bluuebunny/crossref_metadata_2025 huggingface dataset:
Mortgage Borrowing and Chronic Disease Outcomes in Older Age: Evidence From Biomarker Data in the Health and Retirement Study
Authors: Rhodes Alec , Moulton Stephanie , Loibl Cäzilia , Haurin Donald , Joseph Joshua
Published: April 2024

Objectives

The medical diagnosis of a disease is common in older age and can carry significant financial costs. For many older adults, equity in a home is their primary component of wealth; however, housing wealth is illiquid. We analyze the relationship between the liquidation of housing wealth through mortgage borrowing on older homeowners’ ability to successfully control a disease.

Methods

We use data on homeowners aged 65 and older from the 1998–2016 waves of the Health and Retirement Study (N = 3,457). We use biomarkers and physical health indicators to measure disease control following a medical diagnosis of diabetes, heart condition, high blood pressure, lung disease, or cancer. Random effects linear probability and instrumental variable regressions estimate the associations of housing wealth, new mortgage borrowing, and disease control.

Results

Descriptively, 28% of older homeowners who borrow against home equity are not controlled on their disease, compared to 33% of non-borrowers. Panel data instrumental variable regressions show that each $10,000 borrowed from home equity after diagnosis is associated with a 17-percentage-point reduction in the probability of the disease not being controlled.

Discussion

Many older adults are not able or willing to liquidate housing wealth, and the ability to borrow also depends on changes in home values. Thus, housing wealth is not a uniform social determinant of health but is shaped by older adults’ participation in financial markets.
Adjoint sensitivity kernels for free oscillation spectra
Authors: Adourian S , Dursun M S , Lau H C P , Al-Attar D
Published: April 2024

We apply the adjoint method to efficiently calculate sensitivity kernels for long-period seismic spectra with respect to structural and source parameters. Our approach is built around the solution of the frequency-domain equations of motion using the direct solution method (DSM). The DSM is currently applied within large-scale mode coupling calculations and is also likely to be useful within finite-element type methods for modelling seismic spectra that are being actively developed. Using mode coupling theory as a framework for solving both the forward and adjoint equations, we present numerical examples that focus on the spectrum close to four eigenfrequencies (the low-frequency mode, 0S2, and higher frequency modes, namely 2S2, 0S7 and 0S10 for comparison). For each chosen observable, we plot sensitivity kernels with respect to 3-D perturbations in density and seismic wave speeds. We also use the adjoint method to calculate derivatives of observables with respect to the matrices occurring within mode coupling calculations. This latter approach points towards a generalization of the two-stage splitting function method for structural inversions that does not rely on inaccurate self-coupling or group-coupling approximations. Finally, we verify through direct calculation that our sensitivity kernels correctly predict the linear dependence of the chosen observables on model perturbations. In doing this, we highlight the importance of non-linearity within inversions of long-period spectra.
Re-envisioning contributory health schemes to achieve equity in the design of financial protection mechanisms in low- and middle-income countries
Authors: Tegbe Muyiwa , Moon Kyle , Nawaz Saira
Published: April 2024

Universal health coverage has emerged as a global health priority, requiring that financing strategies that ensure low-income and medically and financially at-risk individuals can access health services without the threat of financial catastrophe. Contributory financing schemes and social health insurance (SHI) schemes, in particular, predominate in low- and middle-income countries (LMICs), despite evidence that suggests the most vulnerable remain excluded from such schemes. In this commentary, we discuss the need to re-envision schemes to prioritize equity, offering 3 concrete recommendations: adopt participatory designs for the co-design of schemes with beneficiaries, establish linkages between contributory financial protection schemes with economic empowerment initiatives, and prioritize the needs and preferences of beneficiaries over political expediency. Co-design alone does not necessarily translate into more equitable schemes, underscoring the need for greater monitoring and evaluation of these schemes that consider differential impacts across contexts and subgroups. In doing so, SHI schemes can be both attractive and accessible to populations that have long been excluded from financial protections in LMICs, acting as 1 channel in a broader financing strategy to achieve universal health coverage.
How can solar panels collectors enhance energy efficiency? Utilization of the novel optimization techniques
Authors: Kuterbekov Kairat A , Kabyshev Asset M , Bekmyrza Kenzhebatyr Zh , Kubenova Marzhan M , Ayalew Abebe T
Published: April 2024

Solar energy, which is widely acknowledged for its economic feasibility and sustainable nature, functions as a critical substitute for finite fossil fuels, effectively alleviating ecological consequences. The purpose of this study is to investigate the implementation of solar collectors as a means of harnessing the ample and unaltered solar radiation in Iran, specifically in locations situated within the solar belt. The incorporation of solar energy not only aids in the expansion of energy sources through diversification but also mitigates the rising expenses linked to fossil fuels. The preservation of natural resources, coupled with limited renewable energy options, further accentuates the importance of solar energy. The optimization of solar panel collector angles in photovoltaic systems assumes paramount importance for maximizing energy efficiency. This study, conducted in Yazd, Iran, utilized innovative mathematical and particle swarm optimization (PSO) models to assess ideal inclination angles. Results indicate peak solar energy absorption during June and July, contrasting with minimal absorption in January. The Klein model prescribes inclination angles based on γ values, while the PSO algorithm determines optimal slope and azimuth angles across various periods. Significant enhancements in energy generation, ranging from 23.24 to 25.02% across optimization models, were observed compared to a horizontal surface. These findings underscore the imperative of optimizing solar panel placement in urban settings to augment energy generation. Utilizing the optimal orientation for the photovoltaic power supply system can result in an annual reduction of 1169.6 kg of CO2 emissions in the building, emphasizing the positive environmental impact achievable through strategic solar panel configurations.
Cost-effectiveness of 4CMenB Vaccination Against Gonorrhea: Importance of Dosing Schedule, Vaccine Sentiment, Targeting Strategy, and Duration of Protection
Authors: Nikitin Dariya , Whittles Lilith K , Imai-Eaton Jeffrey W , White Peter J
Published: April 2024

