bluuebunny/crossref_metadata_2025 huggingface dataset:
Sharp-edge-based acoustofluidic chip capable of programmable pumping, mixing, cell focusing, and trapping
Authors: Pavlic Alen , Harshbarger Cooper Lars , Rosenthaler Luca , Snedeker Jess Gerrit , Dual Jürg
Published: January 2023

Precise manipulation of fluids and objects on the microscale is seldom a simple task, but, nevertheless, crucial for many applications in life sciences and chemical engineering. We present a microfluidic chip fabricated in silicon–glass, featuring one or several pairs of acoustically excited sharp edges at side channels that drive a pumping flow throughout the chip and produce a strong mixing flow in their vicinity. The chip is simultaneously capable of focusing cells and microparticles that are suspended in the flow. The multifunctional micropump provides a continuous flow across a wide range of excitation frequencies (80 kHz–2 MHz), with flow rates ranging from nl min−1 to μl min−1, depending on the excitation parameters. In the low-voltage regime, the flow rate depends quadratically on the voltage applied to the piezoelectric transducer, making the pump programmable. The behavior in the system is elucidated with finite element method simulations, which are in good agreement with experimentally observed behavior. The acoustic radiation force arising due to a fluidic channel resonance is responsible for the focusing of cells and microparticles, while the streaming produced by the pair of sharp edges generates the pumping and the mixing flow. If cell focusing is detrimental for a certain application, it can also be avoided by exciting the system away from the resonance frequency of the fluidic channel. The device, with its unique bundle of functionalities, displays great potential for various biochemical applications.
Open quantum systems with nonlinear environmental backactions: Extended dissipaton theory vs core-system hierarchy construction
Authors: Chen Zi-Hao , Wang Yao , Xu Rui-Xue , Yan YiJing
Published: January 2023

In this paper, we present a comprehensive account of quantum dissipation theories with the quadratic environment couplings. The theoretical development includes the Brownian solvation mode embedded hierarchical quantum master equations, a core-system hierarchy construction that verifies the extended dissipaton equation of motion (DEOM) formalism [R. X. Xu et al., J. Chem. Phys. 148, 114103 (2018)]. Developed are also the quadratic imaginary-time DEOM for equilibrium and the λ( t)-DEOM for nonequilibrium thermodynamics problems. Both the celebrated Jarzynski equality and Crooks relation are accurately reproduced, which, in turn, confirms the rigorousness of the extended DEOM theories. While the extended DEOM is more numerically efficient, the core-system hierarchy quantum master equation is favorable for “visualizing” the correlated solvation dynamics.
Laminar drag reduction ability of liquid-infused microchannels by considering different infused lubricants
Authors: Rahimi Amirmohammad , Shahsavari Arghavan , Pakzad Hossein , Moosavi Ali , Nouri-Borujerdi Ali
Published: January 2023

We numerically investigate the pressure drop reduction (PDR) performance of microchannels equipped with liquid-infused surfaces, along with determining the shape of the interface between the working fluid and lubricant within the microgrooves. The effects of different parameters, such as the Reynolds number of working fluid, density and viscosity ratios between the lubricant and working fluid, the ratio of the thickness of the lubricant layer over the ridges to the depth of the groove, and the Ohnesorge number as a representative of the interfacial tension, on the PDR and interfacial meniscus within the microgrooves are comprehensively studied. The results reveal that the density ratio and Ohnesorge number do not significantly affect the PDR. On the other hand, the viscosity ratio considerably affects the PDR, and a maximum PDR of 62% compared to a smooth non-lubricated microchannel is achieved for a viscosity ratio of 0.01. Interestingly, the higher the Reynolds number of the working fluid, the higher the PDR. The meniscus shape within the microgrooves is strongly affected by the Reynolds number of the working fluid. Despite the insignificant effect of interfacial tension on the PDR, the interface shape within the microgrooves is appreciably influenced by this parameter.
Influence of different oil flow directions on the friction performance of asymmetric structures in heavy load hydraulic friction pairs
Authors: Wang Wen’an , Liu Zhiqi , Chen Dongliang
Published: January 2023

Textures have obvious anti-friction and anti-wear effects, but effective textures often have complex and asymmetric characteristics. Because of the texture’s directional lubrication effect and fluid diode effect, different oil flow directions influence the friction reduction effect of asymmetric texture. Simulations and test methods are used to characterize these effects, and the friction coefficient and wear amount are used as evaluation methods to determine the optimal oil flow direction of asymmetric textures. The results show that an appropriate oil flow direction can significantly change the texture’s friction-reducing ability. The friction reduction efficiency of the texture is highest when the angle between the oil flow direction and the inflow edge of the texture is 60°–90°. When the angle between the oil flow direction and the inflow edge of the texture is 0°–30°, the texture’s anti-friction effect and efficiency are weakened.
Lagrangian stretching reveals stress topology in viscoelastic flows
Authors: Kumar Manish , Guasto Jeffrey S. , Ardekani Arezoo M.
Published: January 2023

