bluuebunny/crossref_metadata_2025 huggingface dataset:
A predictive model for identifying patients at risk of delayed transfer of care: a retrospective, cross-sectional study of routinely collected data
Authors: Davy Andrew , Hill Thomas , Jones Sarahjane , Dube Alisen , Lea Simon c , Watts Keiar l , Asaduzzaman M d
Published: September 2021

Background

Delays to the transfer of care from hospital to other settings represent a significant human and financial cost. This delay occurs when a patient is clinically ready to leave the inpatient setting but is unable to because other necessary care, support or accommodation is unavailable. The aim of this study was to interrogate administrative and clinical data routinely collected when a patient is admitted to hospital following attendance at the emergency department (ED), to identify factors related to delayed transfer of care (DTOC) when the patient is discharged. We then used these factors to develop a predictive model for identifying patients at risk for delayed discharge of care.

Objective

To identify risk factors related to the delayed transfer of care and develop a prediction model using routinely collected data.

Methods

This is a single centre, retrospective, cross-sectional study of patients admitted to an English National Health Service university hospital following attendance at the ED between January 2018 and December 2020. Clinical information (e.g. national early warning score (NEWS)), as well as administrative data that had significant associations with admissions that resulted in delayed transfers of care, were used to develop a predictive model using a mixed-effects logistic model. Detailed model diagnostics and statistical significance, including receiver operating characteristic analysis, were performed.

Results

Three-year (2018–20) data were used; a total of 92 444 admissions (70%) were used for model development and 39 877 (30%) admissions for model validation. Age, gender, ethnicity, NEWS, Glasgow admission prediction score, Index of Multiple Deprivation decile, arrival by ambulance and admission within the last year were found to have a statistically significant association with delayed transfers of care. The proposed eight-variable predictive model showed good discrimination with 79% sensitivity (95% confidence intervals (CIs): 79%, 81%), 69% specificity (95% CI: 68%, 69%) and 70% (95% CIs: 69%, 70%) overall accuracy of identifying patients who experienced a DTOC.

Conclusion

Several demographic, socio-economic and clinical factors were found to be significantly associated with whether a patient experiences a DTOC or not following an admission via the ED. An eight-variable model has been proposed, which is capable of identifying patients who experience delayed transfers of care with 70% accuracy. The eight-variable predictive tool calculates the probability of a patient experiencing a delayed transfer accurately at the time of admission.
Postmortem Analysis of Opioids and Metabolites in Skeletal Tissue
Authors: Vandenbosch Michiel , Pajk Stane , Van Den Bogaert Wouter , Wuestenbergs Joke , Van de Voorde Wim , Cuypers Eva
Published: September 2021

Every year, thousands of suspicious deaths are accounted for by an overdose of opioids. Occasionally all traditional matrices are unavailable due to decomposition. Skeletal tissue may pose a valid alternative. However, reference data on postmortem concentrations in bone tissue and bone marrow (BM) is sparse. Therefore, a liquid chromatography--tandem mass spectrometry method was developed and fully validated for the analysis of four opioids and two metabolites (tramadol, O-desmethyltramadol, morphine, fentanyl, norfentanyl, codeine) in bone tissue and BM. Sample preparation was performed using solid phase extraction (BM), methanolic extraction (bone) and a protein precipitation (whole blood). All validation parameters were successfully fulfilled. This method was applied to analyze 22 forensic cases involving opioids. All six opioids were proven to be detectable and quantifiable in all specimens sampled. When tramadol blood concentrations were correlated with bone concentrations, a linear trend could be detected. The same was seen between tramadol blood and BM concentration. A similar linear trend was seen when correlating codeine blood concentration with bone and BM concentration. Although some variability was detected, the same linear trend was seen for morphine. For fentanyl and norfentanyl, the sample size was too small to draw conclusions, regarding correlation. As far as the authors know this is the first-time fentanyl and norfentanyl are quantified in skeletal tissue. In conclusion, due to the absence of reference data for drugs in skeletal tissue, these findings are a step forward toward a more thorough understanding of drug concentration found in postmortem skeletal tissue.
Tramadol-Related Deaths: Genetic Analysis in Relation to Metabolic Ratios
Authors: Aly Sanaa M , Tartar Océane , Sabaouni Naoual , Hennart Benjamin , Gaulier Jean-michel , Allorge Delphine
Published: September 2021

