bluuebunny/crossref_metadata_2025 huggingface dataset:
Time and belief in exercise importance predict increased activity during initial COVID-19 restrictions in Ireland
Authors: Forde Cuisle , Wyse Jason , Barrett Emer
Published: July 2021

The aim of this work was to investigate physical activity levels and the associated barriers and facilitators to physical activity in Irish adults during initial COVID-19 restrictions. Members of the general population completed an online questionnaire. Responses from 1274 participants (1274/1568, 81% completion rate) indicated that the majority (46.1%, n = 587) of people were more active than usual during the restrictions, however, 28.6% (n = 365) reported being less active. Fifty-five percent (55.3%, n = 702) of participants were meeting public health physical activity guidelines and more than half (53.3%, n = 679) reported finding new ways to be active. Walking (86%, n = 1101), physical activity in the home (47%, n = 593) and online resources (38%, n = 483) were the most frequently reported types of physical activity people engaged in. Having more time to be physically active [OR 2.326 (SD 1.948–2.794)] and a greater belief in the importance of physical activity [OR 1.192 (SD 1.001–1.444)] were predictive of exercising more than usual. Being unable to access their usual means of exercise [OR 1.612 (SD 1.369–1.902)], advised not to go outside the home [OR 1.402 (SD 1.165–1.698)] and working more than usual [OR 1.201 (SD 1.013–1.443)] were predictive of exercising less than usual. There was a positive trend in physical activity engagement by Irish adults during initial COVID-19 restrictions, likely influenced by increased time, belief that exercise was important and increased use of home-based and online exercise resources. However, almost one in three people reported being less active than usual, highlighting the need for targeted support during restriction periods.
Semi-supervised target classification in multi-frequency echosounder data
Authors: Choi Changkyu , Kampffmeyer Michael , Handegard Nils Olav , Salberg Arnt-Børre , Brautaset Olav , Eikvil Line , Jenssen Robert
Published: July 2021

Acoustic target classification in multi-frequency echosounder data is a major interest for the marine ecosystem and fishery management since it can potentially estimate the abundance or biomass of the species. A key problem of current methods is the heavy dependence on the manual categorization of data samples. As a solution, we propose a novel semi-supervised deep learning method leveraging a few annotated data samples together with vast amounts of unannotated data samples, all in a single model. Specifically, two inter-connected objectives, namely, a clustering objective and a classification objective, optimize one shared convolutional neural network in an alternating manner. The clustering objective exploits the underlying structure of all data, both annotated and unannotated; the classification objective enforces a certain consistency to given classes using the few annotated data samples. We evaluate our classification method using echosounder data from the sandeel case study in the North Sea. In the semi-supervised setting with only a tenth of the training data annotated, our method achieves 67.6% accuracy, outperforming a conventional semi-supervised method by 7.0 percentage points. When applying the proposed method in a fully supervised setup, we achieve 74.7% accuracy, surpassing the standard supervised deep learning method by 4.7 percentage points.
Identification of recruitment regime shifts with a hidden Markov stock-recruitment model
Authors: Tang Xiaozhuo , Zheng Nan , Rideout Rick M , Wang Shijia , Zhang Fan
Published: July 2021

Stock-recruitment relationships (SRRs) may differ substantially among environmental regimes. We developed a methodology including a Hidden Markov Stock-recruitment Model (HMSM), the maximum likelihood approach and a model selection procedure to identify abrupt changes of stock-recruitment (SR) dynamics. This method allows us to objectively identify the unobserved regimes, estimate regime-specific parameters, and predict the transition probabilities among regimes. First, we used simulation to verify that our method could identify the correct number of regimes and estimate the model parameters well. Then, we applied the models to an Atlantic cod stock on the southern Grand Bank off Newfoundland, Canada. Results indicated that the HMSM assuming 2 regimes performed the best, and the cod stock shifted to a regime characterized with lower productivity and higher density dependence in late 1980s. Additionally, the estimated probability to return to the previous high-productivity regime was very low, suggesting the cod stock may remain at the low-productivity regime for a prolonged period. Overall, we consider the methodology proposed in this paper as a useful tool to model regime shifts of SRRs in fisheries stock assessment.
A high-order fully discrete scheme for the Korteweg–de Vries equation with a time-stepping procedure of Runge–Kutta-composition type
Authors: Dougalis Vassilios A , Durán Ángel
Published: July 2021

We consider the periodic initial-value problem for the Korteweg–de Vries equation that we discretize in space by a spectral Fourier–Galerkin method and in time by an implicit, high-order, Runge–Kutta scheme of composition type based on the implicit midpoint rule. We prove $L^{2}$ error estimates for the resulting semidiscrete and the fully discrete approximations. Some numerical experiments illustrate the results.
Evaluation of Rapid Polymyxin Pseudomonas test in clinical Pseudomonas aeruginosa isolates with various degrees of multidrug resistance
Authors: Sánchez-López Javier , Cortés-Cuevas José Luis , Díez-Aguilar María , López-Causapé Carla , Cantón Rafael , Morosini María Isabel
Published: July 2021

Background

Pseudomonas aeruginosa is of great concern among MDR bacteria and rapid and reliable in vitro antibiotic susceptibility testing methods are extremely necessary. Colistin is, in many cases, among the limited useful alternatives for these isolates. Unfortunately, only a few reliable in vitro methods are validated for testing susceptibility to colistin. Although EUCAST and CLSI recommend broth microdilution (BMD) as the standard method for antibiotic susceptibility testing, this method is not routinely performed in microbiology laboratories. However, some commercial products based upon BMD have tested well and offer consistent results.