Viscoelastic flows are pervasive in a host of natural and industrial processes, where the emergence of nonlinear and time-dependent dynamics regulates flow resistance, energy consumption, and particulate dispersal. Polymeric stress induced by the advection and stretching of suspended polymers feeds back on the underlying fluid flow, which ultimately dictates the dynamics, instability, and transport properties of viscoelastic fluids. However, direct experimental quantification of the stress field is challenging, and a fundamental understanding of how Lagrangian flow structure regulates the distribution of polymeric stress is lacking. In this work, we show that the topology of the polymeric stress field precisely mirrors the Lagrangian stretching field, where the latter depends solely on flow kinematics. We develop a general analytical expression that directly relates the polymeric stress and stretching in weakly viscoelastic fluids for both nonlinear and unsteady flows, which is also extended to special cases characterized by strong kinematics. Furthermore, numerical simulations reveal a clear correlation between the stress and stretching field topologies for unstable viscoelastic flows across a broad range of geometries. Ultimately, our results establish a connection between the Eulerian stress field and the Lagrangian structure of viscoelastic flows. This work provides a simple framework to determine the topology of polymeric stress directly from readily measurable flow field data and lays the foundation for directly linking the polymeric stress to flow transport properties.
A multilingual learner corpus for less commonly taught languages
Authors: Sommer-Farias Bruna , Novikov Aleksey , Picoral Adriana , Centanin-Bertho Mariana , Staples Shelley
Published: January 2023

This article provides a detailed account of the framework, pedagogical and research applications of the Multilingual Academic Corpus of Assignments – Writing and Speech (MACAWS).1 MACAWS is a monitor learner corpus of written and oral assignments produced by foreign language learners in the context of their language learning classrooms. Currently the corpus focuses on two less commonly taught languages rarely represented in learner corpora, Portuguese and Russian, and contains 124,054 words in Russian and 536,168 in Portuguese, being updated each semester as new texts are added to the corpus. The online interface is designed for ease of use by teachers and students. Our novel interactive data-driven learning (iDDL) tool allows embedding of concordance lines into websites and learning management systems (LMS), facilitating student interaction with concordance lines. Researchers can gain access to an offline corpus for greater flexibility.
A scoring chart to evaluate cases of probable vestibular migraine
Authors: Alsarhan Haider
Published: January 2023

Objectives

To suggest a chart for the diagnosis of probable vestibular migraine for cases that cannot fit the internationally agreed diagnostic criteria.

Methods

This retrospective study enrolled patients who presented with chronic dizziness and attacks of severe vertigo in whom the diagnostic criteria for diagnosing probable vestibular migraine were not applicable, and there was no possibility to account for other vestibular diagnoses. The trial of vestibular migraine treatment was started without any labyrinthine sedatives for a month. Patients whose conditions improved and were vertigo free for the trial period were included in this study. Common complaints, clinical examination findings, and hearing and vestibular test results were analyzed. Findings observed in more than 50% of the included patients were added to a chart. The chart was implemented with a score and included female gender, bilateral tinnitus, aural fullness, significant headache, family history of migraine, and reported hypotension. Any one of them increased the score by one point, while bilateral low frequencies sensorineural hearing loss and bilateral frequency tuning of cervical vestibular evoked myogenic potentials increased the score by two points.

Results

All the patients had a score of 5 or more.

Conclusion

The diagnostic chart is useful for suggesting probable vestibular migraine in cases that do not comply with the internationally agreed diagnostic criteria.
Experimental observations on metal-like carrier transport and Mott hopping conduction behaviours in boron-doped Si nanocrystal multilayers
Authors: Chen Jiaming , Li Dongke , Sun Teng , Han Junnan , Zhang Yangyi , Li Wei , Xu Jun , Chen Kunji
Published: January 2023

Studies on the carrier transport characteristics of semiconductor nanomaterials are the important and interesting issues which are helpful for developing the next generation of optoelectronic devices. In this work, we fabricate B-doped Si nanocrystals/SiO2 multilayers by plasma enhanced chemical vapor deposition with subsequent high temperature annealing. The electronic transport behaviors are studied via Hall measurements within a wide temperature range (30–660 K). It is found that when the temperature is above 300 K, all the B-doped Si nanocrystals with the size near 4.0 nm exhibit the semiconductor-like conduction characteristics, while the conduction of Si nanocrystals with large size near 7.0 nm transforms from semiconductor-like to metal-like at high B-doping ratios. The critical carrier concentration of conduction transition can reach as high as 2.2 × 1020 cm−3, which is significantly higher than that of bulk counterpart and may be even higher for the smaller Si nanocrystals. Meanwhile, the Mott variable-range hopping dominates the carrier transport when the temperature is below 100 K. The localization radius of carriers can be regulated by the B-doping ratios and Si NCs size, which is contributed to the metallic insulator transition.
Zero-frequency supercurrent susceptibility signatures of trivial and topological zero-energy states in nanowire junctions
Authors: Baldo Lucas , Dias Da Silva Luis G G V , Black-Schaffer Annica M , Cayao Jorge
Published: January 2023

