bluuebunny/crossref_metadata_2025 huggingface dataset:
Response of optic gland pathways to thermal stress in the reproductive phase of female Octopus maya
Authors: Domínguez-Estrada Alison , Galindo-Sánchez Clara E , Ventura-López Claudia , Rosas Carlos , Juárez Oscar E
Published: July 2022

The octopus optic glands are the source of multiple signalling molecules that control the transitions through different physiological stages, such as maturation, ageing and death. This study focused on the role of the optic glands during the reproductive phase of Octopus maya, investigating the molecular mechanisms that prevent reproduction at elevated temperatures. RNA sequencing was used to analyse and compare optic gland transcriptomic profiles of female O. maya before, during and after egg-laying under optimal and thermal stress (elevated temperature) conditions. Each stage showed well-defined transcriptomic patterns, and all were strongly affected by thermal stress. At optimal temperature, the optic glands contribute importantly to regulating the energetic balance, as suggested by the expression of genes that modulate the metabolic rate, arterial blood pressure and the management of ATP sources in response to food deprivation. At elevated temperatures, the optic glands of mated females (before egg-laying) showed upregulation of genes encoding neuropeptides (FMRF-amide, APGW-amide, PRQFV-amide, FCAP, buccalin and myomodulin) and the dopamine beta-hydroxylase gene. During egg-laying at elevated temperatures, the neuropeptide receptor capaR and the sex peptide receptor were upregulated whereas homologs of fetuin-B and oviduct-specific glycoprotein genes, crucial for fertilization, were downregulated. These changes in optic gland gene expression in O. maya may be the basis for the high-temperature inhibition of egg-laying, previously observed from this octopus species. Furthermore, after egg-laying, during egg incubation thermal stress affected the expression of genes involved in steroid and thyroid hormone biosynthesis and in inflammatory and apoptotic pathways.
Examination of Common Coronavirus Antibodies in SARS-CoV-2-Infected and Uninfected Participants in a Household Transmission Investigation
Authors: Stumpf Megan M , Freeman Brandi , Mills Lisa , Lester Sandra , Chu Victoria T , Kirking Hannah L , Thornburg Natalie J , Killerby Marie E
Published: July 2022

We compared paired serum specimens from household contacts of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cases with detectable SARS-CoV-2 seroconversion with contacts who remained seronegative. No protection from SARS-CoV-2 infection was associated with human coronavirus antibodies; however, an increase in common betacoronavirus antibodies was associated with seroconversion to SARS-CoV-2 in mild to moderately ill cases.
A Novel, Divergent Member of the Rhabdoviridae Family Infects Strawberry
Authors: Medberry Ava N. , Srivastava Ashish , Diaz-Lara Alfredo , Rwahnih Maher Al , Villamor Dan E. V. , Tzanetakis Ioannis E.
Published: July 2022

Strawberry (Fragaria × ananassa) is the most important berry crop worldwide and viruses pose a constant threat to the industry. In this communication, we describe a novel virus in the family Rhabdoviridae referred to as strawberry virus 3 (StrV-3). The virus does not show significant homology when compared with recognized rhabdoviruses and, therefore, the establishment of a new genus should be considered. A triplex reverse-transcription PCR test was developed and successfully employed in a survey of the National Clonal Germplasm Repository Fragaria collection. A CRISPR-Cas-based protocol was also developed and shown to detect the virus in as little as 1 fg of total RNA, a protocol to be used in the detection of the virus in candidate G1 plants. The strawberry aphid (Chaetosiphon fragaefolii) was evaluated—alas, unsuccessfully—as a potential vector of the virus. This work broadens our understanding of the family Rhabdoviridae and assists in the quest of releasing plant material free of viruses.
Factors Leading to Successful Performance on U.S. National Licensure Exams for Medical Students: A Scoping Review
Authors: Jeyaraju Maniraj , Linford Henry , Bosco Mendes Thiago , Caufield-Noll Christine , Tackett Sean
Published: July 2022

Purpose

To synthesize the evidence of the factors leading to successful performance on knowledge-based national licensure exams (NLEs) for medical students.

Method

The authors conducted a scoping review to summarize the peer-reviewed empiric literature that used United States Medical Licensing Examination (USMLE) Step 1 or Step 2 Clinical Knowledge or Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Level 1 or Level 2 Cognitive Evaluation scores as outcomes. The authors searched PubMed and Scopus without date restrictions through April 30, 2021. Two reviewers independently screened and selected studies for inclusion. Data were summarized narratively and with descriptive statistics.

Results

The authors screened 1,185 unique citations and included 233 full-text studies in their review. Of these, 201 (86%) were studies of USMLE exams, 31 (13%) were studies of COMLEX exams, and 1 (0.4%) reported on both. The authors classified 29 studies (12%) as informing NLE preparation, 163 (70%) as attempting to identify predictive variables, and 76 (33%) as using NLE scores for program evaluation. Preparation studies found that the number of practice test items, practice exam scores, and less time in dedicated preparation correlated with higher NLE scores. Use of other commercial resources or study strategies was not consistently associated with higher scores. Predictive studies found the strongest relationships between individuals’ performance on past assessments and their NLE scores.

