bluuebunny/crossref_metadata_2025 huggingface dataset:
IIVRS: an Intelligent Image and Video Rating System to Provide Scenario-Based Content for Different Users
Authors: Kang Rui , Rau Pei-Luen Patrick
Published: July 2024

Voice Intelligent Assistants provide users with new ways of human-computer interaction. With built-in screens, Voice Intelligent Assistants can display images and videos upon users’ requests. Even though images and videos present information in a lively manner, they might also contain overwhelming harmful contents. Due to the lack of effective evaluation mechanisms, it is difficult to prevent the propagation of harmful contents while ensuring the dissemination of compliant visual contents. This research defined a standardized set of classification criteria to identify and classify harmful visual contents. Then, Intelligent Image and Video Rating System, a prototype rating system that implemented the classification criteria was designed and developed. This research further evaluated and verified the reliability and efficiency of the prototype. The prototype system demonstrated additional advantages in swiftly classifying new hazardous contents, and in differentiating the multiple meanings of the same object in different contexts.
Feasibility of a contraceptive-specific electronic health record system to promote the adoption of pharmacist-prescribed contraceptive services in community pharmacies in the United States
Authors: Bustin Devin J , Simmons Rebecca , Galdo Jake , Kucek Mary E , Logan Lissette , Cohn Rich , Smith Heather
Published: July 2024

Objectives

Pharmacists in over half of the United States can prescribe contraceptives; however, low pharmacist adoption has impeded the full realization of potential public health benefits. Many barriers to adoption may be addressed by leveraging an electronic health records (EHR) system with clinical decision support tools and workflow automation. We conducted a feasibility study to determine if utilizing a contraceptive-specific EHR could improve potential barriers to the implementation of pharmacist-prescribed contraceptive services.

Materials and Methods

20 pharmacists each performed two standardized patient encounter simulations: one on the EHR and one on the current standard of care paper-based workflow. A crossover study design was utilized, with each pharmacist performing encounters on both standardized patients with the modality order randomized. Encounters were timed, contraceptive outputs were recorded, and the pharmacists completed externally validated workload and usability surveys after each encounter, and a Perception, Attitude, and Satisfaction survey created by the research team after the final encounter.

Results

Pharmacists were more likely to identify contraceptive ineligibility using the EHR-based workflow compared to the paper workflow (P = .003). Contraceptive encounter time was not significantly different between the 2 modalities (P = .280). Pharmacists reported lower mental demand (P = .003) and greater perceived usefulness (P = .029) with the EHR-based workflow compared to the paper modality.

Discussion and Conclusion

Pharmacist performance and acceptance of contraceptive services delivery were improved with the EHR workflow. Pharmacist-specific contraceptive EHR workflows show potential to improve pharmacist adoption and provision of appropriate contraceptive care.
Genomic evidence of reproductive isolation among the Semisulcospira snails radiated in the ancient Lake Biwa
Authors: Ueno Kazuma , Urabe Misako , Nakai Katsuki , Miura Osamu
Published: July 2024

Determining species boundaries within rapidly evolving species flocks is essential to understanding their evolutionary history but is often difficult to achieve due to the lack of clear diagnostic features. Ancient Lake Biwa harbours endemic snails in the genus Semisulcospira, a species flock with 19 described species. However, their morphological and genetic similarity cast doubt on the validity of their species status and their histories of explosive speciation. To evaluate their species boundaries, we examine patterns of gene flow among the sympatric or parapatric nominal Semisulcospira species in Lake Biwa. The principal component analysis and Bayesian structure analysis based on the genome-wide genotyping dataset demonstrated no gene flow between five pairs of the Semisulcospira species. However, we found the hybrids between the closely related species pair, Semisulcospira decipiens and S. rugosa. Despite the presence of hybrids, these nominal species still formed their own genetic clusters. There are variations in the chromosome numbers among these species, potentially providing an intrinsic barrier to panmictic gene flow. Our study showed complete or partial reproductive isolation among the sympatric or parapatric Semisulcospira species, demonstrating that the Semisulcospira snails are real species assemblages radiated in Lake Biwa. Our study provides significant implications for establishing species boundaries among rapidly evolving freshwater species in ancient lakes.
Bayesian phylogenetic analysis of pitch-accent systems based on accentual class merger: a new method applied to Japanese dialects
Authors: Takahashi Takuya , Onohara Ayaka , Ihara Yasuo
Published: July 2024

