bluuebunny/crossref_metadata_2025 huggingface dataset:
Media Metacommentary, Mediatization, and the Instability of Expertise
Authors: Townsley Eleanor
Published: April 2023

Media metacommentary—a form of media criticism in which the comparison of media formats and media texts is the basis for critical judgment—is analyzed as a case study of how media have transformed expertise in the last half century. A close reading of John Oliver’s use of media metacommentary documents the way his performances simultaneously rely on and destabilize other expert claims. The net result is to accelerate the destabilization of all expert performances. Oliver’s critical performances are also transmedia narratives, which unfold in real time beyond the moment of performance and shape the media practices of his audience, other journalists, and political principals. As transmedia, these performances both leverage the widespread mediatization of society, where pervasive media logics have reshaped and connected all other social institutions, and also stitch together the attention of diverse audiences to craft authentic collective narratives and invoke large democratic publics. Critical media expertise in the new media environment is not only required for all expert performances, then, but also for the constitution of democratic publics.
A Regulatory State of Exception
Authors: Lakoff Andrew
Published: April 2023

This chapter addresses the question of “public trust” in regulatory science by examining the role of experts and government officials in the authorization of a COVID vaccine. It focuses on the period during summer and fall 2020 when there was a widespread public discussion around the vaccine regulation process. The chapter examines how, at this critical moment, key actors defended the autonomy of the regulatory process. An alliance of academic scientists, federal agency staff, and drug-industry leaders drew on the specter of vaccine hesitancy to fend off political interference. Trust in the safety of technical objects such as vaccines is often seen to depend on the objectivity of experts and the autonomy of regulatory agencies; however, the converse was the case here: experts and regulatory officials used the construct of public trust as a means to preserve their autonomy.
Experts in Law
Authors: Golan Tal
Published: April 2023

No other modern institution has explored the application of technoscientific expertise in the pursuit of truth and justice for longer and in more depth than the law. Science has long provided the law with evidence and facts, and the law has provided science with a stage and authority. As science grew influential and authoritative, the legal system was pressed to differentiate genuine scientific expertise from charlatanism and to allow only the first kind into the courtroom. The task has proven to be challenging. This chapter describes and analyses the efforts that led the American judiciary ever deeper into exotic scientific territories of experimental protocols and error rates, charged with the awkward duty of weighing the merit of highly specialized claims.
Taxation
Authors: Beramendi Pablo
Published: April 2023

This chapter outlines the central elements of a historical political economy of taxation. It begins by mapping its main trends and conceptualizing tax development as a collective action problem over an investment that generates potential long-run benefits and certain short-term costs. Thereafter it outlines the conditions under different political responses that have emerged in different regions of the world, paying specific attention to three factors: geography, institutions, and the interdependency between domestic and international factors. The chapter ends with a brief analysis of the distributional implications of long-run historical fiscal legacies.
The Cultural Evolution of Religion and Cooperation
Authors: Bendixen Theiss , Lightner Aaron D. , Purzycki Benjamin Grant
Published: April 2023

Since the earliest days of the social sciences, the relationship between religion and cooperation has been a central topic. In this chapter, we critically review popular cultural evolutionary perspectives on religion and cooperation and consider how they frame the relationships between religious beliefs, behaviours, and the moral rules that motivate cooperation. We then offer an account of how religious systems can contribute to the stability of social life more generally, with cooperative dilemmas occupying a subset of a broader range of socioecological challenges that supernatural appeals might help resolve. We also provide a critical overview of methods used throughout much of the contemporary work on religion and cooperation. In doing so, we provide useful ways forward for testing how appeals to gods, spirits, and other supernatural forces can, in at least some cases, address locally important challenges to cooperation.
Ensuring access to innovative therapies for children, adolescents, and young adults across Canada: The single patient study experience
Authors: Revon-Riviere Gabriel , Young Leah C , Stephenson Elizabeth A , Brodeur-Robb Kathy , Cohen-Gogo Sarah , Deyell Rebecca , Lacaze-Masmonteil Thierry , Palmer Antonia , Parekh Rulan S , Whitlock James A , Morgenstern Daniel A
Published: April 2023

Innovative therapeutic approaches are needed to alleviate the burden of life-limiting, rare, and chronic conditions affecting children, adolescents, and young adults (CAYA). This includes a need for improved access to both clinical research and to non-approved or off-label therapies, together with, ultimately, more therapies achieving regulatory approval in Canada. The single patient study (SPS), also known as an open label individual patient (OLIP) study, was introduced by Health Canada to open access to non-marketed drugs where a clinical trial is not readily available, but the drug is considered too investigational to be managed on a standard Special Access Program. SPS is designed for patients who have a serious or life-threatening condition and have exhausted available treatment options. Our report summarizes this relatively new development in the Canadian regulatory environment and highlights the opportunities and challenges as identified by regulators, pharmaceutical representatives, academic researchers, and patient/parent advocates.
Enhancement of dilepton production rate and electric conductivity around the QCD critical point
Authors: Nishimura Toru , Kitazawa Masakiyo , Kunihiro Teiji
Published: April 2023