Conclusions

The factors leading to successful performance on knowledge-based NLEs align with well-known principles from the cognitive sciences. Learners build on existing foundations of knowledge (reflected in their prior academic performance) and are likely to learn more efficiently with testing and spaced learning over time. While commercial test preparation resources are ubiquitous, there is no evidence that a single resource gives students a competitive advantage on NLEs. Developing habits of regular and continuous learning is necessary for clinical practice and successful NLE performance.
Orthopaedic Surgery Pediatric Sports Medicine: Characterizing Practice Patterns and Subspecialization
Authors: Block Andrew M. , Eisenberg Matthew T. , Ellis Henry B. , Crepeau Allison E. , Schmitz Matthew R. , Carsen Sasha ,   PRiSM Hip RIG, Nepple Jeffrey J.
Published: July 2022

Background:

Pediatric sports medicine is a new and rapidly growing subspecialty within orthopaedic surgery. However, there is very limited literature on the practice of pediatric sports medicine in North America. Therefore, the purpose of this study was to evaluate and describe the current practice patterns of orthopaedic surgeons specializing in pediatric sports medicine.

Methods:

An online survey was distributed to orthopaedic surgeons specializing in pediatric sports medicine through the Pediatric Research in Sports Medicine Society. The purpose of the survey was to characterize (1) surgeon demographics, (2) the breakdown of different joint specialization, and (3) the specific procedures for joints that the surgeons specialize in.

Results:

Responses from 55 orthopaedic surgeons were collected and analyzed. Most respondents considered pediatric sports medicine as the primary focus of their practice (89.1%, n=49/55). The number of fellowships completed was almost evenly split between either a single fellowship (52.7%, n=29/55) or 2 or more (47.3%, n=26/55). The most common combination of fellowships was pediatric orthopaedics and adult sports medicine (32.7%, n=18/55). Most survey respondents had been in practice for <10 years (69.0%, n=38/55) and were affiliated with an academic center (61.8%, n=34/55). On average, 77.5% of the patients treated were <18 years old. The knee joint was the most specialized joint, with 98.2% (n=54/55) respondents reporting that the knee joint constituted ≥25% of their practice. The knee joint constituted a mean of 52.1% of the respondents’ overall practice, followed by the shoulder (15.2%), hip (13.9%), ankle (7.5%), elbow (7.1%), and wrist (4.2%).

Conclusions:

Pediatric sports medicine practices are variable and have distinct practice patterns in pediatric, orthopaedic, and adult sports practices. In the current study, most surgeons are less than 10 years into practice, affiliated with academic centers, and have typically completed either 1 or 2 fellowships after residency. Surgeons were most commonly specialized in the knee joint and cared for patients <18 years old.

Level of Evidence:

Level of evidence IV.
Spinal Cord Injury: The Global Incidence, Prevalence, and Disability From the Global Burden of Disease Study 2019
Authors: Ding Weizhong , Hu Shian , Wang Pengju , Kang Honglei , Peng Renpeng , Dong Yimin , Li Feng
Published: July 2022

Study Design.

A retrospective cohort study.

Objective.

The authors aimed to estimate the incidence, prevalence and years lived with disability (YLDs) of spinal cord injury (SCI) by location, sex, age, injury site and socio-demographic index (SDI) based on the data of the Global Burden of Disease Study (GBD) 2019.

Summary of Background Data.

GBD 2019 estimates the burden of 369 diseases and injuries worldwide in 2019 and the temporal trends in the past 30 years. SCI is estimated as a result of injury from various causes.

Methods.

A Bayesian meta-regression tool, DisMod-MR2.1, was used to produce the estimates. Estimated annual percentage change (EAPC) was calculated based on a linear regression mode of the age standardized rates and the calendar year to represent the temporal trends of the age standardized rates. Spearman rank order correlation was used to determine the correlation between SDI and the incidence and burden of SCI.

Results.

Globally, there were 0.9 [95% uncertainty interval (UI), 0.7 to 1.2] million incident cases, 20.6 (95% UI, 18.9–23.6) million prevalent cases and 6.2 (95% UI, 4.5–8.2) million YLDs of total SCI in 2019. The ASPR increased (EAPC, 0.1; 95% confidence interval, −0.01 to 0.2), while the age standardized incidence rate (ASIR) (EAPC, −0.08; 95% UI, −0.24 to 0.09) and age standardized YLD rate (ASYR) (EAPC, −0.08; 95% confidence interval, −0.24 to 0.09) decreased. Males had higher ASIR and ASYR, and the rate of incidence, prevalence and YLD increased with age. Spinal injuries at neck level caused higher ASYR than injuries below neck level. A positive correlation existed between SDI and ASIR (ρ=0.1626, P<0.05), while a negative correlation was observed between SDI and EAPC of ASYR (ρ=−0.2421, P<0.01).

Conclusion.

Conclusively, the incidence and burden of SCI has increased over the last 30 years. Males and the elderly were affected to a greater degree than females and younger individuals.

Level of Evidence.