Unlike studies of the evolutionary relationship between languages, the dialect-level variation within a language has seldom been studied within the framework of a phylogenetic tree, because frequent lexical borrowing muddles the evidence of shared ancestry. The phonological history of Japanese is an exceptional case study where the phenomenon called accentual class merger enables the phylogenetic analysis of dialectal pitch-accent systems in a way that is not subject to borrowing. However, previous studies have lacked statistical analysis and failed to evaluate the relative credence of alternative hypotheses. Here we developed a novel substitution model that describes the mutation of pitch-accent systems driven by accentual class merger and integrated the model into the framework of Bayesian phylogenetic inference with geographical diffusion. Applying the method to data on the pitch-accent variation in modern Japanese dialects and historical documents collected from literature, we reconstructed the evolutionary history and spatial diffusion of pitch-accent systems. Our result supports the monophyly of each of three groups of pitch-accent systems in conventional categorization, namely Tokyo type, Keihan type, and N-kei (N-pattern) type of Kyushu, whereas the monophyly of the Tokyo type has been highly controversial in previous studies. The divergence time of the mainland pitch-accent systems was estimated to be from mid-Kofun to early Heian period. Also, it is suggested that the modern Kyoto dialect did not inherit its accent patterns from Bumoki but from an unrecorded lineage which survived from the Muromachi period. Analyses on geographical diffusion suggest that the most recent common ancestor (MRCA) of all the taxa and that of Keihan type were located in or around the Kinki region, whereas the MRCA of N-kei type was located in northern to central Kyushu. The geographical location of the MRCA of Tokyo type remains unclear, but the Kinki and Kanto regions are the most plausible candidates.
Proximity driven plastid–nucleus relationships are facilitated by tandem plastid–ER dynamics
Authors: Kunjumon Thomas Kadanthottu , Ghosh Puja Puspa , Currie Laura M J , Mathur Jaideep
Published: July 2024

Peri-nuclear clustering (PNC) of chloroplasts has largely been described in senescent and pathogen- or reactive oxygen species-stressed cells. Stromules, tubular plastid extensions, are also observed under similar conditions. Coincident observations of PNC and stromules associate the two phenomena in facilitating retrograde signaling between chloroplasts and the nucleus. However, PNC incidence in non-stressed cells under normal growth and developmental conditions, when stromules are usually not observed, remains unclear. Using transgenic Arabidopsis expressing different organelle-targeted fluorescent proteins, we show that PNC is a dynamic subcellular phenomenon that continues in the absence of light and is not dependent on stromule formation. PNC is facilitated by tandem plastid–endoplasmic reticulum (ER) dynamics created through membrane contact sites between the two organelles. While PNC increases upon ER membrane expansion, some plastids may remain in the peri-nuclear region due to their localization in ER-lined nuclear indentions. Moreover, some PNC plastids may sporadically extend stromules into ER-lined nuclear grooves. Our findings strongly indicate that PNC is not an exclusive response to stress caused by pathogens, high light, or exogenous H2O2 treatment, and does not require stromule formation. However, morphological and behavioral alterations in ER and concomitant changes in tandem, plastid–ER dynamics play a major role in facilitating the phenomenon.
The Alphabet Soup of Microscopy: An Introduction to Advanced Imaging Techniques. Part I: Super-Resolution’s STED, SIM, SMI, and SMLM
Authors: Worden Austin N
Published: July 2024

As technology advances, the field of microscopy offers unique opportunities for scientific exploration. However, the complex terminology used to describe these cutting-edge techniques often appears as a jumble of letters, akin to alphabet soup. Among the plethora of acronyms, some of the most prevalent are associated with super-resolution microscopy, including Stimulated Emission Depletion Microscopy (STED), Structured Illumination Microscopy (SIM), Spatially Modulated Illumination (SMI), and Single-Molecule Localization Microscopy (SMLM). These techniques push past the limitations of conventional light microscopy, achieving resolutions down to the tens of nanometers. This article aims to decode these common super-resolution techniques, fostering a deeper understanding of microscopy and igniting interest in their application.
Complete list of canonical post-transcriptional modifications in the Bacillus subtilis ribosome and their link to RbgA driven large subunit assembly
Authors: Popova Anna M , Jain Nikhil , Dong Xiyu , Abdollah-Nia Farshad , Britton Robert A , Williamson James R
Published: July 2024

Ribosomal RNA modifications in prokaryotes have been sporadically studied, but there is a lack of a comprehensive picture of modification sites across bacterial phylogeny. Bacillus subtilis is a preeminent model organism for gram-positive bacteria, with a well-annotated and editable genome, convenient for fundamental studies and industrial use. Yet remarkably, there has been no complete characterization of its rRNA modification inventory. By expanding modern MS tools for the discovery of RNA modifications, we found a total of 25 modification sites in 16S and 23S rRNA of B. subtilis, including the chemical identity of the modified nucleosides and their precise sequence location. Furthermore, by perturbing large subunit biogenesis using depletion of an essential factor RbgA and measuring the completion of 23S modifications in the accumulated intermediate, we provide a first look at the order of modification steps during the late stages of assembly in B. subtilis. While our work expands the knowledge of bacterial rRNA modification patterns, adding B. subtilis to the list of fully annotated species after Escherichia coli and Thermus thermophilus, in a broader context, it provides the experimental framework for discovery and functional profiling of rRNA modifications to ultimately elucidate their role in ribosome biogenesis and translation.
Clinical Utility of Plasma Microbial Cell-Free DNA Sequencing Among Immunocompromised Patients With Pneumonia
Authors: Madut Deng B , Chemaly Roy F , Dadwal Sanjeet S , Hill Joshua A , Lee Yeon Joo , Haidar Ghady , Luk Alfred , Drelick Alexander , Chin-Hong Peter V , Benamu Esther , Khawaja Fareed , Nanayakkara Deepa , Papanicolaou Genovefa A , Small Catherine Butkus , Fung Monica , Barron Michelle , Davis Thomas , McClain Micah T , Maziarz Eileen K , Bedoya Armando D , Gilstrap Daniel L , Todd Jamie L , Barkauskas Christina E , Heldman Madeleine R , Bigelow Robert , Leimberger Jeffrey D , Tsalik Ephraim L , Wolf Olivia , Mughar Mona , Lau Constance , Noll Nicholas , Hollemon Desiree , Duttagupta Radha , Lupu Daniel S , Bercovici Sivan , Perkins Bradley A , Blauwkamp Timothy A , Fowler Vance G , Holland Thomas L , Bergin Stephen P
Published: July 2024

Background

Plasma microbial cell-free DNA (mcfDNA) sequencing can establish the etiology of multiple infectious syndromes by identifying microbial DNA in plasma. However, data are needed to define the clinical scenarios where this tool offers the highest clinical benefit.