Objectives

To evaluate the performance of the colorimetric Rapid Polymyxin Pseudomonas Test (RPPT) (ELITech Microbiology, France).

Methods

Eighty-seven clinical P. aeruginosa strains, prospectively collected in two microbiology laboratories exhibiting either susceptibility or various degrees of multidrug resistance, including to colistin, were used. Different susceptibility testing methods were simultaneously performed and compared with reference BMD and interpreted using 2020 EUCAST criteria.

Results

Results indicate an essential agreement (EA) of 97.7% for RPPT while the other tests did not reach 90% of EA [66.7% MicroScan, 63.2% Etest (bioMérieux, France) and 60.9% other MIC Test Strips (MTS, Liofilchem, Italy)]. The categorical agreement was 98.9% for RPPT, 87.4% for MTS, 85.1% for Etest and 64.4% for MicroScan.

Conclusions

The RPPT was able to accurately detect both colistin-susceptible and -resistant isolates within 4 h, offering a rapid alternative for a prompt decision about the inclusion of this antibiotic in a patient’s treatment.
Granular Cell Tumor of the Breast: Radiologic–Pathologic Correlation
Authors: Ghannam Suzanne M , Carter Gloria J , Villatoro Tatiana M , Berg Wendie A
Published: July 2021

Granular cell tumor (GCT) is an uncommon neoplasm arising from perineural Schwann cells that can arise anywhere in the body and is particularly rare in the breast. Imaging typically shows an irregular, noncalcified mass with high density on mammography and intense posterior shadowing on US that mimics malignancy. Benign GCTs can be locally aggressive and invade the skin or chest wall. Core biopsy is necessary for diagnosis. Polygonal- to spindle-shaped cells with prominent cytoplasmic eosinophilic granules show S-100 and CD68 staining on immunohistochemistry and lack cytokeratin, estrogen, or progesterone expression. The vast majority of GCTs are benign, albeit locally infiltrative, tumors cured by wide local excision.
On the discovery of stars, quasars, and galaxies in the Southern Hemisphere with S-PLUS DR2
Authors: Nakazono L , Mendes de Oliveira C , Hirata N S T , Jeram S , Queiroz C , Eikenberry Stephen S , Gonzalez A H , Abramo R , Overzier R , Espadoto M , Martinazzo A , Sampedro L , Herpich F R , Almeida-Fernandes F , Werle A , Barbosa C E , Sodré Jr. L , Lima E V , Buzzo M L , Cortesi A , Menéndez-Delmestre K , Akras S , Alvarez-Candal Alvaro , Lopes A R , Telles E , Schoenell W , Kanaan A , Ribeiro T
Published: July 2021

This paper provides a catalogue of stars, quasars, and galaxies for the Southern Photometric Local Universe Survey Data Release 2 (S-PLUS DR2) in the Stripe 82 region. We show that a 12-band filter system (5 Sloan-like and 7 narrow bands) allows better performance for object classification than the usual analysis based solely on broad bands (regardless of infrared information). Moreover, we show that our classification is robust against missing values. Using spectroscopically confirmed sources retrieved from the Sloan Digital Sky Survey DR16 and DR14Q, we train a random forest classifier with the 12 S-PLUS magnitudes + 4 morphological features. A second random forest classifier is trained with the addition of the W1 (3.4 $\mu\mathrm{m} $) and W2 (4.6 $\mu\mathrm{m} $) magnitudes from the Wide-field Infrared Survey Explorer (WISE). Forty-four per cent of our catalogue have WISE counterparts and are provided with classification from both models. We achieve 95.76 per cent (52.47 per cent) of quasar purity, 95.88 per cent (92.24 per cent) of quasar completeness, 99.44 per cent (98.17 per cent) of star purity, 98.22 per cent (78.56 per cent) of star completeness, 98.04 per cent (81.39 per cent) of galaxy purity, and 98.8 per cent (85.37 per cent) of galaxy completeness for the first (second) classifier, for which the metrics were calculated on objects with (without) WISE counterpart. A total of 2926 787 objects that are not in our spectroscopic sample were labelled, obtaining 335 956 quasars, 1347 340 stars, and 1243 391 galaxies. From those, 7.4 per cent, 76.0 per cent, and 58.4 per cent were classified with probabilities above 80 per cent. The catalogue with classification and probabilities for Stripe 82 S-PLUS DR2 is available for download.
The dust attenuation law in z ∼ 6 quasars
Authors: Di Mascia F , Gallerani S , Ferrara A , Pallottini A , Maiolino R , Carniani S , D’Odorico V
Published: July 2021