We investigate whether the soft mode that becomes massless at the QCD critical point (CP) causes an enhancement of the dilepton production rate (DPR) and electric conductivity around the CP through modification of the photon self-energy using the two-flavor Nambu–Jona-Lasinio model. The modification is described by the so-called Aslamazov–Larkin, Maki–Thompson, and density of states terms, which have been taken into account in our previous study on the DPR near the color-superconducting phase transition, with a replacement of the diquark modes with the soft mode of the QCD CP. We show that the coupling of photons with the soft modes brings about an enhancement of the DPR in the low-invariant-mass region and the conductivity near the CP, which would be observable in relativistic heavy-ion collisions.
The Term Structure of Short Selling Costs
Authors: Weitzner Gregory
Published: April 2023

Short sellers care about (i) how overvalued an asset is and (ii) when the overvaluation will be corrected. Hence, short selling costs should be higher over horizons when negative information is more likely to arrive. This article presents a model formalizing this intuition and tests the model using the put–call parity condition. Forward shorting costs predict future costs and stock returns, consistent with an expectations hypothesis in the shorting market. Additionally, an upward sloping term structure around earnings announcements increases the probability of a negative earnings surprise, evidence that short selling costs are higher over horizons when negative information is more likely to arrive. My findings suggest that the term structure of short selling costs conveys how long overpricings are expected to persist.
Redox-regulation and anti-inflammatory system activation by quercetin-3-O-β-D-glucopyranoside-rich fraction from Spondias mombin leaves: biochemical, reproductive and histological study in rat model of dichlorvos toxicity
Authors: Bukunmi Ogunro Olalekan
Published: April 2023

Objective

This study was designed to investigate the redox-regulation capacity of Spondias mombin leaf fraction rich in Quercetin-3-O-β-D-glucopyranoside (Q3G-RF) in rat model of dichlorvos (DDVP) toxicity.

Method

Male Wistar rats randomly allotted to six groups with 12 rats each were administered appropriate regimens orally – sunflower oil, Q3G-RF (100 mg/kg), dichlorvos (8.8 mg/kg), Q3G-RF (100 mg/kg) + dichlorvos (8.8 mg/kg), Q3G-RF (50 mg/kg) + dichlorvos (8.8 mg/kg), and Q3G-RF (100 mg/kg) + clomid (0.35 mg/kg) for groups 1, 2, 3, 4, 5, and 6 respectively.

Key findings

DDVP reduced the SOD, CAT, GST, GPx, GR, QR, T-SH, GSH, TAC; ALP, ACP, glucose, sialic acid, 3- and 17-β-HSD, TNF-α, IL-6, IL-10, IL-1β, NO, MPO, caspase 3; sperm functions; testosterone, FSH, LH, estradiol, testosterone/estradiol ratio; organ-body weight, body weight, without altering semen volume and semen pH but increased the morphological abnormalities number of sperm cells in head, neck, and tail; level of lipid peroxidation, cholesterol and H2O2 relative to control animals. Co-administration with Q3G-RF or clomid revoked dichlorvos effect relative to the control.

Conclusion

Q3G-RF reversed the induced oxidative stress and inflammation as well as suppressed sperm function and reproductive parameters caused by dichlorvos, suggesting the exploration as a therapeutic agent in managing male fertility disorders.
Surgical Reconstruction of Stage 3 and 4 Pressure Injuries: A Literature Review and Proposed Algorithm from an Interprofessional Working Group
Authors: Awad Samir S. , Stern James D. , Milne Cathy T. , Dowling Shane G. , Sotomayor Ron , Ayello Elizabeth A. , Feo Aguirre Leandro J. , Khalaf Basil Z. , Gould Lisa J. , Desvigne Michael N. , Chaffin Abigail E.
Published: April 2023

OBJECTIVE

Stage 3 and 4 pressure injuries (PIs) present an enormous societal burden with no clearly defined interventions for surgical reconstruction. The authors sought to assess, via literature review and a reflection/evaluation of their own clinical practice experience (where applicable), the current limitations to the surgical intervention of stage 3 or 4 PIs and propose an algorithm for surgical reconstruction.

METHODS

An interprofessional working group convened to review and assess the scientific literature and propose an algorithm for clinical practice. Data compiled from the literature and a comparison of institutional management were used to develop an algorithm for the surgical reconstruction of stage 3 and 4 PIs with adjunctive use of negative-pressure wound therapy and bioscaffolds.

RESULTS

Surgical reconstruction of PI has relatively high complication rates. The use of negative-pressure wound therapy as adjunctive therapy is beneficial and widespread, leading to reduced dressing change frequency. The evidence for the use of bioscaffolds both in standard wound care and as an adjunct to surgical reconstruction of PI is limited. The proposed algorithm aims to reduce complications typically seen with this patient cohort and improve patient outcomes from surgical intervention.

CONCLUSIONS

The working group has proposed a surgical algorithm for stage 3 and 4 PI reconstruction. The algorithm will be validated and refined through additional clinical research.
Sternal Wound Management in Pediatric Cardiac Surgical Patients: A Novel Strategic Interprofessional Approach
Authors: Jha Neerod Kumar , Shafique Muhammad , Thomas Raisy , Pangilinan Cruz Salvacion , Tariq Gulnaz , Kiraly Laszlo
Published: April 2023

OBJECTIVE

Information on sternal wound management in children after cardiac surgery is limited. The authors formulated a pediatric sternal wound care schematic incorporating concepts of interprofessional wound care and the wound bed preparation paradigm including negative-pressure wound therapy and surgical techniques to expedite and streamline wound care in children.