Methods

We conducted a prospective multicenter observational study that evaluated the impact of plasma mcfDNA sequencing compared with usual care testing among adults with hematologic malignancies. This is a secondary analysis of an expanded cohort that evaluated the clinical utility of plasma mcfDNA sequencing across prespecified and adjudicated outcomes. We examined the percentage of participants for whom plasma mcfDNA sequencing identified a probable cause of pneumonia or clinically relevant nonpneumonia infection. We then assessed potential changes in antimicrobial therapy based on plasma mcfDNA sequencing results and the potential for early mcfDNA testing to avoid bronchoscopy and its associated adverse events.

Results

Of 223 participants, at least 1 microbial detection by plasma mcfDNA sequencing was adjudicated as a probable cause of pneumonia in 57 (25.6%) and a clinically relevant nonpneumonia infection in 88 (39.5%). A probable cause of pneumonia was exclusively identified by plasma mcfDNA sequencing in 23 (10.3%) participants. Antimicrobial therapy would have changed for 41 (18.4%) participants had plasma mcfDNA results been available in real time. Among the 57 participants with a probable cause of pneumonia identified by plasma mcfDNA sequencing, bronchoscopy identified no additional probable cause of pneumonia in 52 (91.2%).

Conclusions

Plasma mcfDNA sequencing could improve management of both pneumonia and other concurrent infections in immunocompromised patients with suspected pneumonia.
‘Pirates’, Potentates, and Merchant Petitioning in the Early Nineteenth Century Straits Settlements
Authors: Connors Scott
Published: July 2024

In the nineteenth century Straits of Malacca, one of the globe’s most significant trading crossroads, merchants were integral to imperial stability and growth. Indeed, historians of the British empire have long sought to understand how colonial governments turned to merchants, both British and Asian, to extend commercial networks, establish local hierarchies and extend processes of state-building. Yet, merchants’ conceptions of their relationship to, and place within, colonial governance are less well understood. This article examines the emergence of colonial merchant politics in the British controlled Straits Settlements in the early nineteenth century. It concentrates on petitions produced by Asian merchants who demanded greater intervention by East India Company authorities in matters of maritime security and diplomacy. Petitions enabled the merchants of Singapore and Penang to inject their political and commercial visions into processes of colonial state-building. Moreover, these cases demonstrate that imperial margins — geographic, bureaucratic, linguistic and political — were productive spaces in which colonial power dynamics between state and society were contested and took on new meanings.
Healthy childhood development through outdoor risky play: Navigating the balance with injury prevention
Authors: Beaulieu Emilie , Beno Suzanne
Published: July 2024

Free play is essential for children’s development and for their physical, mental, and social health. Opportunities to engage in outdoor free play—and risky play in particular—have declined significantly in recent years, in part because safety measures have sought to prevent all play-related injuries rather than focusing on serious and fatal injuries. Risky play is defined by thrilling and exciting forms of free play that involve uncertainty of outcome and a possibility of physical injury. Proponents of risky play differentiate “risk” from “hazard” and seek to reframe perceived risk as an opportunity for situational evaluation and personal development. This statement weighs the burden of play-related injuries alongside the evidence in favour of risky play, including its benefits, risks, and nuances, which can vary depending on a child’s developmental stage, ability, and social and medical context. Approaches are offered to promote open, constructive discussions with families and organizations. Paediatricians are encouraged to think of outdoor risky play as one way to help prevent and manage common health problems such as obesity, anxiety, and behavioural issues.
Possible pathophysiologic roles of neurotransmitter systems in men with lifelong premature ejaculation: a scoping review
Authors: van Raaij Joost J , Serefoglu Ege Can , van Amelsvoort Thérèse A M J , Janssen Paddy K C
Published: July 2024

Introduction

Lifelong premature ejaculation (LPE) is a subtype of premature ejaculation. Genetic research on LPE has primarily focused on neurotransmitters such as serotonin, dopamine, and norepinephrine, whereas LPE treatment studies have focused on drugs such as selective serotonin reuptake inhibitors. However, findings from genetic association and pharmacotherapeutic studies have been inconsistent.

Objectives

To provide a quality overview of neurobiological targets that are potentially associated with LPE by investigating genetic association and pharmacotherapeutic studies.

Methods

This scoping review was conducted per the PRISMA-ScR tool (Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews). Five databases were searched in March 2023 without timeline- or language-related restrictions.