We investigate the attenuation law in z ∼ 6 quasars by combining cosmological zoom-in hydrodynamical simulations of quasar host galaxies, with multifrequency radiative transfer calculations. We consider several dust models differing in terms of grain-size distributions, dust mass, and chemical composition, and compare the resulting synthetic spectral energy distributions with data from bright, early quasars. We show that only dust models with grain-size distributions in which small grains ($a\lesssim 0.1~\mu {\rm m}$, corresponding to $\approx 60{{\ \rm per\ cent}}$ of the total dust mass) are selectively removed from the dusty medium provide a good fit to the data. Removal can occur if small grains are efficiently destroyed in quasar environments and/or early dust production preferentially results in large grains. Attenuation curves for these models are close to flat, and consistent with recent data; they correspond to an effective dust-to-metal ratio fd ≃ 0.38, i.e. close to the Milky Way value.
The MAVERIC Survey: Simultaneous Chandra and VLA observations of the transitional millisecond pulsar candidate NGC 6652B
Authors: Paduano Alessandro , Bahramian Arash , Miller-Jones James C A , Kawka Adela , Strader Jay , Chomiuk Laura , Heinke Craig O , Maccarone Thomas J , Britt Christopher T , Plotkin Richard M , Shaw Aarran W , Shishkovsky Laura , Tremou Evangelia , Tudor Vlad , Sivakoff Gregory R
Published: July 2021

Transitional millisecond pulsars are millisecond pulsars that switch between a rotation-powered millisecond pulsar state and an accretion-powered X-ray binary state, and are thought to be an evolutionary stage between neutron star low-mass X-ray binaries and millisecond pulsars. So far, only three confirmed systems have been identified in addition to a handful of candidates. We present the results of a multiwavelength study of the low-mass X-ray binary NGC 6652B in the globular cluster NGC 6652, including simultaneous radio and X-ray observations taken by the Karl G. Jansky Very Large Array and the Chandra X-ray Observatory, and optical spectroscopy and photometry. This source is the second brightest X-ray source in NGC 6652 ($L_{\textrm {X}}\sim 1.8 \times 10^{34}{\, \mathrm{erg\, s}^{-1}}$) and is known to be variable. We observe several X-ray flares over the duration of our X-ray observations, in addition to persistent radio emission and occasional radio flares. Simultaneous radio and X-ray data show no clear evidence of anticorrelated variability. Optical spectra of NGC 6652B indicate variable, broad H α emission that transitions from double-peaked emission to absorption over a time-scale of hours. We consider a variety of possible explanations for the source behaviour, and conclude that based on the radio and X-ray luminosities, short time-scale variability and X-ray flaring, and optical spectra, NGC 6652B is best explained as a transitional millisecond pulsar candidate that displays prolonged X-ray flaring behaviour. However, this could only be confirmed with observations of a change to the rotation-powered millisecond pulsar state.
Predicting bulge to total luminosity ratio of galaxies using deep learning
Authors: Grover Harsh , Bait Omkar , Wadadekar Yogesh , Mishra Preetish K
Published: July 2021

We present a deep learning model to predict the r-band bulge-to-total luminosity ratio (B/T) of nearby galaxies using their multiband JPEG images alone. Our Convolutional Neural Network (CNN) based regression model is trained on a large sample of galaxies with reliable decomposition into the bulge and disc components. The existing approaches to estimate the B/T ratio use galaxy light-profile modelling to find the best fit. This method is computationally expensive, prohibitively so for large samples of galaxies, and requires a significant amount of human intervention. Machine learning models have the potential to overcome these shortcomings. In our CNN model, for a test set of 20 000 galaxies, 85.7 per cent of the predicted B/T values have absolute error (AE) less than 0.1. We see further improvement to 87.5 per cent if, while testing, we only consider brighter galaxies (with r-band apparent magnitude <17) with no bright neighbours. Our model estimates the B/T ratio for the 20 000 test galaxies in less than a minute. This is a significant improvement in inference time from the conventional fitting pipelines, which manage around 2–3 estimates per minute. Thus, the proposed machine learning approach could potentially save a tremendous amount of time, effort, and computational resources while predicting B/T reliably, particularly in the era of next-generation sky surveys such as the Legacy Survey of Space and Time (LSST) and the Euclid sky survey which will produce extremely large samples of galaxies.
Systemic Inflammation and Microbial Translocation Are Characteristic Features of SARS-CoV-2-Related Multisystem Inflammatory Syndrome in Children
Authors: Kumar Nathella Pavan , Venkataraman Aishwarya , Hanna Luke Elizabeth , Putlibai Sulochana , Karthick M , Rajamanikam Anuradha , Sadasivam Kalaimaran , Sundaram Balasubramanian , Babu Subash
Published: July 2021

Background

Multisystem inflammatory syndrome in children (MIS-C) is a rare manifestation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children that can result in increased morbidity and mortality. The inflammatory underpinnings of MIS-C have not been examined in detail.

Methods

We examined the plasma levels of acute phase proteins and microbial translocation markers in children with MIS-C, children with acute coronavirus disease 2019 (COVID-19) infection, SARS-CoV-2-seropositive children, and controls.

Results

MIS-C children exhibited significantly higher levels of C-reactive protein (CRP), alpha2 macroglobulin (α2M), serum amyloid P (SAP), lipopolysaccharide (LPS), sCD14, and LPS binding protein (LBP) and significantly lower levels of haptoglobin (Hp) in comparison with seropositive, control, and/or COVID-19 children. In addition, COVID-19 children exhibited significantly higher levels of most of the above markers in comparison with seropositive and control children. Principal component analysis using a set of these markers could clearly discriminate MIS-C and COVID-19 from seropositive and control children. MIS-C children requiring pediatric intensive care unit admission and COVID-19 children with severe disease had higher levels of CRP, SAP, and/or sCD14 at admission.

