bluuebunny/crossref_metadata_2025 huggingface dataset:
Youth mental health-related presentations at a quaternary centre: Who comes, What are their needs, and Can we meet their needs
Authors: Lee Alison , Davidson Jana , Black Tyler , Kim Grace G , Doan Quynh
Published: February 2022

Background

Mental health issues are increasingly prevalent across Canada, reflected in rising presentations to emergency departments. To effectively address the needs of children and youth seeking mental health-related care in the emergency department and to judiciously use scarce mental health-related resources, we need to better identify the specific areas of psychosocial needs and accessibility of associated services.

Objective

To describe the types and severity of paediatric mental health-related presentations evaluated at a quaternary paediatric emergency department, and to explore the accessibility of community mental health-related resources.

Methods

We conducted a retrospective cohort study of children and youth presenting to a quaternary paediatric emergency department who were assessed using HEARTSMAP, a validated mental health assessment and management tool. We reported the proportion who sought care for a psychiatric, social, or youth health-related mental health complaint. We contacted community mental health-related resources for their estimated wait times to determine accessibility.

Results

Of 1,530 paediatric emergency presentations, 98.8% of patients had psychiatric issues (40.1% were severe), 78.0% of patients had social issues (17.1% were severe), and 71.5% had youth health issues (18.1% were severe). We contacted 123 community mental health-related resources. Community youth health and social services were somewhat accessible, with 50.0% and 38.7%, respectively, able to intake youth within a week of referral. Community psychiatric programs were least accessible, with 59.3% having wait times greater than 1 month.

Conclusions

Many psychiatric concerns presenting in paediatric emergency departments have complex psychosocial challenges requiring non-psychiatric support. A need exists for improved accessibility to community psychiatric programs.
Two major metabolic factors for an efficient NADP-malic enzyme type C4 photosynthesis
Authors: Zhao Honglong , Wang Yu , Lyu Ming-Ju Amy , Zhu Xin-Guang
Published: February 2022

Compared to the large number of studies focused on the factors controlling C3 photosynthesis efficiency, there are relatively fewer studies of the factors controlling photosynthetic efficiency in C4 leaves. Here, we used a dynamic systems model of C4 photosynthesis based on maize (Zea mays) to identify features associated with high photosynthetic efficiency in NADP-malic enzyme (NADP-ME) type C4 photosynthesis. We found that two additional factors related to coordination between C4 shuttle metabolism and C3 metabolism are required for efficient C4 photosynthesis: (1) accumulating a high concentration of phosphoenolpyruvate through maintaining a large PGA concentration in the mesophyll cell chloroplast and (2) maintaining a suitable oxidized status in bundle sheath cell chloroplasts. These identified mechanisms are in line with the current cellular location of enzymes/proteins involved in the starch synthesis, the Calvin–Benson cycle and photosystem II of NADP-ME type C4 photosynthesis. These findings suggested potential strategies for improving C4 photosynthesis and engineering C4 rice.
Physical Therapist and Physical Therapist Student Knowledge, Confidence, Attitudes, and Beliefs About Providing Care for People With Dementia: A Mixed-Methods Systematic Review
Authors: Quick Stephen M , Snowdon David A , Lawler Katherine , McGinley Jennifer L , Soh Sze-Ee , Callisaya Michele L
Published: February 2022

Objective

The purpose of this study was to determine physical therapists’ and physical therapist students’ attitudes and beliefs, knowledge, and confidence in working with people with dementia.

Methods

This was a mixed-methods systematic review. Participants included physical therapists working in any clinical specialty and physical therapist students who had completed at least 1 clinical placement. Eleven databases were searched. The evidence was evaluated using the Joanna Briggs Institute Critical Appraisal Checklists. Data synthesis followed a convergent integrated approach according to Joanna Briggs Institute methodology for mixed-methods systematic reviews. Quantitative data were “qualitized” using thematic analysis and synthesized with qualitative data using thematic synthesis.

Results

Fifteen studies were included (9 quantitative and 6 qualitative studies). Seven key themes evolved. Five related to the belief that (1) working with people with dementia is complex and challenging; (2) opportunities for education in dementia care are lacking; (3) working with people with dementia is a specialized area of practice; (4) there are unsupportive systems for working with people with dementia; and (5) people with dementia deserve rehabilitation, but their potential to improve is less certain. One theme related to knowledge (lack of knowledge in some areas of dementia care), and 1 theme related to confidence (lack of confidence in working with people with dementia).

Conclusions

Physical therapists and physical therapist students believe that working with people with dementia can be challenging. The low levels of knowledge and confidence in areas important to working with people who have dementia suggest that more education about dementia is needed.

Impact

This mixed-methods systematic review highlights that physical therapists and physical therapist students believe that working with people who have dementia is complex and challenging. Physical therapists want more training and support in this growing area of practice.
Seroprevalence of Toxoplasma gondii infection among HIV-positive patients in Southwest Iran and associated risk factors: a case-control study
Authors: Nikbakht Gordafarin , Behrouzi Maryam , Mousavizadeh Ali , Pourabbas Bahman , Rezaei Zahra , Nouripour-Sisakht Sadegh , Arefkhah Nasir
Published: February 2022

Background

The current study aimed to determine the seroprevalence of Toxoplasma gondii infection among HIV-positive patients and healthy subjects.

