bluuebunny/crossref_metadata_2025 huggingface dataset:
Multiple imaging of the quasar 2005 + 403 formed by anisotropic scattering
Authors: Koryukova T A , Pushkarev A B , Kiehlmann S , Readhead A C S
Published: October 2023

We report on the low Galactic latitude (b = 4${_{.}^{\circ}}$3) quasar 2005 + 403, the second active galactic nuclei, in which we detected a rare phenomenon of multiple imaging induced by refractive-dominated scattering. The manifestation of this propagation effect is revealed at different frequencies (≲ 8 GHz) and epochs of Very Long Baseline Array (VLBA) observations. The pattern formed by anisotropic scattering is stretched out along the line of constant Galactic latitude with a local position angle, PA ≈ 40° showing 1–2 sub-images, often on either side of the core. Analysing the multifrequency VLBA data ranging from 1.4 to 43.2 GHz, we found that both the angular size of the apparent core component and the separation between the primary and secondary core images follow a wavelength squared dependence, providing convincing evidence for a plasma scattering origin for the multiple imaging. Based on the Owens Valley Radio Observatory long-term monitoring data at 15 GHz obtained for 2005 + 403, we identified the characteristic flux density excursions occurred in 2019 April and May and attributed to an extreme scattering event (ESE) associated with the passage of a plasma lens across the line of sight. Modelling the ESE, we determined that the angular size of the screen is 0.4 mas and it drifts with the proper motion of 4.4 mas yr−1. Assuming that the scattering screen is located in the highly turbulent Cygnus region, the transverse linear size and speed of the lens with respect to the observer are 0.7 au and 37 km s−1, respectively.
Adaptive RAxML-NG: Accelerating Phylogenetic Inference under Maximum Likelihood using Dataset Difficulty
Authors: Togkousidis Anastasis , Kozlov Oleksiy M , Haag Julia , Höhler Dimitri , Stamatakis Alexandros
Published: October 2023

Phylogenetic inferences under the maximum likelihood criterion deploy heuristic tree search strategies to explore the vast search space. Depending on the input dataset, searches from different starting trees might all converge to a single tree topology. Often, though, distinct searches infer multiple topologies with large log-likelihood score differences or yield topologically highly distinct, yet almost equally likely, trees. Recently, Haag et al. introduced an approach to quantify, and implemented machine learning methods to predict, the dataset difficulty with respect to phylogenetic inference. Easy multiple sequence alignments (MSAs) exhibit a single likelihood peak on their likelihood surface, associated with a single tree topology to which most, if not all, independent searches rapidly converge. As difficulty increases, multiple locally optimal likelihood peaks emerge, yet from highly distinct topologies. To make use of this information, we introduce and implement an adaptive tree search heuristic in RAxML-NG, which modifies the thoroughness of the tree search strategy as a function of the predicted difficulty. Our adaptive strategy is based upon three observations. First, on easy datasets, searches converge rapidly and can hence be terminated at an earlier stage. Second, overanalyzing difficult datasets is hopeless, and thus it suffices to quickly infer only one of the numerous almost equally likely topologies to reduce overall execution time. Third, more extensive searches are justified and required on datasets with intermediate difficulty. While the likelihood surface exhibits multiple locally optimal peaks in this case, a small proportion of them is significantly better. Our experimental results for the adaptive heuristic on 9,515 empirical and 5,000 simulated datasets with varying difficulty exhibit substantial speedups, especially on easy and difficult datasets (53% of total MSAs), where we observe average speedups of more than 10×. Further, approximately 94% of the inferred trees using the adaptive strategy are statistically indistinguishable from the trees inferred under the standard strategy (RAxML-NG).
Alternative splicing of BCL-x is controlled by RBM25 binding to a G-quadruplex in BCL-x pre-mRNA
Authors: Le Sénéchal Ronan , Keruzoré Marc , Quillévéré Alicia , Loaëc Nadège , Dinh Van-Trang , Reznichenko Oksana , Guixens-Gallardo Pedro , Corcos Laurent , Teulade-Fichou Marie-Paule , Granzhan Anton , Blondel Marc
Published: October 2023

BCL-x is a master regulator of apoptosis whose pre-mRNA is alternatively spliced into either a long (canonical) anti-apoptotic Bcl-xL isoform, or a short (alternative) pro-apoptotic Bcl-xS isoform. The balance between these two antagonistic isoforms is tightly regulated and overexpression of Bcl-xL has been linked to resistance to chemotherapy in several cancers, whereas overexpression of Bcl-xS is associated to some forms of diabetes and cardiac disorders. The splicing factor RBM25 controls alternative splicing of BCL-x: its overexpression favours the production of Bcl-xS, whereas its downregulation has the opposite effect. Here we show that RBM25 directly and specifically binds to GQ-2, an RNA G-quadruplex (rG4) of BCL-x pre-mRNA that forms at the vicinity of the alternative 5′ splice site leading to the alternative Bcl-xS isoform. This RBM25/rG4 interaction is crucial for the production of Bcl-xS and depends on the RE (arginine-glutamate-rich) motif of RBM25, thus defining a new type of rG4-interacting domain. PhenDC3, a benchmark G4 ligand, enhances the binding of RBM25 to the GQ-2 rG4 of BCL-x pre-mRNA, thereby promoting the alternative pro-apoptotic Bcl-xS isoform and triggering apoptosis. Furthermore, the screening of a combinatorial library of 90 putative G4 ligands led to the identification of two original compounds, PhenDH8 and PhenDH9, superior to PhenDC3 in promoting the Bcl-xS isoform and apoptosis. Thus, favouring the interaction between RBM25 and the GQ-2 rG4 of BCL-x pre-mRNA represents a relevant intervention point to re-sensitize cancer cells to chemotherapy.
In situ visualization of m6A sites in cellular mRNAs
Authors: Sheehan Charles J , Marayati Bahjat Fadi , Bhatia Janvi , Meyer Kate D
Published: October 2023