METHODS

Authors assessed knowledge about sternal wound care among nurses, surgeons, intensivists, and physicians in a pediatric cardiac surgical unit regarding the latest concepts such as wound bed preparation, NERDS and STONEES criteria for wound infection, and early use of negative-pressure wound therapy or surgery. Management pathways for superficial and deep sternal wounds and a wound progress chart were prepared and introduced in practice after education and training.

RESULTS

The cardiac surgical unit team members demonstrated a lack of knowledge about the current concepts of wound care, although this improved after education. The newly proposed management pathway/algorithm for superficial and deep sternal wounds and a wound progress assessment chart were introduced into practice. Results in 16 observed patients were encouraging, leading to complete healing and no mortality.

CONCLUSIONS

Managing pediatric sternal wounds after cardiac surgery can be streamlined by incorporating evidence-based current wound care concepts. In addition, the early introduction of advanced care techniques with appropriate surgical closure further improves outcomes. A management pathway for pediatric sternal wounds is beneficial.
Best Practices in Pediatric Oncology Pain Management
Authors: Taam Brittany , Lim Fidelindo
Published: April 2023

Pediatric oncology patients are vulnerable to pain that may be caused by the disease or its treatment, and this symptom can be challenging to manage. This article focuses on the importance of pain control, pain assessment and treatment, and special considerations in pediatric oncology pain management, including preparing children for painful procedures and the family's role in managing pain.
Paving the Way Forward for Evidence-Based Continuing Professional Development
Authors: Jeyakumar Tharshini , Karsan Inaara , Williams Betsy , Fried Joyce , Kane Gabrielle , Ambata-Villanueva Sharon , Bennett Ashleigh , McMahon Graham T. , Paton Morag , Williams Nathaniel , Younus Sarah , Wiljer David
Published: April 2023

Continuing professional development (CPD) fosters lifelong learning and enables health care providers to keep their knowledge and skills current with rapidly evolving health care practices. Instructional methods promoting critical thinking and decision making contribute to effective CPD interventions. The delivery methods influence the uptake of content and the resulting changes in knowledge, skills, attitudes, and behavior. Educational approaches are needed to ensure that CPD meets the changing needs of health care providers. This article examines the development approach and key recommendations embedded in a CE Educator's toolkit created to evolve CPD practice and foster a learning experience that promotes self-awareness, self-reflection, competency, and behavioral change. The Knowledge-to-Action framework was used in designing the toolkit. The toolkit highlighted three intervention formats: facilitation of small group learning, case-based learning, and reflective learning. Strategies and guidelines to promote active learning principles in CPD activities within different modalities and learning contexts were included. The goal of the toolkit is to assist CPD providers to design educational activities that optimally support health care providers' self-reflection and knowledge translation into their clinical environment and contribute to practice improvement, thus achieving the outcomes of the quintuple aim.
Tumor Necrosis Factor-α Mediates Inflammation-induced Early-Stage Left Ventricular Systolic Dysfunction
Authors: Manilall Ashmeetha , Mokotedi Lebogang , Gunter Sulè , Le Roux Regina , Fourie Serena , Flanagan Colleen A. , Millen Aletta M. E.
Published: April 2023

Elevated systemic inflammation contributes to pathogenesis of heart failure with preserved ejection fraction (HFpEF), but molecular mechanisms are poorly understood. Although left ventricular (LV) diastolic dysfunction is the main cause of HFpEF, subclinical systolic dysfunction also contributes. We have previously shown that rats with collagen-induced arthritis (CIA) have systemic inflammation, LV diastolic dysfunction, and that increased circulating TNF-α contributes to inflammation-induced HFpEF pathogenesis, but does not mediate LV diastolic dysfunction in CIA rats. Contribution of systemic inflammation to dysfunction of the active process of LV diastolic and systolic function are unknown. In the present study, we used the CIA rat model to investigate the effects of systemic inflammation and TNF-α blockade on systolic function, and mRNA expression of genes involved in active diastolic relaxation and of myosin heavy chain (MyHC) isoforms. Collagen inoculation and TNF-α blockade did not affect LV mRNA expression of genes that mediate active LV diastolic function. Collagen-induced inflammation impaired LV global longitudinal strain (P = 0.03) and velocity (P = 0.04). This impairment of systolic function was prevented by TNF-α blockade. Collagen inoculation decreased mRNA expression of α-MyHC (Myh6, P = 0.03) and increased expression of β-MyHC (Myh7, P = 0.0002), a marker, which is upregulated in failing hearts. TNF-α blockade prevented this MyHC isoform-switch. These results show that increased circulating TNF-α changes the relative expression of MyHC isoforms, favoring β-MyHC, which may underlie changes in contractile function that impair systolic function. Our results indicate that TNF-α initiates early-stage LV systolic, rather than LV diastolic dysfunction.
Why is the Implementation of Beta-Lactam Therapeutic Drug Monitoring for the Critically Ill Falling Short? A Multicenter Mixed-Methods Study
Authors: Barreto Erin F. , Chitre Pooja N. , Pine Kathleen H. , Shepel Kathryn K. , Rule Andrew D. , Alshaer Mohammad H. , Abdul Aziz Mohd Hafiz , Roberts Jason A. , Scheetz Marc H. , Ausman Sara E. , Moreland-Head Lindsay N. , Rivera Christina G. , Jannetto Paul J. , Mara Kristin C. , Boehmer Kasey R.
Published: April 2023

Background:

Beta-lactam therapeutic drug monitoring (BL TDM; drug level testing) can facilitate improved outcomes in critically ill patients. However, only 10%–20% of hospitals have implemented BL TDM. This study aimed to characterize provider perceptions and key considerations for successfully implementing BL TDM.