Level III.
Polymorphisms in toll-like receptor 3 and 4 genes as prognostic and outcome biomarkers in melanoma patients
Authors: Ostojic Nikola , Radevic Tatjana , Kandolf Sekulovic Lidija , Djordjevic Boban , Jaukovic Ljiljana , Stepic Nenad , Supic Gordana
Published: July 2022

Melanoma is one of the most aggressive tumors, and in the setting of rising incidence and mortality, there is an urgent need to identify new prognostic markers. Toll-like receptors (TLRs), are aberrantly expressed in numerous cancers, including melanoma. TLR signaling provides a microenvironment that is involved in antitumor immune response, chronic inflammation, cancer cell proliferation and evasion of immune destruction. In the present study, we investigated whether single nucleotide polymorphisms (SNPs) in TLR3 and TLR4 genes are associated with clinicopathologic features, progression and survival of melanoma patients. The study was conducted on 120 melanoma patients. DNA extracted from peripheral blood was genotyped for TLR3 polymorphisms rs5743312 and rs3775291 (L412F) and TLR4 polymorphisms rs4986790 (D299G) and rs4986791 (T399I), by TaqMan Real-Time PCR Assays. Kaplan–Meier survival curves were compared by the log-rank test. TLR3 polymorphism L412F was associated with a higher mitotic index (P = 0.035). TLR4 D299G and T399I polymorphisms were associated with indicators of melanoma severity, nodal metastases (P = 0.005 and P = 0.007, respectively) and advanced stage III (P = 0.005 and P = 0.004, respectively). Cox regression analysis showed that the presence of tumor-infiltrating lymphocytes (TILs) predicted better overall survival (HR = 0.318; P = 0.004). TLR4 T399I polymorphism was significantly associated with worse survival, P = 0.025. The overall survival rates were significantly lower for patients carrying variant allele T of TLR4 T399I SNP (TC and TT genotypes combined) (P = 0.008, log-rank test), compared to wild-type genotype CC. Our findings indicate that TLR4 polymorphisms T399I (rs4986791) and D299G (rs4986790) could be potential prognostic and survival markers for melanoma patients.
Treatment reality of patients with BRAF-mutant advanced/metastatic melanoma in Switzerland in the era of choice
Authors: Mangana Joanna , Zihler Deborah , Bossart Simon , Brönnimann Daniel , Zachariah Ralph , Gérard Camille Léa
Published: July 2022

Cutaneous melanoma represents a major cause of cancer death in Europe. Without adequate therapy, the 5-year survival rate is 15–20% in distant metastatic disease. Evaluating the status quo of treatment standards in advanced melanoma and rationale for therapy decisions in Switzerland between January 2016 and September 2018. In this retrospective, anonymized registry, data of male and female patients with unresectable advanced/metastatic BRAF-positive cutaneous melanoma treated in first-, second- and third-line with registered substances were analyzed using descriptive statistics. Forty-one patients (56.1% male) were included providing a total of 70 treatment lines (first-line: n = 41; second-line: n = 18; and third-line: n = 11). Within the patients presenting with stage III or IV melanoma, immunotherapy with checkpoint inhibitors was more frequently administered as first-line treatment than targeted therapy (TT) (70.7% vs. 29.3%). Across all lines, patients received TT in 47.1% (predominantly combined BRAF-MEK-inhibition) and immunotherapy in 52.9% of the cases (anti-PD-1 monotherapy in 62.2% and anti-PD-1/anti-CTLA-4 combinations in 37.8%). Most commonly, the treatment type was switched from TT to immunotherapy or vice versa upon disease progression. The most frequent rationales for prescribing either TT or immunotherapy were physician’s preference (40.0%) or remission pressure (28.6%), respectively. Disease progression led to treatment discontinuation more frequently than undesired events. Patients in Switzerland with unresectable advanced or metastatic BRAF-mutant melanoma predominantly receive guideline-recommended treatments. IO was used as predominant front-line therapy, with TT/immunotherapy switch being the predominant treatment principle. Sequencing studies are underway to identify the optimal treatment regimen for those patients. 32: 366–372 Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Dacarbazine in the management of metastatic melanoma in the era of immune checkpoint therapy: a valid option or obsolete?
Authors: Klee Gina , Hagelstein Victoria , Kurzhals J.K. , Zillikens Detlef , Terheyden Patrick , Langan Ewan A.
Published: July 2022

Despite the dramatic improvement in both overall survival (OS) and progression-free survival (PFS) in patients with metastatic melanoma treated with immune checkpoint inhibitors, up to 60% will develop treatment resistance and 50% will die from their disease. Therefore, although dacarbazine is no longer a mainstay of modern melanoma management, we examined the extent to, and in which context, it may still play a role. A retrospective analysis of electronic medical records of patients who had received dacarbazine treatment between October 2014 and October 2021, following innate or acquired resistance to immune checkpoint inhibitors, was performed to determine PFS and OS and examine tolerability. Nine patients with locally advanced (n = 1) or metastatic melanoma (n = 8) were identified (average age: 74 years, 4 males and 5 females). The number of cycles of dacarbazine ranged from 2 to 45 (mean = 12). One-third of patients developed a complete (n = 2) or partial (n = 1) response, two-thirds did not respond to treatment. The median PFS time was 90 days. Common adverse events included blood dyscrasias; one patient developed a grade 3 hepatitis, although it was unclear if this was due to the chemotherapy or the preceding combined immunotherapy. Dacarbazine may still be a valid option in the setting of treatment for refractory, relapsed, or progressive disease. Future studies should focus on the immunomodulatory effects of dacarbazine on the tumor microenvironment, which could be harnessed to potentially restore sensitivity to immune checkpoint-based therapy.
Safety and Efficacy of Transform for Noninvasive Lipolysis and Circumference Reduction of the Abdomen
Authors: Novak Matthew , Weir David , Rohrich Rod J.
Published: July 2022