We propose a method to distinguish between trivial and topological, Majorana, zero-energy states (ZESs) in both short and long superconductor-normal-superconductor junctions based on Rashba nanowires using phase-biased equilibrium transport measurements. In particular, we show how the sawtooth profile of the supercurrent, due to the Majorana oscillation suppression in the topological phase for sufficiently long superconductor regions, leads to a strong signal in its zero-frequency susceptibility for a phase difference of

ϕ
=
π

. This signal is notably insensitive to the chemical potential in the normal region, while trivial ZESs only causes signals in the susceptibility that is highly varying with the chemical potential, thus turning gating of the normal region into a simple experimental control knob. Furthermore, we obtain that, by tuning the junction transparency, critical currents in both short and long junctions undergo a reduction in the number of oscillations as a function of magnetic field only in the topological phase, an effect that find to be intimately linked to Majorana non-locality. Finally, we show that our results also hold at finite temperatures, thus highlighting their potential measurability under realistic experimental conditions.
A functionality-switchable device based on coherent perfect absorption with narrowband absorbing performance and sensing function
Authors: Zhang Yang , Zhang Dan , Zhang Haifeng
Published: January 2023

An optical structure containing the ferrite defects and Fabry-Pérot cavity with a narrowband absorption feature and a sensing performance is proposed and modeled in theoretical scope. These two features appear alternately on adjacent frequency ranges with modulation of the coherent perfect absorption by altering the phase difference between the two coherent incident lights. For the absorption band, the relative bandwidth reaches 9.7%. Benefiting from the modulation of the magnetic field applied in the ferrite layers, the quality value of the absorption peak is 494.85, which indicates the potential for use as a sensor. There are highly linear relationships between the refractive index values of dielectric layers and the spike absorption frequencies. The accurate analysis of the RI from 2.7 to 3.4 can be realized. The sensitivity and the average detection limit are 1.287 THz R−1IU−1 and 7.46 × 10−4 RIU. The figure of merit is up to 83.03 RIU−1. Similarly, the structure is also competent to detect RI of another kind of dielectric layer from 2.2 to 2.85. The corresponding parameters are 1.241 THz RIU−1, 7.12 × 10−4 RIU, and 77.53 RIU−1, respectively. Meanwhile, the effects of the incident angle and machining inaccuracies are also discussed.
Robustness of cosmic birefringence measurement against Galactic foreground emission and instrumental systematics
Authors: Diego-Palazuelos P. , Martínez-González E. , Vielva P. , Barreiro R.B. , Tristram M. , de la Hoz E. , Eskilt J.R. , Minami Y. , Sullivan R.M. , Banday A.J. , Górski K.M. , Keskitalo R. , Komatsu E. , Scott D.
Published: January 2023

The polarization of the cosmic microwave background (CMB) can be used to search for parity-violating processes like that predicted by a Chern-Simons coupling to a light pseudoscalar field. Such an interaction rotates E modes into E modes in the observed CMB signal through an effect known as cosmic birefringence. Even though isotropic birefringence can be confused with the rotation produced by a miscalibration of the detectors' polarization angles, the degeneracy between both effects is broken when Galactic foreground emission is used as a calibrator. In this work, we use realistic simulations of the High-Frequency Instrument of the Planck mission to test the impact that Galactic foreground emission and instrumental systematics have on the recent birefringence measurements obtained through this technique. Our results demonstrate the robustness of the methodology against the miscalibration of polarization angles and other systematic effects, like intensity-to-polarization leakage, beam leakage, or cross-polarization effects. However, our estimator is sensitive to the EB correlation of polarized foreground emission. Here we propose to correct the bias induced by dust EB by modeling the foreground signal with templates produced in Bayesian component-separation analyses that fit parametric models to CMB data. Acknowledging the limitations of currently available dust templates like that of the Commander sky model, high-precision CMB data and a characterization of dust beyond the modified blackbody paradigm are needed to obtain a definitive measurement of cosmic birefringence in the future.
A ceramic-GEM neutron detector with a wide neutron-flux measurement range for the beam monitoring at China spallation neutron source
Authors: Zhu Lin , Zhou Jian-rong , Zeng Li-xin , Xiao Liang , Zhou Xiao-juan , Tan Jin-hao , Xia Yuan-guang , Xu Hong , Jiang Xing-fen , Yang Wen-qin , Wang Yan-feng , Yang Gui-an , Xie Yu-guang , Teng Hai-yun , Li Jia-jie , Qiu Yong-xiang , Shen Pei-xun , Wang Song-lin , Zhuang Jian , Zhao Yu-bin , Zhang Jun-rong , Sun Zhi-jia , Chen Yuan-bo
Published: January 2023