Background

Observational evidence suggests the 4CMenB meningococcal vaccine may partially protect against gonorrhea, with 1 dose being two-thirds as protective as 2 doses. We examined the cost-effectiveness of vaccinating men who have sex with men (MSM) in England, with 1- or 2-dose primary vaccination.

Methods

Integrated transmission-dynamic health-economic modeling explored the effects of targeting strategy, first- and second-dose uptake levels, and duration of vaccine protection, using observational estimates of vaccine protection.

Results

Vaccination with 1 or 2 primary doses is always cost-saving, irrespective of uptake, although vaccine sentiment is an important determinant of impact and cost-effectiveness. The most impactful and cost-effective targeting is offering “vaccination according to risk” (VaR), to all patients with gonorrhea plus those reporting high numbers of sexual partners. If VaR is not feasible to implement then the more restrictive strategy of “vaccination on diagnosis” (VoD) with gonorrhea is cost-effective, but much less impactful. Under conservative assumptions, VaR (2-dose) saves £7.62M (95% credible interval [CrI], 1.15–17.52) and gains 81.41 (95% CrI, 28.67–164.23) quality-adjusted life-years (QALYs) over 10 years; VoD (2-dose) saves £3.40M (95% CrI, .48–7.71) and gains 41.26 (95% CrI, 17.52–78.25) QALYs versus no vaccination. Optimistic versus pessimistic vaccine-sentiment assumptions increase net benefits by approximately 30% (VoD) or approximately 60% (VaR).

Conclusions

At UK costs, targeted 4CMenB vaccination of MSM gains QALYs and is cost-saving at any uptake level. Promoting uptake maximizes benefits and is an important role for behavioral science.
A Phronetic Ethics of Securitization
Authors: Gates Michael P
Published: April 2024

Intervening in recent debates on normativity in securitization theory, I draw on Aristotle’s notion of phronesis and Morgenthau’s formulation of prudence to articulate an ethical theory that takes seriously the idea that securitization is a deeply intersubjective process. First, I critique Rita Floyd's extant “just securitization theory,” which develops universal moral criteria akin to those of just war theory. While insightful, I argue that both her approach to the study of securitization as an empirical phenomenon and to moral theory are flawed. Then, I develop a novel theory by articulating how securitizing actors ought to exercise phronesis as a mode of ethical reasoning rather than a set of rules to follow. Securitizing actors exercise phronesis when they continuously deliberate about the ends of their actions, consider potential long-term consequences, utilize both abstract knowledge and experience, engage in critical self-reflection, and practice restraint. Throughout the paper, I redeploy the “universal” just securitization concepts of just cause and proportionality as rhetorical devices to help stimulate phronetic judgement.
Triazole antifungal drug interactions—practical considerations for excellent prescribing
Authors: Lewis Russell , Niazi-Ali Saarah , McIvor Andrew , Kanj Souha S , Maertens Johan , Bassetti Matteo , Levine Deborah , Groll Andreas H , Denning David W
Published: April 2024

Systemic antifungal therapy is critical for reducing the mortality from many invasive and chronic fungal infections. Triazole antifungals are the most frequently prescribed antifungals but require attention to dosing and drug interactions. Nearly 600 severe drug–drug interactions and over 1100 moderate interactions requiring dose modifications are described or anticipated with systemic antifungal agents (see https://www.aspergillus.org.uk/antifungal-drug-interactions/). In this article, we address the common and less common, but serious, drug interactions observed in clinical practice with triazole antifungals, including a group of drugs that cannot be prescribed with all or most triazole antifungals (ivabradine, ranolazine, eplerenone, fentanyl, apomorphine, quetiapine, bedaquiline, rifampicin, rifabutin, sirolimus, phenytoin and carbamazepine). We highlight interactions with drugs used in children and new agents introduced for the treatment of haematological malignancies or graft versus host disease (midostaurin, ibrutinib, ruxolitinib and venetoclax). We also summarize the multiple interactions between oral and inhaled corticosteroids and triazole antifungals, and the strategies needed to optimize the therapeutic benefits of triazole antifungal therapy while minimizing potential harm to patients.
18 High Mobility Group Box-1 Is Not Correlated with the Persistent Hyperinflammatory Response After Burn Injury
Authors: Pinto Desiree , Le Tuan D , Pusateri Anthony , Matthew Shane , McLawhorn Melissa M , Moffatt Lauren T , Shupp Jeffrey W
Published: April 2024

Introduction

Severe burn injury results in a hyperinflammatory response, that has been linked to mortality. Damage-associated molecular patterns (DAMPS), endogenous molecules released during cell necrosis/apoptosis, are released into circulation immediately after burn injury and contribute to the upregulation of the immune system. The change in DAMP levels and their continued impact on the immune system after burn injury is less known. This study aims to evaluate the evolution of high mobility group box 1 (HMGB1), a specific DAMP, after burn injury and its role in the development of a persistent hyperinflammatory state.