N 6-methyladenosine (m6A) is an abundant RNA modification which plays critical roles in RNA function and cellular physiology. However, our understanding of how m6A is spatially regulated remains limited due to a lack of methods for visualizing methylated transcripts of interest in cells. Here, we develop DART-FISH, a method for in situ visualization of specific m6A sites in target RNAs which enables simultaneous detection of both m6A-modified and unmodified transcript copies. We demonstrate the ability of DART-FISH to visualize m6A in a variety of mRNAs across diverse cell types and to provide information on the location and stoichiometry of m6A sites at single-cell resolution. Finally, we use DART-FISH to reveal that m6A is not sufficient for mRNA localization to stress granules during oxidative stress. This technique provides a powerful tool for examining m6A-modified transcript dynamics and investigating methylated RNA localization in individual cells.
Public sector wage compression and wage inequality: gender and geographic heterogeneity
Authors: Rattsø Jørn , Stokke Hildegunn E
Published: October 2023

Studies of wage inequality concentrate on private wages. Public sector wages are typically assumed to contribute to the overall wage equality. We challenge this understanding in an analysis of the relative skill premium in the public versus private sectors. The analysis of heterogeneity across gender and geography is based on rich register data for Norway. The raw data confirm the relative wage compression in the public sector. However, this is a male phenomenon and only prevalent in large cities when unobserved worker and firm characteristics are taken into account. With identification based on shifters between private and public sectors and movers between city-size groups, wage setting for female workers in the public sector increases wage inequality in all regions, particularly in the periphery. The result is consistent with policies promoting the recruitment of high-educated female workers and the expansion of public services in the periphery counterbalancing the desired equality effect of public wages.
In Vivo Emergence of Pandrug-Resistant Acinetobacter baumannii Strain: Comprehensive Resistance Characterization and Compassionate Use of Sulbactam-Durlobactam
Authors: VanNatta Mollie , Grier Laurie , Khan Muhammad H , Pinargote Cornejo Paulette , Alam Mohammad , Moussa Samir H , Smith Jennifer G , Aitken Samuel L , Malek Alexandre E
Published: October 2023

The treatment of patients with infection secondary to carbapenem-resistant Acinetobacter baumannii with emerging cefiderocol resistance remains challenging and unclear. We present a case of in vivo emergence of pandrug-resistant A baumannii that was successfully treated with the compassionate use of investigational sulbactam-durlobactam–based antibiotic regimen. We also performed a longitudinal genomic analysis of the bacterial isolates and showed the development of resistance and genetic mutations over time.
The LIKE SEX FOUR 1–malate dehydrogenase complex functions as a scaffold to recruit β-amylase to promote starch degradation
Authors: Liu Jian , Wang Xuecui , Guan Zeyuan , Wu Menglong , Wang Xinyue , Fan Rong , Zhang Fei , Yan Junjun , Liu Yanjun , Zhang Delin , Yin Ping , Yan Junjie
Published: October 2023

In plant leaves, starch is composed of glucan polymers that accumulate in chloroplasts as the products of photosynthesis during the day; starch is mobilized at night to continuously provide sugars to sustain plant growth and development. Efficient starch degradation requires the involvement of several enzymes, including β-amylase and glucan phosphatase. However, how these enzymes cooperate remains largely unclear. Here, we show that the glucan phosphatase LIKE SEX FOUR 1 (LSF1) interacts with plastid NAD-dependent malate dehydrogenase (MDH) to recruit β-amylase (BAM1), thus reconstituting the BAM1–LSF1–MDH complex. The starch hydrolysis activity of BAM1 drastically increased in the presence of LSF1–MDH in vitro. We determined the structure of the BAM1–LSF1–MDH complex by a combination of cryo-electron microscopy, crosslinking mass spectrometry, and molecular docking. The starch-binding domain of the dual-specificity phosphatase and carbohydrate-binding module of LSF1 was docked in proximity to BAM1, thus facilitating BAM1 access to and hydrolysis of the polyglucans of starch, thus revealing the molecular mechanism by which the LSF1–MDH complex improves the starch degradation activity of BAM1. Moreover, LSF1 is phosphatase inactive, and the enzymatic activity of MDH was dispensable for starch degradation, suggesting nonenzymatic scaffold functions for LSF1–MDH in starch degradation. These findings provide important insights into the precise regulation of starch degradation.
Kinetic inductance detectors on calcium fluoride substrate for astroparticle physics
Authors: Ishidoshiro K , Kobayashi T , Hosokawa K , Kawamura Y , Kamei Y , Mima S , Otani C , Suzuki A A , Zulfakri M , Taino T
Published: October 2023