The increase of neutron flux in pulsed spallation neutron
facilities imposes demands on the neutron detector for beam
monitoring, including excellent neutron/gamma discrimination, wide
dynamic neutron-flux measurement range, wavelength resolution, and
long-term stability. In this paper, we developed a ceramic GEM-based
(gas electron multiplier) neutron detector with an active area of
100 mm × 100 mm. It adopted a thinner conversion
material and the stopping layer to lower the detection efficiency so
as to extend the dynamic measurement range of the detector. The
detection efficiency of this detector was investigated by the Monte
Carlo (MC) tool FLUKA, showing that the low efficiency around 0.01%
for 1 Åneutrons was reached by using a 0.1 μm
natB4C converter appended with an aluminum film of
2 μm thickness. Its validation of the wavelength spectra
measurement was verified by comparisons with that made with an LND
monitor, and it could work at the condition of
7.1 × 109 n/s for 2.5 Åneutrons. In addition, it was
demonstrated that this detector was able to measure the beam profile
with a position resolution of better than 2.1 ± 0.1 mm. The
results of simulations and experiments show that this ceramic-GEM
neutron detector can meet the requirements of the direct measurement
of high-flux beam, and it will be a new neutron detector for the
beam monitoring at the China spallation neutron source (CSNS).
Recent advances in the development of flexible dye-sensitized solar cells: fabrication, challenges and applications-a review
Authors: Dawo Chandan , Chaturvedi Harsh
Published: January 2023

Flexible dye-sensitized solar cells (FDSSCs) show a huge potential for stretchable electronics and portable power sources due to their lightweight, handy, flexibility, cost-effective, and easy processing. This paper introduces basic operating principles and design opportunities for maximum efficiencies for FDSSCs. Flexible polymers or metal substrates, enabling cost reduction due to large volume production with roll to roll manufacturing technique. DSSCs achieved a power conversion efficiency (PCE) of 14.30% on rigid conductive substrates, 10.28% on flexible metal substrates, and 8% on plastic substrates. A brief distinction has been made on different substrates, preparation of charge transfers materials, coating and printing techniques and processing methods for enhancing the performance of FDSSCs. We also highlight issues pertaining to progress in the stability of devices and the commercialisation of FDSCs technologies will be explained.
The function of the gene loiP in transformation efficiency and outer membrane permeability change of Escherichia coli treated by Ca2+ ions
Authors: Wan Minglai , Zhu Ning , Yang Guangrui , Guo Xiaopeng , Sun Shangchen , Leng Feifan , Wang Yonggang
Published: January 2023

The preparation of Escherichia coli competent cells by calcium chloride is a common method in molecular biology, but the mechanism is poorly understood. In a previous study, using transcriptomics and proteomics approaches, we found that the expression pattern of the gene loiP was upregulated by CaCl2. In order to investigate the function of the loiP gene in Ca2+- mediated formation of competent cells of E. coli DH5α, the loiP gene deletion strains were constructed by the lambda-derived Red homologous recombination technique. Then, the cell morphology, transformation efficiency, and cell membrane changes of the competent cells of the mutant strain were further explored. Compared with the wild-type E. coli DH5α, the mutant strains have no significant differences in the morphology, growth characteristics, and the permeability of the intracellular membrane. However, the transformation efficiencies of the mutant strains to plasmids of different sizes were significantly reduced, and the permeability of the outer membrane decreased by 2.94 times. These results indicate that the deletion of gene loiP may directly affect the transformation efficiency and outer membrane permeability of E. coli competent cells.
Motivational Interviewing With Couples
Authors: Starks Tyrel J.
Published: January 2023

This text outlines the principles, processes, and practice of Motivational Interviewing with couples derived by Dr. Starks through his research over the past decade. Informed by interdependence theory, the approach positions the couple as the client. Relationship functioning—the degree to which partners are satisfied with, committed to, and invested in their relationship—serves as a mechanism of behavior change. It catalyzes relationship partners’ willingness to make sacrifices or compromise around the formation of shared goals and support one another in their accomplishment. The text outlines the application of Motivational Interviewing Spirit and existing Motivational Interviewing processes and techniques with couples. It also introduces the novel process of facilitating dyadic functioning as well as strategies and techniques unique to Motivational Interviewing with couples. In doing so, the text situates couples Motivational Interviewing practice in the larger context of research on dyadic coping, relationship functioning, couples communication, and couples therapy. The past decade and a half have seen an expansion in research on the health of partnered sexual and gender minority people—in particular substance use and sexual health among sexual minority men. The formative work that guided the development of this text is grounded in this tradition. Case examples therefore illustrate the practice of couples Motivational Interviewing in this context, and special issues related to addressing sex and sexual satisfaction in the context of Motivational Interviewing are also discussed.
Gas metallicity distributions in SDSS-IV MaNGA galaxies: what drives gradients and local trends?
Authors: Boardman N , Wild V , Heckman T , Sanchez S F , Riffel R , Riffel R A , Zasowski G
Published: January 2023

The gas metallicity distributions across individual galaxies and across galaxy samples can teach us much about how galaxies evolve. Massive galaxies typically possess negative metallicity gradients, and mass and metallicity are tightly correlated on local scales over a wide range of galaxy masses; however, the precise origins of such trends remain elusive. Here, we employ data from SDSS-IV MaNGA to explore how gas metallicity depends on the local stellar mass density and on galactocentric radius within individual galaxies. We also consider how the strengths of these dependencies vary across the galaxy mass-size plane. We find that radius is more predictive of local metallicity than stellar mass density in extended lower-mass galaxies, while we find density and radius to be almost equally predictive in higher-mass and more compact galaxies. Consistent with previous work, we find a mild connection between metallicity gradients and large-scale environment; however, this is insufficient to explain variations in gas metallicity behaviour across the mass-size plane. We argue our results to be consistent with a scenario in which extended galaxies have experienced smooth gas accretion histories, producing negative metallicity gradients over time. We further argue that more compact and more massive systems have experienced increased merging activity that disrupts this process, leading to flatter metallicity gradients and more dominant density-metallicity correlations within individual galaxies.
Reception of Vatican II in Europe
Authors: Lamberigts Mathijs
Published: January 2023