Conclusions

Our study describes the role of systemic inflammation and microbial translocation markers in children with MIS-C and COVID-19 and therefore helps in advancing our understanding of the pathogenesis of different presentations of SARS-CoV-2 infection in children.
Optical topometry and machine learning to rapidly phenotype stomatal patterning traits for maize QTL mapping
Authors: Xie Jiayang , Fernandes Samuel B , Mayfield-Jones Dustin , Erice Gorka , Choi Min , E Lipka Alexander , Leakey Andrew D B
Published: July 2021

Stomata are adjustable pores on leaf surfaces that regulate the tradeoff of CO2 uptake with water vapor loss, thus having critical roles in controlling photosynthetic carbon gain and plant water use. The lack of easy, rapid methods for phenotyping epidermal cell traits have limited discoveries about the genetic basis of stomatal patterning. A high-throughput epidermal cell phenotyping pipeline is presented here and used for quantitative trait loci (QTL) mapping in field-grown maize (Zea mays). The locations and sizes of stomatal complexes and pavement cells on images acquired by an optical topometer from mature leaves were automatically determined. Computer estimated stomatal complex density (SCD; R2 = 0.97) and stomatal complex area (SCA; R2 = 0.71) were strongly correlated with human measurements. Leaf gas exchange traits were genetically correlated with the dimensions and proportions of stomatal complexes (rg = 0.39–0.71) but did not correlate with SCD. Heritability of epidermal traits was moderate to high (h2 = 0.42–0.82) across two field seasons. Thirty-six QTL were consistently identified for a given trait in both years. Twenty-four clusters of overlapping QTL for multiple traits were identified, with univariate versus multivariate single marker analysis providing evidence consistent with pleiotropy in multiple cases. Putative orthologs of genes known to regulate stomatal patterning in Arabidopsis (Arabidopsis thaliana) were located within some, but not all, of these regions. This study demonstrates how discovery of the genetic basis for stomatal patterning can be accelerated in maize, a C4 model species where these processes are poorly understood.
Sheet-like clay nanoparticles deliver RNA into developing pollen to efficiently silence a target gene
Authors: Yong Jiaxi , Zhang Run , Bi Shengnan , Li Peng , Sun Luyao , Mitter Neena , Carroll Bernard J. , Xu Zhi Ping
Published: July 2021

Topical application of double-stranded RNA (dsRNA) can induce RNA interference (RNAi) and modify traits in plants without genetic modification. However, delivering dsRNA into plant cells remains challenging. Using developing tomato (Solanum lycopersicum) pollen as a model plant cell system, we demonstrate that layered double hydroxide (LDH) nanoparticles up to 50 nm in diameter are readily internalized, particularly by early bicellular pollen, in both energy-dependent and energy-independent manners and without physical or chemical aids. More importantly, these LDH nanoparticles efficiently deliver dsRNA into tomato pollen within 2–4 h of incubation, resulting in an 89% decrease in transgene reporter mRNA levels in early bicellular pollen 3-d post-treatment, compared with a 37% decrease induced by the same dose of naked dsRNA. The target gene silencing is dependent on the LDH particle size, the dsRNA dose, the LDH–dsRNA complexing ratio, and the treatment time. Our findings indicate that LDH nanoparticles are an effective nonviral vector for the effective delivery of dsRNA and other biomolecules into plant cells.
Complicating the Role of White Racial Attitudes and Anti-Immigrant Sentiment in the 2016 US Presidential Election
Authors: Enns Peter K , Jardina Ashley
Published: July 2021

Some scholars argue that Donald Trump’s electoral college victory in 2016 was predicated on his ability to attract racially hostile white voters. Others argue that the increased relationship between whites’ racial attitudes and presidential vote choice in 2016 was because racial attitudes and partisanship had become even more aligned following the presidency of Barack Obama. Building on research that shows voters tend to update their policy positions to align with their preferred candidates, we propose a third mechanism that helps account for the strong relationship between whites’ racial attitudes and vote choice in 2016. We hypothesize that over the course of the presidential campaign, many whites shifted their survey responses on questions related to race and immigration to align with their support for Trump or Clinton. To test this argument, we use a unique panel dataset from surveys conducted by YouGov of more than 5,000 respondents interviewed at multiple points during the 2016 presidential election campaign. We find that the strong link between white attitudes toward Black Americans and Trump support observed in prior studies is likely due as much to white Trump supporters updating their survey responses to report opinions more consistent with Trump’s, as it is to Trump drawing support from more racially antagonistic white voters. Similar results emerge with respect to whites’ immigration opinions. These findings complicate our understanding of the 2016 election by offering direct evidence that Trump’s campaign benefited from and catalyzed racial divisions. The results also hold implications for how we study election and campaign effects and the stability of race and immigration attitudes.
The modification of cancer risk by chemicals
Authors: Harrison David J , Doe John E
Published: July 2021