Methods:

This was a sequential mixed-methods study from 2020 to 2021 of diverse stakeholders at 3 academic medical centers with varying degrees of BL TDM implementation (not implemented, partially implemented, and fully implemented). Stakeholders were surveyed, and a proportion of participants completed semistructured interviews. Themes were identified, and findings were contextualized with implementation science frameworks.

Results:

Most of the 138 survey respondents perceived that BL TDM was relevant to their practice and improved medication effectiveness and safety. Integrated with interview data from 30 individuals, 2 implementation themes were identified: individual internalization and organizational features. Individuals needed to internalize, make sense of, and agree to BL TDM implementation, which was positively influenced by repeated exposure to evidence and expertise. The process of internalization appeared more complex with BL TDM than with other antibiotics (ie, vancomycin). Organizational considerations relevant to BL TDM implementation (eg, infrastructure, personnel) were similar to those identified in other TDM settings.

Conclusions:

Broad enthusiasm for BL TDM among participants was found. Prior literature suggested that assay availability was the primary barrier to implementation; however, the data revealed many more individual and organizational attributes, which impacted the BL TDM implementation. Internalization should particularly be focused on to improve the adoption of this evidence-based practice.
Identification of Adult Patients With Classical Dyskeratosis Congenita or Cryptic Telomere Biology Disorder by Telomere Length Screening Using Age-modified Criteria
Authors: Tometten Mareike , Kirschner Martin , Meyer Robert , Begemann Matthias , Halfmeyer Insa , Vieri Margherita , Kricheldorf Kim , Maurer Angela , Platzbecker Uwe , Radsak Markus , Schafhausen Philippe , Corbacioglu Selim , Höchsmann Britta , Matthias Wilk C. , Hinze Claas , Chromik Jörg , Heuser Michael , Kreuter Michael , Koschmieder Steffen , Panse Jens , Isfort Susanne , Kurth Ingo , Brümmendorf Tim H. , Beier Fabian
Published: April 2023

Telomere biology disorders (TBD) result from premature telomere shortening due to pathogenic germline variants in telomere maintenance-associated genes. In adults, TBD are characterized by mono/oligosymptomatic clinical manifestations (cryptic TBD) contributing to severe underdiagnosis. We present a prospective multi-institutional cohort study where telomere length (TL) screening was performed in either newly diagnosed patients with aplastic anemia (AA) or if TBD was clinically suspected by the treating physician. TL of 262 samples was measured via flow-fluorescence in situ hybridization (FISH). TL was considered suspicious once below the 10th percentile of normal individuals (standard screening) or if below 6.5 kb in patients >40 years (extended screening). In cases with shortened TL, next generation sequencing (NGS) for TBD-associated genes was performed. The patients referred fell into 6 different screening categories: (1) AA/paroxysmal nocturnal hemoglobinuria, (2) unexplained cytopenia, (3) dyskeratosis congenita, (4) myelodysplastic syndrome/acute myeloid leukemia, (5) interstitial lung disease, and (6) others. Overall, TL was found to be shortened in 120 patients (n = 86 standard and n = 34 extended screening). In 17 of the 76 (22.4%) standard patients with sufficient material for NGS, a pathogenic/likely pathogenic TBD-associated gene variant was identified. Variants of uncertain significance were detected in 17 of 76 (22.4%) standard and 6 of 29 (20.7%) extended screened patients. Expectedly, mutations were mainly found in TERT and TERC. In conclusion, TL measured by flow-FISH represents a powerful functional in vivo screening for an underlying TBD and should be performed in every newly diagnosed patient with AA as well as other patients with clinical suspicion for an underlying TBD in both children and adults.
TRPM3 as a novel target to alleviate acute oxaliplatin-induced peripheral neuropathic pain
Authors: Aloi Vincenzo Davide , Pinto Sílvia João Poseiro Coutinho , Van Bree Rita , Luyten Katrien , Voets Thomas , Vriens Joris
Published: April 2023

Chemotherapy-induced peripheral neuropathic pain (CIPNP) is an adverse effect observed in up to 80% of patients of cancer on treatment with cytostatic drugs including paclitaxel and oxaliplatin. Chemotherapy-induced peripheral neuropathic pain can be so severe that it limits dose and choice of chemotherapy and has significant negative consequences on the quality of life of survivors. Current treatment options for CIPNP are limited and unsatisfactory. TRPM3 is a calcium-permeable ion channel functionally expressed in peripheral sensory neurons involved in the detection of thermal stimuli. Here, we focus on the possible involvement of TRPM3 in acute oxaliplatin-induced mechanical allodynia and cold hypersensitivity. In vitro calcium microfluorimetry and whole-cell patch-clamp experiments showed that TRPM3 is functionally upregulated in both heterologous and homologous expression systems after acute (24 hours) oxaliplatin treatment, whereas the direct application of oxaliplatin was without effect. In vivo behavioral studies using an acute oxaliplatin model for CIPNP showed the development of cold and mechano hypersensitivity in control mice, which was lacking in TRPM3 deficient mice. In addition, the levels of protein ERK, a marker for neuronal activity, were significantly reduced in dorsal root ganglion neurons derived from TRPM3 deficient mice compared with control after oxaliplatin administration. Moreover, intraperitoneal injection of a TRPM3 antagonist, isosakuranetin, effectively reduced the oxaliplatin-induced pain behavior in response to cold and mechanical stimulation in mice with an acute form of oxaliplatin-induced peripheral neuropathy. In summary, TRPM3 represents a potential new target for the treatment of neuropathic pain in patients undergoing chemotherapy.
Behavioral cancer pain intervention dosing: results of a Sequential Multiple Assignment Randomized Trial
Authors: Somers Tamara J. , Winger Joseph G. , Fisher Hannah M. , Hyland Kelly A. , Davidian Marie , Laber Eric B. , Miller Shannon N. , Kelleher Sarah A. , Plumb Vilardaga Jennifer C. , Majestic Catherine , Shelby Rebecca A. , Reed Shelby D. , Kimmick Gretchen G. , Keefe Francis J.
Published: April 2023