Vatican II, often described as a European council, created huge expectations among European faithful, at least in the West. In Central and Eastern Europe, where many countries remained behind the Iron Curtain, the reception of Vatican II had to wait until the fall of communism. The council concluded at a moment when secularization was affecting Western European societies. Moreover, the second half of the 1960s was characterized by anti-authoritarian movements, causing unrest, if not crisis, in Roman Catholic central offices. A clash between local European churches and these central offices emerged on several levels: in resistance to local initiatives for religious formation, for the promotion of interaction between priests and faithful, and for the renewal of liturgical life. Central directives were rejected by local communities, resulting in polarization. Crises in episcopal collegiality, priesthood, and the role of women in the Church can also be seen as stemming from the conflicts between centre and periphery. The decline of religious and ordained vocations led the lay faithful to assume new responsibilities in liturgy, health care, education, and social commitment. This chapter argues that in responding to a crisis, Vatican II and its reception encountered many challenges unforeseen by the council fathers.
Other Sources for the Study of Vatican II
Authors: Ruozzi Federico
Published: January 2023

This article explores the impact of media (television, radio, newspapers and reviews, press conferences, and correspondence) on the Second Vatican Council. For the first time, a council was convoked in the age of modern mass media, which, as it turned out, provided relevant sources for interpreting the event itself. The mass media attention created an unexpected relationship of centripetal and centrifugal forces. On the one hand, from internal to external: the media conveyed more information about conciliar events and about what happened inside than had ever been done before, as shown by council fathers’ personal diaries. On the other hand, from external to internal: the media influenced the council fathers themselves and their own discussions. In fact, Vatican II was not only the first in the Church’s history to unfold before radio microphones and in the spotlight of national and international TV and film cameras, it was also the first to receive almost total, simultaneous coverage for the whole period, thus giving the meeting a new and unique format in terms of information and participation.
The Unique Character of Vatican II’s Teaching
Authors: Hünermann Peter
Published: January 2023

Since the end of Vatican II, there has been an ongoing battle on the normativity of this council, the interpretation of its texts, and its peculiar character. This chapter explores the qualitative uniqueness of the council reflected in the events and the documents it produced, from the papal invitation and throughout all the sessions. It argues that Immanuel Kant and his notions of transcendental logic and of the related transcendental form of reflection provide a way to understand the council’s peculiar character and uniqueness and to demonstrate how the epistemological presuppositions of Vatican II are not to be confused with those of Vatican I.
Riemann–Roch theorems in monoidal 2-categories
Authors: Campbell Jonathan A , Ponto  Kate
Published: January 2023

Smooth and proper dg-algebras have an Euler class valued in the Hochschild homology of the algebra. This Euler class is worthy of this name since it satisfies many familiar properties including compatibility with the pairing on the Hochschild homology of the algebra and that of its opposite. This compatibility is the Riemann–Roch theorems of [21, 14]. In this paper, we prove a broad generalization of these Riemann–Roch theorems. We generalize from the bicategory of dg-algebras and their bimodules to symmetric monoidal bicategories and from the Euler class to traces of non-identity maps. Our generalization also implies spectral Riemann–Roch theorems. We regard this result as an instantiation of a 2-dimensional generalized cobordism hypothesis. This perspective draws the result close to many others that generalize results about Euler characteristics and classes to bicategorical traces.
Sudden anisocoria in a healing pediatric multitrauma patient
Authors: Harper David Shane , Bayless Sarah
Published: January 2023

This article describes a teenager who developed anisocoria with no obvious neurologic deficits or decline after a motor vehicle accident. The condition resolved over several hours before reappearing in the opposite eye 2 days later. Again no clinical neurologic deficits were noted and the condition resolved after several hours. The patient's asymptomatic anisocoria was finally determined to be secondary to aerosolized ipratropium treatments and an ill-fitting mask.
Well-being and the early-career PA
Authors: Bernard Kari Sue
Published: January 2023

Objective:

Recent updates to physician associate/assistant (PA) laws reflect less mandated supervision. Although greater autonomy may inspire experienced PAs, newer PAs may struggle with less required oversight. This study examined the influence of autonomy, career length, and the quality of the collaborative physician (CP) relationship on PA well-being.

Methods:

A secondary analysis of data gathered in 2018 by the American Academy of Physician Associates was conducted using bivariate and multiple linear regression with moderated mediation.

Results:

Years of experience positively predicted PA well-being and negatively predicted the percentage of time spent consulting with a CP. The interaction of the percentage of time spent consulting with a CP and the quality of the CP relationship mediated the relationship between years of experience and well-being.

