bluuebunny/crossref_metadata_2025 huggingface dataset:
Late-Onset Sepsis Evaluation and Empiric Therapy in Extremely Low Gestational Age Newborns
Authors: Speier Rebecca L , Cotten C Michael , Benjamin Daniel K , Lewis Kelsey , Keeler Kristin , Kidimbu Glory , Roberts William , Clark Reese H , Zimmerman Kanecia O , Stark Ashley , Greenberg Rachel G
Published: December 2023

Background

Little is known about late-onset sepsis (LOS) evaluations in extremely low gestational age newborns (ELGANs). We describe frequencies of LOS evaluation in ELGANs, infant characteristics, and empiric therapy choices during evaluations.

Methods

Cohort study of infants 22–28 weeks gestational age (GA) discharged from 243 centers from 2009 to 2018, excluding infants with congenital anomalies, discharged or deceased prior to postnatal day (PND) 2, or admitted after PND 2. A new LOS evaluation was defined as the first blood culture obtained between PND 3 and 90, or one obtained ≥1 day following a negative culture and ≥10 days from prior positive cultures. We determined numbers of evaluations and percentage positive by GA, center, and over time. We described characteristics associated with positive evaluations, infants with LOS, and empiric antimicrobials. We calculated descriptive and comparative statistics using Wilcoxon rank sum, Fisher’s exact, or Pearson chi-square tests, as appropriate.

Results

Of 47,187 included infants, 67% had ≥1 LOS evaluation and 21% of evaluated infants had ≥1 LOS (culture positive) episode; 1.6 evaluations occurred per infant and 10% were positive. The percentage of infants evaluated and positive for LOS was higher at earlier GA. LOS was associated with inotrope support (15% vs. 9%; p < .001) and invasive mechanical ventilation (66% vs. 51%; p < .001). Infants with positive cultures were more likely than infants with negative cultures to receive empiric antimicrobials during the LOS evaluation (95% vs. 73%; p < .001).

Conclusions

Among ELGANs, earlier GA and postnatal age were associated with LOS evaluation and positive cultures. Most infants undergoing evaluation were started on empiric antimicrobials.
School Absenteeism as a Marker for Community COVID-19 Rates
Authors: Stark Ashley , Benjamin Daniel K , Kajencki Anthony , Mann Katelyn , Rodriguez Natalie , Troan Ian , Hill Larry , Boutzoukas Angelique E , Zimmerman Kanecia O
Published: December 2023

Background

Reported community transmission rates of coronavirus disease 2019 (COVID-19) may not be accurate, particularly since at-home testing has become widely available. School absenteeism may serve as a marker of broader community COVID-19 transmission.

Methods

We performed an observational study of North Carolina kindergarten through 12th grade schools participating in the ABC Science Collaborative that offered in-school instruction, and contributed severe acute respiratory syndrome coronavirus 2 data for at least 2 of 4 weeks monthly for the 2021–2022 academic year. Additionally, we analyzed publicly available databases including the North Carolina Department of Public Instruction, Centers for Disease Control and Prevention COVID-19 Data Repository, and National Center for Education Statistics. We described community and school COVID-19 infection rates compared with student monthly absenteeism rates to determine if the relationship between community COVID-19 infection rates and student absenteeism varied over time.

Results

We included 500 192 students from 27 school districts. For the 2021–2022 academic year, the student and community COVID-19 infection rates did not show a significant difference (P > .05) across each month of comparison. Student absenteeism rates and community COVID-19 infection rates by month showed a similar trend across the academic year. For every 1% increase in community infection percentage, we found a 1.68% (1.12–2.25%) increase in absenteeism (P < .001); for every 1 month change in time, we found a 0.12% (0.01–0.24%) increase in absenteeism (P < .05).