Results

After deduplication, 3949 records were obtained for review. Following screening and full-text review with citation tracking, 52 studies were included: 18 genetic and 34 pharmacotherapy studies. Serotonergic targets, such as the serotonin transporter and pre- and postsynaptic serotonergic receptors, were most often associated with LPE in genetic and pharmacotherapeutic studies. Mixed results were found among polymorphisms within genetic studies. This mechanism is in accordance with pharmacotherapeutic studies, as the highest efficacy was found for potent serotonergic antidepressants. Successful treatment was also observed with medication acting on phosphodiesterase-5 enzyme, such as tadalafil and vardenafil. Analyses of other genetic association studies did not yield any further evidence for associated targets.

Conclusions

This review is the first comprehensive scoping review on LPE. We found that serotonergic targets are most often associated with LPE, suggesting that the serotonergic pathway is a predisposing factor in LPE. Furthermore, there is some evidence for phosphodiesterase 5 inhibitors, which should be investigated. Other previously investigated neurobiological targets appear less likely to contribute to LPE. Future studies should focus on multiple targets, ideally in a genome-wide association study design.

This review has been registered with the Open Science Framework (doi:10.17605/OSF.IO/JUQSD).
The brominated flame retardant hexabromocyclododecane causes systemic changes in polyunsaturated fatty acid incorporation in mouse lipids
Authors: Kramer Naomi E , Siracusa Jacob , Xu Hannah , Barnett Lillie M , Finnerty Morgan C , Guo Tai L , Wagner John J , Leach III Franklin E , Cummings Brian S
Published: July 2024

Brominated flame retardants are used in many household products to reduce flammability, but often leach into the surrounding environment over time. Hexabromocyclododecane (HBCD) is a brominated flame retardant detected in human blood across the world. HBCD exposure can result in neurological problems and altered lipid metabolism, but to date, the two remain unlinked. As lipids constitute ∼50% of brain dry weight, lipid metabolism plays a critical role in neuronal function and homeostasis. To determine the effect of HBCD exposure on brain lipid metabolism, young adult male C57BL/6 mice were exposed to 1 mg/kg HBCD every 3 d for 28 d. Major lipid classes were found to change across brain regions, including membrane glycerolipids such as phosphatidylcholine and phosphatidylethanolamine, and sphingolipids such as hexosylceramide. In addition, saturated, monounsaturated, and polyunsaturated fatty acids were enriched within brain lipid species. To understand the source of the brain lipidomic alterations, the blood and liver lipidomes and the cecal microbiome were evaluated. The liver and blood demonstrated changes amongst multiple lipid classes, including triacylglycerol suppression, as well as altered esterified fatty acid content. Significant alterations were also detected in the cecal microbiome, with decreases in the Firmicutes to Bacteriodetes ratio, changes in beta diversity, and pathway alterations associated with metabolic pathways and amino acid biosynthesis. These data demonstrate that HBCD can induce lipidomic alterations across brain regions and organs and support a potential role of the microbiome in these alterations.
Isotretinoin-Induced Hypersomnia: A Cross-sectional Study and Literature Review
Authors: Shawky Ahmed , Elsheikh Mohamed , Elrewiny Emad M. , Adwi Mohamed , Rageh Mahmoud A.
Published: July 2024

BACKGROUND

Isotretinoin is an oral retinoic drug for severe resistant acne cases that has controversially been associated with multiple psychiatric adverse effects. Research has primarily focused on depression and suicidality; however, a few case studies reported hypersomnia and sleep changes after isotretinoin initiation.

OBJECTIVE

To assess sleep quality and measure rates of hypersomnia, depression, and anxiety in patients undergoing isotretinoin therapy.

METHODS

This cross-sectional study was conducted at outpatient clinics of the university hospital. The rate of self-reported oversleeping was measured. In addition, researchers used the Pittsburgh Sleep Quality Index to assess sleep quality and conducted semistructured clinical interviews to detect depression and anxiety.

RESULTS

Of 123 patients with acne on isotretinoin, 77 (62.6%) reported oversleeping. Nearly half (60 patients, 48.8%) were categorized as poor sleepers according to the Pittsburgh Sleep Quality Index. The interviews revealed anxiety and depression percentages among 9.8% and 4.9% of participants, respectively.

CONCLUSIONS

Hypersomnia was noticeably high in this study sample; thus, it may cautiously suggest a possible link between isotretinoin and hypersomnia. However, more research is needed to investigate this potential relationship.
Assessing Neural Synchrony in the Cochlear Nerve to Electrical Stimulation in Children With Auditory Neuropathy Spectrum Disorder
Authors: He Shuman , Chao Xiuhua , Yuan Yi , Skidmore Jeffrey , Uhler Kristin M.
Published: July 2024

Objectives:

This study reported phase locking values (PLVs) that quantified the trial-to-trial phase coherence of electrically evoked compound action potentials in children with auditory neuropathy spectrum disorders (ANSD) and children with Gap Junction Beta 2 (GJB2) mutations, a patient population without noticeable cochlear nerve damage.

Design:

PLVs were measured at three electrode locations in 11 children with ANSD and 11 children with GJB2 mutations. Smaller PLVs indicated poorer neural synchrony. A linear mixed-effects model was used to compare PLVs measured at different electrode locations between participant groups.

Results:

After controlling for the stimulation level effect, children with ANSD had smaller PLVs than children with GJB2 mutations at all three electrode locations.