Conclusions:

Findings demonstrate that the quality of the CP relationship is most salient to the well-being of early-career PAs who spend more time in consultation with CPs.
No Advantage for Early Active Mobilization During Mechanical Ventilation
Authors: Rosenberg Karen
Published: January 2023

According to this study:

Among adults undergoing mechanical ventilation in the ICU, early active mobilization didn't increase the number of days patients were alive and out of the hospital compared with usual care.

Adverse events were more common among people who had early mobilization interventions.
Mindfulness-Based Stress Reduction a Viable Option for Treatment of Anxiety
Authors: Rosenberg Karen
Published: January 2023

According to this study:

Mindfulness-based stress reduction is well tolerated and has comparable effectiveness to a first-line medication for people who have anxiety disorders.

At least one study-related adverse event occurred in 78.6% of patients in the escitalopram group and in 15.4% of those in the mindfulness-based stress reduction group.
Promoting the integration of peer support specialists into the healthcare team
Authors: Slater Tammy M. , Rodney Tamar , Finnell Deborah S.
Published: January 2023

The 21st Century Cures Act to address the opioid crisis spurred the expansion of the peer support specialist (PSS) workforce. Nurses are in key positions to promote the successful integration of the PSS into the healthcare team. This article describes the role of the PSS, including key functions that overlap with those of nurses and ways they can help mitigate stigma, which remains a significant barrier to patients' access to treatment.
Clinical nurse to nurse manager
Authors: Hawk Brittani M.
Published: January 2023

Nursing is notorious for heavy reliance on on-the-job training to transition a clinical nurse into a nurse manager (NM). Leadership and management training, when available, may remain unattended by novice NMs due to increasing operational demands. This article describes a framework to support initial and continued NM professional development.
Errors in medicine: punishment versus learning medical adverse events revisited – expanding the frame
Authors: Brattebø Guttorm , Flaatten Hans Kristian
Published: January 2023

Purpose of review

Despite healthcare workers’ best intentions, some patients will suffer harm and even death during their journey through the healthcare system. This represents a major challenge, and many solutions have been proposed during the last decades. How to reduce risk and use adverse events for improvement?

Recent findings

The concept of safety culture must be acknowledged and understood for moving from blame to learning. Procedural protocols and reports are only parts of the solution, and this overview paints a broader picture, referring to recent research on the nature of adverse events. The potential harm from advice based on faulty evidence represents a serious risk.

Focus must shift from an individual perspective to the system, promoting learning rather than punishment and disciplinary sanctions, and the recent opioid epidemic is an example of bad guidelines.
Impact of Time to Intervention on Catheter-Directed Therapy for Pulmonary Embolism
Authors: Lehr Andrew , Guichet Phillip , Garimella Bhaskara , Krolikowski Kelsey , Amoroso Nancy , Sista Akhilesh , Brosnahan Shari B.
Published: January 2023

OBJECTIVES:

Cather-directed therapies (CDTs) are an evolving therapeutic option for patients with intermediate-risk pulmonary embolism (PE). Although many techniques have been studied, there is limited evidence for the impact of timing of intervention on patient outcomes. Our objective was to assess the association between time to CDT in patients presenting with PE on patient-related outcomes such as length of stay (LOS) and mortality.

DESIGN:

Retrospective cohort study.

SETTING:

Single academic center.

PATIENTS:

We identified patients for which the PE response team had been activated from January 2014 to October 2021. Patients were split into two cohorts depending on whether they went to CDT less than 24 hours from admission (early) versus greater than 24 hours (late).

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Data on demographics, timing of interventions, pulmonary hemodynamics, and outcomes were collected. Sixty-four patients were included in analysis. Thirty-nine (63.8%) underwent their procedure less than 24 hours from admission, whereas 25 (36.2%) underwent the procedure after 24 hours. The time from admission to CDT was 15.9 hours (9.1–20.3 hr) in the early group versus 33.4 (27.9–41) in the late group (p ≤ 0.001). There was a greater decrease in pulmonary artery systolic pressure after intervention in the early cohort (14 mm Hg [6–20 mm Hg] vs 6 mm Hg [1–10 mm Hg]; p = 0.022). Patients who received earlier intervention were found to have shorter hospital LOS (4 vs 7 d; p = 0.038) and ICU LOS (3 vs 5 d; p = 0.004). There was no difference in inhospital mortality between the groups (17.9% vs 12%; p = 0.523).

CONCLUSIONS:

Patients who underwent CDT within 24 hours of admission were more likely to have shorter hospital and ICU LOS. The magnitude of change in LOS between the two cohorts was not fully explained by the difference in time to CDT. There were modest improvements in pulmonary hemodynamics in the patients who underwent CDT earlier.
Impact of Antibiotic Time-Outs in Multidisciplinary ICU Rounds for Antimicrobial Stewardship Program on Patient Survival: A Controlled Before-and-After Study
Authors: Mishima Yuka , Nawa Nobutoshi , Asada Mizuho , Nagashima Michio , Aiso Yoshibumi , Nukui Yoko , Fujiwara Takeo , Shigemitsu Hidenobu
Published: January 2023

OBJECTIVES:

The antimicrobial stewardship program (ASP) is an important quality improvement initiative that is recommended in the ICU. However, the shortage of infectious disease physicians in Japan has led to the need for simpler methods for implementing ASPs. We investigated whether antibiotic time-outs (ATOs) during multidisciplinary rounds as part of an ASP can improve patient survival and reduce the number of days of therapy (DOT) with antibiotics.