Conclusions

Student absenteeism and infection rates may be a useful marker of COVID-19 community infection rates when testing frequency and results reporting are inconsistent.
The HulC: confidence regions from convex hulls
Authors: Kuchibhotla Arun Kumar , Balakrishnan Sivaraman , Wasserman Larry
Published: December 2023

We develop and analyse the HulC, an intuitive and general method for constructing confidence sets using the convex hull of estimates constructed from subsets of the data. Unlike classical methods which are based on estimating the (limiting) distribution of an estimator, the HulC is often simpler to use and effectively bypasses this step. In comparison to the bootstrap, the HulC requires fewer regularity conditions and succeeds in many examples where the bootstrap provably fails. Unlike sub-sampling, the HulC does not require knowledge of the rate of convergence of the estimators on which it is based. The validity of the HulC requires knowledge of the (asymptotic) median bias of the estimators. We further analyse a variant of our basic method, called the Adaptive HulC, which is fully data-driven and estimates the median bias using sub-sampling. We discuss these methods in the context of several challenging inferential problems which arise in parametric, semi-parametric, and non-parametric inference. Although our focus is on validity under weak regularity conditions, we also provide some general results on the width of the HulC confidence sets, showing that in many cases the HulC confidence sets have near-optimal width.
TauSTED super-resolution imaging of labile iron in primary hippocampal neurons
Authors: Kittilukkana Aiyarin , Carmona Asuncion , Pilapong Chalermchai , Ortega Richard
Published: December 2023

Iron dyshomeostasis is involved in many neurological disorders, particularly neurodegenerative diseases where iron accumulates in various brain regions. Identifying mechanisms of iron transport in the brain is crucial for understanding the role of iron in healthy and pathological states. In neurons, it has been suggested that iron can be transported by the axon to different brain regions in the form of labile iron; a pool of reactive and exchangeable intracellular iron. Here we report a novel approach to imaging labile ferrous iron, Fe(II), in live primary hippocampal neurons using confocal and TauSTED (stimulated emission depletion) microscopy. TauSTED is based on super-resolution STED nanoscopy, which combines high spatial resolution imaging (<40 nm) with fluorescence lifetime information, thus reducing background noise and improving image quality. We applied TauSTED imaging utilizing biotracker FerroFarRed Fe(II) and found that labile iron was present as submicrometric puncta in dendrites and axons. Some of these iron-rich structures are mobile and move along neuritic pathways, arguing for a labile iron transport mechanism in neurons. This super-resolution imaging approach offers a new perspective for studying the dynamic mechanisms of axonal and dendritic transport of iron at high spatial resolution in living neurons. In addition, this methodology could be transposed to the imaging of other fluorescent metal sensors.
Consensus framework for conducting phase I/II clinical trials for children, adolescents, and young adults with pediatric low-grade glioma: Guidelines established by the International Pediatric Low-Grade Glioma Coalition Clinical Trial Working Group
Authors: Mueller Sabine , Fangusaro Jason , Thomas Arzu Onar , Jacques Thomas S , Bandopadhayay Pratiti , de Blank Peter , Packer Roger J , Fouladi Maryam , van Meeteren Antoinette Schouten , Jones David , Perry Arie , Nakano Yoshiko , Hargrave Darren , Riedl David , Robison Nathan J , Partanen Marita , Fisher Michael J , Witt Olaf
Published: December 2023

Within the last few decades, we have witnessed tremendous advancements in the study of pediatric low-grade gliomas (pLGG), leading to a much-improved understanding of their molecular underpinnings. Consequently, we have achieved successful milestones in developing and implementing targeted therapeutic agents for treating these tumors. However, the community continues to face many unknowns when it comes to the most effective clinical implementation of these novel targeted inhibitors or combinations thereof. Questions encompassing optimal dosing strategies, treatment duration, methods for assessing clinical efficacy, and the identification of predictive biomarkers remain unresolved. Here, we offer the consensus of the international pLGG coalition (iPLGGc) clinical trial working group on these important topics and comment on clinical trial design and endpoint rationale. Throughout, we seek to standardize the global approach to early clinical trials (phase I and II) for pLGG, leading to more consistently interpretable results as well as enhancing the pace of novel therapy development and encouraging an increased focus on functional endpoints as well and quality of life for children faced with this disease.
The impact of the Mediterranean diet on alleviating depressive symptoms in adults: a systematic review and meta-analysis of randomized controlled trials
Authors: Bizzozero-Peroni Bruno , Martínez-Vizcaíno Vicente , Fernández-Rodríguez Rubén , Jiménez-López Estela , Núñez de Arenas-Arroyo Sergio , Saz-Lara Alicia , Díaz-Goñi Valentina , Mesas Arthur Eumann
Published: December 2023