Conclusions:

Cochlear-implanted children with ANSD show poorer peripheral neural synchrony than children with GJB2 mutations.
How to Write an Abstract
Authors: Meade Matthew H. , Michael Mark , Henzes Jamie , Nanavati Ruchir , Woods Barrett
Published: July 2024

The abstract of a research paper functions to attract readers and highlight the clinical significance of a research project in a broadly appealing manner. Abstract structure is commonly dictated by the target journal, however, a basic style typically follows the “Introduction, Methods, Results and Discussion” structure of introduction, materials/methods, results, and discussion/conclusion. The abstract itself is commonly the initial accessible portion of a research paper, so writing in an engaging while informative manner is imperative for increasing manuscript views and citations. Overall, an abstract is a to-the-point synopsis of a research project that succinctly describes the entirety of your work.
Medication burden and anticholinergic use are associated with overt HE in individuals with cirrhosis
Authors: Montrose Jonathan A. , Desai Archita , Nephew Lauren , Patidar Kavish R. , Ghabril Marwan S. , Campbell Noll L. , Chalasani Naga , Qiu Yingjie , Hays Matthew E. , Orman Eric S.
Published: July 2024

Background:

Polypharmacy and anticholinergic medications are associated with cognitive decline in elderly populations. Although several medications have been associated with HE, associations between medication burden, anticholinergics, and HE have not been explored. We examined medication burden and anticholinergics in patients with cirrhosis and their associations with HE-related hospitalization.

Methods:

We conducted a retrospective cohort study of patients aged 18–80 with cirrhosis seen in hepatology clinics during 2019. The number of chronic medications (medication burden) and anticholinergic use were recorded. The primary outcome was HE-related hospitalization.

Results:

A total of 1039 patients were followed for a median of 840 days. Thirty-seven percent had a history of HE, and 9.8% had an HE-related hospitalization during follow-up. The mean number of chronic medications was 6.1 ± 4.3. Increasing medication burden was associated with HE-related hospitalizations in univariable (HR: 1.09, 95% CI: 1.05–1.12) and multivariable (HR: 1.07, 95% CI: 1.03–1.11) models. This relationship was maintained in those with baseline HE but not in those without baseline HE. Twenty-one percent were taking an anticholinergic medication. Anticholinergic exposure was associated with increased HE-related hospitalizations in both univariable (HR: 1.68, 95% CI: 1.09–2.57) and multivariable (HR: 1.71, 95% CI: 1.11–2.63) models. This relationship was maintained in those with baseline HE but not in those without baseline HE.

Conclusions:

Anticholinergic use and medication burden are both associated with HE-related hospitalizations, particularly in those with a history of HE. Special considerations to limit anticholinergics and minimize overall medication burden should be tested for potential benefit in this population.
Design, implementation, and impact of a cirrhosis-specific remote patient monitoring program
Authors: Penrice Daniel D. , Hara Kamalpreet S. , Sordi-Chara Beatriz , Kezer Camille , Schmidt Kathryn , Kassmeyer Blake , Lennon Ryan , Rosedahl Jordan , Roellinger Daniel , Rattan Puru , Williams Katherine , Kloft-Nelson Sara , Leuenberger Angela , Kamath Patrick S. , Shah Vijay H. , Simonetto Douglas A.
Published: July 2024

Background:

Remote patient monitoring (RPM) is an emerging focus in health care, and specialized programs may reduce medical costs, supplement in-office visits, and improve patient satisfaction. In this study, we describe the development, feasibility, and early outcomes of an RPM program for patients with decompensated cirrhosis.

Methods:

Forty-six patients were offered enrollment at the time of hospital discharge in the cirrhosis RPM program (CiRPM), of which 41 completed at least 30 days of monitoring. Participants were mailed remote monitoring equipment and a tablet to be used for patient-reported outcomes. Alerts were continuously monitored by virtual nursing staff who could perform targeted interventions. A cohort of historical controls (n = 74) was created for comparison using inverse probability of treatment weighting.

Results:

Patients were enrolled in the program for a mean of 83.9 days, with 28 (68%) completing the full 90-day program. Participants uploaded vital signs and responded to symptom-based questionnaires on 93% of the monitored days. On end-of-program surveys, over 75% of patients expressed satisfaction with the program. Gender, age, and MELD-Na were similar between CiRPM and weighted control groups. The 90-day readmission rate was 34% in CiRPM and 47% in weighted controls. In the CiRPM group, 12% of subjects had 2 or more admissions, compared to 37% in the weighted control group.

Conclusion:

This study demonstrates the feasibility of a cirrhosis-specific RPM program. Overall, patient satisfaction and utilization of the CiRPM was high. Future studies are needed to confirm the impact of RPM on the reduction of hospital readmissions in decompensated cirrhosis.
Validating perceptions with clinical measures: A latent growth curve on the associations between patient experience and hospital-associated infections in Norway over time
Authors: Addo Seth Ayisi
Published: July 2024

Objective

The aim of the study was to examine the parallel relationships between the growth rates of patient-reported experiences and hospital-associated infections (HAIs) over time.

Data Sources/Study Setting

The study employed five waves (years) of data among hospitals across Norway from the Norwegian Health Directorate website for both patient experience and HAIs.

