bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative invasion ecology ofCarpobrotusfrom four continents: responses to nutrients and competition
Authors: Portela Rubén , Barreiro Rodolfo , Alpert Peter , Xu Cheng-Yuan , Webber Bruce L , Roiloa Sergio R
Published: March 2022

Two key hypotheses in invasion biology are that certain traits underlie invasiveness in introduced species, and that these traits are selected for during or after introduction. We tested these hypotheses by focusing on two traits likely to confer invasiveness, high increase in growth in response to increase in nutrients and low decrease in growth in response to competition. We compared four species of Carpobrotus that differ in invasiveness, using species from four continents: Africa, Australia, Europe and North America. To test for selection for these traits in Carpobrotus edulis, a highly invasive species, we compared plants from its native range in South Africa to plants from the other three regions, where C. edulis has been introduced. Plants were propagated in a common garden. Offspring were then grown alone with or without added nutrients, and together with another species of Carpobrotus or with the grass Ammophila arenaria (a co-occurring native species in Europe) without added nutrients. Response to nutrients did not differ between species of Carpobrotus, nor was competitive response less negative in more invasive species. However, increase in growth in response to added nutrients was greater in introduced than in native C. edulis. Moreover, fresh mass per ramet at the start of treatments was higher in the two invasive species than in the two non-invasive ones. We provide new evidence that introduction can select for response to nutrient enrichment in invasive species and add to the evidence for an association between size and invasiveness in introduced plants.
Diagnosis and management of rectal syphilis—case report
Authors: Afzal Zeeshan , Hussein Adam , O’Donovan M , Bowden David , Davies Richard J , Buczacki Simon
Published: March 2022

The incidence and prevalence of syphilis are rising worldwide. Rectal syphilis is a rare condition with few reported cases in the literature and therefore often missed from differential diagnosis of atypical anorectal ulceration. We report a case of a 64-year-old male who presented with change in the bowel habit and a palpable rectal mass on examination. Colonoscopy revealed a small, ulcerated lesion in the rectum. However, histopathological analysis and radiological assessments were inconclusive. A cutaneous ulceration prompted a repeat biopsy and staining for spirochaetes, which was diagnostic of syphilitic proctitis. He was successfully treated with first line antibiotics via the Genitourinary Medicine clinic. With its increasing incidence, syphilis should be considered as a potential diagnosis of atypical anorectal ulceration. A complete sexual history including relevant risk factors should be taken and a full clinical examination performed actively looking for signs and symptoms of disease.
Assessment of geographic access to monoclonal antibodies in the United States
Authors: Rader Benjamin , Whaley Christopher M , Rogers Wesley S , Brownstein Professor John S , Cantor Jonathan
Published: March 2022

Using spatial modeling techniques, we highlight disparities in access to monoclonal antibodies (mAbs) used to treat COVID-19 patients. Fifteen million individuals in the United States must travel over 30 min to access mAbs. Areas with lower COVID-19 vaccination rates have worse access to essential COVID-19 therapeutics.
Predicting the transmission of SARS-CoV-2 in Africa: the case of Namibia
Authors: Okano Justin T , Valdano Eugenio , Mitonga Honore K , Blower Sally
Published: March 2022

SARS-CoV-2 transmission models have been fairly inaccurate in their predictions for Africa. Here, based on an analysis of surveillance data from Namibia, we conclude that it is necessary to include spatial demography, and travel, in SARS-CoV-2 transmission models in order to make more accurate predictions for COVID-19 epidemics in Africa.
Digital humanities or humanities in digital: revisiting scholarly primitives
Authors: Pacheco André
Published: March 2022

The use of computing tools and methods has irreversibly impacted the creation, use and communication of research. As a result, a still divisive movement of digital humanities (DH) has emerged over the last few decades. This article attempts to provide a theoretical contribution to the discussion of the core fundamentals of the field. In order to do so, it takes a sample of papers indexed under Library and Information Science, in the Web of Knowledge database, and studies them using a quantitative data analysis and a qualitative literature review combined with the author’s personal reflection to illustrate the main research topics. The notion of scholarly primitives, initially formulated by John Unsworth, provides the background for the theoretical analysis. It is concluded that DH embody a community patterned by collaborative and shared networks of communication, where digital tools amplify research possibilities without changing the humanistic values of its practitioners.
Rapid Decline of Ceftazidime Resistance in Antibiotic-Free and Sublethal Environments Is Contingent on Genetic Background
Authors: Hernando-Amado Sara , Laborda Pablo , Valverde José Ramón , Martínez José Luis
Published: March 2022

Trade-offs of antibiotic resistance evolution, such as fitness cost and collateral sensitivity (CS), could be exploited to drive evolution toward antibiotic susceptibility. Decline of resistance may occur when resistance to other drug leads to CS to the first one and when compensatory mutations, or genetic reversion of the original ones, reduce fitness cost. Here we describe the impact of antibiotic-free and sublethal environments on declining ceftazidime resistance in different Pseudomonas aeruginosa resistant mutants. We determined that decline of ceftazidime resistance occurs within 450 generations, which is caused by newly acquired mutations and not by reversion of the original ones, and that the original CS of these mutants is preserved. In addition, we observed that the frequency and degree of this decline is contingent on genetic background. Our results are relevant to implement evolution-based therapeutic approaches, as well as to redefine global policies of antibiotic use, such as drug cycling.
Why Smoke Flavor Capsule Cigarettes? Preferences and Perceptions Among Adult Smokers in Mexico
Authors: Ogunnaike Adebusola , Gallegos-Carrillo Katia , Barrientos-Gutierrez Inti , Arillo Santillán Edna , Cho Yoo Jin , Thrasher James F
Published: March 2022

Introduction

Flavor capsule cigarettes are rapidly gaining global market share, particularly in Latin America; however, little is known about consumer profiles and perceptions since the diffusion of this product innovation has become more widespread.