Tramadol (TR) metabolism is mainly dependent on the enzymatic activity of CYP2D6, which is controlled by genetic polymorphisms. Individuals are classified as poor (PMs), intermediate (IMs), extensive (EMs) or ultrarapid metabolizers (UMs) according to their genotype or phenotype. The determination of the metabolic phenotype for CYP2D6 can be of utmost importance in forensic and clinical contexts that involve TR intake. The present study aimed to describe CYP2D6 genetic variants in cases of TR-related deaths and to assess which metabolic ratio(s) (MRs) would allow to determine CYP2D6 phenotype without having to perform genetic analyses. Forty-eight postmortem blood samples were selected from TR-related death cases previously analyzed in a forensic context in North of France between 2013 and 2019. Initial available data included blood concentrations of TR and its two main metabolites (M1 & M2) determined using an LC--MS-MS method. TR metabolism was expressed as various MRs comprising TR/M1, TR/M2 and M2/M1. After DNA extraction, sequencing was used for genetic variant detections that affect CYP2D6 activity/expression. In the present study, the allelic variants with the higher frequency were CYP2D6*1 (68%), followed by *4 (21%). The most frequent phenotype is EMs (59.6%), followed by IMs (23.4%), PMs (12.8%) and UMs (6.4%). There was no significant correlation between each calculated MR and the genotypically predicted phenotypes, except for M2/M1 which appears related to the PM phenotype. The observed distribution of CYP2D6 genetic variants in this TR-related death population was similar to that found in the general Caucasian population. The present study displayed that the blood M2/M1 ratio could be the best-correlated TR MR to the PM phenotype, and could thus be used in forensic contexts where genetic analyses are not possible or poorly informative. For the other phenotypes, especially the UM phenotype, genetic analysis appears to be the only reliable method to predict the CYP2D6 phenotype.
Pathogenic Assessment of SfMNPV-Based Biopesticide on Spodoptera frugiperda (Lepidoptera: Noctuidae) Developing on Transgenic Soybean Expressing Cry1Ac Insecticidal Protein
Authors: Zakseski Marcelo R , da Silva Filho José G , Rakes Matheus , Pazini Juliano de B , da Rosa Ana Paula S A , Marçon Paula , Popham Holly J R , Bernardi Oderlei , Bernardi Daniel
Published: September 2021

Pathogenic assessment of a baculovirus-based biopesticide containing Spodoptera frugiperda multiple nucleopolyhedrovirus (SfMNPV: Baculoviridae: Alphabaculovirus) infecting fall armyworm, Spodoptera frugiperda (J. E. Smith, 1797) (Lepidoptera: Noctuidae) is reported. In the bioassays, neonates were infected with different doses of SfMNPV applied on Cry1Ac Bt soybean and non-Bt soybean. Our findings indicated that S. frugiperda neonates did not survive at 10 d post infection or develop into adults on Bt and non-Bt soybean sprayed with the field recommended dose of SfMNPV. In contrast, a proportion of the infected neonates developed into adults when infected with lower doses of SfMNPV (50%, 25%, and 10% of field dose) in both Bt and non-Bt soybean. However, S. frugiperda neonates surviving infection at the lowest virus doses on both soybean varieties showed longer neonate-to-pupa and neonate-to-adult periods, lower larval and pupal weights, reduced fecundity, and increased population suppression. Nevertheless, more pronounced pathogenicity of SfMNPV infecting neonates of S. frugiperda were verified on larvae that developed on Bt soybean. These findings revealed that, beyond mortality, the biopesticide containing SfMNPV also causes significant sublethal pathogenic effects on neonates of S. frugiperda developing on Bt and non-Bt soybean and suggested an additive effect among SfMNPV and Cry1Ac insecticidal protein expressed in Bt soybean.
Electromagnetic propagation logging while drilling data acquisition method based on undersampling technology
Authors: Li Xinghan , Zhang Wenxiu , Chen Wenxuan , Zhang Yali , Zheng Jian , Fan Jianbao , Li Hong , Ma Zhenjun
Published: September 2021

With the development of complex and unconventional reservoirs, oil and gas exploration becomes increasingly difficult. Highly deviated wells/horizontal wells are widely used. The electromagnetic propagation logging while drilling (LWD) is more effective in complex geological environment detection owing to geological orientation and real-time formation evaluation. However, its operating frequency is generally at the MHz level. Traditional acquisition techniques require an analogue to digital converter with high sampling rates, which will introduce complex circuit structures and increase sampling costs. The undersampling technology has overcome these disadvantages. The difficulties in the undersampling technology include the selection of an undersampling frequency and the acquisition of a signal correction coefficient. The range of undersampling frequencies and a correction coefficient has been developed to process the electromagnetic propagation LWD measurements in this paper. The range of undersampling frequency ensures the validity of the sampled data. The correction coefficient ensures that different frequency signals use the same undersampling frequency to obtain the same frequency recovery signal. The correctness of these parameters is verified by simulation and field data examples. The range of undersampling frequency and a correction coefficient has been applied, improving the data stability and providing reliable technical support for the exploration and development of unconventional oil and gas.
Characterization and Phylogenetic Analysis of the Complete Mitochondrial Genomes of Two Tiny Necrophagous Phorid Flies, Metopina sagittata and Puliciphora borinquenensis (Diptera: Phoridae)
Authors: Dai Shu-Tong , Feng Dian-Xing , Sun Da-Peng
Published: September 2021

The mitochondrial genome is frequently used for species identification and phylogenetic studies. In this study, we first sequenced and annotated the complete mitochondrial genomes of two phorid species that are forensically important in buried or enclosed environments: Metopina sagittata (Liu) and Puliciphora borinquenensis (Wheeler). The complete mitochondrial genome sequences of M. sagittata and P. borinquenensis were 15,640 bp with an A+T content of 75.97% and 15,429 bp with an A+T content of 75.38%, respectively. Their circular genomes both contained 13 protein-coding genes (PCGs), 22 transfer RNA genes, 2 ribosomal RNA genes, and 1 control region located between rrnS and trnI which was 808 bp for M. sagittata and 746 bp for P. borinquenensis. All the PCGs of both species started with ATN codons except for cox1 which used TTG codon. In addition to the common stop codon TAA and TAG, the incomplete stop codon T was used in two PCGs (cox1 and nad4) of M. sagittata and five PCGs (cox1, cox2, cox3, nad5, and nad4) of P. borinquenensis. There were 3 and 10 mismatched base pairs in the tRNA secondary structures from M. sagittata and P. borinquenensis, respectively. Both maximum likelihood and Bayesian inference analyses indicated that Platypezidae and Phoridae are sister taxa. M. sagittata is closely related to P. borinquenensis within the subfamily Metopininae. This work enhances the databases of Phoridae genomes and contributes to the further study of species identification and phylogenetics of this family.
Neural Injury and Repair in a Novel Neonatal Mouse Model of Listeria Monocytogenes Meningoencephalitis
Authors: Seele Jana , Ballüer Melissa , Tauber Simone C , Bunkowski Stephanie , Schulz Katja , Stadelmann Christine , Beineke Andreas , Pägelow Dennis , Fulde Marcus , Nau Roland
Published: September 2021