Methods

This study was carried out on HIV-positive patients and healthy individuals in Southwest Iran. Five millilitres of venous blood samples were collected aseptically from each individual. Sera and buffy coats were isolated from each sample and evaluated for anti-Toxoplasma antibodies and T. gondii DNA using ELISA kit and real-time PCR, respectively. Statistical analysis was performed using SPSS 18 software.

Results

Of 64 AIDS/HIV-positive patients, six (9.3%, 95% CI 7.2 to 11.3%) were seropositive for only IgG and five (7.8%, 95% CI 6.0 to 9.5%) were seropositive for both IgG and IgM. Moreover, among 64 healthy controls, 10 (15.6%, 95% CI 12.1 to 19.0%) were seropositive for only IgG and 2 (3.1%, 95% CI 2.4 to 3.7%) were seropositive for both IgG and IgM. Toxoplasma gondii DNA was detected in six samples (9.3%, 95% CI 7.2 to 11.3%) in the AIDS/HIV-positive patients group and eight samples (5.95%, 95% CI 4.6 to 7.2%) in the control group using real-time PCR. Consumption of undercooked meat was documented as an associated risk factor for T. gondii seropositivity in AIDS patients (OR 4.06, 95% CI 0.966 to 17.09; p=0.045).

Conclusions

Our findings showed a lower prevalence of Toxoplasma infection in AIDS/HIV-positive patients vs healthy controls; however, a considerable number of AIDS/HIV-positive patients were also seen to be at risk of toxoplasmosis. Based on the findings, screening and prophylaxis for toxoplasmosis should be implemented for all AIDS/HIV-positive patients in Southwest Iran.
Expanding Inpatient Addiction Consult Services Through Accountable Care Organizations for Medicaid Enrollees: A Modeling Study
Authors: King Caroline A. , Cook Ryan , Korthuis P. Todd , McCarty Dennis , Morris Cynthia D. , Englander Honora
Published: February 2022

Introduction

Addiction consult services (ACS) care for hospitalized patients with substance use disorder, including opioid use disorder (OUD). Medicaid Accountable Care Organizations (ACOs) could enhance access to ACS. This study extends data from Oregon’s only ACS to Oregon’s 15 regional Medicaid Coordinated Care Organizations (CCOs) to illustrate the potential value of enhanced in- and out-patient care for hospitalized patients with OUD. The study objectives were to estimate the effects of (1) expanding ACS care through CCOs in Oregon, and (2) increasing community treatment access within CCOs, on post-discharge OUD treatment engagement.

Methods

We used a validated Markov model, populated with Oregon Medicaid data from April 2015 to December 2017, to estimate study objectives.

Results

Oregon Medicaid patients hospitalized with OUD with care billed to a CCO (n = 5878) included 1298 (22.1%) patients engaged in post-discharge OUD treatment. Simulation of referral to an ACS increased post-discharge OUD treatment engagement to 47.0% (95% confidence interval [CI] 45.7%, 48.3%), or 2684 patients (95% CI 2610, 2758). Ten of fifteen (66.7%) CCOs had fewer than 20% of patients engage in post-discharge OUD care. Without ACS, increasing outpatient treatment such that 20% of patients engage increased the patients engaging in post-discharge OUD care from 12.9% or 296 patients in care at baseline to 20% (95% CI 18.1%, 21.4%) or 453 (95% CI 416, 491).

Discussion

ACOs can improve care for patients hospitalized with OUD. Implementing ACS in ACO networks can potentially improve post-discharge OUD treatment engagement, but community treatment systems must be prepared to accept more patients as inpatient addiction care improves.
Tanning Beds, Rue, and Major Burns: An Alarming Association
Authors: Pérez-Camelo Juan Sebastián , Barrios Valeria , Gómez-Ortega Viviana
Published: February 2022

Skin contact with phytotoxic chemicals present in Ruta graveolens L. and UV light exposure might cause a nonallergic contact dermatitis known as phytophotodermatitis. We present a major burns case report associated with the use of rue (an herb used in Colombia for cultural beliefs) before entering a tanning bed. The patient presented superficial wounds that evolved to deeper ones in a phytophotodermatitis reaction that acted as a chemical burn. The patient presented an estimated percentage of total burn surface area of 85% with second-degree burns. It took two and a half months to apply multiple debridements and bandage coverage before discharge. One month later, the patient presented a dark purplish pigmentation mainly in the lower limbs. Since ancient times, rue has been used as part of medical pharmacy, insecticidal activities, and for superstitious purposes. In many countries, rue is used as part of an elixir that helps with bad luck, envy, and anguish, and the risks associated with those uses are unknown. This is a critical and alarming public health problem. Awareness of possible complications that could develop after rue and tanning beds should encourage patients and physicians to prevent and treat this dangerous combination.
Defocus curves: focusing on factors influencing assessment
Authors: Kohnen Thomas , Lemp-Hull Jessie , Suryakumar Rajaraman
Published: February 2022