Behavioral pain management interventions are efficacious for reducing pain in patients with cancer. However, optimal dosing of behavioral pain interventions for pain reduction is unknown, and this hinders routine clinical use. A Sequential Multiple Assignment Randomized Trial (SMART) was used to evaluate whether varying doses of Pain Coping Skills Training (PCST) and response-based dose adaptation can improve pain management in women with breast cancer. Participants (N = 327) had stage I-IIIC breast cancer and a worst pain score of >5/10. Pain severity (a priori primary outcome) was assessed before initial randomization (1:1 allocation) to PCST-Full (5 sessions) or PCST-Brief (1 session) and 5 to 8 weeks later. Responders (>30% pain reduction) were rerandomized to a maintenance dose or no dose and nonresponders (<30% pain reduction) to an increased or maintenance dose. Pain severity was assessed again 5 to 8 weeks later (assessment 3) and 6 months later (assessment 4). As hypothesized, PCST-Full resulted in greater mean percent pain reduction than PCST-Brief (M [SD] = −28.5% [39.6%] vs M [SD]= −14.8% [71.8%]; P = 0.041). At assessment 3 after second dosing, all intervention sequences evidenced pain reduction from assessment 1 with no differences between sequences. At assessment 4, all sequences evidenced pain reduction from assessment 1 with differences between sequences (P = 0.027). Participants initially receiving PCST-Full had greater pain reduction at assessment 4 (P = 0.056). Varying PCST doses led to pain reduction over time. Intervention sequences demonstrating the most durable decreases in pain reduction included PCST-Full. Pain Coping Skills Training with intervention adjustment based on response can produce sustainable pain reduction.
The Clinical Resource Hub Initiative
Authors: Burnett Kedron , Stockdale Susan E. , Yoon Jean , Ragan Addison , Rogers Matthew , Rubenstein Lisa V. , Wheat Chelle , Jaske Erin , Rose Danielle E. , Nelson Karin
Published: April 2023

Health care systems face challenges providing accessible health care across geographically disparate sites. The Veterans Health Administration (VHA) developed regional telemedicine service focusing initially on primary care and mental health services. The objective of this study is to describe the program and progress during the early implementation. In its first year, the Clinical Resource Hub program provided 244 515 encounters to 95 684 Veterans at 475 sites. All 18 regions met or exceeded minimum implementation requirements. The regionally based telehealth contingency staffing hub met early implementation goals. Further evaluation to review sustainability and impact on provider experience and patient outcomes is needed.
Impacts of Culture on Perceptions of Intimate Partner Violence Among Fijian Indian Women in the United States
Authors: Prasad Shayal S. , Bidwell Julie T. , Murray-García Jann L.
Published: April 2023

Introduction

South Asian women are at a higher risk for experiencing intimate partner violence (IPV) in the United States. Fijian Indian (FI) women are part of the diverse South Asian diaspora; however, there are no published data on their experience with IPV. This phenomenological study (a) examined if FI culture influences how women define, experience, and seek help for IPV and (b) identified impacts these themes have on FI women's IPV-related help-seeking, behaviors in regard to U.S. health systems and law enforcement.

Methods

Ten FI women in California, 18 years and older, who either were born in Fiji or had parents born in Fiji, were recruited through convenience and snowball sampling. Semistructured interviews took place either face-to-face or via Zoom. Transcribed interview data underwent reflective thematic analysis by two members of the research team.

Results

Normalizing and silencing of IPV events are bolstered by cultural practices of (a) familism/collectivism that ask women to prioritize family intactness over their own emotional and physical safety, (b) traditional patriarchal gender roles, (c) threats of shame and judgment within the community, and (d) the gendered hierarchy tenets of some forms of Hinduism. FI women are more inclined to seek help for IPV from within versus outside the family, with healthcare providers and law enforcement described as women's last choices for assistance.

Conclusions

Although a small and regionalized immigrant community, this study of FI women reflects the importance of health and human service providers' understanding of the histories and cultural nuances of the local immigrant populations they serve.
Development of the Acute Care Nurse Practitioner Competencies Scale: An Exploratory and Confirmatory Factor Analysis
Authors: TSAY Shiow-Luan , KAU Kevin , HUANG Sheng-Shiung , CHANG Shu-Chen
Published: April 2023

Background

Nurse practitioners (NPs) play a vital role in healthcare, particularly in acute care settings in Taiwan. The professional competencies of NPs are essential for providing safe and effective care to patients. To date, no measurement tool is available for assessing the clinical competencies of NPs in acute care practices.