Methods

This was a prospective observational study that included patients admitted to a regional burn center. Blood samples to measure HMGB1 and cytokine protein levels (IL-1, IL-6, IL-10, IL-12, TNF-a) were collected at admission and at set time intervals up to 21 days after admission. The patients were divided into groups based on mortality status. Differences in HMGB1 levels between groups were compared by using a two-sample t-test or Wilcoxon rank-sum test and chi-square or Fisher exact test for data at admission and a mixed-effect model for repeated measures. HMGB1 levels were correlated to cytokine protein levels using Pearson Correlation Coefficient. A p-value of < 0.05 signified statistical significance.

Results

There were 115 patients with both HMGB1 and cytokine protein levels out of the 158 patients enrolled. Overall mortality was 12.9%, median TBSA was 11.8%, and median age was 40. At admission, the HMGB1 level was significantly higher for patients who died than survived (>10ng/mL vs 6.2ng/mL). For all patients the peak level of HMGB1 was at admission and then markedly decreased over the next 48 hours. A significant difference between patients who died and lived persisted for 48 hours (4.4ng/mL vs 2.9ng/mL). At admission, all cytokine protein levels were significantly elevated. Over the next 48-72 hours, the cytokine protein levels continued to increase for IL-1, IL-6, IL-12, and TNF alpha, and decreased for IL-10. At admission, there was a low positive correlation between HMGB1 and IL-6 (0.21), IL-10 (0.25), and TNF-alpha (0.26), and no positive correlation after admission (p < 0.05).

Conclusions

Mortality was associated with significantly higher levels of a HMGB1 at admission and up to 48 hours after injury. While HMGB1 and other DAMPS may trigger the initial hyperinflammatory response, their contribution to the persistent hyperinflammatory response following burn injury is less clear.

Applicability of Research to Practice

HMGB1, a specific DAMP, has some utility in predicting mortality and serving as a biomarker for inflammation at admission. However, HMGB1 may not be the most appropriate biomarker to determine the development of a persistent hyperinflammatory state in the burn population.
77 Utility of a Decision-Making Aid for Patient Centered Management of Deep Hand Burns
Authors: Parker Kristine A , Sabel Jody I , Orton Caitlin M , Sheckter Clifford C , Pham Tam N
Published: April 2024

Introduction

Patients with deep finger and hand burns often face the challenge of early amputation vs. tissue salvage and complex rehabilitation. The decision-making aid for deep hand burns was developed to help patients/families identify and understand options and recovery goals. The visual aid outlines distinct pathways with anticipated rehabilitative needs across a timeline of months to years. This project aims to consumer test this tool to ensure it can be presented in an understandable, useful and acceptable manner to patients/families.

Methods

We conducted cognitive interviews with individuals living with deep hand burns and their family members. Interviews addressed the utility of the decision-making aid, burn injury and rehabilitation characteristics, use of the decision-making aid to outline patient goals and values, and the medical pathways, including surgical, rehabilitative, and wound care expectations anticipated with each pathway. Interviews were transcribed and coded by three analysts using both deductive and inductive approaches.

Results

A total of 10 interviews represented diverse perspectives (e.g., burn survivor versus family member/caregiver, time since injury, severity of injury). Within the knowledge, attitudes and beliefs framework, six themes emerged: i) time since injury and severity of injury both impact the ability to interpret recovery, ii) a gap in understanding exists about the recovery process (e.g., outcomes, therapy follow up, more operations, timelines), iii) participants prefer clear and concise messaging regarding options, iv) a knowledgeable advocate on deep hand burns (such as a burn therapist) should be included in discussions on treatment options, v) the decision-making aid needs to be more engaging, vi) repeated use of the tool can support decision-making at different stages of recovery.

Conclusions

The decision-making aid is useful in outlining the patient’s values and recovery goals. It facilitates conversations and helps identify gaps in knowledge. This tool should be utilized multiple times to revisit treatment options throughout the recovery process.

Applicability of Research to Practice

For individuals with complex burn injuries, clinicians should consider the routine use of visual decision-making aids to better understand the patient’s values and recovery goals.
128 Use of Sublingual Dexmedetomidine for Burn Wound Care
Authors: Madsen Laura K , Mueller Scott W , Glasheen Jeffrey , Gibson Cameron , Wiktor Arek J
Published: April 2024

Introduction

Dexmedetomidine is a sedative with advantageous analgesic properties. Sublingual administration (SL DEX) has been used successfully in various populations. Burn patients experience high levels of pain and anxiety, often difficult to treat with conventional agents. The aim of this quality improvement project was to evaluate the safety and efficacy of SL DEX when given prior to burn wound care.