To improve the therapy of neonatal central nervous system infections, well-characterized animal models are urgently needed. The present study analyzes neuropathological alterations with particular focus on neural injury and repair in brains of neonatal mice with Listeria monocytogenes (LM) meningitis/meningoencephalitis using a novel nasal infection model. The hippocampal formation and frontal cortex of 14 neonatal mice with LM meningitis/meningoencephalitis and 14 uninfected controls were analyzed by histology, immunohistochemistry, and in situ tailing for morphological alterations. In the dentate gyrus of the hippocampal formation of mice with LM meningitis/meningoencephalitis, an increased density of apoptotic neurons visualized by in situ tailing (p = 0.04) and in situ tailing plus immunohistochemistry for activated Caspase-3 (p < 0.0001) was found. A decreased density of dividing cells stained with an anti-PCNA-antibody (p < 0.0001) and less neurogenesis visualized by anti-calretinin (p < 0.0001) and anti-calbindin (p = 0.01) antibodies were detected compared to uninfected controls. The density of microglia was higher in LM meningitis (p < 0.0001), while the density of astrocytes remained unchanged. Infiltrating monocytes and neutrophilic granulocytes likely contributed to tissue damage. In conclusion, in the brains of LM-infected mice a strong immune response was observed which led to neuronal apoptosis and an impaired neural regeneration. This model appears very suitable to study therapies against long-term sequelae of neonatal LM meningitis.
Inflammatory Pathways Are Impaired in Alzheimer Disease and Differentially Associated With Apolipoprotein E Status
Authors: Kloske Courtney M , Dugan Adam J , Weekman Erica M , Winder Zachary , Patel Ela , Nelson Peter T , Fardo David W , Wilcock Donna M
Published: September 2021

Alzheimer disease (AD) is a neurodegenerative disease characterized by a cognitive decline leading to dementia. The most impactful genetic risk factor is apolipoprotein E (APOE). APOE-ε4 significantly increases AD risk, APOE-ε3 is the most common gene variant, and APOE-ε2 protects against AD. However, the underlying mechanisms of APOE-ε4 on AD risk remains unclear, with APOE-ε4 impacting many pathways. We investigated how the APOE isoforms associated with the neuroinflammatory state of the brain with and without AD pathology. Frozen brain tissue from the superior and middle temporal gyrus was analyzed from APOE-ε3/3 (n = 9) or APOE-ε4/4 (n = 10) participants with AD pathology and APOE-ε3/3 (n = 9) participants without AD pathology. We determined transcript levels of 757 inflammatory related genes using the NanoString Human Neuroinflammation Panel. We found significant pathways impaired in APOE-ε4/4-AD individuals compared to APOE-ε3/3-AD. Of interest, expression of genes related to microglial activation (SALL1), motility (FSCN1), epigenetics (DNMT1), and others showed altered expression. Additionally, we performed immunohistochemistry of P2RY12 to confirm reduced microglial activation. Our results suggest APOE-ε3 responds to AD pathology while potentially having a harmful long-term inflammatory response, while APOE-ε4 shows a weakened response to pathology. Overall, APOE isoforms appear to modulate the brain immune response to AD-type pathology.
Wearable Sensors Detect Movement Differences in the Portable Warrior Test of Tactical Agility After mTBI in Service Members
Authors: Favorov Oleg , Kursun Olcay , Challener Timothy , Cecchini Amy , McCulloch Karen L
Published: September 2021

Introduction

Assessment of functional recovery of service members following a concussion is central to their return to duty. Practical military-relevant performance-based tests are needed for identifying those who might need specialized rehabilitation, for evaluating the progress of recovery, and for making return-to-duty determinations. One such recently developed test is the ‘Portable Warrior Test of Tactical Agility’ (POWAR-TOTAL) assessment designed for use following concussion in an active duty population. This agility task involves maneuvers used in military training, such as rapid stand-to-prone and prone-to-stand transitions, combat rolls, and forward and backward running. The effect of concussion on the performance of such maneuvers has not been established.

Materials and Methods

The Institutional Review Board–approved study was conducted at Ft. Bragg, North Carolina, on 57 healthy control (HC) service members (SMs) and 42 well-matched SMs who were diagnosed with concussion and were referred for physical therapy with the intent to return to duty. Each study participant performed five consecutive trials of the POWAR-TOTAL task at full exertion while wearing inertial sensors, which were used to identify the constituent task maneuvers, or phases, and measure their durations. Statistical analyses were performed on durations of three main phases: (1) rising from prone and running, (2) lowering from vertical to prone, and (3) combat rolls.