Defocus curve assessment is used to emulate defocus over a range of distances and is a valuable tool that is used to differentiate the performance of presbyopia-correcting intraocular lenses. However, defocus curves are limited by a lack of standardization, and multiple factors can affect their generation and interpretation. This review discusses key factors that influence the assessment of defocus curves, including pupil size, level of contrast, sphere vs cylinder defocus, viewing distance, monocular vs binocular assessment, use of Snellen vs logMAR charts, and diopter range and step size. Moreover, different methods to analyze defocus curves, including the direct comparison method, range-of-focus analysis, and area under the curve analysis, can affect result interpretation. A good understanding of these factors and standardization of the methodology are important to ensure optimal cross-study comparisons.
Sexual Assault Nurse Examiner Training: A Review of Literature and Implication for Nursing Education and Service to Rural Communities
Authors: Sheeran Beth , Kiser Lisa , Williams-Gilbert Wendy , Enslow Electra
Published: February 2022

Sexual assault nurse examiners (SANEs) play a critical role in providing quality care to patients who have experienced sexual violence. Recent national legislative initiatives have been launched both to better explore state-specific needs in regard to training SANE nurses as well as pilot programs that will establish evidence-based methods of expanding SANE training to remote, rural, and underserved communities.

A scoping literature review was conducted to identify best practices in SANE training as well as implications for delivering this education to rural and underserved communities. This review analyzed the scientific strengths and weaknesses of existing research, provided an overview of findings within the literature, and identified areas where further research could be directed to inform local, state, and national strategy on SANE education.

Blended learning programs that pair online education with simulated clinical experiences are promising alternatives to the traditional classroom experience; however, more research is needed to know how to enhance retention and engagement of nurses utilizing these methods to obtain preliminary SANE training.
Building a Capacity of Sexual Assault Nurse Examiners in an Underserved U.S.–Mexico Border Region
Authors: Torregosa Marivic B. , Chaudhuri Nandita , del Rosario Benavides Maria , Jackson Anthony
Published: February 2022

Sexual assault nurse examiners (SANEs) conduct medical forensic examinations for persons who have been sexually assaulted. Positive psychological effects, high prosecution rates, and increased victim self-efficacy to seek resources for recovery were reported among sexual assault victims who received forensic care from SANEs. However, such endeavors may be very challenging to achieve because of the severe shortage of certified SANEs. This article will describe how one institution located in a medically underserved U.S.–Mexico border town built a SANE program to increase the capacity of SANEs in the region through 3-year grant funding. The lessons learned, challenges faced during implementation, and sustainability plans including integrating SANEs into the local medicolegal system to seek justice for sexual assault victims are critically addressed in this article.
Myocardial dysfunction after cardiac arrest: tips and pitfalls
Authors: Ortuno Sofia , Geri Guillaume , Bouguoin Wulfran , Cariou Alain , Aissaoui Nadia
Published: February 2022

Postcardiac arrest shock (PCAS) is defined by hemodynamic instability occurring in the first hours after cardiac arrest (CA) and is a major cause of mortality among patients hospitalized after CA. It includes vasoplegia and myocardial dysfunction. This postcardiac arrest myocardial dysfunction is supposed to recover within the 3 days. However, there are many unknowns regarding its definition, its prognosis value and its management. In this review dedicated to emergency physicians, we choose to address tips and pitfalls they should know regarding this prevalent syndrome.
Integrating Interactive Digital Content Into Existing Professional Development Programs for Nurses
Authors: Fredericks Suzanne
Published: February 2022

Current nursing professional development programs include online education related to caring for COVID-19-positive patients. However, these resources failed to attract significant uptake of knowledge acquisition mainly because of poorly structured web pages. This discussion paper presents a unique perspective to designing professional development programs for frontline nurses working during the COVID-19 pandemic and beyond through the use of interactive digital content (IDC). An overview of IDC is provided, followed by strategies for transforming existing nursing professional development education into IDC.
Sudden Death in Diabetic Ketoacidosis Complicated by Sickle Cell Trait
Authors: Dau Georgia E. , Shah Jamie J. , Walsh John C. , Berran Philip J.
Published: February 2022

In a sudden death investigation of a service member with sickle cell trait (SCT), evidence of sickle cell crisis further complicated by coexisting, undiagnosed diabetic ketoacidosis called into question the synergistic effects of diabetic ketoacidosis on red blood cell sickling. Sickle cell trait affects more than 4 million people in the United States (US) with the highest prevalence in non-Hispanic Blacks (7%–9%; Mil Med 2017;182(3):e1819–e1824). The heterozygous state of sickled hemoglobin was previously considered a benign condition causing sickling during hypoxic, high-stress conditions such as exercise and high altitude (Am Assoc Clin Chem 2017). However, research within the last decade shows evidence of sudden death among SCT patients (J Forensic Sci 2011;56(5):1352–1360). It has been shown that the presence of sickled hemoglobin artificially lowers levels of hemoglobin A1c making it a less effective biomarker for red blood cell glycosylation over time in sickle cell patients (JAMA 2017;317(5):507–515). The limited scope of medical understanding of the effects of SCT in combination with other comorbidities requires further investigation and better diagnostic criteria. The uniqueness of the US Military and its screening program for sickle cell disease (SCD) and SCT allows for more detection. Since May 2006, newborn screening for SCD/SCT has been a national requirement; however, anyone older than 14 years may not know their SCD/SCT status (Semin Perinatol 2010;34(2):134–44). The previous absence of such national screening makes it more challenging to identify SCT and SCD patients even within high-risk populations. Furthermore, patients may not know or understand the results of their SCD/SCT status testing. International standards for the autopsy of decedents with SCD and SCT exist (R Coll Pathol 2017). Within the US, testing of vitreous electrolytes is a common practice in suspected natural death cases, but a review of the US literature did not demonstrate any autopsy standards or recommendations for persons with SCT or high-risk persons for sickling pathologies. The identification of a new diagnosis of type 2 diabetes mellitus, as the cause of death, is not uncommon; however, this case indicates that type 2 diabetes mellitus was not the sole contributing factor. It further illustrates that the US may be underestimating the impact of SCD and SCT as a cause of death, a contributing factor to death, and its synergistic effects with other pathologic processes. We propose a stringent literature review in conjunction with a review of international autopsy standards to develop national autopsy standards and possible SCT/SCD screening recommendations for high-risk persons at the time of autopsy.
Do Websites Serve Our Patients Well? A Comparative Analysis of Online Information on Cosmetic Injectables
Authors: Patel Anooj A. , Joshi Chitang , Varghese Jeffrey , Hassan Abbas M. , Janis Jeffrey E. , Galiano Robert D.
Published: February 2022