Advances in understanding of the process of carcinogenesis have undermined the concept of chemicals being classifiable as either carcinogens or non-carcinogens. Elements of carcinogenesis are happening all the time and a proportion of cancers cannot be prevented, the ‘bad luck hypothesis’. Although the proportion that can be prevented is disputed, it is important to continue efforts to reduce it. Factors that increase cancer risk have been grouped into intrinsic factors that cannot be modified, and endogenous and exogenous factors that can be modified. Chemicals are exogenous factors that can be modified by risk management measures. Chemicals can alter three key rates that influence cancer risk: cell division, mutation rate per cell division, transformation rate of mutated cells to cancer. These rates can form the basis of a dynamic cancer risk model, a generic, adverse outcome pathway for carcinogenesis where chemicals are considered for their ability to modify cancer risk rather than simply whether they are classed as carcinogens or non-carcinogens. This allows the development of different strategies for assessing cancer risk that use a range of data sources and are not dependent on using long-term bioassays and epidemiology to identify carcinogens. The framework will also allow difficult questions such as the effect of less than lifetime exposures and the effect of exposures to more than one chemical to be addressed.
The early evolution of cranial appendages in Bovoidea revealed by new species of Amphimoschus (Mammalia: Ruminantia) from China
Authors: Li Yi-Kun , Mennecart Bastien , Aiglstorfer Manuela , Ni Xi-Jun , Li Qiang , Deng Tao
Published: July 2021

The cranial appendage (headgear) is an iconic structure of modern ruminants, and four of the five extant pecoran families display morphological and physiological specialties. They probably share one origin from the same genetic basis, whereas the evolution of the cranial appendages is still debatable, especially in consideration of fossil taxa lacking headgear. Amphimoschus is an enigmatic pecoran that comprises no more than two species, mainly known from the late early/early middle Miocene of Western and Central Europe and considered not to possess any cranial appendages. Here, we present Amphimoschus xishuiensis sp. nov., discovered in the Tabenbuluk area, Gansu Province, China. The new species reveals the first evidence of cranial ornamentations in the genus, including a supraorbital bump, an antorbital protuberance and frontal thickening. In our phylogenetic analysis the genus was inferred as a basal member of the Bovoidea, and thus the cranial ornamentations of A. xishuiensis might provide insight into the early evolution of cranial appendages in Bovoidea. They could be interpreted as weapons to defend territories in intense intraspecific or interspecific competition during the late early Miocene.
Occurrence and Detection of Carbendazim Resistance in Botryosphaeria dothidea from Apple Orchards in China
Authors: Wang Li , Tu Hongtao , Hou Hui , Zhou Zengqiang , Yuan Hongbo , Luo Chaoxi , Gu Qinsheng
Published: July 2021

Botryosphaeria dothidea causes white rot, which is among the most devastating diseases affecting apple crops globally. In this study, we assessed B. dothidea resistance to carbendazim by collecting samples from warts on the infected branches of apple trees or from fruits exhibiting evidence of white rot. All samples were collected from different orchards in nine provinces of China in 2018 and 2019. In total, 440 B. dothidea isolates were evaluated, of which 19 isolates from three provinces were found to exhibit carbendazim resistance. We additionally explored the fitness and resistance stability of these isolates, revealing that they were no less fit than carbendazim-sensitive isolates in terms of pathogenicity, sporulation, and mycelial growth and that the observed carbendazim resistance was stable. Sequencing of the β-tubulin gene in carbendazim-resistant isolates showed the presence of a substitution at codon 198 (GAG to GCG) that results in an alanine substitution in place of glutamic acid (E198A) in all 19 resistant isolates. A loop-mediated isothermal amplification (LAMP) method was then developed to rapidly and specifically identify this E198A mutation. This LAMP method offers value as a tool for rapidly detecting carbendazim-resistant isolates bearing this E198A mutation and can thus be used for the widespread monitoring of apple crops to detect and control the development of such resistance.
The Institute for Health care Quality, Safety, and Efficiency
Authors: Glasheen Jeffrey J. , Cumbler Ethan , Hyman Dan , Kneeland Patrick , Armstrong Gail , Caffrey Sarah , Wiler Jennifer , Fuhlbrigge Anne , Jones Douglas , Pierce Read G.
Published: July 2021

Despite decades of effort to drive quality improvement, many health care organizations still struggle to optimize their performance on quality metrics. The advent of publicly reported quality rankings and ratings allows for greater visibility of overall organizational performance, but has not provided a roadmap for sustained improvement in these assessments. Most quality training programs have focused on developing knowledge and skills in pursuit of individual and project-level improvements. To date, no training program has been associated with improvements in overall organization-level, publicly reported measures. In 2012, the Institute for Health care Quality, Safety, and Efficiency was launched, which is an integrated set of quality and safety training programs, with a focus on leadership development and support of performance improvement through data analytics and intensive coaching. This effort has trained nearly 2000 individuals and has been associated with significant improvement in organization-level quality rankings and ratings, offering a framework for organizations seeking systematic, long-term improvement.
Description and Evaluation of the AACN Synergy Model for Patient Care Employing the Critique Frameworks of Chinn and Kramer (2011) and Fawcett and DeSanto-Madeya (2013)
Authors: Hong Soyun , Kim Eunkyung
Published: July 2021