Results

None of the three phases showed significant correlation with age (range 18-45 years) in either group. Gradual improvement in all three phase durations across five trials was observed in the HC group, but not in the concussed group. On average, control subjects performed significantly faster (P < .004 or less) than concussed subjects in all trials in the lowering and rolling phases, but less so in the rising/running phase. Membership in the concussed group had a strong effect on the lowering phase (Cohen’s d = 1.05), medium effect on the rolling phase (d = 0.72), and small effect on the rising/running phase (d = 0.49). Individuals in the HC group who had a history of prior concussions were intermediate between the concussed group and the never-concussed group in the lowering and rolling phases. Duration of transitional movements (lowering from standing to prone and combat rolls) was better at differentiating individuals’ performance by group (receiver operating characteristic area under the curve [AUC] = 0.83) than the duration of the entire POWAR-TOTAL task (AUC = 0.71).

Conclusions

Inertial sensor analysis reveals that rapid transitional movements (such as lowering from vertical to prone position and combat rolls) are particularly discriminative between SMs recovering from concussion and their concussion-free peers. This analysis supports the validity of POWAR-TOTAL as a useful tool for therapists who serve military SMs.
Local neuronal relational structures underlying the contents of human conscious experience
Authors: Malach Rafael
Published: September 2021

While most theories of consciousness posit some kind of dependence on global network activities, I consider here an alternative, localist perspective—in which localized cortical regions each underlie the emergence of a unique category of conscious experience. Under this perspective, the large-scale activation often found in the cortex is a consequence of the complexity of typical conscious experiences rather than an obligatory condition for the emergence of conscious awareness—which can flexibly shift, depending on the richness of its contents, from local to more global activation patterns. This perspective fits a massive body of human imaging, recordings, lesions and stimulation data but opens a fundamental problem: how can the information, defining each content, be derived locally in each cortical region. Here, I will discuss a solution echoing pioneering structuralist ideas in which the content of a conscious experience is defined by its relationship to all other contents within an experiential category. In neuronal terms, this relationship structure between contents is embodied by the local geometry of similarity distances between cortical activation patterns generated during each conscious experience, likely mediated via networks of local neuronal connections. Thus, in order for any conscious experience to appear in an individual’s mind, two central conditions must be met. First, a specific configural pattern (“bar-code”) of neuronal activity must appear within a local relational geometry, i.e. a cortical area. Second, the individual neurons underlying the activated pattern must be bound into a unified functional ensemble through a burst of recurrent neuronal firing: local “ignitions”.
Clinical and Pregnancy Outcomes of Coronavirus Disease 2019 Among Hospitalized Pregnant Women in the United States
Authors: Ackerman Christina M , Nguyen Jennifer L , Ambati Swapna , Reimbaeva Maya , Emir Birol , Cabrera Javier , Benigno Michael , Malhotra Deepa , Hammond Jennifer , Bahtiyar Mert Ozan
Published: September 2021

Background

Pregnant women with coronavirus disease 2019 (COVID-19) may be at greater risk of poor maternal and pregnancy outcomes. This retrospective analysis reports clinical and pregnancy outcomes among hospitalized pregnant women with COVID-19 in the United States.

Methods

The Premier Healthcare Database—Special Release was used to examine the impact of COVID-19 among pregnant women aged 15–44 years who were hospitalized and who delivered compared with pregnant women without COVID-19. Outcomes evaluated were COVID-19 clinical progression, including the use of supplemental oxygen therapy, intensive care unit admission, critical illness, receipt of invasive mechanical ventilation/extracorporeal membrane oxygenation, maternal death, and pregnancy outcomes, including preterm delivery and stillbirth.

Results

Overall, 473 902 hospitalized pregnant women were included, 8584 (1.8%) of whom had a COVID-19 diagnosis (mean age = 28.4 [standard deviation = 6.1] years; 40% Hispanic). The risk of poor clinical and pregnancy outcomes was greater among pregnant women with COVID-19 compared with pregnant women without a COVID-19 diagnosis in 2020; the risk of poor clinical and pregnancy outcomes increased with increasing age. Hispanic and Black non-Hispanic women were consistently observed to have the highest relative risk of experiencing poor clinical or pregnancy outcomes across all age groups.

Conclusions

Overall, COVID-19 had a significant negative impact on maternal health and pregnancy outcomes. These data help inform clinical practice and counseling to pregnant women regarding the risks of COVID-19. Clinical studies evaluating the safety and efficacy of vaccines against severe acute respiratory syndrome coronavirus 2 in pregnant women are urgently needed.
Quantum noise and vacuum fluctuations in balanced homodyne detections through ideal multi-mode detectors
Authors: Nakamura Kouji
Published: September 2021