Methods

This was a pre-post paired analysis at an ABA verified burn center. Patients who had inadequate pain control during burn wound care utilizing our standard opiate/benzodiazepine/ketamine methods were eligible for SL DEX (2 mcg/kg) 30 minutes prior to wound care provided a baseline heartrate (HR) and mean arterial pressure (MAP) were 65 or greater. Rescue analgesia/anxiolysis, pain/sedation scores (RASS), and hemodynamic variables were the primary outcome measures. Each SL DEX session was matched to an equal amount of previous wound care sessions and averaged overall for efficacy and safety analysis.

Results

A total of 20 patients (79% male) received SL DEX. A total of 86 wound care sessions were analyzed, 43 with SL DEX administrations and 43 without. The median age and TBSA burned were 40 years and 10% (IQR 4.5-22.5), Prior to SL DEX intervention, all patients had already received an oral opiate + lorazepam, 80% oral ketamine, 30% IV DEX, and 30% IV ketamine. Pre-wound care medications and clinical variables were similar between the groups. Non-exclusive indications for SL DEX included: escalation of wound care analgesia 65%, step-down therapy from IV DEX in 35%, pre-emptive for donor site dressing take down in 25%. SL DEX was associated with a significant reduction of average fentanyl administered (166mcg vs 134mcg; P=0.039), average pain and maximum pain scores (7.4 vs 5.9, p=0.042 and 8.6 vs 6.7, p=0.002; respectively), and a numerically less midazolam and IV ketamine (1.37mg vs 1.08mg, p=0.076 and 65.6mg vs 29.7mg, p=0.123). Intra-wound care RASS were not significantly different with SL DEX (matched mean difference -0.06, p>0.8). MAP and HR variables (maximum and minimum) were not different prior to, during, or following wound care.

Conclusions

SL DEX was associated with decreased rescue analgesia requirements and lower patient reported pain scores without causing adverse hemodynamic effects in the difficult to treat burn population. A larger controlled trial is required to elucidate the efficacy and safety of SL DEX for wound care tolerance in the burn population.

Applicability of Research to Practice

SL DEX provides a unique route of an adjunctive agent to improve wound care tolerability, pain, and sedation in difficult to treat patients. It may be a viable alternative to IV DEX for wound care de-escalation.
509 Comparative Analysis of Presepsin and Other Biomarkers in Sepsis Diagnosis Among Burn Patients
Authors: Kym Dohern
Published: April 2024

Introduction

Sepsis and septic shock are life-threatening conditions that pose significant challenges in the medical field, particularly among burn patients. Early and accurate diagnosis is crucial for effective treatment and improved patient outcomes. This study aims to evaluate the diagnostic and prognostic utility of presepsin, a novel biomarker, in comparison to other established biomarkers like procalcitonin, Red Cell Distribution Width (RDW), and platelet count among burn patients suspected of infection.

Methods

A prospective cohort study was conducted, involving 167 patients admitted to the Burn Intensive Care Unit (BICU) with suspected infection. Blood samples were collected within 24 hours of admission for the measurement of presepsin, procalcitonin, RDW, and platelet count. Patients were categorized based on the diagnosis and progression of sepsis and septic shock according to the Sepsis-3 criteria. The study employed logistic regression models to assess the predictive power of each biomarker.

Results

Out of the 167 patients, 133 were diagnosed with sepsis, and the overall mortality rate was 38.9%. Presepsin demonstrated moderate predictive power for sepsis with an Area Under the Curve (AUC) of 0.660. However, it was not statistically significant for predicting mortality. In contrast, RDW and platelet count showed higher predictive values with AUCs of 0.780 and 0.760, respectively.

Conclusions

While presepsin showed limited utility in the diagnosis and prognosis of sepsis and septic shock, other biomarkers like RDW and platelet count exhibited stronger predictive capabilities. These findings suggest that a multi-biomarker approach could enhance the early diagnosis and management of sepsis and septic shock in burn patients.

Applicability of Research to Practice

The study's findings have significant implications for clinical practice. Understanding the predictive potential of various biomarkers can guide clinicians in the early diagnosis and effective management of sepsis and septic shock, particularly in burn patients.
574 Identifying New or Unmanaged Co-Morbidities to Improve Burn Care Management and Establish Care
Authors: Pinto Desiree , Moffatt Lauren T , Travis Taryn E , Shupp Jeffrey W , Tejiram Shawn
Published: April 2024

Introduction

Chronic co-morbidities impact the management of burn patients, as well as their short and long-term outcomes. Conversely and cumulatively, burn injury and the resulting hypermetabolic state can also worsen chronic co-morbidities. The prevalence of diagnosed or undiagnosed existing co-morbidities in burn patients is not well characterized. This study aims to identify the prevalence of new and/or unmanaged chronic co-morbidities after burn injury with admission lab work to determine whether opportunities exist in this area to improve burn care management and manage co-morbidity care.