Aims and Methods

This paper compares profiles and perceptions of smokers who prefer flavor capsule cigarettes and those who do not in Mexico. We analyzed data from six online surveys of adult Mexican smokers (n = 4488) from 2018–2020. Participants identified their preferred brand variety characteristics (no capsule; one capsule; two capsules), and reported perceptions of their brand varieties’ flavor, smoothness, harmfulness, and whether they smoke to control their appetite. Separate multinomial logistic models regressed preferred cigarette type on sociodemographic and smoking-related variables, as well as perceived benefits on preferred cigarette type, adjusting for covariates.

Results

Most participants preferred capsule cigarettes (single capsule = 47.5%; double capsule = 12.9%). Flavor capsule users reported that their preferred varieties mostly tasted like menthol/mint (59% of single capsule users and 23% of double capsule users), cucumber (12% and 27%, respectively) or berries (10% and 22%, respectively). Females were more likely than males to prefer either single or double capsule cigarettes (AOR = 2.26 and 2.01, respectively). Preference for flavor capsules was also higher among younger smokers, e-cigarette users, those who smoke less frequently, and those who recently tried or plan to quit. Smokers who preferred capsules were more likely than non-capsule smokers to perceive their cigarettes as smoother, less harmful, and to smoke to control their appetite.

Conclusions

The high prevalence of capsule use and widespread perceptions of the benefits of capsules over traditional cigarettes may help explain why tobacco control policies have not reduced smoking prevalence in Mexico.

Implications

Flavor capsules are rapidly growing in popularity in many countries around the world, including Mexico. This study found that more Mexican adult smokers prefer brand varieties with capsules (60%) than without capsules (40%), that flavor capsule use strongly correlates with menthol cigarette use, and that perceived flavors of capsules range widely. Flavor capsule smokers have more positive smoking expectancies (eg, lower risk perceptions, dietary control) than noncapsule smokers. Capsules appeal particularly to women, young adults, less frequent smokers, and those who recently tried to quit. Policies should consider banning flavors in cigarettes, including capsules and other filter innovations.
Low Levels of Neutralizing Antibodies After Natural Infection With Severe Acute Respiratory Syndrome Coronavirus 2 in a Community-Based Serological Study
Authors: McDade Thomas W , Sancilio Amelia , D’Aquila Richard , Mustanski Brian , Vaught Lauren A , Reiser Nina L , Velez Matthew E , Hsieh Ryan R , Ryan Daniel T , Saber Rana , McNally Elizabeth M , Demonbreun Alexis R
Published: March 2022

Background

Confidence in natural immunity after infection with severe acute respiratory syndrome coronavirus 2 is one reason for vaccine hesitancy.

Methods

We measured antibody-mediated neutralization of spike protein-ACE2 receptor binding in a large community-based sample of seropositive individuals who differed in severity of infection (N = 790).

Results

A total of 39.8% of infections were asymptomatic, 46.5% were symptomatic with no clinical care, 13.8% were symptomatic with clinical care, and 3.7% required hospitalization. Moderate/high neutralizing activity was present after 41.3% of clinically managed infections, in comparison with 7.9% of symptomatic and 1.9% of asymptomatic infections.

Conclusions

Prior coronavirus disease 2019 infection does not guarantee a high level of antibody-mediated protection against reinfection in the general population.
Sulfanilamide Regulates Flowering Time through Expression of the Circadian Clock Gene LUX
Authors: Hirohata Atsuhiro , Yamatsuta Yuta , Ogawa Kaori , Kubota Akane , Suzuki Takamasa , Shimizu Hanako , Kanesaka Yuki , Takahashi Nozomu , Endo Motomu
Published: March 2022

Flowering time is an agriculturally important trait that can be manipulated by various approaches such as breeding, growth control and genetic modifications. Despite its potential advantages, including fine-tuning the regulation of flowering time, few reports have explored the use of chemical compounds to manipulate flowering. Here, we report that sulfanilamide, an inhibitor of folate biosynthesis, delays flowering by repressing the expression of florigen FLOWERING LOCUS T (FT) in Arabidopsis thaliana. Transcriptome deep sequencing and quantitative polymerase chain reaction analyses showed that the expression of the circadian clock gene LUX ARRYTHMO/PHYTOCLOCK1 (LUX/PCL1) is altered by sulfanilamide treatment. Furthermore, in the lux nox mutant harboring loss of function in both LUX and its homolog BROTHER OF LUX ARRHYTHMO (BOA, also named NOX), the inhibitory effect of sulfanilamide treatment on FT expression was weak and the flowering time was similar to that of the wild type, suggesting that the circadian clock may contribute to the FT-mediated regulation of flowering by sulfanilamide. Sulfanilamide also delayed flowering time in arugula (Eruca sativa), suggesting that it is involved in the regulation of flowering across Brassicaceae. We propose that sulfanilamide is a novel modulator of flowering.
Genome-wide cis-decoding for expression design in tomato using cistrome data and explainable deep learning
Authors: Akagi Takashi , Masuda Kanae , Kuwada Eriko , Takeshita Kouki , Kawakatsu Taiji , Ariizumi Tohru , Kubo Yasutaka , Ushijima Koichiro , Uchida Seiichi
Published: March 2022

