bluuebunny/crossref_metadata_2025 huggingface dataset:
Experience with Ontario’s Parenting Plan Guide and Template
Authors: Birnbaum Rachel , Bala Nicholas
Published: August 2022

Detailed, voluntary parenting plans are being increasing used in many jurisdictions. In conjunction with legislative reforms that came into effect in Canada in 2021 and specifically provide for parenting plans in place of traditional custody and access orders, the Ontario Chapter of the Association of Family and Conciliation Courts (AFCC-O) tasked a multidisciplinary group to prepare materials to assist professionals and parents in making parenting plans, including providing developmentally appropriate advice about parenting time schedules. This research project involved surveys and interviews with a total of 103 participants (lawyers, judges, mediators, mental health professionals, and parents) about their experiences with parenting plans and the AFCC-O materials. The use of parenting plans has increased as a result of the legislative changes, new resources to assist in making plans, and the accompanying professional education programmes. Professionals and parents appreciate having access to the type of jurisdictionally specific resource materials prepared by multidisciplinary groups, and judges have made significant use of these materials. The materials are especially useful for parents who have access to appropriate professional support and who have good literacy skills, and for lower conflict cases. It is, however, clear that the parenting plan materials have limitations, and in particular these resources have limited utility for self-represented litigants and cannot help in resolving higher conflict cases and those cases where family violence exists.
Reflexive combinatory algebras
Authors: Gijzen Marlou M , Ishihara Hajime , Kawai Tatsuji
Published: August 2022

We introduce the notion of reflexivity for combinatory algebras. Reflexivity can be thought of as an equational counterpart of the Meyer–Scott axiom of combinatory models, which indeed allows us to characterize an equationally definable counterpart of combinatory models. This new structure, called strongly reflexive combinatory algebra, admits a finite axiomatization with seven closed equations, and the structure is shown to be exactly the retract of combinatory models. Lambda algebras can be characterized as strongly reflexive combinatory algebras that are stable. Moreover, there is a canonical construction of a lambda algebra from a strongly reflexive combinatory algebra. The resulting axiomatization of lambda algebras by the seven axioms for strong reflexivity together with those for stability is shown to correspond to the axiomatization of lambda algebras due to Selinger (2002, J. Funct. Program., 12, 549–566).
Cluster-independent marker feature identification from single-cell omics data using SEMITONES
Authors: Vlot Anna Hendrika Cornelia , Maghsudi Setareh , Ohler Uwe
Published: August 2022

Identification of cell identity markers is an essential step in single-cell omics data analysis. Current marker identification strategies typically rely on cluster assignments of cells. However, cluster assignment, particularly for developmental data, is nontrivial, potentially arbitrary, and commonly relies on prior knowledge. In response, we present SEMITONES, a principled method for cluster-free marker identification. We showcase and evaluate its application for marker gene and regulatory region identification from single-cell data of the human haematopoietic system. Additionally, we illustrate its application to spatial transcriptomics data and show how SEMITONES can be used for the annotation of cells given known marker genes. Using several simulated and curated data sets, we demonstrate that SEMITONES qualitatively and quantitatively outperforms existing methods for the retrieval of cell identity markers from single-cell omics data.
Validity and reliability of the Patient-Reported Outcomes Measurement Information System (PROMIS®) using computerized adaptive testing in patients with advanced chronic kidney disease
Authors: van der Willik Esmee M , van Breda Fenna , van Jaarsveld Brigit C , van de Putte Marlon , Jetten Isabelle W , Dekker Friedo W , Meuleman Yvette , van Ittersum Frans J , Terwee Caroline B
Published: August 2022

Background

The Patient-Reported Outcomes Measurement Information System (PROMIS®) has been recommended for computerized adaptive testing (CAT) of health-related quality of life. This study compared the content, validity, and reliability of seven PROMIS CATs to the 12-item Short-Form Health Survey (SF-12) in patients with advanced chronic kidney disease.

Methods

Adult patients with chronic kidney disease and an estimated glomerular filtration rate under 30 mL/min/1.73 m2 who were not receiving dialysis treatment completed seven PROMIS CATs (assessing physical function, pain interference, fatigue, sleep disturbance, anxiety, depression, and the ability to participate in social roles and activities), the SF-12, and the PROMIS Pain Intensity single item and Dialysis Symptom Index at inclusion and 2 weeks. A content comparison was performed between PROMIS CATs and the SF-12. Construct validity of PROMIS CATs was assessed using Pearson's correlations. We assessed the test-retest reliability of all patient-reported outcome measures by calculating the intraclass correlation coefficient and minimal detectable change.

Results

In total, 207 patients participated in the study. A median of 45 items (10 minutes) were completed for PROMIS CATs. All PROMIS CATs showed evidence of sufficient construct validity. PROMIS CATs, most SF-12 domains and summary scores, and Dialysis Symptom Index showed sufficient test-retest reliability (intraclass correlation coefficient ≥ 0.70). PROMIS CATs had a lower minimal detectable change compared with the SF-12 (range, 5.7–7.4 compared with 11.3–21.7 across domains, respectively).