The balanced homodyne detection as a readout scheme of gravitational-wave detectors is carefully examined from the quantum field theoretical point of view. The readout scheme in gravitational-wave detectors specifies the directly measured quantum operator in the detection. This specification is necessary when we apply the recently developed quantum measurement theory to gravitational-wave detections. We examine the two models of measurement. One is the model in which the directly measured quantum operator at the photodetector is Glauber’s photon number operator, and the other is the model in which the power operator of the optical field is directly measured. These two are regarded as ideal models of photodetectors. We first show these two models yield the same expectation value of the measurement. Since there is consensus in the gravitational-wave community that vacuum fluctuations contribute to the noises in the detectors, we also clarify the contributions of vacuum fluctuations to the quantum noise spectral density without using the two-photon formulation which is used in the gravitational-wave community. We found that the conventional noise spectral density in the two-photon formulation includes vacuum fluctuations from the main interferometer but does not include those from the local oscillator. Although the contribution of vacuum fluctuations from the local oscillator theoretically yields the difference between the above two models in the noise spectral densities, this difference is negligible in realistic situations.
Center group dominance in quark confinement
Authors: Ikeda Ryu , Kondo Kei-Ichi
Published: September 2021

We show that the color $N$-dependent area law falloffs of the double-winding Wilson loop averages for the $SU(N)$ lattice gauge theory obtained in previous works are reproduced from the corresponding lattice Abelian gauge theory with the center gauge group $Z_N$. This result indicates the center group dominance in quark confinement.
Seed-Stage Success and Growth of Angel Co-investment Networks*
Authors: Venugopal Buvaneshwaran , Yerramilli Vijay
Published: September 2021

Using hand-collected data, we show that coinvestment is widespread in the angel investment market, even among seed-stage startups. Individual angels with demonstrated seed-stage success experience an increase in the quantity, quality, and geographic and industry spread of their coinvestment connections relative to unsuccessful peers and are rewarded with more deal flow. These results are stronger for less-established angels and for angels whose successes are more indicative of their ability. Success also begets more success: the portfolio companies of successful angels are more likely to receive follow-on financing, especially from VC firms. Our results highlight how angels grow their coinvestment networks. (JEL G24, L14, L26, M13).
The effect of deoxynivalenol-contaminated corn and an immune-modulating feed additive on growth performance and immune response of nursery pigs fed corn- and soybean meal-based diets
Authors: Lafleur Larivière Élise , Zhu Cuilan , Zettell Sabrina , Patterson Robert , Karrow Niel A , Huber Lee-Anne
Published: September 2021

One hundred eighty newly weaned pigs (21 days of age; 6.9 ± 0.2 kg BW) were used to determine the effects of deoxynivalenol- (DON) contaminated corn and an immune-modulating feed additive on growth performance and immune response of nursery pigs fed corn- and soybean meal-based diets. Pens were randomly assigned to one of five diets: a high-complexity (HC; containing animal protein sources) or one of four low-complexity diets (LC; containing soybean meal as the main protein source) arranged in a 2 × 2 factorial with low (lDON; average 1.4 ppm) or high (hDON; average 3.5 ppm) DON and with or without a feed additive (2 g/kg in complete feed; n = 6 pens per treatment) provided in a three-phase feeding program. On day 7, small intestinal histomorphology was assessed in two pigs per pen. On days 8 and 25, two pigs per pen were immunized with ovalbumin (OVA). Blood was collected on days 8, 25, and 38 for determination of OVA-specific IgG. There were no corn type by feed additive interactions or feed additive effects for growth performance. The ADG, ADFI, and G:F in phase I were not different for pigs fed hDON vs. lDON, but were less than those fed the HC diet (contrasts; P < 0.05). Over the entire nursery period, ADG and ADFI were less for pigs fed hDON vs. those fed lDON (407 vs. 484 g and 651 vs. 769 g, respectively; P < 0.05), ADG was less for pigs fed hDON vs. HC (496 g; P < 0.05), and pigs fed lDON had ADG and ADFI not different from those fed the HC diet. Pigs fed hDON had lower final BW than those fed lDON (24.6 vs. 27.6 kg; P < 0.01) and tended to have lower final BW than pigs fed the HC diet (27.3 kg; contrast; P = 0.052); final BW was not different between pigs fed lDON and HC diets. Jejunal villus heights were shorter for pigs fed hDON and lDON compared to pigs fed HC (438 and 466 vs. 538 µm; contrasts; P < 0.05 and P = 0.090, respectively) and the villus:crypt ratio tended to be less for pigs fed hDON vs. those fed HC (1.87 vs. 2.22; contrast; P = 0.091). On day 38, plasma OVA-specific IgG 1 tended to be less for pigs fed hDON compared to HC (contrast; P = 0.075) and OVA-specific total IgG were less for pigs fed LC diets without the feed additive vs. HC (P < 0.05). Therefore, high DON (~3.5 ppm) in LC nursery diets interfered with compensatory growth and the humoral immune response. The feed additive did not rescue growth performance, regardless of DON contamination level in LC nursery diets.
Opposition Media, State Censorship, and Political Accountability: Evidence from Chavez’s Venezuela
Authors: Knight Brian , Tribin Ana
Published: September 2021

This study investigates the effects of state censorship in the context of the 2007 government closing of RCTV, a popular opposition television channel in Venezuela. Some parts of the country had access to a second opposition channel, Globovision, while other parts completely lost access to opposition television. The first finding, based upon ratings data, is that viewership fell on the progovernment replacement, following the closing of RCTV, but rose on Globovision in areas with access to the signal. Based upon this switching, the paper investigates whether support for Chavez fell in areas that retained access to opposition television, relative to those that completely lost access. Using three measures, Latinbarometer survey data, electoral returns, and data on protest activity, the second finding is that support for Chavez fell in municipalities that retained access to opposition television, relative to municipalities that lost access to opposition television. Taken together, these two findings suggest that voters switching from censored outlets to uncensored outlets can limit the effectiveness of state censorship.
Predictors of Pressure Injury Prevention Practices Among ICU Nurses in China
Authors: Hu Li , Sae-Sia Wipa , Kitrungrote Luppana
Published: September 2021

OBJECTIVE

To explore the predictors of knowledge of pressure injury (PI) prevention, attitudes on PI prevention, organization support for PI prevention, and the influence of a healthy work environment (HWE) on PI prevention practices among ICU nurses in China.