In the evolutionary history of plants, variation in cis-regulatory elements (CREs) resulting in diversification of gene expression has played a central role in driving the evolution of lineage-specific traits. However, it is difficult to predict expression behaviors from CRE patterns to properly harness them, mainly because the biological processes are complex. In this study, we used cistrome datasets and explainable convolutional neural network (CNN) frameworks to predict genome-wide expression patterns in tomato (Solanum lycopersicum) fruit from the DNA sequences in gene regulatory regions. By fixing the effects of trans-acting factors using single cell-type spatiotemporal transcriptome data for the response variables, we developed a prediction model for crucial expression patterns in the initiation of tomato fruit ripening. Feature visualization of the CNNs identified nucleotide residues critical to the objective expression pattern in each gene, and their effects were validated experimentally in ripening tomato fruit. This cis-decoding framework will not only contribute to the understanding of the regulatory networks derived from CREs and transcription factor interactions, but also provides a flexible means of designing alleles for optimized expression.
Cycling in the dark – the impact of Standard Time and Daylight Saving Time on bicycle ridership
Authors: Wessel Jan
Published: March 2022

The European Union is in the process of abolishing the bi-annual clock change. Against this backdrop, we analyze how daylight and twilight affect the sustainable transport mode of cycling, and find that better daylight conditions generally lead to higher levels of cycling. The extent of this effect depends on the type of traffic and the time of day. An all-year implementation of Daylight Saving Time would then lead to an increase in overall cycling levels of around 3.14 %–3.37 %, compared to an all-year Standard Time. This would imply an increase of around 1.27–1.36 billion cycled kilometers per year in Germany alone. Additionally, we provide monetary estimates for the external effects of such changes in cycling levels.
Single-cell metabolite detection and genomics reveals uncultivated talented producer
Authors: Kogawa Masato , Miyaoka Rimi , Hemmerling Franziska , Ando Masahiro , Yura Kei , Ide Keigo , Nishikawa Yohei , Hosokawa Masahito , Ise Yuji , Cahn Jackson K B , Takada Kentaro , Matsunaga Shigeki , Mori Tetsushi , Piel Jörn , Takeyama Haruko
Published: March 2022

The production of bioactive metabolites is increasingly recognized as an important function of host-associated bacteria. An example is defensive symbiosis that might account for much of the chemical richness of marine invertebrates including sponges (Porifera), 1 of the oldest metazoans. However, most bacterial members of sponge microbiomes have not been cultivated or sequenced, and therefore, remain unrecognized. Unequivocally linking metabolic functions to a cellular source in sponge microbiomes is, therefore, a challenge. Here, we report an analysis pipeline of microfluidic encapsulation, Raman microscopy, and integrated digital genomics (MERMAID) for an efficient identification of uncultivated producers. We applied this method to the chemically rich bacteriosponge (sponge that hosts a rich bacterial community) Theonella swinhoei, previously shown to contain ‘Entotheonella’ symbionts that produce most of the bioactive substances isolated from the sponge. As an exception, the antifungal aurantosides had remained unassigned to a source. Raman-guided single-bacterial analysis and sequencing revealed a cryptic, distinct multiproducer, ‘Candidatus Poriflexus aureus’ from a new Chloroflexi lineage as the aurantoside producer. Its exceptionally large genome contains numerous biosynthetic loci and suggested an even higher chemical richness of this sponge than previously appreciated. This study highlights the importance of complementary technologies to uncover microbiome functions, reveals remarkable parallels between distantly related symbionts of the same host, and adds functional support for diverse chemically prolific lineages being present in microbial dark matter.
Curvilinear Relationships Between Age and Job Performance and the Role of Job Complexity
Authors: Karanika-Murray Maria , Van Veldhoven Marc , Michaelides George , Baguley Thom , Gkiontsi Dimitra , Harrison Natalie
Published: March 2022

Despite suggestions that work performance varies with age, the empirical evidence is inconclusive and contradictory. Possible reasons for this are the lack of differentiation between different types of performance and a naive assumption of a negative linear relationship between age and task performance across the working lifespan. With this study we question and revisit these expectations. We take a lifespan perspective to explore differential and curvilinear relationships between age (measured as chronological age) and three types of task performance (task proficiency, proactivity, and adaptivity), moderated by job complexity (measured as cognitive demands). Using Bayesian polynomial regression on survey data from 903 employees, we tested the relationships between age and each performance type, with job complexity as a moderator. The data indicated a U-shaped age–adaptivity relationship (main effects for job complexity) and an S-shaped age–proactivity relationship that was more pronounced under low job complexity (interaction effect). We identify the turning points for these changes, which show midlife as a critical period for changes in performance where the job context itself shapes the gradient and direction of these changes. Our findings provide crucial evidence that different types of job performance vary by age and the role of perceived job complexity in explaining trajectories in proactivity and adaptivity. Implications for job design, organizational interventions, and human resource management are discussed.
Quadratus Lumborum Block Versus Transversus Abdominis Plane Block for Caesarean Delivery: A Systematic Review and Network Meta-Analysis
Authors: El-Boghdadly K. , Desai N. , Halpern S. , Blake L. , Odor P.M. , Bampoe S. , Carvalho B. , Sultan P.
Published: March 2022