Background:

Patients access online cosmetic health information to help with decision making. This information is unregulated, variable in quality, and may be biased. This study compared the most popular cosmetic injectables websites to assess their readability, quality, and technical performance.

Methods:

A Google search for “Botox” (botulinum toxin type A) and “fillers” was performed in July of 2020, identifying the most popular health information websites. Sites were analyzed for their readability and quality of health information using the validated DISCERN criteria and the Health on the Net Foundation Code of Conduct principles. Technical qualities were evaluated using two website performance algorithms, WooRank and WebsiteGrader.

Results:

Eighty-five websites were analyzed (13 academic/hospital websites, seven commercial websites, 25 private practice board-certified websites, seven private practice not-board-certified websites, 16 online health reference websites, and 17 other websites). The mean readability consensus score was 11 (eleventh grade reading level). The mean DISCERN quality scores were higher for online health reference websites compared to academic/hospital websites (p = 0.045), commercial websites (p = 0.045), private practice board-certified websites (p < 0.001), and private practice not-board-certified websites (p = .002). No correlation between a website’s rank and its DISCERN score was found (ρ = −0.07; p = 0.49).

Conclusions:

Cosmetic injectable websites are too difficult to read by the sixth grade standard recommended by the National Institutes of Health and the American Medical Association. Online health reference sites are higher in quality than physician sites. This has implications for the ability of many patients to be fully informed consumers. The readability, quality, and technical aspects of websites may affect the overall accessibility of patient health information.
Exploring Changes in Patient Safety Incidents During the COVID-19 Pandemic in a Canadian Regional Hospital System: A Retrospective Time Series Analysis
Authors: Lombardi Julia , Strobel Stephenson , Pullar Virginia , Senthil Pooja , Upadhye Suneel , Khemani Ekta
Published: February 2022

Objectives

The COVID-19 pandemic has placed unprecedented strain on healthcare systems and may have consequential impacts on patient safety incidents (PSIs). The primary objective of this study was to examine the impact of the COVID-19 pandemic on PSIs reported in Niagara Health.

Methods

Flexible Farrington models were used to retrospectively detect weeks from January to September 2020 where PSI counts were significantly above expected counts. Incident counts were adjusted to weekly inpatient-days. Outcomes included overall incident numbers, incidents by category, and incidents by ward type.

Results

The overall number of PSIs across Niagara Health did not increase during the first wave of the COVID-19 pandemic. However, significant increases in falls were observed, suggesting that other types of incidents decreased. Falls increased by 75% from February to March 2020, coinciding with the onset of the first wave of the pandemic. Further investigation by unit type revealed that the number of falls increased specifically on internal medicine and complex continuing care wards.

Conclusions

Despite no observed changes in overall number, significant composition shifts in PSIs occurred during the first wave of the COVID-19 pandemic, with increased falls on internal medicine and complex continuing care wards. Possible explanations include restrictions on patient visitation, reduced patient contact/supervision, and/or personal protective equipment requirements. Providers should maintain a particularly high vigilance for patient falls during pandemic outbreaks, and hospitals should consider targeting resources to higher-risk locations. The results of this study reinforce the need for ongoing pandemic PSI monitoring and rapidly adaptive responses to new patient safety concerns.
Brief Report: Retinal Microvasculature and Immune Restoration Among South Eastern Asian Patients With HIV/AIDS Over a 9-Month Antiretroviral Therapy
Authors: Li Ling-Jun , Tan Petrina , Hee Owen , Agrawal Rupesh , Lim Tock-Han , Wong Tien-Yin , Teoh Stephen C
Published: February 2022

Background:

Longitudinal evidence on retinal microvasculature and subsequent systemic inflammatory alteration is lacking. We investigated the association between retinal microvasculature and immune response among patients with HIV/AIDS over a 9-month antiretroviral therapy.

Methods:

We conducted a prospective cohort study on patients with HIV/AIDS at Singapore Communicable Disease Centre since June 2011. We recruited all eligible patients and then reviewed them every 3 months over a 9-month follow-up, including performing blood tests (CD4+/CD8+ T-cell counts and HIV viral load), blood pressure, anthropometry measurements, and retinal photography at each visit. We assessed retinal vascular indexes using a semiautomated computer-based program. Finally, we applied a linear mixed model to analyze associations between baseline retinal vascular indexes and 9-month changes of CD4+/CD8+ T-cell counts and HIV viral load throughout study observation, after adjusting for major confounders.