DESIGN:

Single-center controlled before-and-after study.

SETTING:

Medical/surgical ICU in a tertiary university medical center in Tokyo, Japan.

PATIENTS:

All patients 16 years old or older admitted consecutively in the ICU between October 2016 and March 2020.

INTERVENTIONS:

An intensivist-driven ICU multidisciplinary round was introduced in October 2016, and ATOs with ICU rounds were implemented in June 2018. ATOs were conducted 3, 7, and 14 days after initiation of antibiotics.

MEASUREMENTS AND MAIN RESULTS:

The primary outcome was the subdistribution hazard ratio (SHR) of survival to hospital discharge compared between multidisciplinary rounds (phase 1) and ATO during multidisciplinary rounds (phase 2) using the multivariable Fine-Gray model. The secondary outcomes were the SHR of survival to ICU discharge and the trends in the DOT with IV antibiotics per 1,000 patient-days between October 2016 and March 2020 by using interrupted time-series analysis. The number of patients in phases 1 and 2 was 777 and 796, respectively. The group that underwent ATO during multidisciplinary rounds showed a significant increase in the survival to hospital discharge in comparison with the multidisciplinary round-only group (SHR, 1.13; 95% CI, 1.02–1.25); however, the SHR of survival to ICU discharge showed no significant intergroup difference. The DOT with total IV antibiotics decreased after ATO implementation (change in intercept, –178.26; 95% CI, –317.74 to –38.78; change in slope, –7.00; 95% CI, –15.77 to 1.78).

CONCLUSIONS:

ATOs during multidisciplinary rounds are associated with improved patient survival and reduced DOT.
Impact of Hospital Safety-Net Burden on Outcomes of In-Hospital Cardiac Arrest in the United States
Authors: Olanipekun Titilope , Abe Temidayo , Chris-Olaiya Abimbola , Effoe Valery S. , Bhardwaj Abhishek , Harrison Michael F. , Moreno Franco Pablo , Guru Pramod , Sanghavi Devang
Published: January 2023

IMPORTANCE:

High safety-net burden hospitals (HBHs) treating large numbers of uninsured or Medicaid-insured patients have generally been linked to worse clinical outcomes. However, limited data exist on the impact of the hospitals’ safety-net burden on in-hospital cardiac arrest (IHCA) outcomes in the United States.

OBJECTIVES:

To compare the differences in survival to discharge, routine discharge home, and healthcare resource utilization between patients at HBH with those treated at low safety-net burden hospital (LBH).

DESIGN, SETTING, AND PARTICIPANTS:

Retrospective cohort study across hospitals in the United States: Hospitalized patients greater than or equal to 18 years that underwent cardiopulmonary resuscitation (CPR) between 2008 and 2018 identified from the Nationwide Inpatient Database. Data analysis was conducted in January 2022.

EXPOSURE:

IHCA.

MAIN OUTCOMES AND MEASURES:

The primary outcome is survival to hospital discharge. Other outcomes are routine discharge home among survivors, length of hospital stay, and total hospitalization cost

RESULTS:

From 2008 to 2018, an estimated 555,016 patients were hospitalized with IHCA, of which 19.2% occurred at LBH and 55.2% at HBH. Compared with LBH, patients at HBH were younger (62 ± 20 yr vs 67 ± 17 yr) and predominantly in the lowest median household income (< 25th percentile). In multivariate analysis, HBH was associated with lower chances of survival to hospital discharge (adjusted odds ratio [aOR], 0.88; 95% CI, 0.85–0.96) and lower odds of routine discharge (aOR, 0.6; 95% CI, 0.47–0.75), compared with LBH. In addition, IHCA patients at publicly owned hospitals and those with medium and large hospital bed size were less likely to survive to hospital discharge, while patients with median household income greater than 25th percentile had better odds of hospital survival.

CONCLUSIONS AND RELEVANCE:

Our study suggests that patients who experience IHCA at HBH may have lower rates and odds of in-hospital survival and are less likely to be routinely discharged home after CPR. Median household income and hospital-level characteristics appear to contribute to survival.
Electrical Impedance Tomography As a Bedside Diagnostic Tool for Pulmonary Embolism
Authors: Prins Susanne A. , Weller Dolf , Labout Joost A. M. , den Uil Corstiaan A.
Published: January 2023

BACKGROUND:

Electrical impedance tomography (EIT) has been shown to be of value in evaluating the distribution of ventilation. In addition, several studies, particularly case reports, have demonstrated the use of EIT in the assessment of lung perfusion. EIT may be a potential diagnostic bedside tool in the diagnosis and follow-up of acute pulmonary embolism.

CASE SUMMARY:

We present one case of a patient with COVID-19 who likely had pulmonary thromboembolism where perfusion scans were made before and after thrombolytic therapy. Perfusion scans showed improvement after thrombolytic therapy. This article should therefore be seen as a first step in proving the validity of EIT-derived perfusion scans as a diagnostic for pulmonary embolism.