Purpose

The aim of this study was to develop and investigate the psychometric properties of the Acute Care Nurse Practitioner Competencies Scale (ACNPCS).

Methods

Mixed-method research was employed using samples of experienced NPs. First, we used a focus group of seven experienced NPs who worked for medical centers, community hospitals, and regional hospitals to identify clinical competencies content. Second, we implemented consensus validation using two rounds of the Delphi study and revised it to a 39-item ACNPCS. Third, we conducted content validity with nine NP experts and modified the competency content to 36 items. Finally, we conducted a national survey of 390 NPs from 125 hospitals to determine the extent to which the NP competency content relates to their clinical practice. To examine the reliability of the tool, we tested the internal consistency reliability and test–retest reliability. Exploratory factor analysis, confirmatory factor analysis, and known-group validity were used to test the construct validity of the ACNPCS.

Results

The Cronbach's alpha coefficient for the overall scale was .92, with subscale coefficients ranging from .71 to .89. Test–retest reliability showed the two scores of the ACNPCS on the two occasions tested to be highly correlated (r = .85, p < .001). Exploratory factor analysis revealed that the scale had six factors: providing healthcare, evaluating care, collaboration, education, care quality/research, and leadership/professionalism. Factor loadings for each factor item ranged from .50 to .80 and explained 72.53% of the total variance in the NPs' competencies. Confirmatory factor analysis indicated that the six-factor model showed satisfactory model fit (χ2 = 780.54, p < .01), and the fit indices met the standards for adequate fit (goodness-of-fit index = .90, comparative fit index = .98, Tucker–Lewis index = .97, root mean square error of approximation = .04, and standardized root mean residual = .04). Known-group validity revealed that the total scores for novice NPs differed significantly from those of expert NPs in terms of the competencies (t = 3.26, p < .001). These results validated the psychometric soundness of the newly developed ACNPCS.

Conclusions

The newly developed ACNPCS exhibited satisfactory reliability and validity, supporting the use of the ACNPCS as a tool to assess the clinical competencies of NPs in acute care settings.
A Molecular Landscape of Stress Urinary Incontinence in Women Suggests an Important Role of Beta-Catenin Signaling in Disease Etiology
Authors: Post Wilke M. , Widomska Joanna , Oosterwijk Egbert , De Witte Ward , Coenen Marieke J. H. , Janssen Dick A. W. , Martens Frank , Cartwright Rufus , Minassian Vatche A. , Penney Kathryn L. , Thomas Laurent F. , Skogholt Anne H. , Stafne Signe N. , Hveem Kristian , Kluivers Kirsten B. , Poelmans Geert
Published: April 2023

Purpose:

Stress urinary incontinence (SUI) represents a major health burden in women, but a thorough understanding of the underlying molecular mechanisms is lacking. Our aim was to further elucidate these mechanisms to ultimately find new treatments.

Materials and Methods:

This study integrated the most significant genes from 4 genome-wide association studies (GWASs) of SUI in women with other genetic, expression, and/or functional evidence from the literature into a molecular landscape. A network enrichment analysis of the top SUI GWAS genes was conducted, followed by an extensive literature search to identify interactions between the proteins encoded by the GWAS genes and proteins/molecules implicated in SUI through other evidence.

Results:

In total, 188 GWAS genes were used for network enrichment analysis that yielded 12 networks, of which 8 were overlapping, with beta-catenin as the central protein. Based on this finding and our literature search, we built a molecular landscape of female SUI that centers on beta-catenin signaling. Other important functional landscape themes are epithelial-mesenchymal transition, NANOG signaling, and female sex hormone signaling.

Conclusions:

The molecular landscape of female SUI that we built based on genetic data provides novel molecular insights that may be instrumental for better understanding the etiology of SUI and developing novel SUI treatments.
The role of the electroencephalogram and evoked potentials after cardiac arrest
Authors: Sandroni Claudio , Grippo Antonello , Westhall Erik
Published: April 2023

Purpose of review

In comatose cardiac arrest survivors, the electroencephalogram (EEG) is the most widely used test to assess the severity of hypoxic–ischemic brain injury (HIBI) and guide antiseizure treatment. However, a wide variety of EEG patterns are described in literature. Moreover, the value of postarrest seizure treatment is uncertain. Absent N20 waves of short-latency somatosensory-evoked potentials (SSEPs) are a specific predictor of irreversible HIBI. However, the prognostic significance of the N20 amplitude is less known.

Recent findings

The increasing adoption of standardized EEG pattern classification identified suppression and burst-suppression as ‘highly-malignant’ EEG patterns, accurately predicting irreversible HIBI. Conversely, continuous normal-voltage EEG is a reliable predictor of recovery from postarrest coma. A recent trial on EEG-guided antiseizure treatment in HIBI was neutral but suggested potential benefits in specific subgroups. A prognostic approach based on the amplitude rather than on the presence/absence of the N20 SSEP wave recently showed greater sensitivity for poor outcome prediction and added potential for predicting recovery.