Results:

We found that narrower arteriolar caliber (per 10 μm decrease), wider venular caliber (per 10 μm increase), and larger arteriolar branching angle (per 10° increase) in the retina assessed at baseline were significantly associated with 9-month reductions in CD4+ T-cell count by 52.97 cells/μL (P = 0.006), 33.55 cells/μL (P = 0.01), and 39.09 cells/μL (P = 0.008), accordingly.

Conclusion:

Patients with HIV/AIDS with a suboptimal retinal microvascular morphology tended to fail immune restoration undertaking a 9-month antiretroviral therapy.
A Multicomponent Intervention to Reduce Readmissions Among People With HIV
Authors: Nijhawan Ank E. , Zhang Song , Chansard Matthieu , Gao Ang , Jain Mamta K. , Halm Ethan A.
Published: February 2022

Background:

Hospital readmissions are common, costly, and potentially preventable, including among people with HIV (PWH). We present the results of an evaluation of a multicomponent intervention aimed at reducing 30-day readmissions among PWH.

Methods:

Demographic, socioeconomic, and clinical variables were collected from the electronic health records of PWH or those with cellulitis (control group) hospitalized at an urban safety-net hospital before and after (from September 2012 to December 2016) the implementation of a multidisciplinary HIV transitional care team. After October 2014, hospitalized PWH could receive a medical HIV consultation ± a transitional care nurse intervention. The primary outcome was readmission to any hospital within 30 days of discharge. Multivariate logistic regression and propensity score analyses were conducted to compare readmissions before and after intervention implementation in PWH and people with cellulitis.

Results:

Overall, among PWH, 329 of the 2049 (16.1%) readmissions occurred before and 329 of the 2023 (16.3%) occurred after the transitional care team intervention. After including clinical and social predictors, the adjusted odds ratio of 30-day readmissions for postintervention for PWH was 0.81 (95% confidence interval: 0.66 to 0.99, P= 0.04), whereas little reduction was identified for those with cellulitis (adjusted odds ratio 0.91 (95% confidence interval: 0.81 to 1.02, P= 0.10). A dose–response effect was not observed for receipt of different HIV intervention components.

Conclusions:

A multicomponent intervention reduced the adjusted risk of 30-day readmissions in PWH, although no dose–response effect was detected. Additional efforts are needed to reduce overall hospitalizations and readmissions among PWH including increasing HIV prevention, early diagnosis and engagement in care, and expanding the availability and spectrum of transitional care services.
Hospital readmission after blunt traumatic rib fractures
Authors: Marthy Andrew G. , Mounsey Molly , Ata Ashar , Stain Steven C. , Tafen Marcel
Published: February 2022

BACKGROUND

Hospital readmissions are resource intensive, associated with increased morbidity, and often used as hospital-level quality indicators. The factors that determine hospital readmission after blunt thoracic trauma have not been sufficiently defined. We sought to identify predictors of hospital readmission in patients with traumatic rib fractures.

METHODS

We performed an 8-year (2011–2019) retrospective chart review of patients with traumatic rib fractures who required unplanned readmission within 30 days of discharge at a Level 1 trauma center. Patient characteristics, injury severity, and hospital complications were examined using quantitative analysis to identify readmission risk factors.

RESULTS

There were 13,046 trauma admissions during the study period. The traumatic rib fracture cohort consisted of 3,720 patients. The cohort included 206 patients who were readmitted within 30 days of discharge. The mean age of the traumatic rib fracture cohort was 57 years, with a 6-day median length of stay. The 30-day mortality rate was 5%. Use of anticoagulation (11.0 vs. 5.4; p = 0.029), diagnosis of a psychiatric disorder (10.2 vs. 5.3; p = 0.01), active smoking (7.3 vs. 5.0; p = 0.008), associated hemothorax (8.3 vs. 5.2; p = 0.010), higher abdominal Abbreviated Injury Scale (33.3 vs. 8.4 vs. 6.5; p = 0.002), rapid response activation (8.9 vs. 5.2; p = 0.005), admission to intensive care unit (7.7 vs. 4.5; p = 0.001), and diagnosis of in-hospital pneumonia (10.1 vs. 5.4; p = 0.022) were predictors of hospital readmission. On multivariate analysis, prescribed anticoagulation (odds ratio [OR], 2.22; p = 0.033), active smoking (OR, 1.58; p = 0.004), higher abdominal Abbreviated Injury Scale (OR, 1.50; p = 0.054), and diagnosis of a psychiatric disorder (OR, 2.00; p = 0.016) predicted hospital readmission.

CONCLUSION

In patients with traumatic rib fractures, those with anticoagulant use, those who actively smoke, those with a psychiatric diagnosis, or those with associated abdominal injuries are at the highest risk of rehospitalization following discharge. Quality improvement should focus on strategies and protocols directed toward these groups to reduce nonelective readmissions.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level IV.
ECMO Long Haulers: A Distinct Phenotype of COVID-19–Associated ARDS With Implications for Lung Transplant Candidacy
Authors: Mohanka Manish R. , Joerns John , Lawrence Adrian , Bollineni Srinivas , Kaza Vaidehi , Cheruku Sreekanth , Leveno Matthew , Chen Catherine , Terada Lance S. , Kershaw Corey D. , Torres Fernando , Peltz Matthias , Wait Michael A. , Hackmann Amy E. , Banga Amit
Published: February 2022

Background.