Methods

This retrospective review included all patients over the age of 18 years old admitted to a regional burn center over a 6-month period (Jan- July 2022). Patient demographics, burn injury characteristics, laboratory values for hemoglobin A1c (Ha1c) and screening tests for HIV and acute hepatitis were collected. Undiagnosed diabetes mellitus (DM) was defined as no prior diagnosis/documentation of DM, no prior medication prescribed for glycemic control, and Ha1c ≥ 6.5. Uncontrolled DM was defined as a prior diagnosis/documentation of DM and a Ha1c > 9. New diagnosis of HIV was defined as no prior diagnosis/documentation of HIV, no anti-retroviral medication prescribed, and a positive screening HIV Ab/Ag result. A new diagnosis of hepatitis C was defined as no prior diagnosis/documentation of hepatitis C and a positive result on the acute hepatitis panel.

Results

Of the 268 patients who presented to the hospital for burn injury, 265 patients were included in the analysis. The mean age was 48.5 and 56% were male. Based on insurance status, 50% of patients had Medicaid/Medicare, 33% had private insurance, and 5% had no insurance. Within our population, 2.2% of patients experienced homelessness. Prior to admission, 16.9% of patients had a diagnosis of DM, of which 22% had uncontrolled DM. There were 7 patients (3.2%) newly diagnosed with DM, and about 60% of these patients had Ha1c levels > 9, a level high enough to consider immediate initiation of insulin therapy. Other screening tests identified a new diagnosis of HIV in 4 patients (1.5%) and hepatitis C in 9 patients (4%). For patients previously diagnosed with HIV or hepatitis C, 22% had unmanaged HIV and 75% have never received treatment for hepatitis C.

Conclusions

Burn injury was used as an opportunity to identify patients with new or unmanaged chronic co-morbidities. A high prevalence was seen in our population, indicating a need to continue screening. Identifying co-morbidities impacted treatment management and referral to other providers, including diabetes educators, infectious disease, and primary care physicians.

Applicability of Research to Practice

A screening tool to identify new or unmanaged co-morbidities is easy to implement and has the potential to improve acute and long-term management and outcomes after burn injury.
726 Impact of Opioid-Minimizing Pain Protocols After Burn Injury: An Update of Previous Quality Improvement Project
Authors: Abeln Andrea , Klugh James , Donthula Deepanjli , Almand Catherine , Campbell Taylor , Jiang Chuantao , Freet Daniel J , Huzar Todd F , Wainwright David J , Wade Charles E , Kao Lillian S , Harvin John A
Published: April 2024

Introduction

In 2019, a single-burn center QI project resulted in a significant reduction in opioid prescribing at discharge. Such reductions were achieved through implementation of a pill-based, opioid-minimizing pain protocol. After completion, no additional QI interventions were sustained other than dissemination of the protocols to providers on the unit. We hypothesized that the reductions in opioid prescribing at discharge have been sustained since the QI project ended.

Methods

Three groups of patients admitted to the burn service were compared: 1) Pre (01/2018 to 07/2019), 2) Post (01/2020 to 06/2020), and 3) Follow up (7/2020 to 3/2023). The Pre and Post groups were the same as described in the original QI report. The protocol was implemented from 08/2019 to 12/2019 and these patients are not included. Patient demographics, burn characteristics, and lengths of stay were abstracted from the burn registry. Opioid prescriptions at discharge were obtained from the electronic medical record. The primary outcome was opioid prescribing at discharge. Groups were compared using Kruskal-Wallis rank test, Pearson’s Chi-squared, and Fisher’s Exact test for continuous, binary, and sparse binary outcomes, respectively.

Results

A total of 1,575 patients were included: 495 Pre Group, 174 Post Group, and 906 Follow Up Group. Patients differed between cohorts in median age and proportion of operative burns. The Follow Up Group had a continued reduction in opioid prescribing at discharge (61%) as compared to the Pre Group (83%). The most prescribed opioids at discharge in the Follow Up Group were: 1) oxycodone (76%), 2) tramadol (21%), and hydrocodone (3%).

Conclusions

The previously found reduction in opioid prescribing at discharge after implementation of opioid-minimizing protocols for acute burn pain were found to be sustained. This finding was present despite the significant increase in operative burns admitted to the burn center.

Applicability of Research to Practice

Long-term reduction of opioid prescribing at discharge can be achieved using opioid-minimizing acute pain protocols.
765 Charting a Path to Enhanced Burn Care: Standardized Note Templates and Resident Perspectives
Authors: Malkoff Nicolas , Cannata Brigette , Johnson Dania B , Choe Deborah , Johnson Maxwell B , Gillenwater Justin
Published: April 2024

Introduction

Common Data Elements (CDE) are standardized questions with a set of limited responses that are used systematically across multiple sites. They have been proposed as a means of standardizing clinical documentation and improving interinstitutional data sharing. Our previous work identified 33 CDEs relevant to burn care based on published recommendations and found that they were documented inconsistently in our burn center. Our aim was to assess current charting practices and attitudes toward CDE-focused note templates at our institution as part of a larger effort to standardize and improve clinical documentation quality.

Methods

Four note templates incorporating 33 CDEs were prepared for inpatient history and physical notes (H&P), floor daily progress notes (PN), intensive care unit progress notes (ICU PN), and discharge summary notes (DC). Prior to their implementation, residents who previously rotated through the burn unit from 1/1/2023 to 9/4/2023 were administered a pre-template survey to assess their experiences and attitudes relating to charting with and without templates. Results were summarized using descriptive statistics.