Noninvasive body contouring has seen a precipitous rise in popularity since its advent in the early 2000s. With this rise in popularity, there has been an expansion in the types and number of noninvasive devices for muscle hypertrophy and fat lipolysis. The Transform radiofrequency and electrical muscle stimulation device is a newly introduced device for noninvasive abdominal body contouring. The present study is a prospective clinical trial evaluating the efficacy of the Transform device on abdominal circumference. Fifteen patients were enrolled and received three treatment sessions with the Transform device. On average, patients saw changes in abdominal circumference (−0.43 cm, P = 0.48), caliper pinch thickness (−6.07 mm, P = 0.0036), and ultrasound fat thickness (−5.40 mm, P < 0.001) at 3 months posttreatment with minimal discomfort and high patient satisfaction. Ultimately, this study demonstrates that the Transform device is a safe and effective noninvasive option for fat lipolysis and muscular hypertrophy.
The Safety of Same-day Discharge after Immediate Alloplastic Breast Reconstruction: A Systematic Review
Authors: Marxen Troy , Shauly Orr , Losken Albert
Published: July 2022

Background:

Implant-based breast reconstruction can be accomplished in a variety of ways and can result in vastly different postoperative experiences for patients. The COVID-19 pandemic and recent trends have resulted in a shift toward outpatient management of these patients.

Methods:

A systematic review of PubMed and Embase databases was conducted. A total of 1328 articles were identified on initial search, and after several rounds of review, a total of four met inclusion and exclusion criteria. Manuscripts were included if postmastectomy alloplastic breast reconstruction was performed, and there was documentation of same-day discharge. This cohort of patients was compared with traditional, planned overnight admission cohorts found in the literature. Objective data compared between groups included preoperative patient factors and postoperative complication rates.

Results:

Four studies representing data on a total of 574 patients were included: 289 were same-day discharge and 285 were overnight admission. Patient characteristics of body mass index, radiation, smoking, and bilateral procedures were comparable. Tissue expanders were used more frequently than implants in both cohorts. The rate of overall complications was 33% for same-day discharge and 34% for overnight admission. Rates of major and minor complications, including infection, seroma, and hematoma, were similar. There was no increase in reoperations or readmissions reported in any of the studies.

Conclusions:

Same-day discharge after mastectomy with immediate alloplastic reconstruction is a safe approach to treatment in both the ambulatory and hospital setting. There are comparable rates of common complications such as infection, seroma, and hematoma, with no increase in readmission or reoperation.
TEMPORARY KERATOPROSTHESIS COMBINED WITH VITRECTOMY FOR SEVERE GLOBE INJURY
Authors: Cisiecki Sławomir , Bonińska Karolina , Bednarski Maciej
Published: July 2022

Purpose:

To describe a case of a 44-year-old man with ocular trauma after a mine explosion. From the moment of the injury, the patient reported significant visual impairment (no perception of light in the right eye and a perception of light without localization in the left eye). The patient was diagnosed with a double-sided penetrating corneal scleral wound and traumatic cataract, retinal detachment, and intraocular foreign bodies after a battlefield mine explosion.

Methods:

The three-stage procedure, consisting of using soft contact lens as temporary keratoprosthesis, vitrectomy, and penetrating keratoplasty, was performed in the damaged eye.

Results:

A soft contact lens allowed for excellent visualization of the posterior segment during vitrectomy. At the 1-month follow-up, the eye that was operated on could sense light. The corneal transplant remained translucent, and the retina was attached.

Conclusion:

The described method, when performed by an experienced surgeon, may aid in simultaneously treating coexisting corneal opacification and vitreoretinal disorders.
Capsaicin treatment in neuropathic pain: axon reflex vasodilatation after 4 weeks correlates with pain reduction
Authors: Sendel Manon , Dunst Andreas , Forstenpointner Julia , Hüllemann Philipp , Baron Ralf
Published: July 2022

Capsaicin, an agonist at the transient receptor potential vanilloid 1, is used for the topical treatment of peripheral neuropathic pain. Reversible receptor defunctionalization and degeneration and subsequent regeneration of cutaneous nociceptors are discussed as its mechanism of action. Here, we hypothesize an accelerated functional recovery of a subclass of nociceptive afferents, the peptidergic vasoactive nociceptors, as the potential cause of capsaicin analgesia. In this noninterventional exploratory trial, 23 patients with peripheral neuropathic pain were treated with one topical high-concentration capsaicin application. Baseline pain ratings, comorbidities, and quality of life were assessed. Functional laser speckle contrast analysis (heat-evoked neurogenic vasodilatation to assess functional properties of peptidergic nociceptors) and quantitative sensory testing were performed in the affected skin. Four weeks after treatment, functional laser speckle contrast analysis and questionnaires were repeated. Telephone interviews were conducted at weeks 2, 10, and 12. Topical capsaicin treatment induced a significant reduction in pain intensity with a maximum at 4 weeks. At the same time, heat-evoked neurogenic vasodilatation was on average similar to pretreatment values. Half of the patients not only showed a functional recovery but also an improvement in vasodilatation, indicating regeneration of nerve fibers. Patients with improved heat-evoked neurogenic vasodilatation at week 4 showed a greater pain reduction than those with deterioration. The degree of vasodilatation significantly correlated with pain reduction. These findings suggest that (1) regeneration of peptidergic nociceptors may be the mechanism behind capsaicin-induced analgesia and (2) that a disease-modifying effect of capsaicin on these fibers already occurs 4 weeks after application.
Restenosis Following Bronchoscopic Airway Stenting for Complex Tracheal Stenosis
Authors: Chrissian Ara A. , Diaz-Mendoza Javier , Simoff Michael J.
Published: July 2022