Conclusion

PROMIS CATs showed sufficient construct validity and test-retest reliability in patients with advanced chronic kidney disease. PROMIS CATs required more items but showed better reliability than the SF-12. Future research is needed to investigate the feasibility of PROMIS CATs for routine nephrology care.
Walnut consumption and health outcomes with public health relevance—a systematic review of cohort studies and randomized controlled trials published from 2017 to present
Authors: Lockyer Stacey , de la Hunty Anne E , Steenson Simon , Spiro Ayela , Stanner Sara A
Published: August 2022

Context

Considering the accumulation of recent studies investigating the health effects of walnut consumption, both including and beyond cardiovascular health effects, a systematic review of this literature to investigate the strength of the evidence is warranted.

Objective

To investigate associations between walnut consumption and outcomes with public health relevance (specifically all-cause mortality, type 2 diabetes, CVD, metabolic syndrome, obesity, cancer, neurological and mental health, musculoskeletal, gastrointestinal, and maternal disorders) and the effect on associated disease risk markers, reported in studies published from 2017 to present.

Data Sources

MEDLINE, FSTA, CENTRAL, and Scopus were searched from 1 January 2017 to 5 May 2021.

Data Extraction

Human studies (cohort studies and RCTs) ≥3 weeks in duration comparing consumption of walnuts (whole, pieces, or 100% butter) to a control and measuring associations with relevant public health outcomes and disease risk markers were assessed. Key study characteristics were extracted independently by 2 investigators using a standardized table. The quality of the studies was assessed using the Cochrane Risk-of-Bias tool 2.0 and the Newcastle–Ottawa Scale.

Data Analysis

Only 1 RCT was considered to be at low risk of bias for any of its outcomes. The cohort studies were considered to be of moderate or high quality. The results were synthesized using vote counting, based on the direction of effect. Thirty-three articles, 23 describing RCTs (walnut dose ∼10–99 g/day, 1,948 subjects) and 10 describing cohort studies (∼675,928 subjects), were included. Vote counting could be performed for the blood lipids, cardiovascular function, inflammation- and hemostatic-related factors, markers of glucose metabolism, and body weight and composition outcome groupings. The results are presented in effect direction plots. With respect to blood lipids, results from 8/8 RCTs favoured walnuts, in accordance with associations with a reduced risk of CVD suggested by cohort studies; results from 6/6 RCTs favoured control with respect to body weight and composition, although most of these effects were small. This was contrary to cohort study results suggesting small benefits of walnut consumption on body weight. There was no overall consistent direction of effect for cardiovascular function, markers of glucose metabolism, or inflammation- and hemostatic-related factors.

Conclusions

Evidence published since 2017 is consistent with previous research suggesting that walnut consumption improves lipid profiles and is associated with reduced CVD risk. Evidence is accumulating in other areas, such as cognitive health, although more research is needed to draw firm conclusions.

Systematic Review Registration

PROSPERO registration no. CRD4202122.
Clinical Cure of a Difficult-to-Treat Resistant Pseudomonas aeruginosa Ventriculitis Using Cefiderocol: A Case Report and Literature Review
Authors: Marcelo Cristina , de Gea Grela Alejandro , Palazuelos María Martínez , Veganzones Javier , Grandioso David , Díaz-Pollán Beatriz
Published: August 2022

Ventriculitis is a complication of meningitis (community-acquired or nosocomial) or other central nervous system (CNS) infections such as brain abscess. They are associated with a different spectrum of microorganisms, from resistant gram-negative bacilli to staphylococci, that can lead serious illness with high mortality. Difficult-to-treat resistance (DTR) gram-negative bacilli may increase to 20% of deaths respective to susceptible isolates of the same bacteria. We present the first report of a clinical cured case of DTR Pseudomonas aeruginosa ventriculitis in which cefiderocol penetration into the CNS has been confirmed in blood and cerebrospinal fluid. Cefiderocol might be considered for difficult-to-treat CNS infections in view of the recent new cases published as well as our case.
Pain, Opioid Analgesics, and Cognition: A Conceptual Framework in Older Adults
Authors: Warner Nafisseh S , Mielke Michelle M , Verdoorn Brandon P , Knopman David S , Hooten William M , Habermann Elizabeth B , Warner David O
Published: August 2022

Chronic pain is highly prevalent in older adults and is associated with poor functional outcomes. Furthermore, opioid analgesics are commonly utilized for the treatment of pain in older adults despite well-described adverse effects. Importantly, both chronic pain and opioid analgesics have been linked with impairments in cognitive function, though data are limited. In this manuscript we summarize the evidence and critical knowledge gaps regarding the relationships between pain, opioid analgesics, and cognition in older adults. Furthermore, we provide a conceptual framework to guide future research in the development, implementation, and evaluation of strategies to optimize analgesic outcomes in older adults while minimizing deleterious effects on cognition.
Standardization of Air Stacking as Lung Expansion Therapy for Patients With Restrictive Lung Disease: A Pilot Study
Authors: Cho Han Eol , Choi Won Ah , Lee Sang-Yoep , Kang Seong-Woong
Published: August 2022

Objective

Although air stacking is a widely used lung expansion therapy essential for restrictive lung diseases, important details such as peak insufflation pressure (PIP) and number of squeezes have not been investigated. The purpose of this study was to standardize a method of air stacking to minimize problems with its application by identifying the optimal pressure and number of squeezes performed by professional physicians and investigating the current status of routine air stacking implementation in patients.