Results

The pre-template survey was completed by 14 residents. The majority reported spending 15-30 minutes on average documenting H&Ps (57%), ICU PNs (57%), and DC summaries (64%), while 86% spent less than 15 minutes documenting floor PNs. When asked to rate the burden of charting, 50% reported a 7 or higher on a 10-point scale. Only 7% were 90% confident or higher that they commonly document all 33 CDEs. Most (57%) claimed to record fewer than 20 of the CDEs on average. Assessing resident attitudes towards note templates, it was found 86% agreed or strongly agreed that they would reduce the time spent and the burden of charting. When asked if templates would improve their wellness, 57% agreed or strongly agreed. While 72% of residents agreed or strongly agreed that templates would help them more thoroughly evaluate patients, only 43% thought note templates would provide educational value.

Conclusions

Current charting practices in our burn unit are time-consuming and burdensome for rotating residents, which may contribute to suboptimal acquisition and reporting of critical data elements. Most residents expressed positive attitudes towards the implementation of standardized note templates. Future directions for this quality improvement initiative include implementing note templates to study the effects this has on the inclusion of CDEs in patient notes and residents' charting experiences.

Applicability of Research to Practice

Readers may consider the methodology and results of this study when evaluating charting practices at their own institutions.
Symbolic knowledge innovation through bricolage in the periphery: the Bauhaus movement
Authors: Kesidou Effie , Plakoyiannaki Emmanuella , Tardios Janja Annabel
Published: April 2024

In this article, we examine how symbolic knowledge innovation—that is, the recombination of ideas on aesthetic value in new ways—emerges in the periphery. While symbolic knowledge innovation drives growth, its role in creating new paths in the periphery is largely under-investigated. New path creation has been largely envisaged through macro (e.g., policy) or meso (e.g., industrial R&D) aggregates, overlooking micro-level actors (e.g., individuals), and their agency in mobilizing heterogeneous resources vital for innovation. Viewed in this light, we investigate how the interaction of actors at different levels (macro, meso, and micro) shapes symbolic knowledge innovation in the periphery. We draw on the case of Bauhaus movement to investigate symbolic knowledge innovation in the peripheries of Weimar and Dessau. Our findings illustrate symbolic knowledge innovation at the Bauhaus in terms of three phases, namely, semiotic codes: Bauhaus idea generation and articulation; material basis: development of Bauhaus artefacts; and material basis: Bauhaus commercial success. We further unpack actors’ agency and show how each phase of symbolic knowledge innovation emerges through bricolage. We contribute to the economic geography literature by showing the role of bricolage and actors’ agency in symbolic knowledge innovation for new path creation in the periphery.
DAS-VSP coupled noise suppression based on U-Net network
Authors: Xu Jing-Xia , Ren Hao-Ran , Zhu Zhao-Lin , Wang Tong , Chen Zhi-Hao
Published: April 2024

The emerging distributed fiber-optic acoustic sensing (DAS) technology has broad prospects for application in vertical seismic profiles (VSP). However, the acquired DAS-VSP data often suffers from coupled noise that seriously affects data quality. Traditional methods for suppressing coupled noise are usually time-consuming and not suitable for the large-scale denoising of DAS-VSP data. To address this, a coupled noise suppression method based on the U-Net network is proposed, and a self-attention (SA) block is introduced to enhance the denoising ability of the network. Transfer learning is employed to achieve coupled noise suppression from synthetic data to field data. Denoising results demonstrate that the network can effectively suppress coupled noise in DAS-VSP data while preserving signal energy to a certain extent, exhibiting strong generalization capability. Upon completion of network training, denoising results can be obtained within seconds, making it more convenient and efficient compared to traditional methods.
Optimizing a 5-factor cocktail to prepare reparative macrophages for wound healing
Authors: Yong Rong , Mu Ruoyu , Han Congwei , Chao Tzuwei , Liu Yu , Dong Lei , Wang Chunming
Published: April 2024

The treatment of nonhealing wounds, such as diabetic ulcers, remains a critical clinical challenge. Recent breakthroughs in cell therapy have shown great promise, with one primary focus on preparing cells with comprehensive reparative functions and foreseeable safety. In our previous study, we recapitulated the proregenerative and immunosuppressive functions of tumor-associated macrophages in non-tumor-derived macrophages, endowing the latter with characteristics for promoting diabetic wound healing—termed tumor-associated macrophage–educated macrophages. To eliminate the use of tumor-derived sources and devise a more controllable method to prepare tumor-associated macrophage–educated macrophage–like cells, in this study, we identify a cocktail comprising 5 recombinant proteins as an essential condition to induce nonpolarized macrophages into therapeutic cells with prohealing functions. The screened 5 factors are osteopontin, macrophage inflammatory protein 2, chemokine (C-C motif) ligand 8, vascular endothelial growth factor B, and macrophage colony-stimulating factor. We demonstrate the rationale for screening these factors and the phenotype of the 5 factor-induced tumor-associated macrophage-educated macrophage-like macrophages prepared from murine bone marrow–derived macrophages, which exhibit angiogenic and immunomodulatory effects in vitro. Then, we induce primary human monocytes from periphery blood into the 5 factor-induced tumor-associated macrophage-educated macrophage-like macrophages, which show prohealing effects in a human primary cell-based ex vivo model (T-Skin™). Our study demonstrates a simple, effective, and controllable approach to induce primary macrophages to possess repairing activities, which may provide insights for developing cell-based therapeutics for nonhealing wounds clinically.
The structure of Congolese shrew ensembles: competition and spatial variation in resource abundance
Authors: Van de Perre Frederik , Willig Michael R , Presley Steven J , Leirs Herwig , Verheyen Erik
Published: April 2024