Background:

Nonsurgical patients with complex postintubation tracheal stenosis (PITS) and tracheostomy-associated tracheal stenosis (PTTS) often require airway stenting. However, the optimal approach is unknown. Identifying patients at higher risk for restenosis after stent removal may allow the treating physician to individualize the vigilance and duration of airway stenting, and help optimize outcomes.

Methods:

This was a single-center retrospective analysis of prospectively collected data on all patients with complex PITS and/or PTTS treated with protocolized bronchoscopic airway stenting over a consecutive 16-year period. The primary outcome analyzed was restenosis rate at 1 year after stent removal. Predictors for restenosis and factors influencing risk for death during stent therapy were also assessed.

Results:

Of the 181 subjects treated with silicone airway stenting, 128 were available for analysis of the primary outcome. Restenosis by 1 year after stent removal occurred in 58%. Independent predictors for restenosis were coexisting diabetes [odd ratio (OR)=3.10, 95% confidence interval (CI)=1.04-9.24; P=0.04], morbid obesity (OR=3.13, 95% CI=1.20-8.17; P=0.02), and occurrence of stent-associated complications requiring bronchoscopic management (OR=2.13, 95% CI=1.12-4.03; P=0.02). The overall mortality during the initial stenting period was 14%, and a silicone Y-stent was associated with a higher risk of death (OR=3.58, 95% CI=1.40-9.14; P=0.008).

Conclusion:

Tracheal restenosis after silicone stent therapy for complex PITS and PTTS is common and more likely to occur in patients with diabetes, morbid obesity, and frequent stent-associated complications. Mortality risk during stent therapy is not negligible, and a Y-stent should be utilized only after careful consideration. These findings may be incorporated into the approach to bronchoscopic airway stenting in these patients.
Survival of Patients Treated with Extracorporeal Hemoadsorption and Extracorporeal Membrane Oxygenation: Results from a Nation-Wide Registry
Authors: Heidenreich Adrian , Kaier Klaus , Bode Christoph , Zehender Manfred , von zur Mühlen Constantin , Duerschmied Daniel , Wengenmayer Tobias , Stachon Peter , Supady Alexander
Published: July 2022

Extracorporeal hemoadsorption with the CytoSorb adsorber is increasingly being used during the past years. The use in combination with extracorporeal membrane oxygenation (ECMO) is feasible, but frequency of its use and outcomes have not been assessed in larger cohorts. We analyzed all patients treated with veno-venous (VV) ECMO either with or without CytoSorb in Germany from 2017 to 2019. Data were retrieved from a nationwide claim dataset collected by the Research Data Center of the Federal Bureau of Statistics. During this three-year episode, 7,699 patients were treated with VV ECMO. Among these, the number of CytoSorb-treated patients constantly increased from 156 (6.6%) in 2017 to 299 (11.8%) in 2019. In this large cohort hemoadsorption with the CytoSorb adsorber was associated with higher mortality and increased treatment costs. Due to limited information in the dataset about the severity of disease comparison of outcomes of patients treated with and without CytoSorb has to be interpreted with caution. Further studies have to examine if this finding is due to a negative effect of hemoadsorption with the CytoSorb device or is rather to be attributed to disease severity.
A Qualitative Descriptive Study of Nurse Manager Decision-Making Associated With RN Hiring
Authors: Kester Kelly M. , Engel Jill , Fuchs Mary Ann , Alston Sylvia , Granger Bradi B.
Published: July 2022

OBJECTIVE

To explore the practices and self-confidence of nurse manager (NM) decision-making related to evaluating RN hiring needs.

BACKGROUND

Evidence-based hiring strategies to sustain workforce stability were identified as a gap in the literature. Locally, inconsistencies in the method that NMs use to determine how many RNs to hire and at what frequency to hire them were observed, posing a threat to strategic workforce planning.

METHODS

Using a mixed-methods, qualitative descriptive design, researchers used in-depth interviews and surveys to assess current practices and NM confidence related to evaluating hiring needs.

RESULTS

The overarching theme among the 10 participants was false confidence. Subthemes reflected the dissonance in confidence and high variability in the hiring process. NM stress, time spent, and confidence were not correlated with years' experience.