This study describes and evaluates the AACN Synergy Model for Patient Care that aligns nurses' competencies with the needs of patients and their families, developed by the American Association of Critical-Care Nurses. The description focuses on objectively explaining the theory, while the evaluation is based on established standards to determine its viability for application in nursing practice. This study applies Chinn and Kramer's (2011) theoretical description method and Fawcett and DeSanto-Madeya's (2013) theory analysis method to evaluate the AACN Synergy Model for Patient Care. Focusing on the patient-nurse relationship, the theory is appropriate for various nursing applications.
Shoulder Hemiarthroplasty for Proximal Humerus Fracture
Authors: Schultz Blake J. , Lowe Dylan T. , Egol Kenneth A. , Zuckerman Joseph D.
Published: July 2021

There are a variety of treatment options available for proximal humerus fractures, including nonoperative management, open reduction internal fixation with screws, locking plates, intramedullary nailing, or suture fixation, and arthroplasty, including hemiarthroplasty and total shoulder replacements. Fracture characteristics, including the number of fracture parts and involvement of the humeral head and glenoid and the patient's functional status and postoperative goals help dictate the optimal choice. Although the indications for hemiarthroplasty as treatment for severe proximal humerus fractures have narrowed, the authors believe that there is a still a place for this technique in practice.
Talar Neck and Sustentaculum Fracture Fixation
Authors: He Bo , Neiman Rafael
Published: July 2021

Talar neck fractures are uncommon fractures that result from high-energy trauma causing bony and soft tissue injury. When combined with sustentaculum fractures, care must be taken to plan the approach and fracture fixation strategy. We present a 57-year-old woman who experienced a motor vehicle accident, sustaining a Hawkins II talar neck fracture with associated sustentaculum tali fracture. We demonstrate the dual-incision approach to the talar neck with medial screw and lateral plate fixation. The sustentaculum fixation was accomplished with cannulated screws through a direct medial approach.
Retrograde Intramedullary Nail for Distal Femur Fracture, Through a Total Knee Arthroplasty
Authors: Davis Max , Wilson Jenna , Weick Jack , Hake Mark
Published: July 2021

Distal femur fractures are common in the elderly population. The risk of sustaining a distal femur fracture is increased with the presence of total knee arthroplasty components. Fixation with a retrograde intramedullary nail is a viable option for treatment of these injuries. This case-based video demonstrates the preoperative planning, techniques, and potential technical pitfalls to performing a retrograde intramedullary nail through a total knee arthroplasty in patients with a distal femur fracture.
Treatment of a Chronic Elbow Dislocation With an Internal Fixator
Authors: Schultz Blake J. , Lowe Dylan T. , Pean Christian A. , Egol Kenneth A.
Published: July 2021

There are a variety of ways to treat chronic elbow dislocations, including repeat closed reduction and immobilization, transarticular pinning, temporary bridge plating, hinged or rigid external fixation, and internal fixator application. Although each have distinct advantages and disadvantages, avoiding recurrent instability is critical. The internal-fixator is a relatively new option to maintain a stable, concentric reduction and facilitate early range of motion. This article and accompanying video describe the surgical technique of using an internal joint stabilizer for treatment of a chronically unstable ulnohumeral joint.
Development and optimization of heavy metal lead biosensors in biomedical and environmental applications
Authors: Chang Tai-Jay , Lai Wei-Qun , Chang Yu-Fen , Wang Chia-Lin , Yang De-Ming
Published: July 2021

The detrimental impact of the heavy metal lead (Pb) on human health has been studied for years. The fact that Pb impairs human body has been established from countless painful and sad historical events. Nowadays, World Health Organization and many developmental countries have established regulations concerning the use of Pb. Measuring the blood lead level (BLL) is so far the only way to officially evaluate the degree of Pb exposure, but the so-called safety value (10 μg/dL in adults and 5 μg/dL in children) seems unreliable to represent the security checkpoint for children through daily intake of drinking water or physical contact with a lower contaminated level of Pb contents. In general, unsolved mysteries about the Pb toxicological mechanisms still remain. In this review article, we report on the methods to prevent Pb poison for further Pb toxicological research. We establish high-sensitivity Pb monitoring, and also report on the use of fluorescent biosensors such as genetically-encoded fluorescence resonance energy transfer-based biosensors built for various large demands such as the detection of severe acute respiratory syndrome coronavirus 2. We also contribute to the development and optimization of the FRET-based Pb biosensors. Our well-performed version of Met-lead 1.44 M1 has achieved a limit of detection of 10 nM (2 ppb; 0.2 μg/dL) and almost 5-fold in dynamic range (DR) supported for the real practical applications—that is, the in-cell Pb sensing device for blood and blood-related samples, and the Pb environmental detections in vitro. The perspective of our powerful Pb biosensor incorporated with a highly sensitive bio-chip of the portable device for quick Pb measurements will be addressed for further manipulation.
Acute Care Reimagined: Home Hospital Care Can Support the Triple Aim and Reduce Health Disparities
Authors: Johnson, Emily E.
Published: July 2021

EXECUTIVE SUMMARY

Home hospital care (HHC) is a new and exciting concept that holds the promise of achieving all three components of the Triple Aim and reducing health disparities. As an innovative care delivery model, HHC substitutes traditional inpatient hospital care with hospital care at home for older patients with certain conditions. Studies have shown evidence of reduced cost of care, improved patient satisfaction, and enhanced quality and safety of care for patients treated through this model. The steady growth in Medicare Advantage enrollment and the expansion in 2020 of the Centers for Medicare & Medicaid Services (CMS) Hospitals Without Walls program to include acute hospital care at home creates an opportunity for hospitals to implement such programs and be financially rewarded for reducing costs. Capacity constraints exacerbated by the COVID-19 pandemic suggest that now is the ideal time for healthcare leaders to test and advance the concept of HHC in their communities.
A National Survey of Secondary Traumatic Stress and Work Productivity of Emergency Nurses Following Trauma Patient Care
Authors: Jobe Judy A. , Gillespie Gordon L. , Schwytzer Deborah
Published: July 2021

Background:

Secondary traumatic stress is common for emergency nurses working in trauma care, but it is unknown whether this secondary traumatic stress negatively correlates to work productivity.