(Anaesthesia. 2021;76:393–403. doi: 10.1111/anae.15160. Epub July 4, 2020)

Cesarean deliveries (CD) are the most globally performed surgical operation, thus it is important to improve postoperative pain following CD. The typical approach for improved analgesia outcomes following CD is multimodal analgesia (including long-acting intrathecal and epidural opioid). When long-acting neuraxial opioid options are not available, other analgesia methods, including quadratus lumborum blocks (QLB) and transversus abdominis plane (TAP) blocks have shown to improve postoperative analgesia. This study aims to compare TAP blocks and QLB technique outcomes (eg, 24-h morphine equivalent consumption) following CD.
Postpartum-specific Vital Sign Reference Ranges
Authors: Green L.J. , Pullon R. , Mackillop L.H. , Gerry S. , Birks J. , Salvi D. , Davidson S. , Loerup L. , Tarassenko L. , Mossop J. , Edwards C. , Gauntlett R. , Harding K. , Chappell L.C. , Knight M. , Watkinson P.J.
Published: March 2022

(Obstet Gynecol. 2021;137:295–304. doi: 10.1097/AOG.0000000000004239)

Though the majority of maternal deaths occur in the postpartum period (57% in the United States), compared with the antenatal and intrapartum periods, the postpartum period doesn’t receive as much focus. Abnormal vital signs such as venous thromboembolism, hemorrhage, sepsis, and gestational hypertensive disorders are the leading cause of death during the postpartum period. Little data exists for postpartum vital signs. This study aims to estimate maternal postpartum vital sign ranges.
Efficacy of Resuscitative Infusion With Hemoglobin Vesicles in Rabbits With Massive Obstetric Hemorrhage
Authors: Yuki Y. , Hagisawa K. , Kinoshita M. , Ishibashi H. , Kaneko K. , Ishida O. , Saitoh D. , Sakai H. , Terui K.
Published: March 2022

(Am J Obstet Gynecol. 2021;224:398.e1–398.e11. doi: 10.1016/j.ajog.2020.09.010. Epub September 12, 2020)

Massive transfusion protocol (MTP) is a management strategy for massive obstetric hemorrhage (MOH), an unpredictable birth complication, yet small maternity clinics and birth centers don’t always have access to MTP. Red blood cell (RBC) transfusion is optimally administered to patients requiring resuscitative infusion following MOH, but there are logistical limitations to providing small maternity clinics and birth centers with the supplies required for treatment. Thus, hemoglobin vesicles (HbVs) have been developed and tested as an RBC transfusion substitute with a much more practical and stable shelf life, making it much more affordable for small hospitals to have on hand. Though HbVs are logistically beneficial, there are questions around its efficacy and safety, so animal models have been developed to address these. This study used a rabbit model to substitute RBC transfusion with MOH to show efficacy of HbVs in rabbits with MOH.
The Association Between Labor Epidural Analgesia and Postpartum Depressive Symptoms: A Longitudinal Cohort Study
Authors: Munro A. , George R.B. , Mackinnon S.P. , Rosen N.O.
Published: March 2022

(Can J Anaesth. 2021;68:485–495. doi: 10.1007/s12630-020-01900-4. Epub January 6, 2021)

An estimated 17% of mothers have postpartum depression (PPD) even without a prior history of depression. Several factors are associated with PPD, including pain. This study aimed to find associations between labor epidural analgesia (LEA) and reduced PPD occurrence in women up to 12 months postpartum.
Continued Versus Discontinued Oxytocin Stimulation in the Active Phase of Labour (CONDISOX): Double Blind Randomized Controlled Trial
Authors: Boie S. , Glavind J. , Uldbjerg N. , Steer P.J. , Bor P.
Published: March 2022

(BMJ. 2021;372:n716)

Oxytocin is commonly used to stimulate the uterus and induce labor. Hyperstimulation carries risks to mother and fetus and may increase the likelihood of cesarean delivery (CD). Recent studies suggest that discontinuing oxytocin augmentation will not interrupt labor but may help avoid hyperstimulation. It is unclear if discontinuing oxytocin has an effect on the cesarean rate. This study aims to determine whether discontinuing oxytocin once labor is established reduces the cesarean rate.
Immunogenicity of COVID-19 mRNA Vaccines in Pregnant and Lactating Women
Authors: Collier A.Y. , McMahan K. , Yu J. , Tostanoski L.H. , Aguayo R. , Ansel J. , Chandrashekar A. , Patel S. , Apraku Bondzie E. , Sellers D. , Barrett J. , Sanborn O. , Wan H. , Chang A. , Anioke T. , Nkolola J. , Bradshaw C. , Jacob-Dolan C. , Feldman J. , Gebre M. , Borducchi E.N. , Liu J. , Schmidt A.G. , Suscovich T. , Linde C. , Alter G. , Hacker M.R. , Barouch D.H.
Published: March 2022

(JAMA. 2021;325:2370–2380. doi-10.1001/jama2021.7563)