CONCLUSIONS

NMs experience stress, spend excessive time, and use varying approaches to evaluate hiring needs. Years of managerial experience are unrelated to practical skills or level of confidence in hiring decision-making.
Hospitals That Report Severe Sepsis and Septic Shock Bundle Compliance Have More Structured Sepsis Performance Improvement
Authors: Bolte Ty B. , Swanson Morgan B. , Kaldjian Anna M. , Mohr Nicholas M. , McDanel Jennifer , Ahmed Azeemuddin
Published: July 2022

Purpose

Sepsis is a common cause of death. The Centers for Medicare and Medicaid Services severe sepsis/septic shock (SEP-1) bundle is focused on improving sepsis outcomes, but it is unknown which quality improvement (QI) practices are associated with SEP-1 compliance and reduced sepsis mortality. The objectives of this study were to compare sepsis QI practices in SEP-1 reporting and nonreporting hospitals and to measure the association between sepsis QI processes, SEP-1 performance, and sepsis mortality.

Materials and Methods

This study linked survey data on QI practices from Iowa hospitals to SEP-1 performance data and mortality. Characteristics of hospitals and sepsis QI practices were compared by SEP-1 reporting status. Univariable and multivariable logistic and linear regression estimated the association of QI practices with SEP-1 performance and observed-to-expected sepsis mortality ratios.

Results

One hundred percent of Iowa’s 118 hospitals completed the survey. SEP-1 reporting hospitals were more likely to have sepsis QI practices, including reporting sepsis quality to providers (64% versus 38%, P = 0.026) and using the case review process to develop sepsis care plans (87% versus 64%, P = 0.013). Sepsis QI practices were not associated with increased SEP-1 scores. A sepsis registry was associated with decreased odds of being in the bottom quartile of sepsis mortality (odds ratio, 0.37; 95% confidence interval, 0.14 to 0.96, P = 0.041), and presence of a sepsis committee was associated with lower hospital-specific mortality (observed-to-expected ratio, −0.11; 95% confidence interval, −0.20 to 0.01).

Conclusions

Hospitals reporting SEP-1 compliance conduct more sepsis QI practices. Most QI practices are not associated with increased SEP-1 performance or decreased sepsis mortality. Future work could explore how to implement these performance improvement practices in hospitals not reporting SEP-1 compliance.
The American Society for Gastrointestinal Endoscopy Quality Assurance in Endoscopy Committee's Three Priority Quality Indicators for Screening Colonoscopy Services
Authors: Morrow Linda , Greenwald Beverly
Published: July 2022

Colorectal cancer is the third most commonly diagnosed cancer in men and women in the United States. Small polyps are slow to grow and turn to cancer, which provides time for screening and removal of the precancerous polyps so that colorectal cancer is prevented. Quality colonoscopy services are essential to ensure all polyps are found and removed as the final step of colorectal cancer screening. The American Society for Gastrointestinal Endoscopy Quality Assurance in Endoscopy Committee developed quality indicators for colonoscopy services. The Committee prioritized 3 quality indicators for screening colonoscopies: the frequency of (1) adenoma detection in asymptomatic patients at average risk; (2) adherence to the surveillance intervals for postpolypectomy, postcancer resection, or the 10-year interval for the average-risk patients with good bowel preparations who had negative colonoscopies; and (3) visualization of the cecum by notation and landmark photographic documentation. Gastroenterology nurses, endoscopists, and the quality management team can use the Plan-Do-Study-Act method of quality improvement to meet the established performance targets and prevent interval cancers.
Patient Education Regarding Fasting Recommendations to Shorten Fasting Times in Patients Undergoing Esophagogastroduodenoscopy
Authors: van Noort Harm H. J. , Lamers Carlijn R. , Vermeulen Hester , Huisman-de Waal Getty , Witteman Ben J. M.
Published: July 2022

This study evaluated the applicability and efficacy of patient education regarding fasting recommendations to shorten fasting times in patients undergoing esophagogastroduodenoscopy (EGD). A prospective nonrandomized controlled pilot study was performed. The intervention group (IG) was educated by nurses to eat until 6 hours and drink until 2 hours before EGD. The control group (CG) received usual care. Outcomes were applicability as perceived by patients, adherence to fasting recommendations, gastric visibility, and patients' comfort. A total of 109 patients were included of whom 42 were IG patients (37%). Patients' perspectives on fasting, their experienced discomfort, professional support, and circadian rhythm influenced application of fasting recommendations. Adherence to length of fasting from foods improved with 3:14 hours (p < .001) and from liquids with 5:22 hours (p < .001) in the IG compared with the CG. Gastric visibility during EGD was better in the IG than in the CG. The IG patients experienced significant less thirst, hunger, headache, and anxiety. To successfully reduce fasting times, fasting education should include positive, individual instructions, which help patients apply the fasting recommendations within their biorhythm. Positive, concrete instructions by nurses shortened fasting times before EGD, which improved gastric visibility and reduced patient discomfort.
Decision-making Among Hepatitis C Virus-negative Transplant Candidates Offered Organs from Donors with HCV Infection
Authors: Saine M. Elle , Schnellinger Erin M. , Liu Michel , Diamond Joshua M. , Crespo Maria M. , Prenner Stacey , Potluri Vishnu , Bermudez Christian , Mentch Heather , Moore Michaella , Besharatian Behdad , Goldberg David S. , Barg Frances K. , Reese Peter P.
Published: July 2022

Background.

Historically, many organs from deceased donors with hepatitis C virus (HCV) were discarded. The advent of highly curative direct-acting antiviral (DAA) therapies motivated transplant centers to conduct trials of transplanting HCV-viremic organs (nucleic acid amplification test positive) into HCV-negative recipients, followed by DAA treatment. However, the factors that influence candidates’ decisions regarding acceptance of transplant with HCV-viremic organs are not well understood.