Context

High adherence to the Mediterranean diet (MD) has been associated with a reduced risk of depression in prospective cohort studies, but whether MD interventions are effective among adults with depression is uncertain.

Objective

This study aimed to synthesize findings on the effects of MD interventions on the severity of depressive symptoms in adults with depression.

Data Sources

PubMed, Cochrane CENTRAL, PsycINFO, Scopus, and Web of Science were systematically searched from database inception to March 2023. The Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines and the Cochrane recommendations were followed. We included randomized controlled trials (RCTs) comparing outcomes after MD interventions with outcomes for control conditions in adults with depressive disorders or depressive symptoms.

Data Extraction

Two authors extracted the data independently. The Sidik-Jonkman estimator, the I2 metric, and the prediction interval were used to estimate between-study heterogeneity. To determine the risk of bias and the certainty of evidence from RCTs, we used the Cochrane Collaboration’s Risk of Bias 2 and Grades of Recommendation, Assessment, Development, and Evaluation tools, respectively.

Data Analysis

In total, 1507 participants (mean age range: 22.0 years–53.3 years) with depression were initially included in the 5 RCTs of this review. Compared with control conditions, MD interventions significantly reduced depressive symptoms among young and middle-aged adults with major depression or mild to moderate depressive symptoms (standardized mean difference: –0.53; 95% confidence interval: –0.90 to –0.16; I2 = 87.1%). The prediction interval ranged from –1.86 to 0.81. The overall risk of bias was within the range of “some concerns” to “high,” while the certainty of evidence was low.

Conclusion

MD interventions appear to have substantial potential for alleviating depressive symptoms in people experiencing major or mild depression. However, to establish robust recommendations, there remains a need for high-quality, large-scale, and long-term RCTs.

Systematic Review Registration

PROSPERO registration no. CRD42022341895.
DesC1 and DesC2, Δ9 Fatty Acid Desaturases of Filamentous Cyanobacteria: Essentiality and Complementarity
Authors: Effendi Devi B , Suzuki Iwane , Murata Norio , Awai Koichiro
Published: December 2023

DesC1 and DesC2, which are fatty acid desaturases found in cyanobacteria, are responsible for introducing a double bond at the Δ9 position of fatty-acyl chains, which are subsequently esterified to the sn-1 and sn-2 positions of the glycerol moiety, respectively. However, since the discovery of these two desaturases in the Antarctic cyanobacterium Nostoc sp. SO-36, no further research has been reported. This study presents a comprehensive characterization of DesC1 and DesC2 through targeted mutagenesis and transformation using two cyanobacteria strains: Anabaena sp. PCC 7120, comprising both desaturases, and Synechocystis sp. PCC 6803, containing a single Δ9 desaturase (hereafter referred to as DesCs) sharing similarity with DesC1 in amino acid sequence. The results suggested that both DesC1 and DesC2 were essential in Anabaena sp. PCC 7120 and that DesC1, but not DesC2, complemented DesCs in Synechocystis sp. PCC 6803. In addition, DesC2 from Anabaena sp. PCC 7120 desaturated fatty acids esterified to the sn-2 position of the glycerol moiety in Synechocystis sp. PCC 6803.
Occupational internal monitoring in nuclear medicine service of Sainte-Anne military hospital: previous considerations and results
Authors: Gervot Héloïse , Letessier Wilfried , Loess Jérôme , Bayle-Escurat Christopher , Métivier Denis , Saurat Dominique , Jamet-Anselme Emilie
Published: December 2023

