evidence from the last few decades indicates that pollinator abundance and diversity are at risk, with many species in decline. Anthropogenic impacts have been the focus of much recent work on the causes of these declines. However, natural processes, from plant chemistry, nutrition and microbial associations to landscape and habitat change, can also profoundly influence pollinator health. Here, we argue that these natural processes require greater attention and may even provide solutions to the deteriorating outlook for pollinators. Existing studies also focus on the decline of individuals and colonies and only occasionally at population levels. In the light of this we redefine pollinator health and argue that a top-down approach is required focusing at the ecological level of communities. We use examples from the primary research, opinion and review articles published in this special issue to illustrate how natural processes influence pollinator health, from community to individuals, and highlight where some of these processes could mitigate the challenges of anthropogenic and natural drivers of change.This article is part of the theme issue ‘Natural processes influencing pollinator health: from chemistry to landscapes’.
Potential effects of nectar microbes on pollinator health
Authors: Martin Valerie N. , Schaeffer Robert N. , Fukami Tadashi 
Published: May 2022

Floral nectar is prone to colonization by nectar-adapted yeasts and bacteria via air-, rain-, and animal-mediated dispersal. Upon colonization, microbes can modify nectar chemical constituents that are plant-provisioned or impart their own through secretion of metabolic by-products or antibiotics into the nectar environment. Such modifications can have consequences for pollinator perception of nectar quality, as microbial metabolism can leave a distinct imprint on olfactory and gustatory cues that inform foraging decisions. Furthermore, direct interactions between pollinators and nectar microbes, as well as consumption of modified nectar, have the potential to affect pollinator health both positively and negatively. Here, we discuss and integrate recent findings from research on plant–microbe–pollinator interactions and their consequences for pollinator health. We then explore future avenues of research that could shed light on the myriad ways in which nectar microbes can affect pollinator health, including the taxonomic diversity of vertebrate and invertebrate pollinators that rely on this reward.
This article is part of the theme issue ‘Natural processes influencing pollinator health: from chemistry to landscapes’.
Exploring connections between pollinator health and human health
Authors: Garibaldi Lucas A. , Gomez Carella Dulce S. , Nabaes Jodar Diego N. , Smith Matthew R. , Timberlake Thomas P. , Myers Samuel S. 
Published: May 2022

Despite recent advances in understanding the role of biodiversity in ecosystem-service provision, the links between the health of ecosystem-service providers and human health remain more uncertain. During the past decade, an increasing number of studies have argued for the positive impacts of healthy pollinator communities (defined as functionally and genetically diverse species assemblages that are sustained over time) on human health. Here, we begin with a systematic review of these impacts, finding only two studies that concomitantly quantified aspects of pollinator health and human health. Next, we identify relevant research relating to four pathways linking pollinator health and human health: nutrition, medicine provisioning, mental health and environmental quality. These benefits are obtained through improved pollination of nutritious crops and an estimated approximately 28 000 animal-pollinated medicinal plants; the provisioning of pollinator-derived products such as honey; the maintenance of green spaces and biocultural landscapes that improve mental health; and cleaner air, water and food resulting from pollinator-centred initiatives to reduce agrochemical use. We suggest that pollinator diversity could be a proxy for the benefits that landscapes provide to human health.
This article is part of the theme issue ‘Natural processes influencing pollinator health: from chemistry to landscapes’.
Complex networks of parasites and pollinators: moving towards a healthy balance
Authors: Brown Mark J. F. 
Published: May 2022

Parasites are viewed as a major threat to wild pollinator health. While this may be true for epidemics driven by parasite spillover from managed or invasive species, the picture is more complex for endemic parasites. Wild pollinator species host and share a species-rich, generalist parasite community. In contrast to the negative health impacts that these parasites impose on individual hosts, at a community level they may act to reduce competition from common and abundant pollinator species. By providing rare species with space in which to exist, this will act to support and maintain a diverse and thus healthier pollinator community. At this level, and perhaps paraxodically, parasites may be good for pollinators. This stands in clear contrast to the obvious negative impacts of epidemic and spillover parasites on wild pollinator communities. Research into floral resources that control parasites could be best employed to help design landscapes that provide pollinators with the opportunity to moderate their parasite community, rather than attempting to eliminate specific parasites from wild pollinator communities.
This article is part of the theme issue ‘Natural processes influencing pollinator health: from chemistry to landscapes’.
Rodent responses to volatile compounds provide insights into the function of floral scent in mammal-pollinated plants
Authors: Johnson Steven D. , Govender Keeveshnee 
Published: May 2022