Methods.

To explore patient-level perceptions, influences, and experiences that inform candidate decision-making regarding transplant with organs from HCV-viremic donors, we conducted a qualitative semistructured interview study embedded within 3 clinical trials investigating the safety and efficacy of transplanting lungs and kidneys from HCV-viremic donors into HCV-negative recipients. The study was conducted from June 2019 to March 2021.

Results.

Among 44 HCV-negative patients listed for organ transplant who were approached for enrollment in the applicable clinical trial, 3 approaches to decision-making emerged: positivist, risk analyses, and instinctual response. Perceptions of risk contributed to conceptualizations of factors influencing decisions. Moreover, most participants relied on multiple decision-making approaches, either simultaneously or sequentially.

Conclusions.

Understanding how different decisional models influence patients’ choices regarding transplant with organs from HCV-viremic donors may promote shared decision-making among transplant patients and providers.
Management of Ascites Following Deceased Donor Liver Transplantation: A Case Series
Authors: Al-Zoubi Mohammad , Alarabiyat Moath , Hann Angus , Mehrzhad Homoyon , Karkhanis Salil , Muiesan Paolo , Abradelo Manuel , Hartog Hermien , Roberts Keith , Mirza Darius F. , Isaac John R. , Dasari Bobby V.M.
Published: July 2022

Background.

Persistent ascites after orthotropic liver transplantation has numerous causes and can be challenging to manage. This study aimed to determine the outcomes associated with conservative and endovascular intervention of posttransplant ascites after deceased donor liver transplantation.

Methods.

Adult (≥18 y) liver transplant recipients (between 2006 and 2019) who underwent hepatic venous pressure studies to investigate posttransplant ascites were included in this retrospective study. Comparisons were made between those who were managed with conservative therapy versus endovascular intervention and were also based on hepatic venous wedge pressure gradient (normal [≤10 mm Hg] versus elevated [>10 mm Hg]).

Results.

A total of 30 patients underwent hepatic venography to investigate ascites during the study period. The median time from transplant to venography was 70 d. At least 1 endovascular intervention was performed in 18 of 30 patients (62%), and 12 of 30 patients (38%) were managed conservatively. Endovascular interventions included angioplasty (n = 4), hepatic vein stenting (n = 9), or a transjugular intrahepatic portosystemic shunt (n = 7). The mean (range) hepatic venous wedge pressure gradient for the conservative and endovascular intervention groups was 12 mm Hg (3–23) and14 mm Hg (2–35), respectively. At a 6-mo follow-up, ascites resolved in 6 of 12 patients (50%) and 11 of 18 patients (61%) in the medical management and endovascular groups, respectively. The graft survival rates at 6 and 12 mo were (7/12 [58%] versus 17/18 [94%], P = 0.02) and (7/12 [58%] versus 14/18 [78%], P = 0.25), respectively.

Conclusions.

Despite medical or endovascular intervention, resolution of ascites is achieved in <60% of patients with persistent ascites. Biopsy findings and venographic pressure studies should be carefully integrated into the management of posttransplant ascites.
Neural substrates of substance use disorders
Authors: Paulus Martin P.
Published: July 2022

Purpose of review

Substance use disorders account for a tremendous burden to society, yet despite substantial progress in basic studies, our understanding of the brain-basis of these disorders is still emerging. This review summarizes the recent findings of neuroimaging studies with substance use disorder individuals.

Recent findings

Resting-state functional connectivity studies support for some but not all substances of abuse and disruption in executive control. Structural neuroimaging findings point towards reduced subcortical volumes, which may emerge as an interaction between preexisting factors and recent substance use. Longitudinal studies implicate some of the same core brain structures and their functional role that have also been identified via case–control studies. Finally, meta-analyses support the idea of dysregulation of cortical control over subcortical salience processing.

Although progress has been made and there is both structural and functional imaging evidence of an imbalance between brain structures involved in executive control and salience processing, there is emerging evidence that brain-behaviour relationships, which are core to discovering the neural processes that lead to and maintain substance use, are small and require larger consortia that prospectively examine individuals with substance use disorder.
Reproducibility and replicability in neuroimaging data analysis
Authors: Adali Tü̈lay , Calhoun Vince D.
Published: July 2022

Purpose of review

Machine learning solutions are being increasingly used in the analysis of neuroimaging (NI) data, and as a result, there is an increase in the emphasis of the reproducibility and replicability of these data-driven solutions. Although this is a very positive trend, related terminology is often not properly defined, and more importantly, (computational) reproducibility that refers to obtaining consistent results using the same data and the same code is often disregarded.

Recent findings

We review the findings of a recent paper on the topic along with other relevant literature, and present two examples that demonstrate the importance of accounting for reproducibility in widely used software for NI data.