We propose the utilization of inorganic crystals as substrates for kinetic inductance detectors (KIDs), which are thin-film superconducting resonators, for future rare event studies. When energy is deposited on the substrate, phonons are generated and propagate from the substrate to the surface, where KIDs are fabricated. This approach expands the potential for utilizing a diverse range of target crystals. We implement KIDs on calcium fluoride (CaF2) substrates, since 19F is sensitive to dark matter with spin-dependent interaction and 48Ca is one of the double-β decay nuclei. We have experimentally demonstrated the operation of the KIDs on the CaF2 substrate and their phonon-mediated particle detection.
Quantifying Turning Tasks With Wearable Sensors: A Reliability Assessment
Authors: Weston Angela R , Antonellis Prokopios , Fino Peter C , Hoppes Carrie W , Lester Mark E , Weightman Margaret M , Dibble Leland E , King Laurie A
Published: October 2023

Objective

The aim of this study was to establish the test–retest reliability of metrics obtained from wearable inertial sensors that reflect turning performance during tasks designed to imitate various turns in daily activity.

Methods

Seventy-one adults who were healthy completed 3 turning tasks: a 1-minute walk along a 6-m walkway, a modified Illinois Agility Test (mIAT), and a complex turning course (CTC). Peak axial turning and rotational velocity (yaw angular velocity) were extracted from wearable inertial sensors on the head, trunk, and lumbar spine. Intraclass correlation coefficients (ICCs) were established to assess the test–retest reliability of average peak turning speed for each task. Lap time was collected for reliability analysis as well.

Results

Turning speed across all tasks demonstrated good to excellent reliability, with the highest reliability noted for the CTC (45-degree turns: ICC = 0.73–0.81; 90-degree turns: ICC = 0.71–0.83; and 135-degree turns: ICC = 0.72–0.80). The reliability of turning speed during 180-degree turns from the 1-minute walk was consistent across all body segments (ICC = 0.74–0.76). mIAT reliability ranged from fair to excellent (end turns: ICC = 0.52–0.72; mid turns: ICC = 0.50–0.56; and slalom turns: ICC = 0.66–0.84). The CTC average lap time demonstrated good test–retest reliability (ICC = 0.69), and the mIAT average lap time test–retest reliability was excellent (ICC = 0.91).

Conclusion

Turning speed measured by inertial sensors is a reliable outcome across a variety of ecologically valid turning tasks that can be easily tested in a clinical environment.

Impact

Turning performance is a reliable and important measure that should be included in clinical assessments and clinical trials.
Cost-effectiveness of farm- vs. regional-level climate change mitigation policies
Authors: Tarruella Marta , Huber Robert , Mack Gabriele , El Benni Nadja , Finger Robert
Published: October 2023

Agriculture is a significant source of global greenhouse gas (GHG) emissions, making reduction targets crucially needed. Worldwide, countries have set agricultural GHG reduction goals and discussed methods to reach them. A crucial aspect is, whether the policy target level is set at the individual farm or at a regional level. In this context, we assess the advantages regarding cost-effectiveness and GHG-reduction potential of targets at the regional level. First, we use the bioeconomic farm-level model FarmDyn to simulate the changes in income and GHG emissions of 65 Swiss dairy farms. Secondly, we develop an optimisation algorithm to compare the efficiency and efficacy of these two target approaches. Our analysis reveals that regional targets, which consider the heterogenous abatement costs of the sector, are more cost-efficient than farm-level ones. Specifically, they enable a 10 per cent GHG reduction at 88 per cent lower costs, suggesting they might be a more cost-effective alternative to taxation.
Silicon law of oligarchy: patterns of member participation in the decision-making of platform cooperatives
Authors: Bunders Damion J
Published: October 2023

Platform cooperatives that are owned and governed by gig workers themselves have been proposed as a silver bullet to improve these workers’ influence on organizational decision-making. However, they remain relatively rare compared with dominant investor-owned platforms. Traditionally, worker cooperatives strive for alternative organizing based on the ideal of workplace democracy but are often faced with unequal participation by members in decision-making processes. To test for participation inequalities, this study used survey data (n = 418) from a network of four platform worker cooperatives in Italy. The results show that members with lower affective commitment towards their cooperative and less social capital among other members are less likely to participate, but that there is no effect of cooperative size and human capital.
From Praising the Remedy to Eulogising the Patient: Cristóbal de Castillejo’s Satire of Guaiac in Early Modern Spain
Authors: Bičak Ivana
Published: October 2023

The article examines the contemporary satiric treatment of a new transatlantic drug, guaiac, in a sixteenth-century poem by the Castilian writer Cristóbal de Castillejo, entitled En alabança del palo de las Indias, estando en la cura dél (In Praise of the Wood of the Indies, being under its treatment). The article contributes to the body of scholarship on the history of medicine in general and the history of herbal medicine in particular. The investigation of the poem embraces historical contextualisation, early modern rhetoric and classical reception. The article demonstrates the two-way relationship between early modern satire and medicine, arguing that the special significance of satiric productions that engage with medical themes lies in the inventive combination of the literary reality and empirical reality.
Medial Septal Glutamatergic Neurons Modulate States of Consciousness during Sevoflurane Anesthesia in Mice
Authors: Xia Jun-Ming , Fan Bing-Qian , Yi Xiu-Wen , Ni Wen-Wen , Zhou Yu , Chen Dan-Dan , Yi Wen-Jing , Feng Li-Li , Xia Ying , Li Shuang-Shuang , Qu Wei-Min , Han Yuan , Huang Zhi-Li , Li Wen-Xian
Published: October 2023

Background

Multiple neural structures involved in maintaining wakefulness have been found to promote arousal from general anesthesia. The medial septum is a critical region that modulates arousal behavior. This study hypothesized that glutamatergic neurons in the medial septum play a crucial role in regulating states of consciousness during sevoflurane general anesthesia.