Objective:

The purpose of this research was to examine the relationship between secondary traumatic stress and work productivity of emergency nurses who provide trauma patient care in the emergency department.

Methods:

This study used a cross-sectional survey design with a systematic random sample of emergency nurses. Respondents (N = 255) completed the Impact of Events Scale-Revised (IES-R) and the Healthcare Productivity Survey (HPS) on the basis of trauma patient care within the preceding 30 days. A 2-tailed Pearson correlation was calculated to explore the relationship between secondary traumatic stress and work productivity for emergency nurses providing trauma patient care.

Results:

Mean IES-R score was 19.1, and HPS score was 2.7. About 38% of respondents reported high secondary traumatic stress, and 29% reported decreased work productivity. Although overall correlation between IES-R and HPS was not significant, IES-R-Intrusion was significantly correlated with HPS-Cognitive Demands (p = .003) and HPS-Safety and Competency (p = .011), IES-R-Avoidance with HPS-Safety and Competency (p = .003), and IES-R-Hyperarousal with HPS-Cognitive Demands (p = .002) and HPS-Handle/Manage Workload (p = .015).

Conclusions:

Secondary traumatic stress and decreased work productivity were significant problems for some emergency nurses. To address this problem, employers can provide stress reduction and management techniques to emergency nurses providing trauma patient care. In addition, emergency nurses need to be proactive in seeking social support and using stress mitigation and reduction programs.
A Critical Pathway for Mass Casualty Incident Preparedness
Authors: Moran Mary E. , Blecker Nathan , Gothard M. David , George Richard L.
Published: July 2021

Background:

Rates of mass casualty incidents (MCIs) have been on the rise in the United States, highlighting the need for health care systems to have an emergency response plan. Trauma centers are fundamental during MCIs and serve a crucial leadership role in preparedness for them.

Objective:

The purpose of this study was to describe the design and implementation of simulated MCI drills at an American College of Surgeons verified Level I trauma center in the Midwest.

Methods:

A quasi-experimental time-series design was utilized to determine MCI simulation effects on staff performance using an emergency department checklist to measure emergency department throughput time. A multidisciplinary MCI design team developed a checklist for the emergency department, which identified tasks required to complete it. The 16-item checklist, Critical Pathway Management methodology, was used to identify the critical pathway for patient throughput during a surge. Two in situ MCI simulation drills were conducted in the emergency department (October and December 2019), and Critical Pathway Management identified the primary patient throughput rate limiters as notification and inpatient nursing staff presentation.

Results:

Emergency department throughput decreased from a mean of 15 to 11 min (reduction of 26.7%) between the two time periods after focusing on rate-limiting tasks.

Conclusion:

This quality improvement project demonstrated that the use of institution-specific checklists and Critical Pathway Management to identify critical pathways and potential rate limiters led to patient throughput improvements.
Catalyzing the Translation of Patient-Centered Research Into United States Trauma Care Systems
Authors: Zatzick Douglas , Moloney Kathleen , Palinkas Lawrence , Thomas Peter , Anderson Kristina , Whiteside Lauren , Nehra Deepika , Bulger Eileen
Published: July 2021

Background:

The expedient translation of research findings into sustainable intervention procedures is a longstanding health care system priority. The Patient-Centered Outcomes Research Institute (PCORI) has facilitated the development of “research done differently,” with a central tenet that key stakeholders can be productively engaged throughout the research process. Literature review revealed few examples of whether, as originally posited, PCORI’s innovative stakeholder-driven approach could catalyze the expedient translation of research results into practice.

Objectives:

This narrative review traces the historical development of an American College of Surgeons Committee on Trauma (ACS/COT) policy guidance, facilitated by evidence supplied by the PCORI-funded studies evaluating the delivery of patient-centered care transitions. Key elements catalyzing the guidance are reviewed, including the sustained engagement of ACS/COT policy stakeholders who have the capacity to invoke system-level implementation strategies, such as regulatory mandates linked to verification site visits. Other key elements, including the encouragement of patient stakeholder voice in policy decisions and the incorporation of end-of-study policy summits in pragmatic comparative effectiveness trial design, are discussed.