Pregnant women are at a greater risk of severe complications from symptomatic COVID-19, including ICU admission, needing mechanical ventilation, and death compared with their nonpregnant peers. Similarly, women who contract influenza and other viruses during pregnancy often have more severe illnesses as pregnancy reduces immune system effectiveness to prevent an immune system response to foreign DNA in a fetus. Women are encouraged to receive influenza and pertussis vaccines during pregnancy. In addition to protecting the mother from complications from these viruses while pregnant, studies have shown the baby also carries antibodies to prevent these viral infections after birth while it is too young to yet receive these vaccinations. A patient biorepository study from Beth Isreal Deaconess Medical Center investigated if babies of pregnant or lactating mothers who received a COVID-19 vaccine also carried antibodies to prevent this new virus. In addition the number of antibodies in babies born to women who had contracted COVID-19 while pregnant was compared to antibodies of babies whose mothers had only received a vaccine.
Comparison of Perinatal Outcomes for All Modes of Second Stage Delivery in Obstetric Theaters: A Retrospective Observational Study
Authors: Gurney L. , Wattar B.H.A.I. , Sher A. , Echevarria C. , Simpson H.
Published: March 2022

(BJOG. 2021;128:1248–1255)

The World Health Organization recommend techniques to encourage vaginal delivery to mitigate unnecessary cesarean deliveries and the associated complications. These techniques include Keilland’s rotational forceps delivery, direct forceps delivery, manual rotation followed by forceps delivery, or ventouse delivery. Although this study demonstrated that Keilland’s rotational forceps delivery may be associated with successful vaginal delivery, some clinicians currently avoid instrumental delivery to evade maternal or neonatal harm, which ultimately leads to less skilled instrumental delivery and therefore, a riskier alternative. This study evaluated the effectiveness and safety of instrumental vaginal delivery techniques. In addition, it compared adverse perinatal outcomes between instrumental delivery and primary emergency cesarean section at full dilation (pEmCS).
Maternal Body Mass Index and Risk of Obstetric, Maternal and Neonatal Outcomes: A Cohort Study of Nulliparous Women With Spontaneous Onset of Labor
Authors: Dalbye R. , Gunnes N. , Blix E. , Zhang J. , Eggebø T. , Nistov Tokheim L. , Øian P. , Bernitz S.
Published: March 2022

(Acta Obstet Gynecol Scand. 2021;100:521–530. doi: 10.1111/aogs.14017. Epub November 27, 2020)

Worldwide obesity and body mass index (BMI) have dramatically increased in the past few decades. As obesity can increase risk for serious health problems, understanding its impact on pregnancy and delivery is essential to improve patient care, labor outcomes, and health outcomes. Despite past work, there is still a need for studies examining impact of BMI on nulliparous women versus multiparous women and on induced and spontaneous onset of labor. This study focuses on nulliparous women with a singleton fetus in cephalic presentation with spontaneous onset of labor at term within the Ten-Group Classification System (TGCS) group 1. The aim of this study was to analyze those within TGCS group 1 and investigate the relational effect of early-pregnancy maternal BMI and obstetric, maternal, and neonatal outcomes.
Randomized Trial of Fetal Surgery for Severe Left Diaphragmatic Hernia
Authors: Deprest J.A. , Nicolaides J.H. , Benachi A. , Gratacos E. , Ryan G. , Persico N. , Sago H. , Johnson A. , Wielgoś M. , Berg C. , Van Calster B. , Russo F.M. ,   for the TOTAL Trial for Severe Hypoplasia Investigators
Published: March 2022

(Engl J Med. 2021;385:107–118)

Congenital diaphragmatic hernia (CDH) can lead to serious lifelong complications, but may be treated if diagnosed before birth. In fetoscopic endoluminal tracheal occlusion (FETO), a balloon is inserted into the fetal trachea in utero to stimulate fetal lung growth and is removed prior to birth. One study of 210 fetuses undergoing FETO for severe lung hypoplasia due to isolated CDH found a nearly doubled survival rate among fetuses who received FETO compared with controls (49% vs. 24%). This current study, Tracheal Occlusion to Accelerate Lung Growth (TOTAL), aimed to test whether fetuses with surgical treatment of severe left CDH had superior survival rates compared with fetuses who received expectant prenatal care.
Fetal Tracheal Occlusion for Congenital Diaphragmatic Hernia
Authors: Cole F.
Published: March 2022

(N Engl J Med. 2021;385:177–178)

Studies on prenatal surgical interventions have historically been limited due to rarity and potential maternal complications. In 2011, the Management of Myelomeningocele Study (MOMS) found neonatal benefits associated with fetal surgery, including reduced need for cerebrospinal fluid shunting and improved infant motor outcomes at 30 months of age, but also found an increased risk of premature birth and maternal complications. This study provided an important framework for studies on fetal surgery: the inclusion of short- and long-term neonatal outcomes, attention to maternal complications, careful patient selection, and the use of multiple care centers.
Predictability of Preoperative Carotid Artery-corrected Flow Time for Hypotension After Spinal Anaesthesia in Patients Undergoing Caesarean Section: A Prospective Observational Study
Authors: Kim H.J. , Choi Y.S. , Kim S.H. , Lee W. , Kwon J.-Y. , Kim D.H.
Published: March 2022

(Eur J Anaesthesiol. 2021;38:394–401)

Hypotension affects more than 50% of cesarean delivery (CD) patients receiving spinal anesthesia (SA). Fluid administration (preload and co-load), as well as prophylactic use of phenylephrine, noradrenaline, and ondansetron are all used to prevent hypotension. There are a number of reasons for hypotension following SA, and predicting the pathway leading to hypotension by monitoring hemodynamics may help inform the best prevention and treatment. Corrected blood flow time (FTc) in the carotid artery is affected by left ventricular preload and associated with myocardial afterload. This study aimed to evaluate preanesthetic FTc as a predictor of hypotension in CD patients receiving spinal anesthesia.
PROSPECT Guideline for Elective Cesarean Section: Updated Systematic Review and Procedure-specific Postoperative Pain Management Recommendations
Authors: Roofthooft E , Joshi GP , Rawal N , Van de Velde M ,   PROSPECT Working Group* of the European Society of Regional Anaesthesia and Pain Therapy and supported by the Obstetric Anaesthetists’ Association
Published: March 2022

