Clinical Outcomes of Angiotensin Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers in COVID-19 Patients With Pre-existing Cardiac Comorbidities: A Literature Review.

The growing research regarding the implementation of angiotensin-converting enzyme-2 inhibitors (ACEi) and angiotensin receptor blockers (ARBs) in the treatment of COVID-19 in patients with pre-existing cardiac comorbidities has become a large topic of discussion since the onset of the pandemic. Previous research primarily associates positive outcomes to the use of these drug classes due to their mechanism of action, which involves the downregulation of angiotensin I-converting enzyme 2 (ACE2) in the renin-angiotensin-aldosterone-system (RAAS) pathway, inflammatory mediators, and cytokines. Thus, these medications can convey preventative and protective effects in patients suffering from a SARS-CoV-2 infection. While we explored the studies that supported the positive outcomes of the use of these drugs in the first half of this review, we also expanded on the limitations of these studies in the latter portion. We also further explored the contradictory studies that indicated that using these antihypertensives can paradoxically increase the severity of COVID-19 infection as well. The studies in support of the use of these medications should consider epigenetic variations, ACE2 variants and acknowledge inherent genetic variations in certain ethnic groups as some have a predisposition for a severe COVID-19 infection. Additionally, mortality rates need to be taken into consideration in these studies as they naturally differ throughout the trajectory of the COVID-19 pandemic. While some studies are in support of the use of these antihypertensives despite other studies suggesting otherwise, further research is needed to explore the long-term effects of these antihypertensives and observe whether they are truly beneficial or not in reducing the severity of COVID-19 infections.

Flaws and all: How mindfulness reduces error hiding by enhancing authentic functioning.

Hiding errors can undermine safety by amplifying the risks of undetected errors. This article extends research on occupational safety by investigating error hiding in hospitals and applies self-determination theory to examine how mindfulness decreases error hiding through authentic functioning. We examined this research model in a randomized control trial (mindfulness training vs. active control group vs. waitlist control group) within a hospital setting. First, we used latent growth modeling to confirm that our variables were related as hypothesized, both statically or cross-sectionally as well as dynamically as they evolved over time. Next, we analyzed whether changes in these variables were a function of the intervention and confirmed the effects of the mindfulness intervention on authentic functioning and indirectly on error hiding. To elaborate on the role of authentic functioning, in a third step, we qualitatively explored the phenomenological experience of change experienced by participants in mindfulness and Pilates training. Our findings reveal that error hiding is attenuated because mindfulness encourages a receptive view of one's whole self, and authentic functioning enables an open and nondefensive way of relating to positive and negative information about oneself. These results add to research on mindfulness in organizations, error hiding, and occupational safety. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

What do people mean when they talk about mindfulness?

Psychological theories cast mindfulness as a form of awareness in which accepting the presence of stressful thoughts and feelings facilitates engaged exploration and identification of adaptive responses. Critics of mindfulness' popularization suggest that lay people misconstrue acceptance as a passive endorsement of experience, undermining engaged problem-solving. To evaluate this criticism, we traced the contemporary semantic meaning of mindfulness in three of the most extensive linguistic corpora of English language and found that general public's depictions of mindfulness highlight engagement-related processes. We further analyzed the nomological network of mindfulness. While mindfulness theories suggest a general convergence of facets representing awareness and acceptance, in a meta-analysis (k = 145; N = 41,966) of the Five Facet Mindfulness Questionnaire only expert- and clinical samples reported convergence, whereas lay people showed absent or even antagonistic associations. Further, contrary to the synergistic model of awareness and acceptance contributing to greater engagement, empirical probes of two lay samples (Ntotal = 406) show that acceptance is either unrelated or inversely related to markers of engagement. To overcome resulting conceptual and methodological challenges, we highlight the need for a contextualized mindfulness framework whereby acceptance enables the process of engaging with life's challenges rather than avoiding them.

The Role of Individual and Collective Mindfulness in Promoting Occupational Safety in Health Care.