Study Design

The study employed a longitudinal design, testing and comparing different models. A latent growth curve model with autoregressions emerged as the best fit for the data.

Data Collection/Extraction Methods

The data extracted from the website included 102 hospitals. However, the study used 61 hospitals after data cleaning, each with 400 patient respondents for each year.

Principal Findings

The results showed that for both patient experiences and HAIs, hospitals that recorded higher scores at the starting point experienced a lower growth rate over time compared to hospitals that recorded lower infections at the starting point. Second, it was found that the starting point for patient experience significantly related to the starting point for HAIs, such that the higher the score for patient experience, the lower the score on infections across hospitals. The results also indicated that almost all lagged effects on either patient-reported experience or HAIs were significant.

Conclusions

This study shows the significance of patient experience, not only for patient-reported outcomes but also for clinical outcomes. This thus ascertains the relevance of the patient experience pillar for the other pillars of quality health care, namely, clinical effectiveness and safety.
Abdominal Hartmann reversal versus combined transanal/abdominal approach: Outcomes and technical notes
Authors: Barugola Giuliano , Bertocchi Elisa , Gentile Irene , Masini Gaia , Secci Federica , Mazzi Cristina , Ruffo Giacomo
Published: July 2024

Background:

Hartmann’s reversal (HR) is one of the most technically challenging operations in colorectal surgery. A small percentage of HR operations are performed laparoscopically. The pelvic dissection is the key point of the procedure and can be demanding when the rectal stump is extraperitoneal and if the pelvic condition is complex.

Methods:

A retrospective observational single-center study was designed to analyze the outcomes of patients with an extraperitoneal rectal stump who underwent HR from January 2015 to December 2020 at IRCCS Sacro Cuore Don Calabria Hospital in Negrar of Valpolicella. The patients were divided into two groups: group 1 underwent a purely abdominal Hartmann’s reversal (A-HR) and group 2 underwent a combined transanal and abdominal Hartmann’s reversal (TA-HR).

Results:

Forty-two patients were divided into the groups as follows: 22 (52.3%) patients in the A-HR group versus 20 (47.62%) patients in the TA-HR. The transanal approach did not significantly affect the operative time. The rate of rectovaginal fistula was higher in the TA-HR group (65% vs. 4.5%). The anastomosis was performed mechanically in all A-HR cases and 50% of TA-HR patients (P < 0.01). No difference in temporary stoma creation was found. The rate of complications was lower in the TA-HR group (P = 0.05). The A-HR group was statistically significantly associated with redo surgery (P = 0.04). Stoma failure rate at the end of the follow-up did not differ between the two groups.

Conclusions:

Transanal Hartmann reversal seems to be a safe approach in patients with a complex pelvis and extraperitoneal rectal stump.
Enhancing Sepsis Outcomes: A 7-Year Multidisciplinary Endeavor
Authors: Paudel Robin , Lessard Sarah , Jaekel Camilla , Albrecht Pamela , Forati Amir Masoud , Heiderscheit Chris
Published: July 2024

Regulatory bodies in the United States have implemented quality metrics aimed at improving outcomes for patients with severe sepsis and septic shock. The current study was a quality improvement (QI) project in a community-based academic center aimed at improving adherence to sepsis quality metrics, time to antibiotic administration, and patient outcomes. Electronic health record systems were utilized to capture sepsis-related data. Regular audits and feedback sessions were conducted to identify areas for improvement, with a focus on the timely administration of antibiotics. Interventions included improving access to antibiotics, transitioning from intravenous piggyback to intravenous push formulations, and providing continuous staff education and training. This multidisciplinary QI initiative led to significant improvements in the mortality index, length of stay index, and direct cost index for patients with sepsis. Targeted multidisciplinary QI interventions resulted in improved quality metrics and patient outcomes.
Development and validation of a novel predictive model for postpancreatectomy hemorrhage using lasso-logistic regression: an international multicenter observational study of 9631 pancreatectomy patients
Authors: Duan Yunjie , Du Yongxing , Mu Yongrun , Guan Xiao , He Jin , Zhang Jianwei , Gu Zongting , Wang Chengfeng
Published: July 2024

Background:

Hemorrhage following pancreatectomy represents a grave complication, exerting a significant impact on patient prognosis. The formulation of a precise predictive model for postpancreatectomy hemorrhage risk holds substantial importance in enhancing surgical safety and improving patient outcomes.

Materials and methods:

This study utilized the patient cohort from the American College of Surgeons National Surgical Quality Improvement Program database, who underwent pancreatectomy between 2014 and 2017 (n=5779), as the training set to establish the Lasso-logistic model. For external validation, a patient cohort (n=3852) from the Chinese National Multicenter Database of Pancreatectomy Patients, who underwent the procedure between 2014 and 2020, was employed. A predictive nomogram for postpancreatectomy hemorrhage was developed, and polynomial equations were extracted. The performance of the predictive model was assessed through the receiver operating characteristic curve, calibration curve, and decision curve analysis.

