bluuebunny/crossref_metadata_2025_split huggingface dataset:
North Carolina Board of Nursing's Alternative Program COVID-19 Response
Authors: Bailey Alison T. , Griffith Sara A. 
Published: February 2022

Abstract
The North Carolina Board of Nursing (NCBON) implemented an alternative-to-discipline program (AP) in 1995 for nurses experiencing a substance use disorder. There have been programmatic changes since the inception of the AP. However, COVID-19 posed significant challenges related to balancing the NCBON's public protection mandate against COVID-19 impacts on the nurse's ability to comply with the AP conditions. The changes to the AP structure in response to COVID-19 included transition from in-person orientation interviews to virtual, drug screening process modifications, acceptance of virtual treatment and 12-step meeting attendance, and specific employment condition waiver accommodations. The NCBON identified modifications facilitated opportunities for nurses to remain compliant with the conditions of the AP while meeting the mandate of public protection.
Seven suggestions for successful SGLT2i use in glomerular disease - a standalone CKD therapy?
Authors: McQuarrie Emily P. , Gillis Keith A. , Mark Patrick B. 
Published: February 2022

Purpose of review
Recent advances in the world of glomerular diseases have largely focussed on remission induction with immune modulating therapy. It is well recognised that even with the best available treatments, patients with glomerular diseases may have an increased risk of progressive renal and cardiovascular disease.

Recent findings
The arrival of large trials looking at the benefits of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in patients with chronic kidney disease (CKD) and diabetes or not has shifted the entire focus of current management and the shift needs to go further. This review summarises the background to these landmark trials and provides practical guidance for implementation of the results in a general nephrology clinic. In sub-group analyses of the Dapagliflozin and Prevention of Adverse Outcomes in Chronic Kidney Disease (DAPA-CKD) clinical trial, SGLT2i improved renal outcomes in patients with immunoglobulin A (IgA) nephropathy highlighting the potential for this drug class in glomerular disease. We also discuss where the gaps in evidence are and where future trials in glomerular diseases, be they primary or secondary, should be focussed.

Summary
The renal community has never before had evidence of this strength upon which to base recommendations for patients with CKD and we should be grasping it with both hands.
Point-of-Care Ultrasound-Guided Aspiration of the Hip Joint by an Emergency Medicine Physician
Authors: Berant Ron , Bder Moad , Kaufman-Shriqui Vered , Shahar-Nissan Keren 
Published: February 2022

Objectives
Early administration of antibiotics is crucial to treating septic hip. This study aimed to describe the clinical course and outcomes of children with septic hip diagnosed using point-of-care ultrasound (POCUS)–guided hip aspirations performed by an emergency medicine physician.

Methods
A retrospective case series analysis.

Results
Between January 1, 2014, and December 31, 2019, 10 children with septic hip were diagnosed by emergency physicians using POCUS-guided hip aspirations. Six of them were female; the mean age was 4.2 ± 4.5 years, and the mean time from onset of symptoms to diagnosis was 2.9 ± 1.7 days. Seven patients (70%) had a history of fever. All the patients had elevated inflammatory blood markers (white blood cell count >12 K/μL, erythrocyte sedimentation rate >40 mm/h, or a C-reactive protein >2 mg/dL). The mean time from hospital arrival to the first antibiotic dose was 5.2 + 4.0 hours. All the children were discharged fully ambulatory and did not require rehospitalization or repeat aspiration after discharge.

Conclusions
This case series shows that POCUS-guided hip aspiration is both safe and feasible in diagnosing septic hip in the pediatric emergency department. The procedure enables rapid diagnosis and early initiation of antibiotic treatment, thus reducing the risk for complications related to delayed initiation of therapy.
A Review of the Diagnosis and Management of Acute Flaccid Myelitis in the Emergency Department
Authors: Daniels Danielle K. , Conners Gregory P. 
Published: February 2022