Methods

This prospective cross-sectional test–retest study involved individuals who had neuromuscular disorders and had performed air stacking exercise for longer than 1 year. PIP and number of squeezes were measured to identify the differences between caregivers and physicians. Cases of incorrectly performed air stacking were investigated and categorized. The problems associated with air stacking were evaluated.

Results

A total of 45 participants were included. PIP was 41.4 (SD = 4.2; range = 34.8–50.0) cm H2O, and optimal number of squeezes was 3.1 (SD = 0.5; range = 2–4). When the air stacking methods used by caregivers were evaluated, 19 of 45 caregivers (42.2%) used methods inappropriately. Higher PIP and larger number of squeezes were observed with caregiver implementation. Thirty caregivers (66.7%) experienced finger or wrist pain; this problem was observed especially in female caregivers, who tended to incorrectly perform air stacking.

Conclusions

This pilot study showed that the optimal pressure of air stacking was 35 to 50 cm H2O. Caregivers often perform air stacking inappropriately, leading to complications without achieving the purpose of air stacking. The introduction of a new method, such as manometry, can be helpful for achieving optimal air stacking.

Impact

Optimal pressure of air stacking can be measured with inexpensive, simple, and commercially available digital manometry. This approach enables air stacking to be performed and taught more accurately and efficiently and reduces complications in both patients and caregivers.
Opportunities and Capabilities to Perform Pelvic Floor Muscle Training Are Critical for Participation: A Systematic Review and Qualitative Meta-Synthesis
Authors: Sayner Alesha M , Tang Clarice Y , Toohey Kellie , Mendoza Chennelle , Nahon Irmina
Published: August 2022

Objective

Pelvic floor muscle training (PFMT) is considered a behavioral task that requires the interaction of physical, social, and cognitive processes. Enablers and barriers to participation in PFMT have been explored primarily in women. This review aimed to identify the barriers and enablers that influence participation in PFMT in all adult populations.

Methods

A systematic review and meta-synthesis of qualitative literature was conducted. The inclusion criteria comprised qualitative studies with populations of people aged 18 years and older who have been recommended for PFMT. Line-by-line coding and an inductive thematic analysis identified themes that were applied to the Theoretical Domains Framework and Capabilities, Opportunities, and Motivation Behavioral Model to determine behavioral influences on PFMT.

Results

Twenty full-text articles met inclusion criteria. PFMT was mostly influenced by individual opportunities impacted by social determinants and competing demands. Capability of carrying out PFMT was impacted by knowledge, understanding, and appropriate skill acquisition linked to self-efficacy.

Conclusion

Increasing opportunities and capabilities for engagement in PFMT are the most important factors in optimizing positive behavior changes. Ways to address these factors include clear patient communication to boost confidence in skill acquisition and using technology to encourage autonomy and improve convenience. Future research should address the impact of health professionals’ beliefs about patient participation, assess the role of social values and gender roles, and explore the timing of the implementation of behavioral change strategies to improve PFMT.

Impact

This is believed to be the first systematic review and qualitative meta-synthesis to consider the enablers and barriers to participation in PFMT for all adult populations, purposes, and symptom complexes. Patient opportunities and capabilities are the greatest influencers on participation and self-efficacy. Individualized treatment approaches that acknowledge and address social influencers and competing demands will optimize self-efficacy and participation.

Lay Summary

If you have pelvic floor muscle dysfunction, your opportunities and capabilities are the greatest influencers on participation and self-efficacy in PFMT. Your physical therapist can design individualized treatment approaches that acknowledge and address social influencers and competing demands to help you optimize participation.
DOSE MEASUREMENT PRECISION OF AN RPLD-BASED EYE LENS DOSEMETER APPLICABLE TO THE MEDICAL SECTOR
Authors: Kowatari Munehiko , Nagamoto Keisuke , Nakagami Koichi , Yoshitomi Hiroshi , Moritake Takashi , Kunugita Naoki
Published: August 2022

We demonstrate a practical calibration method and its applicability for a commercially available radiophotoluminescence dosemeter (RPLD), i.e. the GD-352M (AGC Techno Glass, Shizuoka, Japan) to eye lens dose monitoring, by performing the calibration according to the ISO recommendations. The calibration was then verified through a series of experiments. For verification of the derived calibration factor (1.21 ± 0.04, k = 1) of the RPLD, we performed standard irradiations in the ISO narrow series X-ray reference fields and the simulation measurements in the actual radiation fields in a hospital. The TLD-based commercially available dosemeters, DOSIRIS™ was also put on the ISO cylinder phantom and the RANDO phantom together with the GD-352M in the verification experiments. The personal dose equivalents Hp(3) obtained from the GD-352M and those obtained from the DOSIRIS™ were in good agreement with each other. Our results demonstrate the proper calibration of a commercially available RPLD that is applicable to the additional monitoring of the lens of the eyes for medical staff.
Mathematical connections established in the teaching of functions
Authors: Hatisaru Vesife
Published: August 2022