Studies indicate that the recovery from coronavirus disease 2019 (COVID-19)–associated acute respiratory distress syndrome may be slower than other viral pneumonia. There are limited data to guide decisions among patients who need extracorporeal membrane oxygenation (ECMO) support, especially the expected time of recovery and considering lung transplantation (LT).

Methods.

This was a retrospective chart review of patients with COVID-19–associated acute respiratory distress syndrome placed on ECMO between March 1, 2020, and September 15, 2021 (n = 20; median age, 44 y; range, 22–62 y; male:female, 15:5). We contrasted the baseline variables and clinical course of patients with and without the need for ECMO support >30 d (ECMO long haulers, n = 10).

Results.

Ten patients met the criteria for ECMO long haulers (median duration of ECMO, 86 d; range, 42–201 d). The long haulers were healthier at baseline with fewer comorbidities but had worse pulmonary compliance and higher partial pressure of CO2. They had a significantly higher number of membrane oxygenator failures, changes to their cannulation sites, and suffer more complications on ECMO. One of the long hauler was bridged to LT while another 6 patients recovered and were discharged. Overall survival was better among the ECMO long haulers (70% versus 20%; 9.3, 1.2–73; P = 0.03).

Conclusions.

Despite worse pulmonary physiology, frequent complications, and a tortuous hospital course that may appear to portend a poor prognosis, ECMO long haulers have the potential to recover and be weaned off ECMO without the need for LT. A customized approach comprising a more conservative timeline for the consideration of LT may be prudent among these patients.
Disparity in socio-economic status explains the pattern of self-medication of antibiotics in India: understanding from game-theoretic perspective
Authors: Malik Bhawna , Hasan Farooqui Habib , Bhattacharyya Samit
Published: February 2022

The emergence of antimicrobial resistance has raised great concern for public health in many lower-income countries including India. Socio-economic determinants like poverty, health expenditure and awareness accelerate this emergence by influencing individuals' attitudes and healthcare practices such asself-medication. This self-medication practice is highly prevalent in many countries, where antibiotics are available without prescriptions. Thus, complex dynamics of drug- resistance driven by economy, human behaviour, and disease epidemiology poses a serious threat to the community, which has been less emphasized in prior studies. Here, we formulate a game-theoretic model of human choices in self-medication integrating economic growth and disease transmission processes. We show that this adaptive behaviour emerges spontaneously in the population through a self-reinforcing process and continual feedback from the economy, resulting in the emergence of resistance as externalities of human choice under resource constraints situations. We identify that the disparity between social-optimum and individual interest in self-medication is primarily driven by the effectiveness of treatment, health awareness and public health interventions. Frequent multiple-peaks of resistant strains are also observed when individuals imitate others more readily and self-medication is more likely. Our model exemplifies that timely public health intervention for financial risk protection, and antibiotic stewardship policies can improve the epidemiological situation and prevent economic collapse.
Electro-osmotic and viscous effects upon pressure to drive a droplet through a capillary
Authors: Grassia Paul
Published: February 2022

A charged oil droplet advancing into a charged capillary is considered, assuming the special case in which charges are opposite and equal. The droplet is surrounded by an aqueous phase that wets the capillary wall, such that a thin film adjacent to the wall is laid down as the droplet advances. Electro-osmotic conjoining pressures contrive to make the film even thinner than in an uncharged case. The pressure drop needed to drive the droplet along is examined. The pressure drop is dominated by capillarity but contains electro-osmotic and viscous corrections. The viscous correction is shown to be remarkably insensitive to the presence of electro-osmotic effects. The electro-osmotic pressure correction is negative, reflecting work done by the electro-osmotic conjoining pressure as film is laid down. The negative electro-osmotic correction to pressure drop can far exceed the positive viscous correction. As a result, in the presence of conjoining pressures, a droplet can be driven along a capillary channel with even less pressure drop than is seen for a static uncharged droplet.
Overlapping timescales obscure early warning signals of the second COVID-19 wave
Authors: Dablander Fabian , Heesterbeek Hans , Borsboom Denny , Drake John M.
Published: February 2022

Early warning indicators based on critical slowing down have been suggested as a model-independent and low-cost tool to anticipate the (re)emergence of infectious diseases. We studied whether such indicators could reliably have anticipated the second COVID-19 wave in European countries. Contrary to theoretical predictions, we found that characteristic early warning indicators generallydecreasedrather thanincreasedprior to the second wave. A model explains this unexpected finding as a result of transient dynamics and the multiple timescales of relaxation during a non-stationary epidemic. Particularly, if an epidemic that seems initially contained after a first wave does not fully settle to its new quasi-equilibrium prior to changing circumstances or conditions that force a second wave, then indicators will show a decreasing rather than an increasing trend as a result of the persistent transient trajectory of the first wave. Our simulations show that this lack of timescale separation was to be expected during the second European epidemic wave of COVID-19. Overall, our results emphasize that the theory of critical slowing down applies only when the external forcing of the system across a critical point is slow relative to the internal system dynamics.
New opabiniid diversifies the weirdest wonders of the euarthropod stem group
Authors: Pates Stephen , Wolfe Joanna M. , Lerosey-Aubril Rudy , Daley Allison C. , Ortega-Hernández Javier
Published: February 2022