Results:

In the training and validation cohorts, 9.0% (520/5779) and 8.5% (328/3852) of patients, respectively, experienced postpancreatectomy hemorrhage. Following selection via lasso and logistic regression, only nine predictive factors were identified as independent risk factors associated with postpancreatectomy hemorrhage. These included five preoperative indicators [BMI, American Society of Anesthesiologists (ASA) ≥3, preoperative obstructive jaundice, chemotherapy within 90 days before surgery, and radiotherapy within 90 days before surgery], two intraoperative indicators (total operation time, vascular resection), and two postoperative indicators (postoperative septic shock, pancreatic fistula). The new model demonstrated high predictive accuracy, with an area under the receiver operating characteristic curve of 0.87 in the external validation cohort. Its predictive performance significantly surpassed that of the previous five postpancreatectomy hemorrhage risk prediction models (P<0.001, likelihood ratio test).

Conclusion:

The Lasso-logistic predictive model we developed, constructed from nine rigorously selected variables, accurately predicts the risk of PPH. It has the potential to significantly enhance the safety of pancreatectomy surgeries and improve patient outcomes.
Management of intensive care unit withdrawal syndrome
Authors: Sun Yao , Zhao Huiying
Published: July 2024

Intensive care unit (ICU) patients frequently develop physical and psychological dependence on analgesic and sedative medications, which can lead to Iatrogenic withdrawal syndrome (IWS) upon discontinuation or tapering. The incidence of IWS in adult ICU patients varies significantly, with reported rates ranging from 12% to 100%. Identified risk factors for IWS include advanced age, obesity, medication dosage, and duration of exposure. The clinical manifestations of IWS are varied and include increased excitability of the central nervous system, gastrointestinal disturbances, and sympathetic nervous system hyperactivity. Preventive and therapeutic strategies for IWS encompass individualized medication regimens, structured withdrawal protocols, and a combination of pharmacological and non-pharmacological interventions. This review emphasizes the critical need for heightened awareness and improved management strategies to mitigate the incidence of IWS in ICU patients.
Complicated Pleural Infection is Associated With Prolonged Recovery and Reduced Functional Ability
Authors: Meggyesy Austin M. , Wilshire Candice L. , Bograd Adam J. , Chiu Shih Ting , Gilbert Christopher R. , Rahman Najib M. , Bedawi Eihab O. , Vallieres Eric , Gorden Jed A.
Published: July 2024

Background:

Management of complicated pleural infections (CPIs) had historically been surgical; however, following the publication of the second multicenter intrapleural sepsis trial (MIST-2), combination tissue plasminogen (tPA) and dornase (DNase) offers a less invasive and effective treatment. Our aim was to assess the quality of life (QOL) and functional ability of patients’ recovery from a CPI managed with either intrapleural fibrinolytic therapy (IPFT) or surgery.

Methods:

We identified 565 patients managed for a CPI between January 1, 2013 and March 31, 2018. There were 460 patients eligible for contact, attempted through 2 phone calls and one mailer. Two questionnaires were administered: the Short Form 36-Item Health Survey (SF-36) and a functional ability questionnaire.

Results:

Contact was made in 35% (159/460) of patients, and 57% (90/159) completed the survey. Patients had lower QOL scores compared to average US citizens; those managed with surgery had higher scores in physical functioning (surgery: 80, IPFT: 70, P=0.040) but lower pain scores (surgery: 58, IPFT: 68, P=0.045). Of 52 patients who returned to work, 48% (25) reported an impact on their work effectiveness during recovery, similarly between management strategies (IPFT: 50%, 13/26 vs. surgery: 46%, 12/26; P=0.781).

Conclusion:

Patients with a CPI had a lower QOL compared with average US citizens. Surgically managed patients reported improved physical functioning but worse pain compared with patients managed with IPFT. Patients returned to work within 4 weeks of discharge, and nearly half reported their ability to work effectively was impacted by their recovery. With further research into recovery timelines, patients may be appropriately counselled for expectations.
Reduction in Unindicated Cervical Cancer Screening in Adolescents in a Large Health Care System
Authors: Geng Bertie , Oliveira Carlos R. , Hosier Hillary , Sheth Sangini S. , Vash-Margita Alla
Published: July 2024

Objectives/Purpose

Evidence-based guidelines recommend against screening for cervical cancer (Pap testing) in average-risk adolescents <21 years old. Despite this, many still undergo unindicated screenings with subsequent detrimental reproductive health and economic consequences. Our aim was to reduce unindicated cervical cancer screening in individuals <21 years old in a large health care system by utilizing an electronic provider notification.

Methods

Starting in July 2020, a Best Practice Advisory (BPA) appeared in the electronic medical record (EMR) if providers ordered Pap testing on individuals <21 years old. This BPA reiterated that screening was not indicated for average-risk adolescents and prompted users to choose an indication if they wanted to proceed.

A retrospective chart review, pre/post intervention study was performed comparing individuals <21 years old with Pap testing performed before and after intervention (January 2019–June 2020 and July 2020–June 2021, respectively). Patient characteristics were extracted from the EMR and analyzed using Fisher exact tests, Kruskal-Wallis tests, and logistic regression.

Results

There were 140 subjects included: 106 preintervention and 34 postintervention. There were no differences in baseline characteristics. Neither Pap nor human papillomavirus testing results differed between the groups. Preintervention, 6.6% of cytology tests were indicated compared to 20.6% postintervention (p = .042). The proportion of indicated human papillomavirus testing did not differ preintervention and postintervention at 65% and 45%, respectively (p = .295). The overall reduction in unindicated cervical cancer screening postintervention was 13.9% (95% CI = 4.0–23.7).