Abstract
Since 2014, biennial rises in acute flaccid myelitis (AFM) have brought attention to this rare but debilitating condition. Children with AFM typically present with acute onset, flaccid weakness accompanied by longitudinally extensive gray matter injury demonstrated on magnetic resonance imaging. A clearer understanding of the epidemiology and suspected pathogenesis of AFM may result in increased recognition. The purpose of this review article is to guide emergency physicians in recognizing key clinical features, initiating diagnostic evaluation and providing appropriate interventions for children with suspected AFM.
Arcade Suture Upper Blepharoplasty Combined With the Forceps Technique
Authors: Chuang Chih-Chao , Ma Hsu , Liao Wen-Chieh 
Published: February 2022

Background
Double-eyelid blepharoplasty is the most popular cosmetic surgery in Taiwan. The creation of a small palpebral fold along with reduction of eyelid fullness makes the eye look slightly larger, thereby leading to an appearance of youthfulness, alertness, and vitality. Herein, we propose a method of combining the techniques of arcade buried suture and forceps, which is designed to create a more physiologically natural double eyelid.

Materials and Methods
We conducted a retrospective review of 45 patients who underwent double-eyelid surgery between December 2015 and December 2019. The procedures were performed by one senior surgeon using arcade suture upper blepharoplasty combined with the forceps technique. The patients' age ranged from 18 to 38 years (mean, 28 years). Ninety-one percent of the patients were women and were undergoing surgery for cosmetic reasons.

Results
Of the 45 patients who underwent arcade suture upper blepharoplasty with the forceps technique, no patients developed stitch abscess or granuloma, obvious asymmetry, disappearance of line, chemosis, and corneal injury. The follow-up period ranged from 3 months to 4 years (mean, 32 months). Patient satisfaction was very high.

Conclusions
The arcade suture upper blepharoplasty combined with the forceps technique is a simple method for establishing a durable double eyelid without serious complication and providing excellent results.
Prognostic Role of Subsequent Thrombocytopenia in Necrotizing Fasciitis Without Liver Disease
Authors: Chen Yu-Ching , Liou Yaw-Tzeng , Tsai Wei-Hsuan , Chen Lee-Wei 
Published: February 2022

Background
Necrotizing fasciitis (NF) is a life-threatening disease with a fulminant presentation. Although early diagnosis can be aided by combining physical examination, the Laboratory Risk Indicator for Necrotizing Fasciitis score, and computed tomography, a mortality rate of 30% is still reported. In the modern times, an economical and efficient biomarker for predicting mortality in NF patients is still lacking. Platelet count is typically measured in routine blood tests and aids in predicting disease severity. We aimed to clarify the role of platelet count as a predictive factor for aspects of prognosis, such as mortality and surgical outcomes, in patients with NF.

Methods
We identified 285 patients with NF between 2018 and 2020 in a single medical center in southern Taiwan. Medical records were collected for the evaluation of patients with thrombocytopenia. Univariate and multivariate analyses were performed for different outcomes.

Results
We included 115 patients with confirmed diagnoses of NF. Twelve patients died with a mortality rate of 10.4%. Patients with thrombocytopenia exhibited a higher mortality rate (20.9% vs 4.2%, P = 0.006), more shock episodes (51.2% vs 11.1%, P < 0.001), higher intensive care unit admission rate (46.5% vs 13.9%, P < 0.001), and longer hospital length of stay (37.49 ± 24.12 days vs 28.82 ± 14.63 days, P = 0.037) than those without thrombocytopenia. All patients infected with Vibrio species exhibited thrombocytopenia. In multivariate analysis, independent risk factors for mortality were thrombocytopenia (odds ratio, 4.57; 95% confidence interval, 1.08–19.25) and single gram-negative bacterial culture from the wound (odds ratio 6.88; 95% confidence interval, 1.58–29.96).