Methods

Adult male mice were used in this study. The effects of sevoflurane anesthesia on neuronal activity were determined by fiber photometry. Lesions and chemogenetic manipulations were used to study the effects of the altered activity of medial septal glutamatergic neurons on anesthesia induction, emergence, and sensitivity to sevoflurane. Optogenetic stimulation was used to observe the role of acute activation of medial septal glutamatergic neurons on cortical activity and behavioral changes during sevoflurane-induced continuous steady state of general anesthesia and burst suppression state.

Results

The authors found that medial septal glutamatergic neuronal activity decreased during sevoflurane anesthesia induction and recovered in the early period of emergence. Chemogenetic activation of medial septal glutamatergic neurons prolonged the induction time (mean ± SD, hM3Dq–clozapine N-oxide vs. hM3Dq–saline, 297.5 ± 60.1 s vs. 229.4 ± 29.9 s, P < 0.001, n = 11) and decreased the emergence time (53.2 ± 11.8 s vs. 77.5 ± 33.5 s, P = 0.025, n = 11). Lesions or chemogenetic inhibition of these neurons produced the opposite effects. During steady state of general anesthesia and deep anesthesia–induced burst suppression state, acute optogenetic activation of medial septal glutamatergic neurons induced cortical activation and behavioral emergence.

Conclusions

The study findings reveal that activation of medial septal glutamatergic neurons has arousal-promoting effects during sevoflurane anesthesia in male mice. The activation of these neurons prolongs the induction and accelerates the emergence of anesthesia.

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Temporal trends in surgical implants for in situ fixation of stable slipped capital femoral epiphysis
Authors: Chervonski Ethan , Wingo Taylor , Pargas-Colina Carlos , Castañeda Pablo
Published: October 2023

Stable slipped capital femoral epiphysis (SCFE) is a pediatric hip disorder managed within situfixation of the proximal femoral epiphysis, otherwise known as ‘pinning the hip’. The objective of this study was to characterize how the choice of implant forin situfixation of stable SCFE has changed over time. A systematic review of publications concerningin situfixation of stable SCFE from January 1993 to November 2021 was conducted. The change in the type, diameter, and number of implants used in publications over time and the age of their respective patient cohorts was evaluated. A total of 207 articles met inclusion criteria. There was an increase in publications using cannulated screws over time (P = 0.0113). As the yearly percentage of publications using threadless non-cannulated implants decreased (P = 0.0309), the percentage using cannulated screws increased (P = 0.0047). Single-implant fixation also increased (P = 0.0409). While there was no difference in the rate of increase of implants < 7 mm or ≥ 7 mm in diameter (P = 0.299), patients with larger-diameter implants were, on average, older than patients with smaller-diameter implants (P = 0.0462). In general, the age of patients undergoingin situfixation of stable SCFE has not changed (P = 0.595). Irrespective of patient-specific considerations, single cannulated screws have become the implant of choice forin situfixation of stable SCFE. There has not been a consensus on the optimal implant diameter; instead, patient-specific considerations are of paramount importance in this decision.
What Are the Psychosocial Effects of Pavlik Harness Treatment? A Prospective Study on Perceived Impact on Families and Maternal-Infant Bonding
Authors: Batley Morgan G. , Gornitzky Alex L. , Sarkar Sulagna , Sankar Wudbhav N.
Published: October 2023

Background:

The Pavlik harness (PH) is the most common treatment for infants with developmental dysplasia of the hip. Although success rates are high when used appropriately, brace treatment may impact family function and parental bonding. The purpose of this study was to prospectively determine how PH treatment affected these psychosocial variables.

Methods:

This is a prospective, single-surgeon study at a tertiary-care, urban, academic children’s hospital between November 2022 and March 2023. All patients newly treated with a Pavlik were eligible. Caregivers were administered the Postpartum Bonding Questionnaire and the Revised Impact on Family Scale (rIOFS) at the baseline visit and 2- and 6 weeks following treatment initiation. Demographic and treatment-specific information was collected through surveys and retrospective chart review. Descriptive statistics and bivariate analysis were used.

Results:

A total of 55 caregiver-child dyads were included in the final analysis. Most patients were female (89%) and/or first-born (73%). Forty (73%) hips were diagnosed as having stable dysplasia. rIOFS scores steadily improved from baseline, through 2- and 6 weeks posttreatment initiation. Six-week rIOFS scores were significantly lower than both baseline (P=0.002) and 2 weeks (P=0.018). Average parental bonding scores also improved steadily throughout treatment and did not surpass the threshold of clinical concern at any time. Neither full-time harness use (24 h/d vs. 23 h/d based upon clinical stability) nor age at treatment initiation had a statistically significant effect on parental bonding or family functioning (allP>0.05). Additional demographic variables such as birth order, parental history of anxiety/depression, and relative socioeconomic disadvantage also had no significant effect on psychosocial outcomes.