This study explores the types of mathematical connections established in the classroom in the teaching of functions. An extended model for mathematical connections (different representations (DR), procedural (PC), if-then (I-T), part-whole connections (PWC), feature/property (F/P), analogies, and instruction-oriented connections (IOC)) is used as the analytical framework. The context for the study is classroom observations of two secondary mathematics teachers teaching functions to Grade 9 students. The strength of teachers’ mathematical knowledge for teaching (MKT) the concept of function is different: one has stronger MKT, while the other has weaker MKT. A total of 485 connections are identified in a sample of 24 ninth-grade lessons observed (12 lessons per teacher). The teacher with stronger MKT produces far more connections (f = 317) than the teacher with weaker MKT (f = 168), and she mostly establishes I-T, DR, PWC and F/P type of connections. The teacher with weaker MKT frequently makes procedural types of connections. This ‘connections gap’ may reflect differences in the teachers’ MKT and in their beliefs about the teaching and learning of mathematics. The study also documents some of the important internal connections within functions based on the observed lessons, and an additional IOC has emerged from the data.
The Foam Cell Formation Associated With Imbalanced Cholesterol Homeostasis Due to Airborne Magnetite Nanoparticles Exposure
Authors: Yu Haiyi , Xu Liting , Cui Tenglong , Wang Yu , Wang Baoqiang , Zhang Ze , Su Ruijun , Zhang Jingxu , Zhang Rong , Wei Yanhong , Li Daochuan , Jin Xiaoting , Chen Wen , Zheng Yuxin
Published: August 2022

Fine particulate matter (PM) is a leading environmental cause for the increased morbidity and mortality of atherosclerosis (AS) worldwide, but little is known about the toxic component and disturbance of PM exposure on foam cell formation, a crucial pathological process in AS. Airborne magnetite nanoparticles (NPs) have been reported to be detected in human serum, which inevitably encounter with macrophages in atherosclerotic plaques, thus throwing potential disturbance on the formation of macrophage-derived foam cells. Here we comprehensively unveiled that the environmental concentrations of PM exposure triggered and potentiated the formation of macrophage-derived foam cells using both real-ambient PM-exposed mice and AS mice models, including high-fat diet-fed mice and apolipoprotein E-deficient mice. The in vitro model further defined the dose-dependent response of PM treatment on foam cell formation. Interestingly, airborne magnetite NPs rather than nonmagnetic NPs at the same concentration were demonstrated to be the key toxic component of PM in the promoted foam cell formation. Furthermore, magnetite NPs exposure led to abnormal cholesterol accumulation in macrophages, which was attributed to the attenuation of cholesterol efflux and enhancement of lipoprotein uptake, but independent of cholesterol esterification. The in-depth data revealed that magnetite NPs accelerated the protein ubiquitination and subsequent degradation of SR-B1, a crucial transporter of cholesterol efflux. Collectively, these findings for the first time identified magnetite NPs as one key toxic component of PM-promoted foam cell formation, and provided new insight of abnormal cholesterol metabolism into the pathogenesis of PM-induced AS.
Quantitative Genetic Analysis of Interactions in the Pepper–Phytophthora capsici Pathosystem
Authors: Vogel Gregory , Giles Garrett , Robbins Kelly R. , Gore Michael A. , Smart Christine D.
Published: August 2022

The development of pepper cultivars with durable resistance to the oomycete Phytophthora capsici has been challenging due to differential interactions between the species that allow certain pathogen isolates to cause disease on otherwise resistant host genotypes. Currently, little is known about the pathogen genes involved in these interactions. To investigate the genetic basis of P. capsici virulence on individual pepper genotypes, we inoculated sixteen pepper accessions, representing commercial varieties, sources of resistance, and host differentials, with 117 isolates of P. capsici, for a total of 1,864 host-pathogen combinations. Analysis of disease outcomes revealed a significant effect of inter-species genotype-by-genotype interactions, although these interactions were quantitative rather than qualitative in scale. Isolates were classified into five pathogen subpopulations, as determined by their genotypes at over 60,000 single-nucleotide polymorphisms (SNPs). While absolute virulence levels on certain pepper accessions significantly differed between subpopulations, a multivariate phenotype reflecting relative virulence levels on certain pepper genotypes compared with others showed the strongest association with pathogen subpopulation. A genome-wide association study (GWAS) identified four pathogen loci significantly associated with virulence, two of which colocalized with putative RXLR effector genes and another with a polygalacturonase gene cluster. All four loci appeared to represent broad-spectrum virulence genes, as significant SNPs demonstrated consistent effects regardless of the host genotype tested. Host genotype–specific virulence variants in P. capsici may be difficult to map via GWAS with all but excessively large sample sizes, perhaps controlled by genes of small effect or by multiple allelic variants that have arisen independently.

[Formula: see text] Copyright © 2022 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Foliar Fungicides Containing FRAC 11 Mitigate Phomopsis Stem Canker in Sunflower (Helianthus annuus)
Authors: Dangal Nabin K. , Rekabdarkolaee Hossein M. , Markell Samuel G. , Harveson Robert M. , Mathew Febina M.
Published: August 2022