We note that reproducibility should be a first step in all NI data analyses including those focusing on replicability, and introduce available solutions for assessing reproducibility. We add the cautionary remark that when not taken into account, lack of reproducibility can significantly bias all subsequent analysis stages.
Applications of conceptual models from lifecourse epidemiology in ecology and evolutionary biology
Authors: Laubach Zachary M. , Holekamp Kay E. , Aris Izzuddin M. , Slopen Natalie , Perng Wei
Published: July 2022

In ecology and evolutionary biology (EEB), the study of developmental plasticity seeks to understand ontogenetic processes underlying the phenotypes upon which natural selection acts. A central challenge to this inquiry is ascertaining a causal effect of the exposure on the manifestation of later-life phenotype due to the time elapsed between the two events. The exposure is a potential cause of the outcome—i.e. an environmental stimulus or experience. The later phenotype might be a behaviour, physiological condition, morphology or life-history trait. The latency period between the exposure and outcome complicates causal inference due to the inevitable occurrence of additional events that may affect the relationship of interest. Here, we describe six distinct but non-mutually exclusive conceptual models from the field of lifecourse epidemiology and discuss their applications to EEB research. The models include Critical Period with No Later Modifiers, Critical Period with Later Modifiers, Accumulation of Risk with Independent Risk Exposures, Accumulation of Risk with Risk Clustering, Accumulation of Risk with Chains of Risk and Accumulation of Risk with Trigger Effect. These models, which have been widely used to test causal hypotheses regarding the early origins of adult-onset disease in humans, are directly relevant to research on developmental plasticity in EEB.
Quantifying the effect of human population mobility on malaria risk in the Peruvian Amazon
Authors: Carrasco-Escobar Gabriel , Matta-Chuquisapon Jose , Manrique Edgar , Ruiz-Cabrejos Jorge , Barboza Jose Luis , Wong Daniel , Henostroza German , Llanos-Cuentas Alejandro , Benmarhnia Tarik
Published: July 2022

The impact of human population movement (HPM) on the epidemiology of vector-borne diseases, such as malaria, has been described. However, there are limited data on the use of new technologies for the study of HPM in endemic areas with difficult access such as the Amazon. In this study conducted in rural Peruvian Amazon, we used self-reported travel surveys and GPS trackers coupled with a Bayesian spatial model to quantify the role of HPM on malaria risk. By using a densely sampled population cohort, this study highlighted the elevated malaria transmission in a riverine community of the Peruvian Amazon. We also found that the high connectivity between Amazon communities for reasons such as work, trading or family plausibly sustains such transmission levels. Finally, by using multiple human mobility metrics including GPS trackers, and adapted causal inference methods we identified for the first time the effect of human mobility patterns on malaria risk in rural Peruvian Amazon. This study provides evidence of the causal effect of HPM on malaria that may help to adapt current malaria control programmes in the Amazon.
Projected climate change impacts on the phylogenetic diversity of the world's terrestrial birds: more than species numbers
Authors: Voskamp Alke , Hof Christian , Biber Matthias F. , Böhning-Gaese Katrin , Hickler Thomas , Niamir Aidin , Willis Stephen G. , Fritz Susanne A.
Published: July 2022

Ongoing climate change is a major threat to biodiversity. As abiotic tolerances and dispersal abilities vary, species-specific responses have the potential to further amplify or ameliorate the ensuing impacts on species assemblages. Here, we investigate the effects of climate change on species distributions across non-marine birds, quantifying its projected impact on species richness (SR) as well as on different aspects of phylogenetic diversity globally. Going beyond previous work, we disentangle the potential impacts of species gains versus losses on assemblage-level phylogenetic diversity under climate change and compare the projected impacts to randomized assemblage changes. We show that beyond its effects on SR, climate change could have profound impacts on assemblage-level phylogenetic diversity and composition, which differ significantly from random changes and among regions. Though marked species losses are most frequent in tropical and subtropical areas in our projections, phylogenetic restructuring of species communities is likely to occur all across the globe. Furthermore, our results indicate that the most severe changes to the phylogenetic diversity of local assemblages are likely to be caused by species range shifts and local species gains rather than range reductions and extinctions. Our findings highlight the importance of considering diverse measures in climate impact assessments.
Long-distance vocalizations of spotted hyenas contain individual, but not group, signatures
Authors: Lehmann Kenna D. S. , Jensen Frants H. , Gersick Andrew S. , Strandburg-Peshkin Ariana , Holekamp Kay E.
Published: July 2022

In animal societies, identity signals are common, mediate interactions within groups, and allow individuals to discriminate group-mates from out-group competitors. However, individual recognition becomes increasingly challenging as group size increases and as signals must be transmitted over greater distances. Group vocal signatures may evolve when successful in-group/out-group distinctions are at the crux of fitness-relevant decisions, but group signatures alone are insufficient when differentiated within-group relationships are important for decision-making. Spotted hyenas are social carnivores that live in stable clans of less than 125 individuals composed of multiple unrelated matrilines. Clan members cooperate to defend resources and communal territories from neighbouring clans and other mega carnivores; this collective defence is mediated by long-range (up to 5 km range) recruitment vocalizations, called whoops. Here, we use machine learning to determine that spotted hyena whoops contain individual but not group signatures, and that fundamental frequency features which propagate well are critical for individual discrimination. For effective clan-level cooperation, hyenas face the cognitive challenge of remembering and recognizing individual voices at long range. We show that serial redundancy in whoop bouts increases individual classification accuracy and thus extended call bouts used by hyenas probably evolved to overcome the challenges of communicating individual identity at long distance.