Conclusion:

PH treatment did not significantly impact maternal-fetal bonding or family dynamics. Relative to other pediatric diseases, PH treatment has an impact on family life greater than that of single-leg spica, but less than that of school-age children with chronic medical illnesses. As PH treatment is a widely used treatment for infantile developmental dysplasia of the hip, this study provides information that clinicians may use to more accurately counsel families and assuage parental concerns.

Levels of Evidence:

Level IV—prospective uncontrolled cohort study.
Subtalar Distraction Bone Block Arthrodesis for Calcaneus Fracture Malunion
Authors: Ramanathan Deepak , Rascoe Alexander S. , Anastasio Albert T. , McGroarty Neil K. , Chen Jie , Schweitzer Karl M.
Published: October 2023

Intra-articular calcaneus fractures are associated with a high rate of malunion resulting in hindfoot and ankle impingement, peroneal tendinitis, sural neuritis, arthritis, hindfoot varus or valgus deformity, loss of hindfoot height, and resulting gastrocnemius-soleus complex weakness and gait dysfunction. These issues can arise whether the patient’s injury is treated conservatively with non–weight-bearing precautions, neglected/missed, or treated surgically with open reduction and internal fixation. The sequelae of calcaneal malunions can arise early or late in this process.

For patients undergoing subtalar arthrodesis following calcaneus fracture malunion, the use of a bone block wedge can assist with achieving a stable, well-aligned, pain-free hindfoot. Patient selection, preoperative planning, careful surgical technique, and compliance with postoperative care pathways are critical to optimize patient outcomes and healing of this complex reconstruction. Recent evidence supports the utility of weight-bearing CT to assist with preoperative planning for subtalar arthrodesis.

Wedges used in subtalar distraction arthrodesis include bulk autograft (tricortical iliac crest), allograft (pre-fashioned or intraoperatively fashioned wedges from femoral head allograft or other source), and metallic wedges. These wedges are typically secured with screws spanning and compressing the arthrodesis site, which is filled with a mixture of concentrated bone marrow aspirate, bone growth factors, and allograft bone. Concomitant procedures may be indicated to ensure the overall success of the procedure, such as extra-articular, calcaneal osteotomy for additional realignment purposes and/or arthrolysis. A review of the literature shows high rates of union following subtalar bone block arthrodesis with improved functional outcomes. Our preferred technique for a bone block distraction subtalar arthrodesis, described herein, includes the use of an allograft wedge.

Ongoing advances, such as the development of novel materials and structures for use in subtalar bone block arthrodesis, but most importantly, the incorporation of weight-bearing CT technology and potential for preoperative CT navigation to make this procedure more predictable, are all important areas for further exploration and future research.

Level of Evidence:

Level—IV.
Delirium Care by Intensive Care Unit Nurses
Authors: Ku Ya-Lie , Tang Min-Hua , Chen Shu-Ming , Kuo Wen-Ying , Huang Kuo-Tung
Published: October 2023

Objectives

Studies have identified many nursing interventions that can prevent delirium and fall accidents in clinical patients, detect and treat delirium early to prevent functional decline in the patient, shorten hospitalization duration, and lower the death rate. This study aimed to explore delirium care by intensive care unit (ICU) nurses in a medical center of southern Taiwan.

Methods

This study conducted 3 semistructured focus group interviews, each for a single medical ICU, involving groups of 6 to 8 nurses each. The nurses were recruited through purposive sampling. This research was approved by an institutional review board in the medical center of southern Taiwan from March 31, 2020, to January 30, 2021. The co–principal investigator described the purpose and process of this study to the participants before they provided their written informed consents. The interviews were conducted in the meeting room and were audiotape recorded. The recordings were transcribed and subject to content analysis to identify the themes of delirium care.

Results

For nursing interventions of delirium, satisfying the patient's physical needs: comfort care, massages, and early rehabilitation; and psychological care: being presence, communication, and ensuring familial support were included. In terms of environmental interventions for delirium, providing reorientation, music, light, belongings with sentimental value, and audiovisual equipment were included. However, according to the recruited medical ICU nurses, these nonpharmacological interventions, although effective, do not have long-lasting effects. Finally, nurses reported themselves as having been attacked by patients with delirium. Thus, they all agreed that restraining patients with delirium may be necessary, but restraining is a double-edged sword for ICU delirium patients.

Conclusions

Research team suggests for future studies to extend their evidence-based findings of physical, psychological, and environmental care for ICU delirium patients toward integrating the efforts of various health care professionals.
Analysis of Nursing Staff Management for a Semi-intensive Pulmonology Unit During the COVID-19 Pandemic Using the Nursing Activities Score
Authors: Tack Jérôme , Bruyneel Arnaud , Bouillon Yoan , Taton Olivier , Taccone Fabio , Pirson Magali
Published: October 2023

Objectives

During the COVID-19 pandemic, a shortage of intensive care unit beds was encountered across Europe. Opening a semi-intensive pulmonary ward freed up intensive care unit beds. This study aimed to determine the appropriate nurse staffing level for a semi-intensive pulmonology unit (SIPU) for patients with COVID-19 and to identify factors associated with an increase in nursing workload in this type of unit.

Methods

This was a retrospective study of the SIPU of the Erasme university clinics in Belgium. Nursing staff was determined with the Nursing Activities Score (NAS) during the second wave of COVID-19 in Belgium.