Flowers pollinated by mammals have evolved in many plant families. Several scent compounds that attract bats to flowers have been identified, but the chemical ecology of pollination mutualisms between plants and ground-dwelling mammals is poorly understood. Rodents are key pollinators in South Africa and rely heavily on olfaction to locate food. Our aim was to identify compounds that may function to attract rodents to flowers. Eighteen volatile compounds, including 14 that are prominent in the scent of rodent-pollinated flowers, were used in choice experiments involving wild-caught individuals of four native rodent species. Rodents were generally attracted to oxygenated aliphatic compounds, specifically ketones and esters, but not to some aromatic compounds common in floral scents of insect-pollinated species, nor to a sulfide compound that is attractive to bats. Associative conditioning using sugar solution as a reward had only weak effects on the attractiveness of compounds to rodents. The attractive effect of some compounds disappeared when they were blended with compounds that did not attract rodents. We conclude that aliphatic ketones and esters are likely to play a key role in attracting rodents to flowers. Deployment of these compounds may allow plants to exploit rodent sensory bias that evolved in other contexts such as intra-specific communication and searching for seeds.
This article is part of the theme issue ‘Natural processes influencing pollinator health: from chemistry to landscapes’.
Do amino and fatty acid profiles of pollen provisions correlate with bacterial microbiomes in the mason beeOsmia bicornis?
Authors: Leonhardt Sara Diana , Peters Birte , Keller Alexander 
Published: May 2022

Bee performance and well-being strongly depend on access to sufficient and appropriate resources, in particular pollen and nectar of flowers, which constitute the major basis of bee nutrition. Pollen-derived microbes appear to play an important but still little explored role in the plant pollen–bee interaction dynamics, e.g. through affecting quantities and ratios of important nutrients. To better understand how microbes in pollen collected by bees may affect larval health through nutrition, we investigated correlations between the floral, bacterial and nutritional composition of larval provisions and the gut bacterial communities of the solitary megachilid beeOsmia bicornis. Our study reveals correlations between the nutritional quality of pollen provisions and the complete bacterial community as well as individual members of both pollen provisions and bee guts. In particular pollen fatty acid profiles appear to interact with specific members of the pollen bacterial community, indicating that pollen-derived bacteria may play an important role in fatty acid provisioning. As increasing evidence suggests a strong effect of dietary fatty acids on bee performance, future work should address how the observed interactions between specific fatty acids and the bacterial community in larval provisions relate to health inO. bicornis.This article is part of the theme issue ‘Natural processes influencing pollinator health: from chemistry to landscapes’.
Landscape-scale drivers of pollinator communities may depend on land-use configuration
Authors: Gillespie Mark A. K. , Baude Mathilde , Biesmeijer Jacobus , Boatman Nigel , Budge Giles E. , Crowe Andrew , Davies Nancy , Evans Rebecca , Memmott Jane , Morton R. Daniel , Moss Ellen , Murphy Mark , Pietravalle Stephane , Potts Simon G. , Roberts Stuart P. M. , Rowland Clare , Senapathi Deepa , Smart Simon M. , Wood Claire , Kunin William E. 
Published: May 2022

Research into pollinators in managed landscapes has recently combined approaches of pollination ecology and landscape ecology, because key stressors are likely to interact across wide areas. While laboratory and field experiments are valuable for furthering understanding, studies are required to investigate the interacting drivers of pollinator health and diversity across a broader range of landscapes and a wider array of taxa. Here, we use a network of 96 study landscapes in six topographically diverse regions of Britain, to test the combined importance of honeybee density, insecticide loadings, floral resource availability and habitat diversity to pollinator communities. We also explore the interactions between these drivers and the cover and proximity of semi-natural habitat. We found that among our four drivers, only honeybee density was positively related to wild pollinator abundance and diversity, and the positive association between abundance and floral resources depended on insecticide loadings and habitat diversity. By contrast, our exploratory models including habitat composition metrics revealed a complex suite of interactive effects. These results demonstrate that improving pollinator community composition and health is unlikely to be achieved with general resource enhancements only. Rather, local land-use context should be considered in fine-tuning pollinator management and conservation.
This article is part of the theme issue ‘Natural processes influencing pollinator health: from chemistry to landscapes’.