(Anaesthesia. 2021;76:665–680. doi: 10.1111/anae.15339. Epub December 28, 2020)

Although postoperative pain from cesarean delivery (CD) can be severe and cause adverse maternal outcomes, it is often underestimated and undertreated. The PROSPECT working group is a multidisciplinary team of surgeons and anesthetists that collaborated to systematically review the current literature and provide evidence-based guidelines to optimize post-delivery analgesia for elective CDs. The PROSPECT group deemed an update from the last systematic review necessary to incorporate more recent approaches, including quadratus lumborum blocks.
Reliability of Uncertainty Tolerance Scales Implemented Among Physicians and Medical Students: A Systematic Review and Meta-Analysis
Authors: Stephens Georgina C. , Karim M. Nazmul , Sarkar Mahbub , Wilson Adam B. , Lazarus Michelle D.
Published: March 2022

Purpose

Uncertainty tolerance (UT) is a construct describing individuals’ perceptions of, and responses to, uncertainty across their cognition, emotion, and behavior. Various UT scales have been designed for physician and medical student populations. However, links between UT and other variables (e.g., training stages) are inconsistent, raising concerns about scale reliability and validity. As reliability is a precondition for validity, a necessary first step in assessing UT scales’ efficacy is evaluating their reliability. Accordingly, the authors conducted a meta-analysis of the reliability of UT scales designed for, and implemented among, physician and medical student populations.

Method

In 2020, the authors searched 4 electronic databases alongside a citation search of previously identified UT scales. They included English-language, peer-reviewed studies that implemented UT scales in physician and/or medical student populations and reported reliability evidence. A meta-analysis of studies’ Cronbach’s alphas evaluated aggregated internal consistency across studies; subgroup analyses evaluated UT scales by named scale, population, and item characteristics.

Results

Among 4,124 records screened, 35 studies met the inclusion criteria, reporting 75 Cronbach’s alphas. Four UT scales appeared in at least 3 included studies: Physicians’ Reactions to Uncertainty scale 1990 (PRU1990) and 1995 (PRU1995) versions, Tolerance for Ambiguity scale (TFA), and Tolerance of Ambiguity in Medical Students and Doctors scale (TAMSAD). The scores from these scales ranged in reliability from very good (PRU1990: 0.832, PRU1995: 0.818) to respectable (TFA: 0.761, TAMSAD: 0.711). Aggregated internal consistency was significantly higher (P < .001) among physicians (0.797) than medical students (0.711).

Conclusions

UT scales generally demonstrated respectable internal consistency when administered among physicians and medical students, yet the reliability among medical students was significantly lower. The authors caution against using UT scores for decision-making purposes (e.g., applicant selection, program evaluation), especially among medical student populations. Future research should explore the reasons underlying these observed population differences.
Unreamed Intramedullary Nailing Versus External Fixation for the Treatment of Open Tibial Shaft Fractures in Uganda: A Randomized Clinical Trial
Authors: Kisitu Daniel K. , O'Hara Nathan N. , Slobogean Gerard P. , Howe Andrea L. , Blachut Piotr A. , O'Brien Peter J. , Stockton David J.
Published: March 2022

Objective:

To compare unreamed intramedullary nailing versus external fixation for the treatment of Gustilo–Anderson type II and IIIA open tibial fractures admitted to a hospital in rural Uganda.

Design:

Randomized clinical trial.

Setting:

Regional referral hospital in Uganda.

Patients:

Fifty-five skeletally mature patients with a Gustilo–Anderson type II or IIIA open tibia shaft fracture treated within 24 hours of injury between May 2016 and December 2019.

Intervention:

Unreamed intramedullary nailing (n = 31) versus external fixation (n = 24).

Main Outcome Measurements:

The primary outcome was function within 12 months of injury, measured using the Function IndeX for Trauma (FIX-IT) score. Secondary outcomes included health-related quality of life (HRQoL) using the 3-level version of the 5-dimension EuroQol instrument (EQ-5D-3L), radiographic healing using the Radiographic Union Scale for Tibia (RUST) fractures score, and clinical complications.

Results:

Treatment with an intramedullary nail resulted in a 1.0-point higher [95% credible intervals (CrI), 0.1 to 1.9] FIX-IT score compared with external fixation. Results were similar for the secondary patient-reported outcomes, EQ-5D-3L and the visual analog scale component of the EuroQol instrument (EQ-VAS). RUST scores were not different between groups at any time point. Treatment with an intramedullary nail was associated with a 22.1% (95% CrI, −42.6% to 1.7%) lower rate of malunion and a 20.8% (95% CrI, −44.0% to 2.9%) lower rate of superficial infection.

Conclusion:

In rural Uganda, treatment of open tibial shaft fractures with an unreamed intramedullary nail results in marginal clinically important improvements in functional outcomes, although there is likely an important reduction in malunion and superficial infection.