Conclusions
In patients with NF and subsequent thrombocytopenia, a higher mortality rate, greater numbers of shock episodes, higher demand for intensive care unit, and longer hospital length of stay were observed than in those without thrombocytopenia. In patients with NF, platelet count is a valuable and economic indicator of prognosis. Once thrombocytopenia developed in patients with necrotizing fasciitis, aggressive antibiotic treatment and surgical management are required to improve the chances of recovery.
Perioperative Myocardial Infarction in Free Flap for Head and Neck Reconstruction
Authors: Sou Weng-Kit , Perng Cherng-Kang , Ma Hsu , Shih Yu-Chung 
Published: February 2022

Introduction
Acute myocardial infarction (AMI) is a postoperative complication of major surgical procedures, including free flap surgery. It is the most common cause of postoperative morbidity and mortality. Moreover, patients receiving free flap reconstruction for the head and neck have significant risk factors such as coexisting coronary artery disease (CAD). Our primary aim was to ascertain predictors of perioperative AMI to enable early detection and consequently early treatment of perioperative AMI. Our secondary aim was to determine the group of patients who would be at a high risk for perioperative AMI after free flap surgery.

Materials and Methods
This retrospective study enrolled patients who underwent free flap reconstruction surgery at the Division of Plastic and Reconstructive Surgery of Taipei Veterans General Hospital between 2013-01 and 2017-12.

Results
This study included 444 patients and 481 free flap head and neck reconstruction surgeries. Fifteen (3.1%) patients were diagnosed with perioperative AMI. Statistical analysis of the variables revealed that patients with underlying CAD or cerebrovascular accident (CVA) were at a high risk of developing perioperative AMI (odds ratio: 6.89 and 11.11, respectively). The flap failure rate was also higher in patients with perioperative AMI compared with those without perioperative AMI (P = 0.015).

Conclusions
Patients with underlying diseases, such as CAD or CVA, constituted high-risk groups for perioperative AMI.
Kimura Disease of the Thigh Treated With Surgical Excision and Dupilumab
Authors: Huang Hsuan-Yu , Yang Chin-Yi , Yao Wen-Teng , Chen Yu-Fan , Yu Chia-Meng , Tung Kwang-Yi , Tsai Ming-Feng 
Published: February 2022

Abstract
Kimura disease (KD) is a rare, chronic inflammatory disorder presenting with solitary or multiple masses. Treatment options include surgical excision, corticosteroids, and radiotherapy; however, optimal therapy remains to be established. Moreover, efficacy of a humanized monoclonal antibody, dupilumab (Dupixent), requires to be demonstrated. Here, we present a 36-year-old male patient with an enlarging mass in the left medial thigh and chronic eczema over the abdomen and lower legs. Kimura disease was diagnosed after surgical excision. Postoperative treatment with dupilumab was applied with an initial dose of 600 mg followed by 300 mg every 2 weeks for 8 months. No recurrence of KD was observed in the 1-year follow-up. The eczematous lesions improved greatly. To our knowledge, this is the first report of using dupilumab for treating KD.
A Monte Carlo based approach to the resource assessment of Jamaica's geothermal energy potential
Authors: Koon Koon Randy , Lewis Santana , Mohammed-Koon Koon Khatiza , Chen A. Anthony , Shah Kalim U. 
Published: February 2022

The Eastern Caribbean chain of islands is commonly known to exhibit high-enthalpy systems for geothermal energy exploitation. The northernmost Caribbean Community member state of Jamaica possesses physical manifestations of 12 hot springs across the island. Previous investigations indicate that of the potential 12 hot springs, Bath, Windsor and Milk River springs have cogent geothermometry of their thermal fluids with estimated temperature ranges of (80–102°C), (128–156°C), and (158–206°C), respectively. The paper provides numerical findings for each geothermal system of interest and performs Monte Carlo simulations to optimize calculated findings. The determined quantitative findings are considered under the context of environmental savings and policy regime conditions for driving geothermal energy development. The three areas of interest are situated within the Rio Minho Basin, the Dry Harbour Mountains and the Blue Mountain South Basin. Through the consideration of a 25-year lifetime for production, a collective total of 94.81 MWe of geothermal power reserves can be absorbed into the national energy mix, displacing an estimated 0.38 million barrels of oil imports, resulting in approximately 0.44 million tonnes of carbon dioxide emissions being avoided per year.This article is part of the theme issue ‘Developing resilient energy systems’.
Scientific advice for policymakers on climate change: the role of evidence synthesis
Authors: Surkovic Elizabeth , Vigar David 
Published: February 2022