Interspecific competition, environmental filtering, or spatial variation in productivity can contribute to positive or negative spatial covariance in the abundances of species across ensembles (i.e., groups of interacting species defined by geography, resource use, and taxonomy). In contrast, density compensation should give rise to a negative relationship between ecomorphological similarity and abundance of species within ensembles. We evaluated (1) whether positive or negative covariances characterized the pairwise relationships of 21 species of Congolese shrew, and (2) whether density compensation characterized the structure of each of 36 Congolese shrew ensembles, and did so based on the abundances or biomasses of species. In general, positive covariance is more common than negative covariance based on considerations of abundance or biomass, suggesting dominant roles for environmental filtering and productivity. Nonetheless, negative covariance is more common for ecomorphologically similar species, suggesting a dominant role for competition within functional groups. Effects of abundance or biomass compensation, via pairwise or diffuse competitive interactions, were detected less often than expected by chance, suggesting that interspecific competition is not the dominant mechanism structuring these ensembles. Effects of competition may be balanced by responses to variation in resource abundance among sites in a landscape or among niche spaces within sites. Future studies of compensatory effects should incorporate considerations of heterogeneity in the abundance and distribution of resources in ecological space to better isolate the effects of competition and resource abundance, which can have opposing effects on community structure.
Thermal adaptation in plants: understanding the dynamics of translation factors and condensates
Authors: Lohmann Julia , Herzog Oliver , Rosenzweig Kristina , Weingartner Magdalena
Published: April 2024

Plants, as sessile organisms, face the crucial challenge of adjusting growth and development with ever-changing environmental conditions. Protein synthesis is the fundamental process that enables growth of all organisms. Since elevated temperature presents a substantial threat to protein stability and function, immediate adjustments of protein synthesis rates are necessary to circumvent accumulation of proteotoxic stress and to ensure survival. This review provides an overview of the mechanisms that control translation under high-temperature stress by the modification of components of the translation machinery in plants, and compares them to yeast and metazoa. Recent research also suggests an important role for cytoplasmic biomolecular condensates, named stress granules, in these processes. Current understanding of the role of stress granules in translational regulation and of the molecular processes associated with translation that might occur within stress granules is also discussed.
‘My Advocacy is Not About Me, My Advocacy is About Canadians’: A Qualitative Study of how Caregivers and Patients Influence Regulation of Medical Assistance in Dying in Canada
Authors: Jeanneret Ruthie , Close Eliana , Downie Jocelyn , Willmott Lindy , White Ben P
Published: April 2024

Medical assistance in dying (MAiD) was legalised federally in Canada after the Supreme Court decision in Carter v Canada (Attorney General) [2015] 1 SCR 331. The federal legislative framework for MAiD was established via Bill C-14 in 2016. Caregivers and patients were central to Carter and subsequent litigation and advocacy, which resulted in amendments to the law via Bill C-7 in 2021. Research has primarily focused on the impacts of regulation on caregivers and patients. This qualitative study investigates how caregivers and patients influence law reform and the operation of MAiD practice in Canada (ie, behave as ‘regulatory actors’), using Black’s definition of regulation. We found that caregivers and patients performed sustained, focused, and intentional actions that influenced law reform and the operation of MAiD in practice. Caregivers and patients are not passive objects of Canadian MAiD regulation, and their role in influencing regulation (eg, law reform and MAiD practice) should be supported where this is desired by the person. However, recognising the burdens of engaging in regulatory action to address barriers to accessing MAiD or to quality care, and MAiD system gaps, other regulatory actors (eg, governments) should minimise this burden, particularly where a person engages in regulatory action reluctantly.
Secular evolution of circumbinary 2-planet systems with isotropically varying masses
Authors: Minglibayev Mukhtar Zh , Prokopenya Alexander N , Kosherbayeva Aiken B
Published: April 2024

We investigate the secular evolution of a four-body planetary system, where two planets move around a binary star configuration on quasi-elliptic orbits. It is assumed that the masses of all bodies can change isotropically at different rates and the bodies attract each other according to Newton’s law of universal gravitation. The purpose of this work is to investigate an influence of variability of the masses of the binary stars and their planets on the dynamical evolution of the planetary system. We consider the case of small eccentricities and inclinations of the bodies orbits and assume that their orbits do not intersect during evolution. Differential equations of the perturbed motion in the osculating analogues of canonical Poincaré elements were obtained in a general case of the many-body problem with variable masses in our previous work. Here we solve these equations numerically and investigate the secular evolution of some fictitious circumbinary 2-planet system under assumption that the two stars of the binary system lose their masses independently at different rates. In order to demonstrate the dynamical features of the equations we use the known parameters of the TOI-1338 system. Comparing the results of calculations in the cases of constant and variable masses, we show that the isotropic variability of the masses of bodies can influence substantially the secular perturbation of the orbital elements.
RNAscape: geometric mapping and customizable visualization of RNA structure
Authors: Mitra Raktim , Cohen Ari S , Rohs Remo
Published: April 2024