METHODS

A descriptive, predictive, online survey was conducted among 510 ICU nurses in Guizhou province, China. A PI prevention knowledge questionnaire, PI prevention attitude questionnaire, organizational support for PI prevention questionnaire, HWE assessment tool, and PI prevention practice questionnaire were used for data collection. A hierarchical regression analysis was used to determine the influence of certain predictive factors.

RESULTS

An HWE, organizational support for PI prevention, and positive attitudes toward PI prevention were significant predictors of good practice regarding PI prevention. However, knowledge of PI prevention was not a significant predictor.

CONCLUSIONS

To achieve optimal nursing quality in terms of PI prevention, hospital and nursing administrators should develop strategies or interventions to create and sustain an HWE and supportive organizational culture for ICU nurses and enhance positive attitudes toward PI prevention.
Decoding Billing Practices in Cochlear Implant Programs
Authors: Hall Melissa W. , Prentiss Sandra M. , Coto Jennifer , Zwolan Teresa A. , Holcomb Meredith A.
Published: September 2021

Objectives:

The purpose of this study was to examine current cochlear implant (CI) billing practices across CI audiologists in the United States, to determine if CI audiologists are following the National Correct Coding Initiative (NCCI) edits, and to assess the CI audiologist’s exposure to billing education.

Design:

A 48-question survey was electronically distributed to and completed by audiologists who bill for CI services. Demographic data including work setting, population served, years of experience, number of CI patients managed per week, and exposure to billing education were collected. Data were analyzed to identify codes and modifiers used to bill for commonly performed CI procedures such as unilateral and bilateral CI programming, preoperative and postoperative testing, and objective measures.

Results:

Data were obtained from 96 audiologists. The majority (86.3%, n = 82) of respondents agreed or strongly agreed they understand billing and coding practices for cochlear implants and 94.7% (n = 89) rated themselves as somewhat to highly efficient when performing these practices. Only 16.8% (n = 16) of respondents reported receiving formal training for practice management, and half of the respondents (51.1%, n = 48) reported unfamiliarity with national billing guidelines. Those who received formal training reported higher billing efficiency. Wide variability was seen for various billing scenarios. Billing questions were presented, and answers were coded as correct or incorrect based on the NCCI edits. Respondents who reported higher agreement with understanding billing and who received formal training scored better on common billing questions related to the NCCI edits.

Conclusions:

Most CI audiologists rated themselves as efficient in billing; however, wide variance in billing practices was observed. Incorporating practice management and current billing education into daily practice and into audiology training programs is essential to clinic efficiency, practice management, and CI program viability. CI audiologists should be knowledgeable about appropriate billing practices to ensure long-term sustainability of programs.
Biomechanical Comparison of 2 Double Plating Methods in a Coronal Fracture Model of Bicondylar Tibial Plateau Fractures
Authors: Samsami Shabnam , Pätzold Robert , Neuy Tim , Greinwald Markus , Müller Peter E. , Chevalier Yan , Püschel Klaus , Augat Peter
Published: September 2021

Objectives:

Because management of bicondylar tibial plateau fractures are complicated even for expert surgeons, with using a coronal fracture model, we aimed to compare 2 kinds of double locked plating techniques that consisted of the lateral locking plate and the medial locking plate inserted medial anteriorly (MA-ly) or medial posteriorly (MP-ly).

Methods:

Fourteen fresh-frozen tibias stabilized with the MA or MP methods were allocated into 2 groups with similar bone mineral density values. Implanted samples were tested under incremental fatigue loading conditions using a customized load applicator. An optical motion tracking system was used to assess relative displacements and rotations of fracture fragments during loading. Static and dynamic global stiffness, failure load, failure cycles, as well as movements of fracture fragments were measured.

Results:

There were no significant differences between the 2 fixation methods regarding global stiffness, failure load, or failure cycles (P = 0.67–0.98, depending on the parameter). The kinematic evaluations, however, revealed that different positions of the medial locking plates altered the directions of movements for the medial-anterior or medial-posterior fracture segments.

Conclusions:

The mechanical stability of tibia-implant constructs fixed with the double plating methods was not remarkably affected by the location of the medial locking plate. Depending on clinical conditions and surgeons' preferences, bicondylar tibial plateau fractures can be managed with either MA or MP methods.
Risk of Surgical Site Infections in OTA/AO Type C Tibial Plateau and Tibial Plafond Fractures: A Systematic Review and Meta-Analysis
Authors: Bullock Travis S. , Ornell Samuel S. , Naranjo Jose M. G. , Morton-Gonzaba Nicholas , Ryan Patrick , Petershack Matthew , Salazar Luis M. , Moreira Alvaro , Zelle Boris A.
Published: September 2021

Objectives:

To analyze the current incidence of postoperative infection for OTA/AO type C fractures of the tibial plateau and tibial plafond.