The Nuclear Medicine Department of Sainte-Anne military hospital in Toulon uses 99mTc, 123I and 18F unsealed sources to provide therapeutic and diagnostic care. For a few years, only ambient air and surface monitoring were performed to check the absence of internal contamination risk for workers. To verify this risk assessment hypothesis, confirmatory monitoring programme including in vivo and in vitro measurements was performed by the French defence radiation protection service (SPRA, Clamart). Here, due to the short half-life of targeted radionuclides, the analytical sensitivity was determined with estimations of minimal detectable activities and derived recording levels. It was shown that sensitivity was sufficient to detect an internal contamination leading to an effective dose of 0.1 mSv for few days post intake. At the same time, around 20 whole-body countings were performed. Results were below minimal detectable activity and were confirmed by 24-hours urine analysis. So, actual working conditions do not lead to measurable internal contamination for nuclear medicine staff.
New regulation of family foundations in Poland and their usefulness in intergenerational estate planning
Authors: Moszyńska Anna
Published: December 2023

Through the Family Foundation Act of 22 May 2023, a new institution of family (private) foundation has been introduced in the Polish legal system. This was long awaited, because while Polish law does not recognise either trusts or any trust-like institutions, the need for a legal instrument enabling intergenerational succession planning was relatively high. It is therefore not surprising that this new institution of family foundations quickly gained popularity. Presenting the most important rules introduced into Polish law allows us to point out the advantages and disadvantages of these new provisions.
Pulmonary Metastasis at the First Site After Curative Surgery for Colon Cancer: Incidence and Risk Factors According to TNM Stage
Authors: Kim Seijong , Huh Jung Wook , Lee Woo Yong , Yun Seong Hyeon , Kim Hee Cheol , Cho Yong Beom , Park Yoon Ah , Shin Jung Kyong
Published: December 2023

BACKGROUND:

The lungs are one of the most common sites for colon cancer metastasis. A few studies reported that approximately 2–10% of colon cancer patients developed pulmonary metastasis. However, among these studies, patient characteristics were heterogeneous and information on pulmonary metastasis incidence by TNM stage was scarce.

OBJECTIVE:

This study evaluated the incidence of pulmonary metastasis in colon cancer without synchronous metastasis treated with radical surgery and identified risk factors for pulmonary metastasis according to TNM stage.

DESIGN AND SETTINGS:

This retrospective study included all patients with colon cancer without metastasis who underwent radical surgery for primary tumor at Samsung Medical Center between January 2007 and December 2016.

PATIENTS:

A total of 4,889 patients who underwent radical surgery for stage I–III colon cancer was included.

MAIN OUTCOME MEASURES:

The main outcome measures were incidence of pulmonary metastasis and overall survival

RESULTS:

A total of 156 patients (3.2%) were diagnosed with pulmonary metastasis with a 16-month median duration from the time of radical surgery for colon cancer to detection of pulmonary metastasis. The pulmonary metastasis incidence rate by TNM stage was 0.5% in stage I, 1.6% in stage II, and 6% in stage III. Risk factors for pulmonary metastasis were preoperative CEA higher than 5 ng/ml, cancer obstruction, N stage, vascular invasion, perineural invasion, and adjuvant chemotherapy for primary colon cancer in multivariable analysis.

LIMITATION:

This was a retrospective single-center study.

CONCLUSION:

Preoperative CEA higher than 5 ng/ml, cancer obstruction, pN stage, vascular invasion, perineural invasion, and receiving adjuvant chemotherapy for primary colon cancer were risk factors for pulmonary metastasis in colon cancer. Therefore, patients with risk factors for pulmonary metastasis should be recommend for intensive follow-up to detect lung metastases. See Video Abstract.
Plastic Surgical Outreach to Low- and Middle-income Countries and Global Health Priorities: An Analysis of 96 Nongovernmental Organizations
Authors: Yan Allison , Castellanos Sydney L. , Chao Albert H.
Published: December 2023

Background:

Conditions that are treated by surgery constitute a significant portion of the global burden of disease. In low- and middle-income countries (LMICs), allocation of resources toward the most cost-effective surgical procedures (essential surgery) and care delivery platforms is critical. Nongovernmental organizations (NGOs) and the plastic surgeons who work with them play a significant role in plastic surgical outreach to LMICs. However, it is unknown whether their work aligns with existing global public health recommendations.