Phomopsis stem canker reduces yield of sunflower (Helianthus annuus L.) up to or exceeding 40%; however, management recommendations have not been developed for U.S. farmers. Between 2009 and 2020, foliar fungicide trials were conducted in Minnesota, Nebraska, North Dakota, and South Dakota for a total of 49 location-years. Random effects meta-analyses were performed on the disease severity index (DSI) and yield data collected from the foliar fungicide trials to determine the overall and individual effectiveness of the tested fungicides. Effect sizes, Cohen’s f or Hedges’ g, were calculated as the difference in DSI or yield between the fungicide treatment and nontreated control (NTC) divided by the pooled SD. The pooled Cohen’s f for DSI and yield was 0.40 (95% CI = [0.29, 0.42]), indicating a large effect size and that fungicide treatments had a significant effect on DSI and yield (P < 0.0001). Among the fungicide groups, quinone outside inhibitor (QoI) (DSI [k = 45; g = −0.47] and yield [k = 46; g = 0.41]) is moderately effective and premixes of demethylation inhibitors (DMI), succinate dehydrogenase inhibitors (SDHI), and QoI (DMI + SDHI + QoI) (DSI [k = 3; g = −0.79] and yield [k = 3; g = 0.94]) are largely effective in comparison with NTC. Upon performing prediction analyses, the probability of not recovering the fungicide application cost (Ploss) associated with QoI (pyraclostrobin) was <0.35 for a range of sunflower grain prices suggesting a greater probability of return on investment from a single application of fungicide. Overall, our study suggests that the use of QoI fungicides is likely to be profitable in the presence of Phomopsis stem canker (DSI > 5%).
A Polyketide Synthetase Gene Cluster Is Responsible for Antibacterial Activity of Burkholderia contaminans MS14
Authors: Deng Peng , Jia Jiayuan , Foxfire Adam , Baird Sonya M. , Smith Leif J. , Lu Shi-En
Published: August 2022

Burkholderia contaminans MS14, isolated from a soil sample in Mississippi, is known for producing the novel antifungal compound occidiofungin. In addition, MS14 exhibits a broad range of antibacterial activities against common plant pathogens. Random mutagenesis and gene complementation indicate that four genes are required for antibacterial activity of strain MS14 against the fire blight pathogen Erwinia amylovora. With the aim of finding the biosynthetic gene cluster for the unknown antibacterial compound, we used RNA-seq to analyze the transcriptome of MS14 wild type and mutants lacking antibacterial activity. The twofold lower expressed genes in all mutants were studied, and a polyketide synthase (PKS) gene cluster was predicted to be directly involved in MS14 antibacterial activities. The nptII-resistance cassette and CRISPR-Cas9 systems were used to mutate the PKS gene cluster. Plate bioassays showed that either insertion or frame-shifting one of the PKS genes resulted in a loss of antibacterial activity. Considering that the antibacterial-defective mutants maintain the same antifungal activities as the wild-type strain, the results suggest that this PKS gene cluster is highly likely to be involved in or directly responsible for the production of MS14 antibacterial activity. Purification efforts revealed that the antibacterial activity of the compound synthesized by the gene cluster is sensitive to UV radiation. Nevertheless, these findings have provided more insights to understand the antibacterial activity of strain MS14.
Severe, Nondelirium Agitation as an Underreported Characteristic of Precipitated Fentanyl Withdrawal: A Case Report
Authors: Terasaki Dale , Brady Jennifer
Published: August 2022

Opioid overdose deaths continue to rise in conjunction with a surge in fentanyl use. Treating withdrawal and initiating recovery may involve rapid initiations of medications for opioid use disorder, such as buprenorphine, but there is a high risk of precipitated withdrawal. We report a case of a 30-year-old man in police custody who experienced precipitated fentanyl withdrawal, and it was refractory to continued buprenorphine escalation. After buprenorphine, he exhibited a particularly dramatic, nondelirium agitation, which we suspect is a common yet underreported characteristic of precipitated withdrawal. Although there was initial concern for delirium secondary to benzodiazepine withdrawal, this was ruled out by mental status examination and verified later by the patient himself. Nondelirium agitation, clarified by mental status testing, ought to be further reported and characterized in future studies of precipitated withdrawal as clinicians and researchers tackle the new challenges of widespread fentanyl use in the United States.
Using Machine Learning to Predict Treatment Adherence in Patients on Medication for Opioid Use Disorder
Authors: Burgess-Hull Albert J. , Brooks Caleb , Epstein David H. , Gandhi Devang , Oviedo Enrique
Published: August 2022

Objective

Patients receiving medication for opioid use disorder (MOUD) may continue using nonprescribed drugs or have trouble with medication adherence, and it is difficult to predict which patients will continue to do so. In this study, we develop and validate an automated risk-modeling framework to predict opioid abstinence and medication adherence at a patient's next attended appointment and evaluate the predictive performance of machine-learning algorithms versus logistic regression.

Methods

Urine drug screen and attendance records from 40,005 appointments drawn from 2742 patients at a multilocation office-based MOUD program were used to train logistic regression, logistic ridge regression, and XGBoost models to predict a composite indicator of treatment adherence (opioid-negative and norbuprenorphine-positive urine, no evidence of urine adulteration) at next attended appointment.

Results

The XGBoost model had similar accuracy and discriminative ability (accuracy, 88%; area under the receiver operating curve, 0.87) to the two logistic regression models (accuracy, 88%; area under the receiver operating curve, 0.87). The XGBoost model had nearly perfect calibration in independent validation data; the logistic and ridge regression models slightly overestimated adherence likelihood. Historical treatment adherence, attendance rate, and fentanyl-positive urine at current appointment were the strongest contributors to treatment adherence at next attended appointment.