Although the importance of safety regulations is highly emphasized in hospitals, nurses frequently work around, or intentionally bypass, safety regulations. We argue that work-arounds occur because adhering to safety regulations usually requires more time and work process design often lacks complementarity with safety regulations. Our main proposition is that mindfulness is associated with a decrease in occupational safety failures through a decrease in work-arounds. First, we propose that individual mindfulness may prevent the depletion of motivational resources caused by worrying about the consequences of time lost when adhering to safety regulations. Second, we argue that collective mindfulness may provide nursing teams with a cognitive infrastructure that facilitates the detection and adaptation of work processes. The results of a multilevel analysis of 580 survey responses from nurses are consistent with our propositions. Our multilevel analytic approach enables us to account for the unique variance in work-arounds that individual and collective mindfulness explain.

The researcher as experimental subject: using self-experimentation to access experiences, understand social phenomena, and stimulate reflexivity.

The current article argues that researcher-as-subject self-experimentation can provide valuable insight and systematic knowledge to social psychologists. This approach, the modus operandi of experimental psychology when the field was in its infancy, has been largely eclipsed by an almost exclusive focus on participant-as-subject other-experimentation. Drawing from the non-experimental first-person traditions of autoethnography, participant observation, and phenomenology, we argue that participating as both observer and subject within one's own social psychological experiment affords researchers at least three potential benefits: (1) access to "social qualia," that is, the subjective experience of social phenomena; (2) improved mental models of social phenomena, potentially stimulating new research questions; and (3) an enhanced ability to be reflexive about the given experiment. To support our position, we provide first-person self-reflections from researchers who have self-experimented with transformed social interactions involving Milgram's cyranoid method. We close by offering guidelines on how one might approach self-experimentation, and discuss a variety of first-person perspective ethnographic technologies that can be incorporated into the practice.

Exsanguination by intent: controlled phlebotomy during resection of a giant vascular malformation in a 22-month-old child.

Resection of large vascular malformations may require transection across the lesion, resulting in uncontrollable bleeding with the risk of exsanguination or massive transfusion-related complications such as hyperkalemic cardiac arrest. We present the anesthetic management of a 22-month-old child with a giant vascular malformation who required surgical intervention because of increasing pain and bleeding from the lesion. As a standard resection carried a high risk of mortality for the patient, a novel surgical approach was performed, consisting of gradual compression of the lesion, reducing its base to allow transection across the smallest possible area. This compression resulted in acute massive autotransfusion managed by therapeutic phlebotomy of more than twice the circulating blood volume of the patient, guided by CVP and blood pressure. Although subsequent resection was still associated with large blood loss, the hemodynamic course of the patient was stable, and both bleeding and massive transfusion occurred in a controlled fashion allowing safe and successful resection of the malformation.

Correlation between computed tomography and bone single photon emission-computed tomography scintigraphy in patients with chronic rhinosinusitis.

BACKGROUND: Computed tomography (CT) has been the imaging study of choicefor evaluating chronic rhinosinusitis (CRS). 99mTc-MDP bone single photon emission-computed tomography (SPECT) has proven useful at identifying inflammation of bone and its use in CRS has been discussed recently. No studies, however, have documented the correlation between these two imaging modalities in CRS. METHODS: A retrospective analysis was performed of 30 patients with CRS who underwent CT and SPECT scan of the paranasal sinuses. Increased radiotracer uptake during SPECT scan was compared with CT findings graded on the Lund-Mackay score (LMS). The findings of the two imaging modalities were compared and evaluated for standard correlative statistics for diagnostic tests. RESULTS: SPECT imaging was abnormal in 25/30 patients, and CT was abnormal in 27/30 patients. Correlation between the two was highest for the ethmoid sinuses at 73.3%. SPECT had a high positive predictive value for mucosal inflammation on CT of 84.1%. Approximately 25% of individual sinuses with a positive SPECT in patients without prior surgery were not positive in corresponding sinuses onl CT. There was a positive correlation between the LMS and the number of SPECT positive sinuses within the same patient (r = 0.486; p = 0.006). CONCLUSION: 99mTc-MDP SPECT scan in patients with CRS is shown to be a useful indicator of bone involvement. The relatively high rate of bone involvement in the absence of mucosal inflammation as seen in this study warrants additional research and the potential need for different therapies than are currently available.

Office versus operating room insertion of the bone-anchored hearing aid: a comparative analysis.