Level of Evidence:

Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Validation of an Electronic Phenotyping Algorithm for Patients With Acute Respiratory Failure
Authors: Essay Patrick , Fisher Julia M. , Mosier Jarrod M. , Subbian Vignesh
Published: March 2022

OBJECTIVES:

Acute respiratory failure is a common reason for ICU admission and imposes significant strain on patients and the healthcare system. Noninvasive positive-pressure ventilation and high-flow nasal oxygen are increasingly used as an alternative to invasive mechanical ventilation to treat acute respiratory failure. As such, there is a need to accurately cohort patients using large, routinely collected, clinical data to better understand utilization patterns and patient outcomes. The primary objective of this retrospective observational study was to externally validate our computable phenotyping algorithm for patients with acute respiratory failure requiring various sequences of respiratory support in real-world data from a large healthcare delivery network.

DESIGN:

This is a cross-sectional observational study to validate our algorithm for phenotyping acute respiratory patients by method of respiratory support. We randomly selected 5% (n = 4,319) from each phenotype for manual validation. We calculated the algorithm performance and generated summary statistics for each phenotype and a priori defined clinical subgroups.

SETTING:

Data were extracted from a clinical data warehouse containing electronic health record data from 46 ICUs in the southwest United States.

PATIENTS:

All adult (≥ 18 yr) patient records requiring any type of oxygen therapy or mechanical ventilation between November 1, 2013, and September 30, 2020, were extracted for the study.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Micro- and macroaveraged multiclass specificities of the algorithm were 0.902 and 0.896, respectively. Sensitivity and specificity of phenotypes individually were greater than 0.90 for all phenotypes except for those patients extubated from invasive to noninvasive ventilation. We successfully created clinical subgroups of common illnesses requiring ventilatory support and provide high-level comparison of outcomes.

CONCLUSIONS:

The electronic phenotyping algorithm is robust and provides a necessary tool for retrospective research for characterizing patients with acute respiratory failure across modalities of respiratory support.
Albumin Kinetics in Sepsis and COVID-19
Authors: Siddiqui Suhail Sarwar , Chakraborty Nilanchal , Muzaffar Syed Nabeel , Gurjar Mohan
Published: March 2022

Hypoalbuminemia has been associated with poor outcome in critically ill population including sepsis and COVID-19. The observational study by Su et al showed a favorable albumin kinetics, with an initial downwards trend followed by recovery back to the predicted albumin levels, in survivors of COVID-19 and sepsis-induced acute respiratory distress syndrome (ARDS). However, nonsurvivors in COVID-19 group did not have an upwards recovery slope, while those in sepsis group did not follow any sort of albumin kinetics. Thus, authors concluded that the pattern of albumin kinetics may be predictive of outcome in COVID-19 and sepsis-induced ARDS. Here, we would like to highlight a few more points in this letter.
The Different Challenges in Being an Adult Versus a Pediatric Intensivist
Authors: Dennis Diane , van Heerden Peter , Khanna Rahul , Knott Cameron , Zhang Simone , Calhoun Aaron
Published: March 2022

OBJECTIVES:

There is little current research comparing stress, burnout, and resilience in pediatric and adult intensive care practitioners. This article analyzes data derived from a 2018 qualitative study of burnout and resilience among ICU providers to explore differences that may exist between the pediatric and adult domains of practice.

DESIGN:

This study represents a thematic subanalysis of textual data derived from a larger qualitative study of ICU provider burnout and resilience.

SETTING:

Six international critical care units (Australia, Israel, United States).

SUBJECTS:

Physicians working at the above sites who had been practicing as intensivists for a minimum period of 4 years.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Data were collected using a semistructured interview process, and resulting transcripts were analyzed using postpositivist framework analysis. A secondary analysis was then performed separately on pediatric and adult datasets using the initial coding framework as a template. Three themes related to perceived differences were noted: differences in the patient characteristics within both cohorts, differences in the relationships between staff and family, and personal biases of individual intensivists. Pediatric and adult practitioners differed in their perceptions of the patient’s perceived responsibility for their illness. Emotional responses to the stressor of child abuse (particularly as they related to clinician-family relationships) also differed. The stress of dealing with family expectations of patient survival even in dire circumstances was unique to the pediatric environment. Both pediatric and adult practitioners commented on the perceived difficulty of assuming the opposite role. Differences in life expectancy and mortality rate were significant factors in this.

CONCLUSIONS:

Although similar stressors exist within each group, meaningful differences in how these are perceived and personally processed by individual clinicians exist. Better understanding of these differences will assist attempts to enhance the resilience and provide career guidance to aspiring intensive care clinicians.
Cardioprotective Effect of Growth Differentiation Factor 15 Against Isoproterenol-Induced Cardiomyocyte Apoptosis via Regulation of the Mitochondrial Fusion
Authors: Zhang Yan , Mei Zhu , Jia Xiaodong , Song Haixu , Liu Jing , Tian Xiaoxiang
Published: March 2022

Objective:

Pressure overload-induced myocardial apoptosis is a critical pathologically initiated process leading to heart failure (HF). Growth differentiation factor 15 (GDF15) dramatically increases during cardiac hypertrophy and dysfunction, but its functions and mechanisms are barely known. This study aims to elucidate the role and mechanism of GDF15 in HF.