Standardized EEG terminology and quantitative approach to SSEP are promising for improving the neuroprognostic accuracy of these tests. Further research is needed to identify the potential benefits of antiseizure treatment after cardiac arrest.
In-hospital cardiac arrest
Authors: Soar Jasmeet
Published: April 2023

Purpose of review

To describe our knowledge about in-hospital cardiac arrest (IHCA) including recent developments.

Recent findings

Improving trends in IHCA outcomes appear to have stalled or reversed since the COVID-19 pandemic. There are disparities in care based on patient sex, ethnicity and socioeconomic status that need to be tackled. The increased use of emergency treatment plans that include do-not attempt cardiopulmonary resuscitation recommendations will help to decrease the number of resuscitation attempts. System approaches and strong local leadership through resuscitation champions can improve patient outcomes.

In-hospital cardiac arrest is a global health problem with a 25% survival in high-income settings. There remain significant opportunities to both decrease the incidence of, and outcomes from IHCA.
Devices for assessing microcirculation
Authors: Edul Vanina K. , Gutierrez Facundo J.
Published: April 2023

Purpose of review

Devices for assessing microcirculation at the bedside have been a technological breakthrough in the critical care field. Thanks to this technology, a large body of scientific evidence has highlighted the relevance of microcirculatory disruptions during critical illness. The goal of this review is to analyze the current knowledge concerning microcirculation monitoring, mainly focused on clinically available devices.

Recent findings

New evidence in oxygenation monitoring, advances in hand-held vital microscopes, and improvements in laser-based techniques ensure the possibility of detecting poor resuscitation, testing vascular reactivity, and assessing the effect of therapy during shock and resuscitation.

Currently, there are several methods for microcirculatory monitoring. To properly apply and correctly interpret the information they provide, clinicians should know the fundamental principles and the strengths and weaknesses of the clinically available devices.
The Intersection of Disorders of Gut-Brain Interaction With Avoidant/Restrictive Food Intake Disorder
Authors: Weeks Imani , Abber Sophie R. , Thomas Jennifer J. , Calabrese Samantha , Kuo Braden , Staller Kyle , Murray Helen Burton
Published: April 2023

High rates of overlap exist between disorders of gut-brain interaction (DGBI) and eating disorders, for which common interventions conceptually conflict. There is particularly increasing recognition of eating disorders not centered on shape/weight concerns, specifically avoidant/restrictive food intake disorder (ARFID) in gastroenterology treatment settings. The significant comorbidity between DGBI and ARFID highlights its importance, with 13% to 40% of DGBI patients meeting full criteria for or having clinically significant symptoms of ARFID. Notably, exclusion diets may put some patients at risk for developing ARFID and continued food avoidance may perpetuate preexisting ARFID symptoms. In this review, we introduce the provider and researcher to ARFID and describe the possible risk and maintenance pathways between ARFID and DGBI. As DGBI treatment recommendations may put some patients at risk for developing ARFID, we offer recommendations for practical treatment management including evidence-based diet treatments, treatment risk counseling, and routine diet monitoring. When implemented thoughtfully, DGBI and ARFID treatments can be complementary rather than conflicting.
A Comparison of Etiologies and Characteristics of Solitary Versus Synchronous Pancreatic Masses Undergoing Endoscopic Ultrasound-Guided Biopsy
Authors: Levine Irving , Suchman Kelly , Patel Zankesh , Ghani Maham , Hussein Karim , Ramada Michael , Cubillan Mark Patrick , Garg Shashank , Trindade Arvind J.
Published: April 2023

Objectives

Pancreatic mass lesions are often solitary, although rarely synchronous pancreatic masses are encountered. No study has compared synchronous lesions with solitary lesions in the same population. The aim of the present study was to determine the prevalence, clinical, radiographic, and histologic findings of multiple pancreatic masses on consecutive patients undergoing endoscopic ultrasound (EUS) for pancreatic mass lesion.

Methods

All patients undergoing EUS for pancreatic mass lesions with histologic sampling over a 5-year span were identified. Charts were abstracted for demographics, medical history, radiographic findings, EUS findings, and histology and were reviewed.

Results

A total of 646 patients were identified, of which 27 patients (4.18%) had more than 1 pancreatic mass on EUS or cross-sectional imaging. The 2 groups were comparable with each other in terms of demographic factors and medical history. The 2 cohorts were comparable in location of the largest pancreas lesion and EUS characteristics. Patients with synchronous mass lesions were more likely to have metastatic lesions (P = 0.01). No other differences in histology were noted between the 2 groups.

Conclusions

Patients with multiple pancreatic mass lesions were more likely to have metastatic lesions compared with patients with solitary lesions.
A Real-World Observational Study of the Use and Associated Costs of Treating Neuroendocrine Tumors With Somatostatin Analogs in Canada
Authors: Cheung Winson Y. , LaForty Callahan , Liovas Anna , McKechnie Heather , Loree Jonathan M.
Published: April 2023

Objectives

Somatostatin analogs (SSAs; lanreotide autogel and octreotide long-acting release) are used to treat neuroendocrine tumors; however, factors that influence SSA use are unclear.

Methods

This real-world, observational study collected data from private/public pharmacy claims for patients using SSAs in Canada. Data relating to dosing regimens, injection burden, treatment persistence, and costs were retrospectively analyzed for treatment-naive patients.