Conclusions:

Informed by comparative effectiveness trials, ACS/COT policy has expedited introduction of the patient-centered care construct into US trauma care systems. A comparative health care systems conceptual framework for transitional care which incorporates Research Lifecycle, pragmatic clinical trial and implementation science models is articulated. When combined with Rapid Assessment Procedure Informed Clinical Ethnography (RAPICE), employed as a targeted implementation strategy, this approach may accelerate the sustainable delivery of high-quality patient-centered care transitions for US trauma care systems.
Pragmatic Considerations in Incorporating Stakeholder Engagement Into a Palliative Care Transitions Study
Authors: de Forcrand Claire , Flannery Mara , Cho Jeanne , Reddy Pidatala Neha , Batra Romilla , Booker-Vaughns Juanita , Chan Garrett K. , Dunn Patrick , Galvin Robert , Hopkins Ernest , Isaacs Eric D. , Kizzie-Gillett Constance L. , Maguire Margaret , Navarro Martha , Rosini Dawn , Vaughan William , Welsh Sally , Williams Pluscedia , Young-Brinn Angela , Grudzen Corita R.
Published: July 2021

Background:

Stakeholder involvement in health care research has been shown to improve research development, processes, and dissemination. The literature is developing on stakeholder engagement methods and preliminarily validated tools for evaluating stakeholder level of engagement have been proposed for specific stakeholder groups and settings.

Objectives:

This paper describes the methodology for engaging a Study Advisory Committee (SAC) in research and reports on the use of a stakeholder engagement survey for measuring level of engagement.

Methods:

Stakeholders with previous research connections were recruited to the SAC during the planning process for a multicenter randomized control clinical trial, which is ongoing at the time of this writing. All SAC meetings undergo qualitative analysis, while the Stakeholder Engagement Survey instrument developed by the Patient-Centered Outcomes Research Institute (PCORI) is distributed annually for quantitative evaluation.

Results:

The trial’s SAC is composed of 18 members from 3 stakeholder groups: patients and their caregivers; patient advocacy organizations; and health care payers. After an initial in-person meeting, the SAC meets quarterly by telephone and annually in-person. The SAC monitors research progress and provides feedback on all study processes. The stakeholder engagement survey reveals improved engagement over time as well as continued challenges.

Conclusions:

Stakeholder engagement in the research process has meaningfully contributed to the study design, patient recruitment, and preliminary analysis of findings.
Prevention of infection and optimizing vaccination in the solid organ transplant candidate and recipient
Authors: Ryu HaYoung , Narayanan Navaneeth , Bhatt Pinki J.
Published: July 2021

Purpose of review

Infections can result in serious complications in solid organ transplant (SOT) patients. The need to remain up to date on recommendations on screening, vaccinations, and chemoprophylaxis is paramount in the management of SOT patients. The goal of this review is to provide an overview of current recommendations for the prevention of infections and optimization of vaccinations from the pretransplant through posttransplant periods.

Recent findings

There is an emphasis on thorough pretransplant evaluation to guide clinicians and pretransplant testing based on epidemiological and endemic risk factors. Additionally, recent studies on vaccine safety and efficacy of newer vaccine formulations in SOT recipients are addressed.

This review provides insight on updated recommendations for pretransplant screening, new data on vaccine optimization in SOT recipients and posttransplant prophylaxis. Further research is needed in order to improve preventive measures including screening tests, vaccines, and chemoprophylaxis.
Characteristics and Outcomes of Pediatric Patients With a Ventricular Assist Device Presenting to the Emergency Department
Authors: Pokrajac Nicholas , Cantwell Lauren M. , Murray Jenna M. , Dykes John C.
Published: July 2021

Objectives

A growing number of children receive support from left ventricular assist devices (LVADs) in the outpatient setting. Unexpected complications of LVAD support occur that require emergent management, and no studies examine how pediatric LVAD patients present to the emergency department (ED). The goals of this study were (1) to describe frequency of visits, clinical characteristics, adverse events, and outcomes of LVAD-supported children treated in ED settings and (2) to evaluate for associations between specified patient outcomes and ED care location.

Methods

This was a retrospective cohort study of children in a single-center outpatient VAD program who presented to several EDs during a 10-year period. We defined adverse events according to the Advanced Cardiac Therapies Improving Outcomes Network registry guidelines. Secondary analysis evaluated for associations between specified patient outcomes (adverse events, hospitalizations, intensive care unit admissions) and ED care location (institutional vs other ED).

Results

Of 104 subjects with LVAD implantations during the study period, 30 (28.8%) transitioned to outpatient care. Among subjects in the outpatient VAD program, 24 (80%) of 30 had 54 visits to various EDs over 141.9 patient-months. The median age at time of ED visit was 13.5 years (range, 7.2–17.9 years). The median number of visits per subject was 1 (range, 0–6). The most common complaints on arrival to the ED were vomiting or abdominal pain (16.7%), fever (15.3%), and headache (13.9%). Seventeen adverse events occurred during 14 (25.9%) of 54 ED visits. The most common adverse events were major infection (33.3%) and right heart failure (16.7%). Hospital admission resulted from 41 (75.9%) of 54 ED visits, including 17 (41.5%) of 41 to a cardiovascular intensive care unit. Care at a nonspecialty ED was associated with a higher rate of hospitalization (93.8% vs 68.4%, P = 0.049). During the study period, 4 subjects (13.3%) died, including 1 patient on destination therapy, 1 with multisystem organ failure due to cardiogenic shock, and 2 with hemorrhagic stroke. No patient died while in the ED.

Conclusions

Among subjects in a single outpatient pediatric VAD program presenting to the ED, the most common complaints were abdominal pain/vomiting, fever, and headache. The most common adverse events were major infection and right heart failure. Subjects had a high rate of ED utilization and hospital admission.