Conclusions

We demonstrated that incorporating a BPA to the EMR reduces unindicated cervical cancer screening.
Effects of Aromatherapy on Physical and Psychological Symptoms in Cancer Patients
Authors: Liu Yantong , Xu Mengmeng , Tian Qi , Yu Shuanghan , Cao Minglu , Zhao Wei , Han Yujie , Wang Ziqi , Zhang Wei
Published: July 2024

Background

Numerous physical and psychological symptoms experienced by cancer patients seriously affect their normal lives. Many academics and medical professionals have attempted to use aromatherapy in this situation to help cancer patients manage their physical and emotional problems.

Objective

To systematically investigate the efficacy of aromatherapy on physical and psychological symptoms in cancer patients.

Methods

A systematic review and meta-analysis of randomized controlled trials was performed. Four electronic databases were searched. The review process followed a registered priori review protocol and was reported using Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Data extraction and quality assessment were performed in parallel.

Results

Twenty-six studies with 2912 subjects were included. Meta-analysis showed that aromatherapy significantly improved sleep quality, fatigue, anxiety, and depression. We performed a subgroup analysis according to the different plant or animal aromatics contained in the oil, which found that lavender oil significantly reduced preoperative anxiety. In addition, aromatherapy massage was superior to inhaled aromatherapy in reducing anxiety. Moreover, cancer patients who used aromatherapy reduced the frequency of vomiting in 24 hours.

Conclusions

Aromatherapy is a useful treatment for improving sleep quality and reducing symptoms of fatigue, anxiety, and depression in cancer patients, as well as the frequency of vomiting over 24 hours.

Implications for Practice

Healthcare providers can use aromatherapy to alleviate psychological and physical symptoms in cancer patients. The use of lavender oil and massage is recommended in clinical settings to improve anxiety symptoms in cancer patients.
Internal Audit to Monitor the Injected Activity in PET/CT Using Control Charts
Authors: Russo Sara , Almeida Pedro , Lúcio Teresa , Oliveira Luís , Conde Isabel , Aleixo Ana , Matos Ana Sofia
Published: July 2024

Background and Objective:

In an effort to limit the risks associated with medical radiation exposure, the last century witnessed the development of dose control mechanisms, recommended by the International Commission on Radiological Protection. This organization recommends the optimization of radiation protection to provide the highest level of safety that may reasonably be achievable. Adhering to the “as low as reasonably achievable” principle, the purpose of this study was to monitor the 18F-FDG injected activity in PET and optimize the radiation protection through an internal audit process. This monitoring allows the identification of opportunities for improvement in patient care and safety, as well as to establish a periodic review of the medical unit reference levels.

Methods:

The methodology is based on short run Quesenberry (Q) statistics and normalized nonconstant sample size (Z-chart) control charts. Anonymized data from 512 patients were selected from a set of 18F-FDG PET/CT (Siemens, Biograph 6) examinations performed during 10 months. The analyzed variable was the ratio between the 18F-FDG injected activity (MBq) and patient weight (kg).

Results:

Mean injected 18F-FDG activity was 347.811 ± 64.967 MBq corresponding to a mean effective dose of 6.608 ± 1.234 mSv. The ratio between the 18F-FDG injected activity and the body mass of patients was reduced from 5.243 ± 0.716 to 5.171 ± 0.672 MBq/kg during the statistical data analysis. The study demonstrates that control charts can be a useful tool to signal situations where patients receive an activity significantly different from the standard practice in a medical unit.

Conclusion:

The use of joint control charts is a suitable tool for detecting nonoptimized radiopharmaceutical administration. This analysis provides opportunities to evaluate and improve the quality of practice in nuclear medicine. This methodology constitutes an internal audit that may help health care professionals to make appropriate decisions to ensure all patients receive the safest and most appropriate care.
Diagnostic criteria for amyotrophic lateral sclerosis
Authors: Timmins Hannah C. , Thompson Alexandra E. , Kiernan Matthew C.
Published: July 2024

Purpose of review

The present review will discuss the evolution of diagnostic criteria for amyotrophic lateral sclerosis (ALS) and biomarker considerations.

Recent findings

To address the limitations of existing ALS diagnostic criteria, a consortium of key stakeholders developed the Gold Coast consensus criteria (GCC). The GCC has similar or greater sensitivity compared with the revised El Escorial (rEEC) and Awaji criteria (AC), particularly for atypical phenotypes, maintained across disease duration, severity, and site of onset. In addition to improving diagnostic sensitivity, using the GCC in clinical trials may promote an increased enrolment of up to 50% of ALS patients who do not currently meet the full diagnostic eligibility requirements of the rEEC. Future inclusion of genetic biomarkers may mitigate some limitations of the GCC, to further improve diagnostic utility. In advance of such a process, validation of these biomarkers will be required before inclusion as additional criteria.

The GCC are simpler to use than previous consensus criteria, with demonstrated greater sensitivity and, enabling an earlier and more definitive ALS diagnosis, thereby facilitating wider enrolment into clinical trials. Broader implementation of the GCC in clinical trial settings is currently underway, globally.