Discussion

There is a need for risk prediction tools to improve delivery of MOUD. This study presents an automated and portable risk-modeling framework to predict treatment adherence at each patient's next attended appointment. The XGBoost algorithm appears to provide similar classification accuracy to logistic regression models; however, XGBoost may offer improved calibration of risk estimates compared with logistic regression.
Bridging the Macro-micro Divide: A Qualitative Meta-synthesis on the Perspectives and Experiences of Health Care Providers on the Extramedical Use and Diversion of Buprenorphine
Authors: Kankanam Gamage Kasunka , Tejpar Serena , Majid Umair , Dixon Kirsten , Sabioni Pamela , Sud Abhimanyu
Published: August 2022

Objectives

Opioid agonist therapy using buprenorphine is one of the most effective treatments for opioid use disorder. However, concerns regarding its extramedical use and diversion, such as adverse patient outcomes and damage to the legitimacy of addictions practice, are persistent. The aim of this review is to synthesize the perspectives and experiences of health care providers around the extramedical use of buprenorphine.

Methods

A qualitative meta-synthesis was conducted based on a systematic search of 8 databases. All primary qualitative and mixed-methods studies relating to the views of health care providers on the extramedical use of buprenorphine were included. A qualitative analysis informed by the constant comparative method was conducted, using NVivo for data management.

Results

Sixteen studies were included in this review. Findings were organizedunder 2 key themes: (1) Harm-producing versus harm-reducing effects of extramedical buprenorphine use and (2) driving forces of and responses to extramedical buprenorphine use.

Conclusions

The studies included in our review identified a disconnect—health care providers noted that macro, health care system–level challenges drove extramedical use whereas the recommended solutions for prevention and management were primarily aimed at the micro, individual level. This study emphasizes the critical role that health care providers can play, in partnership with patients, in informing appropriate policies and health care system design to optimize the care for people with opioid use disorder.
Attitudes Regarding Medications for Opioid Use Disorder Among Peer Recovery Coaches
Authors: Suzuki Joji , Loguidice Frank , Martin Bianca
Published: August 2022

Objectives

A growing number of individuals are employed as peer recovery coaches to mentor, support, and educate those in recovery. Despite the robust evidence base for the benefits of medications for treating opioid use disorder (OUD), prior research has identified peers in recovery to hold both positive and negative attitudes toward medications for OUD (MOUDs). We aimed to survey peer recovery coaches in Massachusetts about their attitudes toward working with individuals utilizing MOUDs.

Methods

All 202 individuals certified as peer recovery coaches in Massachusetts were invited to participate in a brief, anonymous online survey between August and October 2020. The survey collected the respondents' age, sex, certification year, duration of employment as a coach, personal history of substance use disorders, and MOUD treatment.

Results

A total of 129 responses were received, representing a 63.9% response rate. Eighty-six (64.3%) reported a personal history of OUD, of whom 64 (74.4%) reported prior MOUD treatment. The majority held positive views about MOUDs, endorsing them as appropriate treatments to achieve sobriety. Coaches with personal history of MOUDs were more likely to report enjoying working with patients on methadone. Coaches without any personal history of OUD or MOUDs were older, more likely to have an alcohol use disorder, and more likely to encourage drug-free treatments before MOUDs and shorter duration of MOUD treatment.

Conclusions

Results indicate that peer recovery coaches in Massachusetts hold generally positive attitudes toward MOUDs, but those without any personal history of OUD or MOUDs may be less likely to encourage MOUD treatment.
RNA m6A modification: Mapping methods, roles, and mechanisms in acute myeloid leukemia
Authors: Yin Rong , Li Yashu , Tian Wen , Zhou Fuling , Zhang Haojian
Published: August 2022

N6-Methyladenosine (m6A) is the most abundant modification in eukaryotic mRNA, and plays important biological functions via regulating RNA fate determination. Recent studies have shown that m6A modification plays a key role in hematologic malignancies, including acute myeloid leukemia. The current growth of epitranscriptomic research mainly benefits from technological progress in detecting RNA m6A modification in a transcriptome-wide manner. In this review, we first briefly summarize the latest advances in RNA m6A biology by focusing on writers, readers, and erasers of m6A modification, and describe the development of high-throughput methods for RNA m6A mapping. We further discuss the important roles of m6A modifiers in acute myeloid leukemia, and highlight the identification of potential inhibitors for AML treatment by targeting of m6A modifiers. Overall, this review provides a comprehensive summary of RNA m6A biology in acute myeloid leukemia.
Impact of ultrasound enhancing agents on clinical management
Authors: Fraiche Ariane M. , Strom Jordan B.
Published: August 2022

Purpose of review

Ultrasound enhancing agents (UEAs), microbubbles which are composed of lipid or albumin shells containing high molecular weight gases with nonlinear acoustic properties in the ultrasound field, are important components of the diagnostic armamentarium in echocardiography. This review highlights the substantial value of UEAs in delineating endocardial border definition and influencing downstream decision-making in cardiovascular ultrasound.

Recent findings

In this article, we review recent updates to the clinical applications of UEAs, special circumstances regarding use, the impact of use on downstream testing and cost-effectiveness, and recommended approaches for optimizing workflow in the echocardiography laboratory with UEAs.