CONCLUSION:

The hypertonic saline bolus EIT method as a diagnostic tool for pulmonary embolism is a promising new technique, which can be particularly meaningful for critically ill patients. Further study is required to evaluate the sensitivity and specificity of this technique and the impact on decision-making and outcomes of critically ill patients.
Assessment of Opioid-Induced Immunomodulation in Experimental and Clinical Sepsis
Authors: Bissell Brittany D. , Sturgill Jamie L. , Bruno Maria E. C. , Lewis Erick D. , Starr Marlene E.
Published: January 2023

CONTEXT:

Opioids remain a standard supportive therapy in patients admitted to the ICU with sepsis. However, as preclinical models indicate an association between opioid exposure and immunosuppression, the use of this class of drugs warrants investigation. The objective of this study was to investigate whether opioid exposure causes immunosuppression in patients with sepsis, and to use a murine sepsis model to determine the effects of opioid exposure on secondary infection.

HYPOTHESIS:

We hypothesized opioid exposure would be associated with immunosuppression in patients with sepsis and secondary infection in a murine sepsis model.

METHODS AND MODELS:

This was a two-phase preclinical and clinical study. The clinical phase included a subgroup of patients with sepsis from an existing randomized controlled trial while the preclinical phase used a murine model of sepsis with C57BL/6 mice. In the clinical phase, a post hoc analysis was performed in subjects receiving fentanyl versus no opioid receipt. In the preclinical phase, a murine cecal slurry-induced sepsis model followed by secondary infection was used. Mice were randomized to fentanyl versus no fentanyl concomitantly.

RESULTS:

In clinical sepsis, a significant decrease in interleukin-23 (IL-23) level in patients with fentanyl exposure was observed and lower IL-23 was associated with mortality (p < 0.001). Other measured cytokines showed no significant differences. Concomitant fentanyl exposure during murine sepsis was associated with a significantly higher bacterial burden (p < 0.001) after secondary infection; however, immune cell counts and plasma cytokine levels were largely unaffected by fentanyl.

INTERPRETATION AND CONCLUSIONS:

Minimal alterations in cytokines were seen with opioid exposure during clinical sepsis. In a preclinical model, opioid exposure during sepsis was associated with ineffective bacterial clearance upon secondary infection. Further studies are warranted to evaluate the immunomodulatory role of opioids and their implications, especially in the post-sepsis period.
Characteristics of Mid-Term Post-Intensive Care Syndrome in Patients Attending a Follow-Up Clinic: A Prospective Comparison Between COVID-19 and Non-COVID-19 Survivors
Authors: Rousseau Anne-Françoise , Colson Camille , Minguet Pauline , Kellens Isabelle , Collard Maxine , Vancraybex Camille , Guiot Julien , Lambermont Bernard , Misset Benoit
Published: January 2023

IMPORTANCE:

At present, it is not clear if critically ill COVID-19 survivors have different needs in terms of follow-up compared with other critically ill survivors, and thus if duplicated post-ICU trajectories are mandatory.

OBJECTIVES:

To compare the post-intensive care syndrome (PICS) of COVID-19 acute respiratory distress syndrome and non-COVID-19 (NC) survivors referred to a follow-up clinic at 3 months (M3) after ICU discharge.

DESIGN, SETTING, AND PARTICIPANTS:

Adults who survived an ICU stay greater than or equal to 7 days and attended the M3 consultation were included in this observational study performed in a post-ICU follow-up clinic of a single tertiary hospital.

MAIN OUTCOMES AND MEASURES:

Patients underwent a standardized assessment, addressing health-related quality of life (3-level version of EQ-5D), sleep disorders (Pittsburgh Sleep Quality Index [PSQI]), physical status (Barthel index, handgrip and quadriceps strengths), mental health disorders (Hospital Anxiety and Depression Scale and Impact of Event Scale-Revised [IES-R]), and cognitive impairment (Montreal Cognitive Assessment [MoCA]).

RESULTS:

A total of 143 survivors (86 COVID and 57 NC) attended the M3 consultation. Their median age and severity scores were similar. NC patients had a shorter ICU stay (10 d [8–17.2 d]) compared with COVID group (18 d [10.8–30 d]) (p = 0.001). M3 outcomes were similar in the two groups, except for a higher PSQI (p = 0.038) in the COVID group (6 [3–9.5]) versus NC group (4 [2–7]), and a slightly lower Barthel index in the NC group (100 [100–100]) than in the COVID group (100 [85–100]) (p = 0.026). However, the proportion of patients with abnormal values at each score was similar in the two groups. Health-related quality of life was similar in the two groups. The three MoCA (≥ 26), IES-R (<33), and Barthel (=100) were normal in 58 of 143 patients (40.6%). In contrast, 68.5% (98/143) had not returned to their baseline level of daily activities.

CONCLUSIONS AND RELEVANCE:

In our follow-up clinic at 3 months after discharge, the proportion of patients presenting alterations in the main PICS domains was similar whether they survived a COVID-19 or another critical illness, despite longer ICU stay in COVID group. Cognition and sleep were the two most affected PICS domains.