Results

Overall, 1545 patients were included in the analysis of dosing regimens, 908 for injection burden, 453 for treatment persistence, and 903 for treatment-associated costs. Compared with lanreotide, treatment with octreotide long-acting release was more likely associated with treatment above the maximum recommended dose (odds ratio, 16.2; 95% confidence interval, 4.3–136.2; P < 0.0001), higher weighted average long-acting SSA injection burden (13.4 vs 12.5, P < 0.0001), and a higher number of rescue medication claims per patient (0.22 vs 0.03, P < 0.0001). Treatment with lanreotide autogel was associated with greater treatment persistence (hazard ratio, 0.58; 95% confidence interval, 0.42–0.80; P = 0.001) and lower mean annual costs of treatment than octreotide long-acting release (Canadian dollars $27,829.35 vs $31,255.49; P < 0.0001).

Conclusions

These findings provide valuable insight into SSA use in clinical settings and may inform treatment selection.
Does Chronic Use of High Dose Proton Pump Inhibitors Increase Risk for Pancreatic Cancer?
Authors: Huber Matthew A. , Nadella Sandeep , Cao Hong , Kallakury Bhaskar , Tucker Robin D. , Gay Martha D. , Shivapurkar Narayan , Edmondson Elijah F. , Yue Yuanzhen , Dou Wenyu , Fang Hong-Bin , Smith Jill P.
Published: April 2023

Objectives

To analyze whether use of proton pump inhibitors increase the risk for pancreatic cancer in a mouse model and human clinical cohorts.

Methods

p48-Cre/LSL-KrasG12D mice that develop precancerous pancreatic intraepithelial neoplasia (PanINs) were treated with low- or high-dose proton pump inhibitors (PPIs) orally for 1 and 4 months. The mechanism for the cholecystokinin receptor 2 (CCK-2R) activation was investigated in vitro. Two resources were employed to analyze the risk of pancreatic cancer in human subjects with PPI use.

Results

Serum gastrin levels were increased 8-fold (P < 0.0001) in mice treated with chronic high-dose PPIs, and this change correlated with an increase (P = 0.02) in PanIN grade and the development of microinvasive cancer. The CCK-2R expression was regulated by microRNA-148a in the p48-Cre/LSL-KrasG12D mice pancreas and in human pancreatic cancer cells in vitro. Proton pump inhibitor consumption in human subjects was correlated with pancreatic cancer risk (odds ratio, 1.54). A validation analysis conducted using the large-scale United Kingdom Biobank database confirmed the correlation (odds ratio, 1.9; P = 0.00761) of pancreatic cancer risk with PPI exposure.

Conclusions

This investigation revealed in both murine models and human subjects, PPI use is correlated with a risk for development of pancreatic cancer.
Defining the Optimal Duration of Neoadjuvant Therapy for Pancreatic Ductal Adenocarcinoma
Authors: Puleo Amanda , Malla Midhun , Boone Brian A.
Published: April 2023

Despite recent advances, pancreatic ductal adenocarcinoma (PDAC) continues to be associated with dismal outcomes, with a cure evading most patients. While historic treatment for PDAC has been surgical resection followed by 6 months of adjuvant therapy, there has been a recent shift toward neoadjuvant treatment (NAT). Several considerations support this approach, including the characteristic early systemic spread of PDAC, and the morbidity often surrounding pancreatic resection, which can delay recovery and preclude patients from starting adjuvant treatment. The addition of NAT has been suggested to improve margin-negative resection rates, decrease lymph node positivity, and potentially translate to improved survival. Conversely, complications and disease progression can occur during preoperative treatment, potentially eliminating the chance of curative resection. As NAT utilization has increased, treatment durations have been found to vary widely between institutions with an optimal duration remaining undefined. In this review, we assess the existing literature on NAT for PDAC, reviewing treatment durations reported across retrospective case series and prospective clinical trials to establish currently used approaches and seek the optimal duration. We also analyze markers of treatment response and review the potential for personalized approaches that may help clarify this important treatment question and move NAT toward a more standardized approach.
Racial Variations in Pain Management and Outcomes in Hospitalized Patients With Acute Pancreatitis
Authors: McHenry Nicole , Shah Ishani , Ahmed Awais , Freedman Steven D. , Kothari Darshan J. , Sheth Sunil G.
Published: April 2023

Objectives

Acute pancreatitis (AP) is a common cause of hospitalization. Black AP patients have higher risk for alcoholic etiology and hospitalization than White patients. We evaluated outcomes and treatment disparities by race in hospitalized AP patients.

Methods

We retrospectively analyzed Black and White AP patients admitted 2008–2018. Primary outcomes were length of stay, intensive care unit admission, 30-day readmissions, and mortality. Secondary outcomes included pain scores, opioid dosing, and complications.

Results

We identified 630 White and 186 Black AP patients. Alcoholic AP (P < 0.001), tobacco use (P = 0.013), and alcohol withdrawal (P < 0.001) were more common among Blacks. There were no differences in length of stay (P = 0.113), intensive care unit stay (P = 0.316), 30-day readmissions (P = 0.797), inpatient (P = 0.718) or 1-year (P = 0.071) mortality, complications (P = 0.080), or initial (P = 0.851) and discharge pain scores (P = 0.116). Discharge opioids were prescribed more frequently for Whites (P = 0.001).

Conclusions

Hospitalized Black and White AP patients had similar treatment and outcomes. Standardized protocols used to manage care may eliminate racial biases. Disparities in discharge opioid prescriptions may be explained by higher alcohol and tobacco use by Black patients.