In multiple studies, UEAs have been identified as a useful tool in echocardiography, improving study accuracy and reader confidence, while reducing downstream testing and procedures and resulting in significant changes in clinical management. Despite their proven efficacy and cost-effectiveness, recent studies have suggested utilization remains low, in part due to perceived concerns and workflow issues that impair uptake. With an increasingly broader list of indications for echocardiography, UEAs will continue to play an important role in the diagnosis and management of patients with cardiovascular and noncardiovascular diseases.
Predictive factors of inhospital mortality for ICU patients with acute-on-chronic liver failure undergoing liver transplantation
Authors: Laici Cristiana , Guizzardi Chiara , Morelli Maria Cristina , Vitale Giovanni , Caraceni Paolo , Cescon Matteo , Ravaioli Matteo , Bacchi Reggiani Maria Letizia , Baldassarre Maurizio , Siniscalchi Antonio
Published: August 2022

Introduction

Liver transplantation (LT) is the only effective treatment for acute-on-chronic liver failure (ACLF), but it is limited by organ availability. This study aims to identify predictive factors of mortality for LT candidates based on parameters measured at the admission into the ICU.

Methods

Sixty-four patients diagnosed with ACLF, admitted consecutively into ICU between 2015 and 2019, were retrospectively enrolled in the study. Data were assessed using univariate and multivariate regression analyses to identify risk factors for inhospital mortality and 1-year mortality.

Results

A total of 67% of patients were diagnosed with ACLF grade 3, and 25 and 8% with grades 2 and 1. Thirty percent received LT with a 1-year mortality rate of 16%, whereas for nontransplanted patients it reached 90%. Clinical features were compared according to transplant eligibility. In the univariate analysis model, lung failure (HR, 3.01; 95% CI, 1.48–6.09; P = 0.002), high lactate levels (HR, 1.03; 95% CI, 1.02–1.04; P < 0.001) and CLIF-ACLF score (HR, 1.04; 95% CI, 1.01–1.09; P = 0.026) were independently correlated to increased inhospital mortality. LT reduced mortality risk (HR, 0.16; 95% CI, 0.04–0.72; P = 0.016).

Conclusion

Lung failure, CLIF-ACLF score and blood lactate levels at admission were the only statistically significant independent predictors of inhospital mortality, more accurate in determining transplant success than ACLF grade.
Gastrointestinal sequalae months after severe acute respiratory syndrome corona virus 2 infection: a prospective, observational study
Authors: Liptak Peter , Duricek Martin , Rosolanka Robert , Ziacikova Ivana , Kocan Ivan , Uhrik Peter , Grendar Marian , Hrnciarova Martina , Bucova Patricia , Galo David , Banovcin Peter
Published: August 2022

Introduction

Post-coronavirus disease (post-COVID) symptoms arise mostly from impaired function of respiratory tract although in many patients, the dysfunction of gastrointestinal tract and liver among other organ systems may persist.

Methods

Primary data collection was based on a short gastrointestinal symptom questionnaire at the initial screening. A brief telephone survey within the patient and control group was performed 5–8 months after the initial screening. R ver. 4.0.5 and imbalanced RandomForest (RF) machine-learning algorithm were used for data explorations and analyses.

Results

A total of 590 patients were included in the study. The general presence of gastrointestinal symptoms 208.2 days (153–230 days) after the initial acute severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) infection was 19% in patients with moderate-to-serious course of the disease and 7.3% in patients with mild course compared with 3.0% in SARS-CoV-2 negative controls (P < 0.001). Diarrhea and abdominal pain are the most prevalent post-COVID gastrointestinal symptoms. RF machine-learning algorithm identified acute diarrhea and antibiotics administration as the strongest predictors for gastrointestinal sequelae with area under curve of 0.68. Variable importance for acute diarrhea is 0.066 and 0.058 for antibiotics administration.

Conclusion

The presence of gastrointestinal sequelae 7 months after the initial SARS-CoV-2 infection is significantly higher in patients with moderate-to-severe course of the acute COVID-19 compared with asymptomatic patients or those with mild course of the disease. The most prevalent post-COVID gastrointestinal symptoms are diarrhea and abdominal pain. The strongest predictors for persistence of these symptoms are antibiotics administration and acute diarrhea during the initial infection.
Under-triage: A New Trigger to Drive Quality Improvement in the Emergency Department
Authors: Berkowitz Deena , Morrison Sephora , Shaukat Haroon , Button Katherine , Stevenson Michele , LaViolette Debbie , Meisler Yael , Gallagher Kerri A. , Chamberlain James
Published: August 2022

Introduction:

The emergency department (ED) is a care setting with a high risk for medical error. In collaboration with our nursing colleagues, we identified a new trigger, under-triage, and demonstrated how its implementation could detect and reduce medical errors in the ED.

Methods:

We defined under-triage as patient visits with an Emergency Severity Index (ESI) score of 4 or 5 (ie, low acuity), and the patient was admitted to the hospital during the same visit. We defined mistriage, or medical error, when nurse-physician dyad reviewers determined that a different ESI level should have been assigned based on the information available at triage. A multidisciplinary team used nominal group technique to build consensus on key drivers and outcome metrics for this new trigger. We randomly selected 267 charts for review utilizing the under-triage trigger.

Results:

Of the 125,457 patients triaged as level 4 or 5 in 2019 and 2020, 1.1% (n = 1,423) were under-triaged. Of the 267 charts reviewed, 127 were categorized as mistriage, making the under-triage’s positive predictive value trigger 48%. Reviews took 2–10 minutes per chart. We identified 10 categories of under-triage. Nine themes emerged, with four specific and measurable action items mapped to process and outcome metrics.