Once considered ‘weird wonders’ of the Cambrian, the emblematic Burgess Shale animals
Anomalocaris
and
Opabinia
are now recognized as lower stem-group euarthropods and have provided crucial data for constraining the polarity of key morphological characters in the group.
Anomalocaris
and its relatives (radiodonts) had worldwide distribution and survived until at least the Devonian. However, despite intense study,
Opabinia
remains the only formally described opabiniid to date. Here we reinterpret a fossil from the Wheeler Formation of Utah as a new opabiniid,
Utaurora comosa
nov. gen. et sp. By visualizing the sample of phylogenetic topologies in treespace, our results fortify support for the position of
U. comosa
beyond the nodal support traditionally applied. Our phylogenetic evidence expands opabiniids to multiple Cambrian stages. Our results underscore the power of treespace visualization for resolving imperfectly preserved fossils and expanding the known diversity and spatio-temporal ranges within the euarthropod lower stem group.
A diversification relay race from Caribbean-Mesoamerica to the Andes: historical biogeography of
Xylophanes
hawkmoths
Authors: Li Xuankun , Hamilton Chris A. , St Laurent Ryan , Ballesteros-Mejia Liliana , Markee Amanda , Haxaire Jean , Rougerie Rodolphe , Kitching Ian J. , Kawahara Akito Y.
Published: February 2022

The regions of the Andes and Caribbean-Mesoamerica are both hypothesized to be the cradle for many Neotropical lineages, but few studies have fully investigated the dynamics and interactions between Neotropical bioregions. The New World hawkmoth genus
Xylophanes
is the most taxonomically diverse genus in the Sphingidae, with the highest endemism and richness in the Andes and Caribbean-Mesoamerica. We integrated phylogenomic and DNA barcode data and generated the first time-calibrated tree for this genus, covering 93.8% of the species diversity. We used event-based likelihood ancestral area estimation and biogeographic stochastic mapping to examine the speciation and dispersal dynamics of
Xylophanes
across bioregions. We also used trait-dependent diversification models to compare speciation and extinction rates of lineages associated with different bioregions. Our results indicate that
Xylophanes
originated in Caribbean-Mesoamerica in the Late Miocene, and immediately diverged into five major clades. The current species diversity and distribution of
Xylophanes
can be explained by two consecutive phases. In the first phase, the highest
Xylophanes
speciation and emigration rates occurred in the Caribbean-Mesoamerica, and the highest immigration rates occurred in the Andes, whereas in the second phase the highest immigration rates were found in Amazonia, and the Andes had the highest speciation and emigration rates.
Upper-limit agricultural dietary exposure to streptomycin in the laboratory reduces learning and foraging in bumblebees
Authors: Avila Laura , Dunne Elizabeth , Hofmann David , Brosi Berry J.
Published: February 2022

In the past decade, the broadcast-spray application of antibiotics in US crops has increased exponentially in response to bacterial crop pathogens, but little is known about the sublethal impacts on beneficial organisms in agroecosystems. This is concerning given the key roles that microbes play in modulating insect fitness. A growing body of evidence suggests that insect gut microbiomes may play a role in learning and behaviour, which are key for the survival of pollinators and for their pollination efficacy, and which in turn could be disrupted by dietary antibiotic exposure. In the laboratory, we tested the effects of an upper-limit dietary exposure to streptomycin (200 ppm)—an antibiotic widely used to treat bacterial pathogens in crops—on bumblebee (
Bombus impatiens
) associative learning, foraging and stimulus avoidance behaviour. We used two operant conditioning assays: a free movement proboscis extension reflex protocol focused on short-term memory formation, and an automated radio-frequency identification tracking system focused on foraging. We show that upper-limit dietary streptomycin exposure slowed training, decreased foraging choice accuracy, increased avoidance behaviour and was associated with reduced foraging on sucrose-rewarding artificial flowers. This work underscores the need to further study the impacts of antibiotic use on beneficial insects in agricultural systems.
Antimicrobial susceptibility and risk factors for resistance amongEscherichia coliisolated from canine specimens submitted to a diagnostic laboratory in Indiana, 2010-2019
Authors: Ekakoro John E. , Hendrix G. Kenitra , Guptill Lynn F. , Ruple Audrey
Published: February 2022