Results

During the study period, 59 patients were admitted to the SIPU, and a total of 416 NAS scores were encoded. The mean (±SD) NAS was 70.3% (±16.6%). Total NAS varied significantly depending on the reason for admission: respiratory distress (mean [SD] NAS, 71.6% [±13.9%]) or critical illness–related weakness (65.1% ± 10.9%). The items encoded were significantly different depending on the reason for admission. In multivariate analysis, body mass index > 30 (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.07-3.30) and higher Simplified Acute Physiology Score II score (OR, 1.05; 95 CI, 1.02-1.11) were associated with higher NAS. Patients admitted via the emergency department (OR, 2.45; 95% CI, 1.15-5.22) had higher NAS. Patients on noninvasive ventilation (OR, 13.65; 95% CI, 3.76-49.5) and oxygen therapy (OR, 4.29; 95% CI, 1.27-14.48) had higher NAS. High peripheral venous oxygen saturation (OR, 0.86; 95% CI, 0.78-0.94) was a predictor of lower workload.

Conclusion

A ratio of 2 nurses to 3 patients is necessary for SIPU care of patients with COVID-19. Factors associated with higher workload were high Simplified Acute Physiology Score II score, body mass index > 30, admission via emergency room, patients on oxygen, and noninvasive ventilation.
Barriers to Organ Donation
Authors: Holthe Erlend , Husby Vigdis S.
Published: October 2023

Background

An increasing number of patients affected by organ failure can be treated with organ transplantation. The need for organs available for transplantation is critical and patients die while on the transplant list. Intensive care unit (ICU) nurses are essential in facilitating organ donation through their ceaseless bedside care for potential organ donors and their families.

Aims and objectives

The aim of this study was to describe the challenges faced by ICU nurses in the organ donation process.

Design

A descriptive qualitative study design was used.

Method

Semistructured individual interviews of 9 ICU nurses from 1 university hospital were performed. Data were analyzed using Malterud's systematic text condensation.

Results

Three themes describe the core of the results: (1) practical tasks, (2) challenging care for the next of kin, and (3) ethical and emotional challenges.

Conclusions

Practical tasks represent challenges in the organ donation process that are not previously revealed. Actions to address these challenges should be prioritized to promote organ donation. Simulation-based training may optimize practical aspects of the organ donation process and implementation of simulation-based training should be assessed by future research.
Resuscitation Team Members' Perceptions of Supporting Parents During Cardiopulmonary Resuscitation of Children
Authors: Ghavi Arezoo , Hassankhani Hadi , Powers Kelly
Published: October 2023

Introduction

Supporting parents is a crucial part of family-centered care in pediatric and neonate resuscitation.

Objectives

The aim of this systematic review was to appraise and synthesize studies conducted to determine resuscitation team members' perspectives of support for parents during pediatric and neonate resuscitation.

Methods

The PRISMA model guided the systematic literature search of Google Scholar, PubMed, MEDLINE, CINAHL, Cochrane, and Scopus for studies published until May 2022. The authors independently screened all titles, abstracts, and full-text articles for eligibility. There was agreement about screened articles for inclusion. Full texts of all potentially relevant studies were evaluated for the rigor of the study design, sample, and analysis. This review included quantitative, qualitative, and mixed-methods studies. The quality of evidence across the included studies was assessed using the risk of bias in non-randomized studies of interventions (ROBINS-I) tool as part of GRADE’s (Recommendations Assessment, Development, and Evaluations) certainty rating process.

Results

There were 978 articles located. After reviewing for relevancy, 141 full-text articles were assessed, and 13 articles met criteria and were included in this review (4 quantitative, 7 qualitative, and 2 mixed-methods design). Five themes were revealed to summarize resuscitation team members' perspectives of parental support in pediatric resuscitation: providing information to parents, family facilitator, emotional support, presence of parents during resuscitation, and spiritual and religious support.

Conclusions

The results of this systematic review can be used to improve support for parents by informing the education of resuscitation team members and clarifying policies and guidelines of resuscitation team roles to include support for parents.
A National Survey of Stress and Burnout in Critical Care Nurses
Authors: Villarante Delwin Millan , O'Donoghue Sharon C. , Medeiros Monica , Milton Erin , Walsh Kayley , O'Donoghue Ashley L. , Celi Leo Anthony , Hayes Margaret M. , Dilibero Justin
Published: October 2023

Background

Critical care nurses (CCNs) experience a higher level of stress and burnout than nurses in other specialties. Approximately 50% of CCNs are mildly stressed, and almost 20% are moderately stressed. Prolonged periods of stress can lead to burnout, which has been shown to have deleterious effects on quality and patient safety.

Objectives

The purpose of this study is to determine the prevalence of burnout among a national sample of CCNs and the association with environmental factors.

Methods

A national survey of CCNs working in the United States was implemented using an exploratory descriptive design. The anonymous survey was developed iteratively according to best practices of survey design. The survey included the Perceived Stress Scale and the Copenhagen Burnout Inventory tool. Pretesting and pilot testing were conducted with CCN specialists, and the survey was revised based on their feedback. An anonymous link was distributed to respondents using convenience sampling through social media and further disseminated via snowball sampling.