Data Sources:

Three medical databases: PubMed/MEDLINE, ScienceDirect, and the Cochrane Library, were used in our systematic literature search. Search results were restricted to articles transcribed in English/Spanish and publication date after January 1, 2000, to present day.

Study Selection:

Inclusion criteria were studies reporting postoperative infection data for OTA/AO type 41C, 43C, or equivalent fractures of skeletally mature individuals. A minimum of 6 total fractures of interest and a frequency of 75% overall were required. Studies reporting on pathologic fractures, stress fractures, or low-energy fracture types were excluded.

Data Extraction:

Two authors independently screened abstracts, evaluated full-text manuscripts, and extracted relevant data from included studies. Any instances of discrepancy were resolved within the study committee by consensus.

Data Synthesis:

Outcomes were expressed using direct proportions (PR) with a 95% confidence interval. The effects of comorbidities on infection rates were reported using odds ratios with a 95% confidence interval. All analyses used a DerSimonian–Laird estimate with a random-effects model based on heterogeneity. The presence of publication bias was evaluated using funnel plots and Egger's tests.

Conclusions:

Patients with these specific fractures develop infections at a notable frequency. The rates of deep infections were approximately 6% in tibial plateau fractures and 9% in tibial plafond fractures. These results may be useful as a reference for patient counseling and other future studies aimed at minimizing postoperative infection for these injuries.

Level of Evidence:

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Additive effects of resveratrol and doxorubicin on bladder cancer cells
Authors: Soares Luciana Bicalho Moreira , Lima Ana Paula Braga , Melo André Sacramento , Almeida Tamires Cunha , de Medeiros Teixeira Luiz Fernando , da Silva Glenda Nicioli
Published: September 2021

The treatment of bladder cancer remains a challenge in clinical practice. Different chemotherapeutic protocols can be used; however, it is common to observe tumor recurrence and secondary effects that result in toxicity. Doxorubicin (DOX), one of the most effective anticancer agents used to treat bladder cancer, can cause chronic cardiotoxicity, limiting its use in clinical practice. Resveratrol (RES), a natural product with potential antitumor activity against bladder cancer, is associated with rapid metabolism and low bioavailability and needs to be combined with chemotherapeutic drugs to improve its use. Our study aimed to assess the therapeutic effect of a low concentration of DOX (2 µM) in combination with RES (150, 200 and 250 µM) on two bladder cancer cell lines. We investigated the mechanism of interaction between the drugs by performing cytotoxicity, clonogenic, oxidative stress, cell migration, cell morphology and nuclear division index (NDI) assays. Cytotoxicity evaluation revealed an additive interaction between RES and DOX for both cell lines. Additionally, the results of cell colony formation, oxidative stress, cell migration, cell morphology and NDI assays showed that a combination of DOX and RES was more effective than RES or DOX alone. In conclusion, a low concentration of DOX combined with RES could potentiate the antitumor effects of the drugs on bladder cancer cells, thus overcoming the secondary effects caused by DOX and the low bioavailability of resveratrol.
Hypotension from afatinib in epidermal growth factor receptor-mutated non-small cell lung cancer: a case report and literature review
Authors: Tang Zhiwei , Ji XiuHai , Zhou Guanghui , Chen Ruhua , Fen Yan , Ding Hui
Published: September 2021

Side effects of afatinib are a problem in patients with advanced non-small cell lung cancer (NSCLC). However, little is known about the occurrence of afatinib-induced hypotension. An 81-year-old man with NSCLC had an epidermal growth factor receptor-positive genotype with the p.L861Q mutation in exon 21. He was administered afatinib (40 mg/day) as anticancer therapy. Hypotension occurred twice after afatinib initiation. He suffered from dizziness and nausea. Blood pressure gradually returned to normal after afatinib cessation. Clinicians should be aware of hypotension in patients with NSCLC after afatinib initiation.
In Utero Gene Therapy for Primary Immunodeficiencies
Authors: MARDY ANNE H. , NORTON MARY E.
Published: September 2021

Primary immunodeficiencies (PIDs) have become a prime target for gene therapy given the morbidity, mortality, and the single gene etiology. Given that outcomes are better the earlier gene therapy is implemented, it is possible that fetal gene therapy may be an important future direction for the treatment of PIDs. In this chapter, the current treatments available for several PIDs will be reviewed, as well as the history and current status of gene therapy for PIDs. The possibility of in utero gene therapy as a possibility will then be discussed.
Financial Analysis of Cardiac Rehabilitation and the Impact of COVID-19
Authors: Melbostad Heidi S. , Savage Patrick D. , Mahoney Katharine , Gaalema Diann E. , Ades Philip A. , Shepard Donald S.
Published: September 2021

Purpose:

Provision of phase 2 cardiac rehabilitation (CR) has been directly impacted by coronavirus disease-19 (COVID-19). Economic analyses to date have not identified the financial implications of pandemic-related changes to CR. The aim of this study was to compare the costs and reimbursements of CR between two periods: (1) pre-COVID-19 and (2) during the COVID-19 pandemic.

Methods:

Health care costs of providing CR were calculated using a microcosting approach. Unit costs of CR were based on staff time, consumables, and overhead costs. Reimbursement rates were derived from commercial and public health insurance. The mean cost and reimbursement/participant were calculated. Staff and participant COVID-19 infections were also examined.