Conclusions:

We identify a new, feasible ED trigger, under-triage, that identifies medical error with a high positive predictive value. We identify process and outcome metrics and interventions to improve triage for future patients.
Splenic Vessels as a Rescue for Pediatric Kidney Retransplantation in Children With Iliac-caval Agenesis or Thrombosis
Authors: Tandoi Francesco , Peruzzi Licia , Lonardi Pietro , Cussa Davide , Catalano Silvia , Verri Aldo , Merlo Maurizio , Sedigh Omidreza , Gerocarni Nappo Simona , Melloni Claudia , Patrono Damiano , Gianoglio Bruno , Romagnoli Renato
Published: August 2022

Background.

Unavailability of the iliac-caval system due to thrombosis or aberrant anatomy may preclude kidney transplantation (KT) in small infants, exposing them to the complications of long-term dialysis. A tailored approach may enable KT also in these difficult patients.

Methods.

We report the cases of 2 pediatric patients with a history of long-term hemodialysis, a previously failed KT, pending exhaustion of vascular accesses for dialysis, and unsuitability of the iliac-caval axis as a site for KT. Both patients were successfully managed by using splenic vessels as a source of arterial inflow or venous drainage during KT. Notably, one patient also had a previous liver transplant.

Results.

Both kidney grafts showed primary function. Posttransplant courses were uneventful, and no rejection episode was observed. At 64- and 10-mo follow-ups, both children had optimal renal function and excellent quality of life.

Conclusions.

When the iliac-caval system is unavailable, kidney graft implantation on splenic vessels represents a safe and effective option for pediatric KT.
An Assessment of the Value of Donor-derived Cell-free DNA Surveillance in Patients With Preserved Kidney Allograft Function
Authors: Huang Edmund , Haas Mark , Gillespie Matt , Sethi Supreet , Peng Alice , Najjar Reiad , Vo Ashley , Jordan Stanley C.
Published: August 2022

Background.

Donor-derived cell-free DNA (dd-cfDNA) is a biomarker validated to detect rejection when measured to assess kidney allograft dysfunction. However, it remains unclear whether routine surveillance with dd-cfDNA provides additional information over standard monitoring of kidney allografts with creatinine and donor-specific antibodies (DSAs), particularly among those with little suspicion of rejection or injury. We investigated the value of measuring dd-cfDNA in patients with preserved allograft function and describe its association with future events.

Methods.

Three-hundred seventeen kidney transplant recipients with a creatinine ≤1.5 mg/dL, no current DSA, and no prior rejection were assessed with dd-cfDNA and categorized into low (dd-cfDNA <0.5%; n = 239), moderate (dd-cfDNA 0.5% to <1.0%; n = 43), and high (dd-cfDNA ≥1.0%; n = 35) groups. The occurrence of rejection, DSA, graft loss, and change in estimated glomerular filtration rate over time after dd-cfDNA assessment was compared.

Results.

Over follow-up, rejections were more commonly found among patients with high vs low dd-cfDNA (17% versus 5%; P = 0.01); a similar nonsignificant trend was observed among patients with moderate compared to low dd-cfDNA (12% versus 5%; P = 0.13). DSA development was uncommon and not different between groups (low: 4%; moderate: 3%; high: 0%; P = 0.52). There was only 1 graft loss in a patient with low dd-cfDNA, and dd-cfDNA was not associated with graft dysfunction over time.

Conclusions.

Most patients with elevated dd-cfDNA in conjunction with preserved allograft function remained stable over follow-up without deterioration in function or graft loss. Studies are needed to differentiate patients with elevated dd-cfDNA who will develop adverse outcomes from those who will remain clinically stable.
Short Report: Evaluating the Effects of Automated Donor Referral Technology on Deceased Donor Referrals
Authors: Levan Macey L. , Trahan Chad , Klitenic Samantha B. , Hewlett Jonathan , Strout Tyler , Levan Michael A. , Vanterpool Karen B. , Segev Dorry L. , Adams Bradley L. , Massie Allan B. , Niles Patricia
Published: August 2022

Background.

Automation of deceased donor referrals with standardized clinical triggers allows organ procurement organizations to be rapidly aware of medically eligible potential donors without the need for manual reporting and subjective decision-making of otherwise very busy hospital staff. In October 2018, 3 Texas hospitals (pilot hospitals) began using an automated referral system; our goal was to evaluate the impact of this system on eligible donor referral.

Methods.

We studied ventilated referrals (n = 28 034) in a single organ procurement organization from January 2015 to March 2021. We estimated the change in referral rate in the 3 pilot hospitals due to the automated referral system using a difference-in-differences analysis with Poisson regression.

Results.

Ventilated referrals from the pilot hospitals increased from mean 11.7 per month pre-October 2018 to 26.7 per month post-October 2018. The difference-in-differences analysis estimated that automated referral was associated with a 45% increase in referrals (adjusted incidence rate ratio [aIRR] = 1.30 1.45 1.62), an 83% increase in approaches for authorization (aIRR = 1.34 1.83 2.48), a 73% increase in authorizations (aIRR = 1.18 1.73 2.55), and a 92% increase in organ donors (aIRR = 1.13 1.92 3.09).

Conclusions.

Following deployment of an automated referral system that did not require any actions by the referring hospital, referrals, authorizations, and organ donors increased substantially in the 3 pilot hospitals. Broader deployment of automated referral systems may lead to increases in the deceased donor pool.