Science has a role to play in providing the evidence on both climate change and the solutions to it. In this paper, we look at the nature of expert advice to public policymakers and examine one approach to the synthesis of scientific evidence. We focus on a series of briefings for policymakers that summarize evidence from 12 areas of science and technology which are keys to accelerating progress towards net zero greenhouse gas emissions and resilience to climate change.
This article is part of the theme issue ‘Developing resilient energy systems’.
Deep Augmentation for Electrode Shift Compensation in Transient High-density sEMG: Towards Application in Neurorobotics
Authors: Sun Tianyun , Libby Jacqueline , Rizzo JohnRoss , Atashzar S. Farokh 
Published: February 2022

AbstractGoing beyond the traditional sparse multichannel peripheral human-machine interface that has been used widely in neurorobotics, high-density surface electromyography (HD-sEMG) has shown significant potential for decoding upper-limb motor control. We have recently proposed heterogeneous temporal dilation of LSTM in a deep neural network architecture for a large number of gestures (>60), securing spatial resolution and fast convergence. However, several fundamental questions remain unanswered. One problem targeted explicitly in this paper is the issue of “electrode shift,” which can happen specifically for high-density systems and during doffing and donning the sensor grid. Another real-world problem is the question of transient versus plateau classification, which connects to the temporal resolution of neural interfaces and seamless control. In this paper, for the first time, we implement gesture prediction on the transient phase of HD-sEMG data while robustifying the human-machine interface decoder to electrode shift. For this, we propose the concept of deep data augmentation for transient HD-sEMG. We show that without using the proposed augmentation, a slight shift of 10mm may drop the decoder’s performance to as low as 20%. Combining the proposed data augmentation with a 3D Convolutional Neural Network (CNN), we recovered the performance to 84.6% while securing a high spatiotemporal resolution, robustifying to the electrode shift, and getting closer to large-scale adoption by the end-users, enhancing resiliency.
Temporally extended and reversible neuronal silencing with Aion
Authors: Rodriguez-Rozada Silvia , Wietek Jonas , Tenedini Federico , Sauter Kathrin , Hegemann Peter , Soba Peter , Wiegert J. Simon 
Published: February 2022

AbstractOptogenetic silencing allows to reveal the necessity of selected neuronal populations for various neurophysiological functions ranging from specific behaviors to neuronal network activity. An ideal optogenetic silencing tool should be switchable between active and inactive states with precise timing while preserving its activity in the absence of light until switched to an inactive state. Although bistable anion-conducting channelrhodopsins (ACRs) were previously engineered to reach this goal, their conducting state life time was limited to only a few minutes and some ACRs were not fully switchable. Here we report Aion, a bistable ACR displaying a long-lasting open state with a spontaneous closing time constant close to 15 min. Moreover, Aion can be switched between the open and closed state with millisecond precision using blue and orange light, respectively. The long conducting state enables overnight silencing of neurons with minimal light exposure. We further generated trafficking-optimized versions of Aion, which show enhanced membrane localization and allow precisely timed, long-lasting all-optical control of nociceptive responses in larvae of Drosophila melanogaster.
Molecular and mineral responses of corals grown under artificial Calcite Sea conditions
Authors: Conci Nicola , Griesshaber Erika , Rivera-Vicéns Ramón E. , Schmahl Wolfgang W. , Vargas Sergio , Wörheide Gert 
Published: February 2022