Methods:

Between January 2017 and August 2018, 57 patients diagnosed with chronic HF (aged >18  years, with left ventricular ejection fraction (LVEF) ≤35%) and 57 non-HF patients (aged >18  years, LVEF >35%) were prospectively enrolled in this study based on the balance of the baseline characteristics. Other acute or chronic diseases and pregnant/lactating women were excluded. The serum concentrations of GDF15 were detected. Isoproterenol (ISO)-induced HF mouse model was established by pumping with ISO (30 mg/(kg·day)) for 4  weeks, and the GDF15 expression in serum and heart tissue was evaluated in vivo. Primary cardiomyocytes were cultured and treated with ISO to induce cardiomyocytes damage. The apoptosis of cardiomyocytes and the effect of GDF15 on ISO-induced cardiomyocytes injury was evaluated in vitro.

Results:

After adjusting the baseline characteristic, serum levels of GDF15 were significantly higher in HF subjects than in non-HF patients. Similarly, in the ISO-induced HF mouse model, the significant increase in GDF15 was associated with the process of HF in vivo. Moreover, the elevation of GDF15 occurred prior to heart remodeling in the ISO-induced HF mouse model. Furthermore, using primary cardiomyocytes, we demonstrated that the GDF15 was remarkably enhanced in serum from pathological HF patients and cardiac tissue from the ISO-induced mouse model. Reducing GDF15 exaggerated the ISO-induced cell apoptosis by blocking mitochondrial fusion and increasing oxidative stress. In contrast, the silence of GDF15 aggravated the ISO-induced cardiomyocytes damage.

Conclusions:

GDF15 acts as a protective factor against cardiomyocyte apoptosis by improving mitochondria fusion during HF. These findings indicate that GDF15 may be a potential therapeutic target for HF.
The Perspectives of Healthcare Teachers on Their Technological Pedagogical Content Knowledge of Three-Dimensional Technology
Authors: Alhonkoski Mika , Veermans Marjaana , Artukka Kalle , Salminen Leena
Published: March 2022

In the future, healthcare teachers will need to have evidence-based teaching strategies. Moreover, three-dimensional technology is a promising element to support teaching. This mixed methods study aimed to describe the self-reported insight of healthcare teachers in relation to their knowledge of the utilization of technology, in general, and, more specifically, three-dimensional technology, in their healthcare teaching. The Technological Pedagogical Content Knowledge framework served as the theoretical base for this study. A survey (n = 55) and interviews (n = 17) were carried out on Finnish healthcare teachers at vocational institutes. The analysis was guided by the TPACK-deep scale. Teachers found three-dimensional technology to be a positive addition to their teaching and use of three-dimensional technology was also quite incidental, focusing on three-dimensional images and three-dimensional environments rather than three-dimensional printing or three-dimensional holograms. Additionally, different themes emphasizing the elements teachers should focus on when implementing three-dimensional technology in their teaching emerged. An example of these was time usage. This study found that, despite there being several elements that teachers should prepare for and implement before utilizing three-dimensional technology, teachers should see three-dimensional technology as a promising technology for use in healthcare education.
Comparison of Oura Smart Ring Against ActiGraph Accelerometer for Measurement of Physical Activity and Sedentary Time in a Free-Living Context
Authors: Niela-Vilen Hannakaisa , Azimi Iman , Suorsa Kristin , Sarhaddi Fatemeh , Stenholm Sari , Liljeberg Pasi , Rahmani Amir M. , Axelin Anna
Published: March 2022

Smart rings, such as the Oura ring, might have potential in health monitoring. To be able to identify optimal devices for healthcare settings, validity studies are needed. The aim of this study was to compare the Oura smart ring estimates of steps and sedentary time with data from the ActiGraph accelerometer in a free-living context. A cross-sectional observational study design was used. A convenience sample of healthy adults (n = 42) participated in the study and wore an Oura smart ring and an ActiGraph accelerometer on the non-dominant hand continuously for 1 week. The participants completed a background questionnaire and filled out a daily log about their sleeping times and times when they did not wear the devices. The median age of the participants (n = 42) was 32 years (range, 18–46 years). In total, 191 (61% of the potential) days were compared. The Oura ring overestimated the step counts compared with the ActiGraph. The mean difference was 1416 steps (95% confidence interval, 739–2093 steps). Daily sedentary time was also overestimated by the ring; the mean difference was 17 minutes (95% confidence interval, −2 to 37 minutes). The use of the ring in nursing interventions needs to be considered.
Feasibility of Electronic Health Record Integration of a SMART Application to Facilitate Patient-Provider Communication for Medication Management
Authors: Spratt Susan E. , Ravneberg David , Derstine Beury , Granger Bradi B.
Published: March 2022

Increased treatment complexity in patients with diabetes contributes to medication nonadherence. Patient portals that are accessible through electronic health records may offer improved patient-provider communication and better medication management in patients with diabetes and uncontrolled hypertension. We conducted a prospective, mixed-methods evaluation of the Duke PillBox application, a SMART-on-FHIR medication management application integrated into the electronic health record patient portal. Adults with active portal status, diabetes, and uncontrolled hypertension participated in a usability/feasibility survey and communicated with a pharmacist via the portal-based application who conducted medication reconciliation and discussed medication indications, side effects, and barriers to use with patients. Of the eligible patients (n = 285), 29 (10%) were interested, and 12 (8%) participated. Challenges to usability were due to the electronic health record–portal communication interface (91%), browser access and compatibility (55%), and persistent lists of unused medications in the electronic health record (27%). The findings of this study suggest that electronic health record–integrated medication applications are desirable as indicated in patient interactions at the outset and conclusion of the study. Persistent challenges included electronic health record integration, interoperability, user interface, and browser connectivity for both patients and providers.