Results:

The mean number of CR participants enrolled/mo declined during the pandemic (−10%; 33.8 ± 2.0 vs 30.5 ± 3.2, P = .39), the mean cost/participant increased marginally (+13%; $2897 ± $131 vs $3265 ± $149, P = .09), and the mean reimbursement/participant decreased slightly (−4%; $2959 ± $224 vs $2844 ± $181, P = .70). However, these differences did not reach statistical significance. The pre-COVID mean operating surplus/participant ($62 ± $140) eroded into a deficit of −$421 ± $170/participant during the pandemic. No known COVID-19 infections occurred among the 183 participants and 14 on-site staff members during the pandemic period.

Conclusions:

COVID-19-related safety protocols required CR programs to modify service delivery. Results demonstrate that it was possible to safely maintain this critically important service; however, CR program costs exceeded revenues. The challenge going forward is to optimize CR service delivery to increase participation and achieve financial solvency.
Review of Recent Cardiac Rehabilitation Research Related to Enrollment/Adherence, Mental Health, and Other Populations
Authors: Ozemek Cemal , Lavie Carl J. , Kaminsky Leonard A.
Published: September 2021

This review overviews three topic areas observed to be highly active in the cardiac rehabilitation (CR) research literature published in 2019 and 2020. Topics summarized were enrollment or adherence in CR programs; mental health, particularly depression, stress, and anxiety of patients participating in CR programs; and patients participating in CR programs with diagnoses other than coronary artery bypass graft, myocardial infarction, or percutaneous coronary interventions.
THE SPECTRUM OF INTERNAL LIMITING MEMBRANE DISEASE IN ALPORT SYNDROME
Authors: Cicinelli Maria Vittoria , Ritter Markus , Ghossein Cybele , Aschauer Constantin , Laccone Franco , Nagel Mato , Schmidt-Erfurth Ursula M. , Jampol Lee M. , Gill Manjot K.
Published: September 2021

Purpose:

To characterize the spectrum of internal limiting membrane (ILM) disease in Alport syndrome using multimodal imaging, including widefield (WF) and ultra-widefield (UWF) modalities, and to report their relative prevalence according to the genetic pattern of inheritance.

Methods:

Cross-sectional clinical study of patients diagnosed with Alport syndrome. All patients underwent UWF color photography and autofluorescence, WF-optical coherence tomography angiography and spectral-domain optical coherence tomography. Demographics, past medical and ophthalmic history, and genetic mutation history were collected.

Results:

Forty-two eyes of 21 patients (11 men; age 36.6 ± 12.9 years) were included. Macular spectral-domain optical coherence tomography revealed ILM granularity, more frequent in X-linked Alport syndrome and corresponding to dot maculopathy on color fundus. Mid-peripheral spectral-domain optical coherence tomography scans revealed multilamellated ILM in eight eyes (19%), presumably progressive, which corresponded to a cavitary pattern on en-face OCT. En-face OCT revealed multiple areas of retinal nerve fiber layer dehiscence in the macula, overlapping with vascular lacunae on optical coherence tomography angiography, and a coarse arrangement of retinal nerve fiber layer above and below the temporal raphe in 20 eyes (52%).

Conclusion:

Multimodal imaging allowed for the detection/characterization of retinal findings (ILM granularity, progressive ILM lamellation, retinal nerve fiber layer dehiscence, vascular lacunae, and coarse arrangement of retinal nerve fiber layer toward the disc) as multifaceted manifestations of ILM disease in Alport syndrome.
MYOPIC PRESENTATION OF CENTRAL SEROUS CHORIORETINOPATHY
Authors: Ravenstijn Monica , van Dijk Elon H. C. , Haarman Annechien E. G. , Kaden Talia R. , Vermeer Koenraad A. , Boon Camiel J. F. , Yannuzzi Lawrence A. , Klaver Caroline C. W. , Yzer Suzanne
Published: September 2021

Purpose:

To increase insight into the myopic presentation of central serous chorioretinopathy (CSC) by comparing a large group of myopic patients with CSC with reference groups with only one of the diagnoses.

Methods:

Myopic patients with CSC (spherical equivalent ≤−3D, n = 46), emmetropic patients with CSC (spherical equivalent −0.5 to 0.5 D, n = 83), and myopic, non-CSC patients (n = 50) were included in this multicenter cross-sectional study. Disease characteristics and imaging parameters, such as subfoveal choroidal thickness and indocyanine green angiography patterns, were compared between cases and reference groups.

Results:

In myopic patients with CSC, median subfoveal choroidal thickness (286 µm [IQR 226–372 µm]) was significantly thicker than subfoveal choroidal thickness in myopic, non-CSC patients (200 µm [IQR 152–228 µm], P < 0.001) but thinner than emmetropic patients with CSC (452 µm [IQR 342–538 µm], P < 0.001). They also had pachyvessels in 70% of the eyes comparable with emmetropic CSC (76%, P = 0.70). Choroidal hyperpermeability was frequently present on indocyanine green angiography in both myopic and emmetropic CSC eyes. Need for treatment, treatment success, and recurrence rate were not significantly different between CSC groups.

Conclusion:

Myopic CSC presents with similar imaging and clinical characteristics as emmetropic CSC, apart from their thinner choroids. Keeping in mind the structural changes of myopia, other imaging characteristics could aid the diagnostic process.