Escherichia coli(E. coli) is the most common Gram-negative pathogen isolated in human infections. Antimicrobial resistant (AMR)E. colioriginating from dogs may directly or indirectly cause disease in humans. The objective of this study was to calculate the proportion of antimicrobial susceptibleE. coliisolated from canine specimens submitted to the Indiana Animal Disease Diagnostic Laboratory and to identify temporal patterns of susceptibility among these isolates. Susceptibility data of 2,738E. coliisolates from dogs from 2010 through 2019 were used in this study. Proportions of isolates susceptible to the various antimicrobials were calculated using SAS statistical software and the Cochran-Armitage trend test was used to investigate the temporal trends in susceptibility. A multivariable binary logistic regression model was built to investigate the association between host factors and AMR. Overall, 553/2,738 (20.2%) of the isolates were susceptible to 17 of the 27 antimicrobials examined. Of the 2,638 isolates examined for amikacin susceptibility, 2,706 (97.5%) were susceptible, 2,657/2,673 (99.4%) isolates were susceptible to imipenem, and 2,099/2,670 (78.6%) were susceptible to marbofloxacin. A significant decreasing trend in susceptibility was observed for amoxicillin-clavulanic acid (P<0.0001), ampicillin (P<0.0001), Cefazolin (P<0.0001), ceftazidime (P=0.0067), chloramphenicol (P<0.0001), and orbifloxacin (P=0.008). The overall percentage of AMR isolates (isolates not susceptible to at least one antimicrobial) was 61.7% (1,690/2,738) and 29.3 % (801/2,738) of isolates were multidrug resistant. Multivariable regression analyses showed significant associations between AMR and age (P=0.0091), breed (P=0.0008), and sample isolation site/source (P<0.0001). The decreasing trend in the proportion of isolates susceptible to several beta-lactam antimicrobials suggests that resistance ofEscherichia coliin dogs to these antimicrobials could be increasing in Indiana. The decreasing trend in susceptibility to these drugs could be due to selection pressure from antimicrobial use.
The Role of Genetic Testing in Diagnosis and Care of Inherited Cardiac Conditions in a Specialised Multidisciplinary Clinic
Authors: Stafford Fergus , Krishnan Neesha , Richardson Ebony , Butters Alexandra , Hespe Sophie , Burns Charlotte , Gray Belinda , Medi Caroline , Nowak Natalie , Isbister Julia C , Raju Hariharan , Richmond David , Ryan Mark P , Singer Emma S , Sy Raymond W , Yeates Laura , Bagnall Richard D , Semsarian Christopher , Ingles Jodie
Published: February 2022

Background

The diagnostic yield of genetic testing for inherited cardiac diseases is up to 40% and primarily indicated for screening of at-risk relatives. Here we evaluate the role of genomics in diagnosis and management among consecutive individuals attending a specialised clinic and identify those with highest likelihood of having a monogenic disease.

Methods

Retrospective audit of 1697 consecutive, unrelated probands referred to a specialised, multidisciplinary clinic between 2002 and 2020. A concordant clinical and genetic diagnosis was considered solved. Cases were classified as likely monogenic based on a score comprising a positive family history, young age at onset and severe phenotype, whereas low scoring cases were considered to have a likely complex aetiology. The impact of a genetic diagnosis was evaluated.

Results

A total of 888 probands fulfilled inclusion criteria, and genetic testing identified likely pathogenic or pathogenic (LP/P) variants in 330 individuals (37%), and suspicious variants of uncertain significance (VUS) in 73 (8%). Research-focused efforts identified 46 (5%) variants, missed by conventional genetic testing. Where a variant was identified, this changed or clarified the final diagnosis in a clinically useful way for 51 (13%). The yield of suspicious VUS across ancestry groups ranged from 15-20%, compared to only 10% among Europeans. Even when the clinical diagnosis was uncertain, those with the most monogenic disease features had the greatest diagnostic yield from genetic testing.

Conclusion

Research-focused efforts can increase the diagnostic yield by up to 5%. Where a variant is identified, this will have clinical utility beyond family screening in 13%. We demonstrate the value of genomics in reaching an overall diagnosis, and highlight inequities based on ancestry. Acknowledging our incomplete understanding of disease phenotypes, we propose a framework for prioritising likely monogenic cases to solve their underlying cause of disease.
The Heart’s Pacemaker Mimics Brain Cytoarchitecture and Function: Autonomic innervation, a peripheral glial cell web, and a novel S100B expressing interstitial cell type impart structural and functional complexity to the sinoatrial node
Authors: Bychkov Rostislav , Juhaszova Magdalena , Calvo-Rubio Miguel , Donald Lorenzo A. H. , Coletta Chris , Shumaker Chad , Moorman Kayla , Sirenko Syevda Tagirova , Maltsev Alex V. , Sollott Steven J. , Lakatta Edward G.
Published: February 2022

Objectives

This study sought to describe the 3D cytoarchitecture of sinoatrial node tissue, including autonomic innervation, peripheral glial cells, and pacemaker cells.

Background

The sinoatrial node of the heart produces rhythmic action potentials (AP), generated via calcium signaling within and among pacemaker cells. Our previous work has described the SAN as composed of an HCN4-expressing pacemaker cell meshwork, which merges with a network of CX43+/F-actin+ cells. It is also known that sympathetic and parasympathetic innervation from epicardial ganglia create an autonomic plexus in the sinoatrial node, which modulates heart rate and rhythm. However, the anatomical details of the interaction of this plexus with the pacemaker cell meshwork have yet to be described.

Methods

3D confocal laser-scanning microscopy of triple immunolabeled SAN whole mount preparations with combinations of antibodies for HCN4, S100B, GFAP, ChAT or VAChT, and TH, and transmission electron microscopy (TEM).

Results

The SAN exhibited heterogeneous autonomic innervation, which was accompanied by a web of peripheral glial cells (PGCs). Further, we identified a novel S100B+/GFAP- interstitial cell population, with unique morphology and distinct distribution pattern, creating complex interactions with other cell types in the node. TEM images showed a similar population of cells, here identified as telocytes, which appeared to secrete vesicles towards pacemaker cells. Application of S100B protein to SAN preparations induced distinct changes in rhythmogenic calcium signaling.

Conclusions

The autonomic plexus and its associated peripheral glial cell web, a novel network of S100B expressing interstitial cells resembling telocytes, and a meshwork of HCN4+ cells interact to impart structural complexity to the sinoatrial node.

Summary Table