BACKGROUND: The Bone-anchored Hearing Aid is indicated for patients with unilateral deafness and/or an irreversible conductive hearing loss. The insertion of this device is usually performed in the operating room under intravenous sedation or general anesthesia. We suggest that the placement of the abutment can occur easily and safely in the clinic setting, reducing time and costs for both the patient and the physician. STUDY DESIGN: Retrospective study. METHODS: Ten patients requiring 11 devices (1 bilateral) were implanted with the Bone-anchored Hearing Aid device in the outpatient clinic and another 8 patients were implanted in the operating room. All office procedures were done under local anesthesia; operating room procedures used either general anesthesia or intravenous sedation. Follow-up occurred over 12 months. Time required, cost of the procedure, and other logistical concerns between operating room and office-based insertion were evaluated and compared. RESULTS: When performed in the office, patient fees were reduced by 31%, and patient time investment was reduced 73%. Physician time was reduced by 50%. After office-based insertion, patients were able to return to their normal routine immediately after the procedure, and no chaperone or designated driver was required. No infection or complications occurred in either group. CONCLUSION: Bone-anchored Hearing Aid insertion in the clinic setting is safe and cost-effective, saving the patient and physician significant time and resources.

Surgical reconstruction of lentigo maligna defects.

OBJECTIVE: To review our experience with lentigo maligna, a melanoma in situ that occurs primarily on the head and neck in older adults, and reconstructive efforts applied in managing the large defects following lentigo maligna excision that are not amenable to primary closure. METHODS: We reviewed the records of 23 patients who underwent serial excision of lentigo maligna using a modified Mohs technique. We compared the sizes of the initial lesion and postexcision defect, examined photographs taken before and after surgery, and studied techniques used in reconstruction. RESULTS: The final surgical defect after staged Mohs excision of lentigo maligna lesions ranged from 2 to 10 times the original lesion size. Invasive melanoma was identified in 2 surgical specimens on pathologic evaluation. We reviewed successful reconstructive techniques including local flaps and tissue expansion. CONCLUSIONS: Surgical excision remains the standard of care for lentigo maligna. Because of the subclinical spread and extensive radial growth characteristic of these lesions, patients are often left with large defects that are not amenable to primary closure. Appropriate preoperative patient counseling includes preparation for the possibility of a large surgical defect that requires staged reconstruction. Creative techniques, including local flaps and tissue expansion, must be in the head and neck reconstructive surgeon's armamentarium for the management of defects following lentigo maligna excision.

Indene bioconversion by a toluene inducible dioxygenase of Rhodococcus sp. I24.

Rhodococcus sp. I24 can oxygenate indene via at least three independent enzyme activities: (i) a naphthalene inducible monooxygenase (ii) a naphthalene inducible dioxygenase, and (iii) a toluene inducible dioxygenase (TID). Pulsed field gel analysis revealed that the I24 strain harbors two megaplasmids of approximately 340 and approximately 50 kb. Rhodococcus sp. KY1, a derivative of the I24 strain, lacks the approximately 340 kb element as well as the TID activity. Southern blotting and sequence analysis of an indigogenic, I24-derived cosmid suggested that an operon encoding a TID resides on the approximately 340 kb element. Expression of the tid operon was induced by toluene but not by naphthalene. In contrast, naphthalene did induce expression of the nid operon, encoding the naphthalene dioxygenase in I24. Cell free protein extracts of Escherichia coli cells expressing tidABCD were used in HPLC-based enzyme assays to characterize the indene bioconversion of TID in vitro. In addition to 1-indenol, indene was transformed to cis-indandiol with an enantiomeric excess of 45.2% of cis-(1S,2R)-indandiol over cis-(1R,2S)-indandiol, as revealed by chiral HPLC analysis. The Km of TID for indene was 380 microM. The enzyme also dioxygenated naphthalene to cis-dihydronaphthalenediol with an activity of 78% compared to the formation of cis-indandiol from indene. The Km of TID for naphthalene was 28 microM. TID converted only trace amounts of toluene to 1,2-dihydro-3-methylcatechol after prolonged incubation time. The results indicate the role of the tid operon in the bioconversion of indene to 1-indenol and cis-(1S,2R)-indandiol by Rhodococcus sp. I24.