AbstractThe formation of skeletal structures composed of different calcium carbonate polymorphs (aragonite and calcite) appears to be regulated both biologically and environmentally. Among environmental factors influencing aragonite and calcite precipitation, changes in seawater conditions – primarily in the molar ratio of magnesium and calcium during so-called “Calcite” (mMg:mCa below 2) or “Aragonite” seas (mMg:mCa above 2) – have had profound impacts on the distribution and performance of marine calcifiers throughout the Earth’s history. Nonetheless, the fossil record shows that some species appear to have counteracted such changes and kept their skeleton polymorph unaltered. Here, the aragonitic octocoralHeliopora coeruleaand the aragonitic scleractinianMontipora digitatawere exposed to Calcite Sea-likemMg:mCa with various levels of changes in magnesium and calcium concentration, and both mineralogical (i.e., CaCO3polymorph) and gene expression changes were monitored. Both species maintained aragonite deposition at lowermMg:mCa ratios, while concurrent calcite presence was only detected inM. digitata. Despite a strong variability between independent experimental replicates for both species, the expression for a set of putative calcification-related genes, including known components of scleractinian skeleton organic matrix, was found to consistently change at lowermMg:mCa. These results support previously proposed involvements of the skeleton organic matrix in counteracting decreases in seawatermMg:mCa. Although no consistent changes in expression for calcium and magnesium transporters were observed, down-regulation calcium channels inH. coeruleain one experimental replicate and at anmMg:mCa of 2.5 might indicate the possibility of active calcium uptake regulation by the corals under alteredmMg:mCa.
Agent-based models help interpret patterns of clinical drug resistance by contextualizing competition between distinct drug failure modes
Authors: Leighow Scott M , Landry Benjamin , Lee Michael J. , Peyton Shelly R. , Pritchard Justin R. 
Published: February 2022

Structured AbstractIntroductionModern targeted cancer therapies are carefully crafted small molecules. These exquisite technologies exhibit an astonishing diversity of failure modes (drug resistance mechanisms) in the clinic. This diversity is surprising because back of the envelope calculations and classic modeling results in evolutionary dynamics suggest that the diversity in the modes of clinical drug resistance should be considerably smaller than what is observed. These same calculations suggest that known microenvironmental resistance mechanisms should not be able to compete for outgrowth with genetic resistance within a tumor, and yet evidence of microenvironmental resistance is often observed in the clinic. Quantitatively understanding the underlying biological mechanisms of failure mode diversity may improve the next generation of targeted anticancer therapies. It also provides insights into how intratumoral heterogeneity might shape interpatient diversity during clinical relapse.Materials and MethodsWe employed spatial agent-based models to explore regimes where spatial constraints enable microenvironmental resistance to significantly compete with genetically resistant subclones. In order to parameterize a model of microenvironmental resistance, BT20 cells were cultured in the presence and absence of fibroblasts from 16 different tissues. The degree of resistance conferred by cancer associated fibroblasts (CAFs) in the tumor microenvironment was quantified by treating mono- and co-cultures with letrozole and then measuring the death rates.Results and DiscussionOur simulations indicate that, even when a mutation is more drug resistant, its outgrowth can be delayed by abundant, low magnitude microenvironmental resistance across large regions of a tumor. These observations hold for different modes of microenvironmental resistance, including juxtacrine signaling, soluble secreted factors, and remodeled ECM. This result helps to explain the remarkable diversity of resistance mechanisms observed in solid tumors, which subverts the presumption that the failure mode that causes the quantitatively fastest growth in the presence of drug should occur most often in the clinic.ConclusionOur model results demonstrate that spatial effects can interact with low magnitude of resistance microenvironmental effects to successfully compete against genetic resistance that is orders of magnitude larger. Clinical outcomes of solid tumors are intrinsically connected to their spatial structure, and the tractability of spatial agent-based models like the ones presented here enable us to understand this relationship more completely.
Trophic strategies explain the ocean niches of small eukaryotic phytoplankton
Authors: Edwards Kyle F. , Li Qian , McBeain Kelsey A. , Schvarcz Christopher R. , Steward Grieg F. 
Published: February 2022

AbstractA large fraction of marine primary production is performed by diverse small protists, and many of these phytoplankton are mixotrophs that also consume bacterial prey. However, the mechanisms structuring this diversity and its biogeochemical consequences remain poorly understood. Here we use isolates from seven major taxa to demonstrate tradeoffs between phototrophic and phagotrophic abilities. We then show that trophic strategy along the autotrophy-mixotrophy spectrum correlates strongly with global niche differences, across depths and across gradients of stratification and chlorophyll a. A model of competition shows that community shifts can be explained by greater fitness of faster-grazing mixotrophs when nutrients are scarce and light is plentiful. Our results illustrate how basic physiological constraints and principles of resource competition can organize complexity in the surface ocean ecosystem.