Results

Two hundred seventy nurses responded to the survey. The mean (SD) Perceived Stress Scale score in the study population was 18.5 (6.4), indicating moderate stress. The mean (SD) Copenhagen Burnout Inventory score was 61.9 (16.5), indicating moderate burnout. Our study found that the overall health of the work environment was one of the most important factors associated with both stress and burnout.

Conclusions

This study has demonstrated the relationship between the health of the work environment and burnout among CCNs. It is imperative that health care organizations evaluate and implement strategies to optimize the health of the work environment to mitigate burnout and its negative sequelae on the nurse, patient, and system.
Use of Prophylactic High-Dose Statin Therapy to Reduce Contrast-Induced Acute Kidney Injury in Adults Undergoing Acute Coronary Angiography
Authors: Jones Judith E. , Tuite Patricia , Guttendorf Jane
Published: October 2023

Background

Development of contrast-induced acute kidney injury (CI-AKI) is associated with increased morbidity, mortality, hospital length of stay, and overall health care costs.

Objectives

The purpose of this project was to evaluate a clinical practice change—the addition of high-dose statin therapy to standard renal protection measures—in adults undergoing acute cardiac catheterization procedures and assessing its effect on CI-AKI.

Method

The evaluation was a pretest/posttest descriptive design. Adult patients undergoing acute cardiac catheterization procedures were evaluated for the rate of CI-AKI before (10 months preimplementation, N = 283) and after (10 months postimplementation, N = 286) a recent practice change that added high-dose statin therapy (within 24 hours of dye exposure) to a standard renal protection bundle (intravenous fluids, maximum dye calculations, and avoidance of nephrotoxic medications). Outcomes included the rate of CI-AKI, stage of acute kidney injury, need for new hemodialysis, discharge disposition (alive or died in the hospital), and hospital length of stay.

Results

Patients in the postintervention group that received renal protection bundle with high-dose statin had significantly lower incidence of CI-AKI (10.1% pre vs 3.2% post; P < .001). There were no significant differences in hospital length of stay, need for new hemodialysis, or mortality. Administration of high-dose statin within 24 hours of the cardiac catheterization procedure improved significantly (19.4% pre vs 74.1% post; P < .001). Adherence to all 5 components of the renal bundle improved post intervention (17% pre vs 73.4% post; P < .001).

Discussion

The addition of a high-dose statin in addition to existing renal protective measures in patients with acute cardiac procedures is associated with a decreased incidence of CI-AKI.
Cocaine Nose Correction: A Nonsurgical Approach Using a Novel Hyaluronic Acid Filler
Authors: Jalali Arash
Published: October 2023

Background:

The use of hyaluronic acid (HA) fillers for correcting nasal deformities offers an increasingly popular alternative to surgical rhinoplasty. However, this can sometimes be extremely challenging, for example, in patients with a permanent defect in the nasal septum secondary to chronic drug use.

Methods:

We report a case in which nonsurgical intervention with a high G’ HA filler was used therapeutically to improve the permanent nasal disfigurement of an individual with previous long-term drug use (now in remission)

Results:

This approach led to high levels of patient satisfaction and empowerment in her personal and professional life. Despite the high risk in this case, only immediate minor complications were recorded, including temporary edema and ecchymoses, and these resolved spontaneously

Conclusions:

Nonsurgical treatment using an appropriate HA filler may offer a safe and effective option in selected patients with nasal deformities resulting from pathological conditions.
A Novel Approach to Intraluminal Mitomycin C Instillation for Treatment of High Grade Nonmuscle Invasive Upper Tract Urothelial Carcinoma
Authors: Ellis Elizabeth , Messing Edward
Published: October 2023

Introduction and Objective:

We present a novel technique for intrapelvicalyceal mitomycin C (MMC) instillation mixed with a contrast agent for treatment of high-grade nonmuscle invasive upper tract urothelial carcinoma in patients in whom nephroureterectomy would render them dialysis-dependent.

Methods:

After incomplete endoscopic resection, the patient underwent 3 intrapelvicalyceal instillations of MMC mixed with iopamidol, each 2 weeks apart.

Results:

Treatment has had a durable response for over 2 years after treatment.

Conclusions:

Intraluminal MMC mixed with iopamidol is an approach which helps to avoid pyelovenous backflow and provides visual confirmation that the drug is in adequate contact with the tumor.
Bone health in children undergoing solid organ transplantation
Authors: Pinto Bianca , Muzumdar Radhika , Hecht Baldauff Natalie
Published: October 2023

Purpose of review

Pediatric solid organ transplant recipients are a unique and growing patient population who are at risk for metabolic bone disease both before and after transplantation.

Recent findings

The odds of sustaining a fracture in adulthood are significantly higher if an individual has sustained at least one childhood fracture, therefore, close monitoring before and after transplant is essential. Emerging data in patients with chronic kidney disease mineral and bone disorder (CKD-MBD) and hepatic osteodystrophy highlights the role of fibroblast growth factor 23 in the pathogenesis of metabolic bone disease in these conditions. While dual X-ray absorptiometry (DXA) is the most widely used imaging modality for assessment of bone mass in children, quantitative computer tomography (QCT) is an emerging modality, especially for patients with glucocorticoid-induced osteoporosis.