Analyzing and visualizing the tertiary structure and complex interactions of RNA is essential for being able to mechanistically decipher their molecular functions in vivo. Secondary structure visualization software can portray many aspects of RNA; however, these layouts are often unable to preserve topological correspondence since they do not consider tertiary interactions between different regions of an RNA molecule. Likewise, quaternary interactions between two or more interacting RNA molecules are not considered in secondary structure visualization tools. The RNAscape webserver produces visualizations that can preserve topological correspondence while remaining both visually intuitive and structurally insightful. RNAscape achieves this by designing a mathematical structural mapping algorithm which prioritizes the helical segments, reflecting their tertiary organization. Non-helical segments are mapped in a way that minimizes structural clutter. RNAscape runs a plotting script that is designed to generate publication-quality images. RNAscape natively supports non-standard nucleotides, multiple base-pairing annotation styles and requires no programming experience. RNAscape can also be used to analyze RNA/DNA hybrid structures and DNA topologies, including G-quadruplexes. Users can upload their own three-dimensional structures or enter a Protein Data Bank (PDB) ID of an existing structure. The RNAscape webserver allows users to customize visualizations through various settings as desired. URL: https://rnascape.usc.edu/.
A method to comprehensively identify germline SNVs, INDELs and CNVs from whole exome sequencing data of BRCA1/2 negative breast cancer patients
Authors: Bianchi Andrea , Zelli Veronica , D’Angelo Andrea , Di Matteo Alessandro , Scoccia Giulia , Cannita Katia , Dimas Antigone S , Glentis Stavros , Zazzeroni Francesca , Alesse Edoardo , Di Marco Antinisca , Tessitore Alessandra
Published: April 2024

In the rapidly evolving field of genomics, understanding the genetic basis of complex diseases like breast cancer, particularly its familial/hereditary forms, is crucial. Current methods often examine genomic variants—such as Single Nucleotide Variants (SNVs), insertions/deletions (Indels), and Copy Number Variations (CNVs)—separately, lacking an integrated approach. Here, we introduced a robust, flexible methodology for a comprehensive variants’ analysis using Whole Exome Sequencing (WES) data. Our approach uniquely combines meticulous validation with an effective variant filtering strategy. By reanalyzing two germline WES datasets from BRCA1/2 negative breast cancer patients, we demonstrated our tool’s efficiency and adaptability, uncovering both known and novel variants. This contributed new insights for potential diagnostic, preventive, and therapeutic strategies. Our method stands out for its comprehensive inclusion of key genomic variants in a unified analysis, and its practical resolution of technical challenges, offering a pioneering solution in genomic research. This tool presents a breakthrough in providing detailed insights into the genetic alterations in genomes, with significant implications for understanding and managing hereditary breast cancer.
Mendelian Randomization Analysis of the Causal Effect of Cigarette Smoking on Hospital Costs
Authors: Dixon Padraig , Sallis Hannah , Munafò Marcus , Davey Smith George , Howe Laura
Published: April 2024

Introduction

Knowledge of the impact of smoking on health care costs is important for establishing the external effects of smoking and for evaluating policies intended to modify this behavior. Conventional analysis of this association is difficult because of omitted variable bias, reverse causality, and measurement error.

Aims and Methods

We approached these challenges using a Mendelian Randomization study design; genetic variants associated with smoking behaviors were used in instrumental variables models with inpatient hospital costs (calculated from electronic health records) as the outcome. We undertook genome-wide association studies to identify genetic variants associated with smoking initiation and a composite smoking index (reflecting cumulative health impacts of smoking) on up to 300 045 individuals (mean age: 57 years at baseline, range 39–72 years) in the UK Biobank. We followed individuals up for a mean of 6 years.

Results

Genetic liability to initiate smoking (ever vs. never smoking) was estimated to increase mean per-patient annual inpatient hospital costs by £477 (95% confidence interval (CI): £187 to £766). A one-unit change in genetic liability to the composite smoking index (range: 0–4.0) increased inpatient hospital costs by £204 (95% CI: £105 to £303) per unit increase in this index. There was some evidence that the composite smoking index causal models violated the instrumental variable assumptions, and all Mendelian Randomization models were estimated with considerable uncertainty. Models conditioning on risk tolerance were not robust to weak instrument bias.

Conclusions

Our findings have implications for the potential cost-effectiveness of smoking interventions.

Implications

We report the first Mendelian Randomization analysis of the causal effect of smoking on health care costs. Using two smoking phenotypes, we identified substantial impacts of smoking on inpatient hospital costs, although the causal models were associated with considerable uncertainty. These results could be used alongside other evidence on the impact of smoking to evaluate the cost-effectiveness of antismoking interventions and to understand the scale of externalities associated with this behavior.