Solid organ transplantation improves organ function and quality of life; however, bone mineral density can decline following transplantation, particularly during the first three to six months. Immunosuppressive medications, including glucocorticoids, are a major contributing factor. Following transplant, treatment should be tailored to achieve mineral homeostasis, correct nutritional deficiencies, and improve physical conditioning. In summary, early identification and treatment of metabolic bone disease can improve the bone health status of pediatric transplant recipients as they enter adulthood.

Video abstract

http://links.lww.com/MOP/A71
Evaluating the Impact of an Evidence-Based Practice Education Program in a Nurse Residency Program on Evidence-Based Practice Beliefs, Implementation, and Competency
Authors: Hu Amy , Whitney Robin L.
Published: October 2023

This quality improvement project examined implementation of the John Hopkins Nursing evidence-based practice (EBP) model, a standardized EBP education curriculum, in a hospital-based nurse residency program. We found that EBP education increased nurse residents' EBP beliefs, implementation frequency, and competencies. Our findings suggest that adopting existing EBP curricula is a convenient and effective approach to EBP education. Staff development professionals should continue to support and advocate for the adoption of EBP education within their organizations.
Critical Care Utilization in Children With Cancer: U.S. Pediatric Health Information System Database Cohort 2012–2021
Authors: Rogerson Colin M. , Rowan Courtney M.
Published: October 2023

OBJECTIVES:

To determine changes in pediatric oncology hospitalizations requiring intensive care over the period 2012–2021.

DESIGN:

Retrospective study of hospital admission.

SETTING:

Registry data from 36 children’s hospitals in the U.S. Pediatric Health Information Systems database.

PATIENTS:

Children 18 years or younger admitted to any of 36 hospitals with an oncology diagnosis.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

There were a total of 55,827 unique patients accounted for 281,221 pediatric oncology hospitalizations over the 10-year period, and 16.6% of hospitalizations included admission to the PICU. Hospitalizations and PICU admissions steadily increased over this decade. Between 2012 and 2016, 15.1% of oncology hospitalizations were admitted to the PICU compared with 18.0% from 2017 to 2021 (difference 2.9% [95% CI, 2.6–3.2%]p≤ 0.0001). Support with invasive mechanical ventilation also increased over time with 3.7% during 2012–2016 compared with 4.1% from 2017 to 2021 (difference 0.4% [95% CI, 0.2–0.5%]p≤ 0.0001). Similar results were seen with cardiorespiratory life support using extracorporeal membrane oxygenation (difference 0.05% [95% CI, 0.02–0.07%]p= 0.0002), multiple vasoactive agent use (difference 0.3% [95% CI, 0.2–0.4%]p< 0.0001), central line placement (difference 5.3% [95% CI, 5.1–5.6%],p< 0.001), and arterial line placement (difference 0.4% [95% CI, 0.3–0.4%],p< 0.001). Year-on-year case fatality rate was unchanged over time (1.3%), but admission to the PICU during the second 5 years, compared with the first 5 years, was associated with lower odds of mortality (difference 0.7% [95% CI, 0.3–1.1%]) (odds ratio 0.82 [95% CI, 0.75–0.90%]p< 0.001).

CONCLUSIONS:

The percentage of pediatric oncology hospitalizations resulting in PICU admission has increased over the past 10 years. Despite the increasing use of PICU admission and markers of acuity, and on comparing 2017–2021 with 2012–2016, there are lower odds of mortality.
Mpox severity and associated hospitalizations among people with HIV and related immunosuppression in Brazil
Authors: Silva Mayara S.T. , Coutinho Carolina , Torres Thiago S. , Peixoto Eduardo M. , Bastos Matheus O. , Mesquita Maira B. , Tavares Isabel C.F. , Andrade Hugo B. , Reges Paula P.S. , Martins Pedro S. , Echeverría-Guevara Amanda , Moreira Ronaldo I. , Lessa Flavia Cristina S. , Hoagland Brenda , Nunes Estevão P. , Cardoso Sandra W. , Veloso Valdilea G. , Grinsztejn Beatriz
Published: October 2023

Objectives:

This study aimed to analyze characteristics of mpox hospitalization in a Brazilian cohort, further exploring the impact of HIV on mpox-related outcomes and hospitalization.

Design:

We conducted a descriptive analysis, comparing characteristics of individuals diagnosed with mpox according to hospitalization and HIV status, and described the mpox cases among those living with HIV.

Methods:

This was a single-center, prospective cohort study conducted at a major infectious diseases referral center in Rio de Janeiro, Brazil, that enrolled participants older than 18 years of age diagnosed with mpox. Information was collected on standardized forms, including data on sociodemographic, behavioral, clinical and laboratory characteristics. For comparisons, we used chi-squared, Fisher's exact and the Moods median tests whenever appropriate.

Results:

From June to December, 2022, we enrolled 418 individuals diagnosed with mpox, of whom 52% were people with HIV (PWH). PWH presented more frequently with fever, anogenital lesions and proctitis. The overall hospitalization rate was 10.5% (n = 43), especially for pain control. Among hospitalized participants, PWH had more proctitis and required invasive support. Mpox severity was related to poor HIV continuum of care outcomes and low CD4+ cell counts. All deaths (n = 2) occurred in PWH with CD4+ less than 50 cells/μl.

Conclusion:

HIV-related immunosuppression likely impacts mpox clinical outcomes. This is of special concern in settings of poor adherence and late presentation to care related to socioeconomic inequalities, such as Brazil. The HIV continuum of care must be taken into account when responding to the mpox outbreak.