Methods:

A previously established internet-based methodology was used to identify plastic surgical NGOs. Through direct correspondence with NGOs and publicly available data, plastic surgical NGOs were cataloged with respect to the subspecialty areas of plastic surgery performed, care delivery platforms, and geographic sites. These results were then compared with the existing global public health recommendations.

Results:

A total of 96 NGOs met inclusion criteria. The most common subspecialty area was cleft surgery (80.3%), followed by pediatric plastic surgery (46.9%). No NGOs used a continuous care delivery platform. Instead, all NGOs used an intermittent model through short-term surgical missions, of which 62.8% used a nonrotating care model and returned to the same site(s) annually, whereas 37.2% used a rotating care model.

Conclusions:

Most NGOs perform cleft surgery, an area considered essential surgery, and thus, collectively, the work of NGOs largely aligns with global public health priorities. However, there is room for improvement for both the types of procedures performed and the care delivery platforms to provide the most cost-effective and sustainable care.
Changes in OCTA measures throughout the day: Diurnal variation or test-retest variability?
Authors: Altinbay Beyza Tekin , Kurt Emin , Altinisik Muhammed
Published: December 2023

Purpose:

To evaluate the repeatability and diurnal variation of the retinal vessel density (VD) and foveal avascular zone (FAZ) parameters using optical coherence tomography angiography (OCTA).

Methods:

41 healthy individuals were measured twice in the morning and once in the evening. FAZ area, perimetry, foveal density (FD); superficial and deep capillary plexus (SCP, DCP) VD, central macular thickness (CMT) were evaluated with the intraclass correlation coefficient (ICC), coefficient of repeatability (CR) and Bland-Altman plots.

Results:

Repeatability was evaluated with two consecutive scans taken in the morning. The CRs (%) was 5.4; 4.3 and 8.8 for the FAZ area, perimetry and FD respectively with excellent ICCs. ICC was poor for parafovea (0.33), whereas excellent for fovea (0.97) in SCP-VD. CR for fovea and parafovea, were 19.19% and 10.43% respectively. ICC values were poor (0.3-0.4) with 10-16% measurement differences in DCP-VD parameters. CRs for CMT were between 1-2% with excellent ICC. The analysis on diurnal variation yielded comparable results.

Conclusion:

Except for the parafoveal VD, OCTA is a highly reproducible device for measuring FAZ and VD using 6x6 scans with undilated pupils. However, variation in OCTA parameters observed throughout the day could be attributed to test-retest variation rather than diurnal rhythm.
Quantitative autofluorescence in central serous chorioretinopathy
Authors: Weber Constance , Schaetzle Lea Sophie , Stasik Isabel , Emde Leon von der , Holz Frank G. , Liegl Raffael
Published: December 2023

Introduction:

Central serous chorioretinopathy (CSC) is associated with pachychoroid and dysfunctional RPE. Autofluorescence (AF) is typically altered. We performed this study to quantify these alterations using quantitative AF (qAF) in patients with CSC and in their fellow-eye in comparison with a healthy control group.

Material and Methods:

Patients with CSC and healthy patients were recruited prospectively. All patients received a full clinical examination including best corrected visual acuity (BCVA), enhanced depth imaging-OCT and qAF. QAF images were taken with a confocal scanning laser ophthalmoscope (Heidelberg Engineering). QAF values were assessed in specified regions of the inner eight (IN8) and the middle ring (MID) of the Delori-grid.

Results:

141 eyes of 77 patients with CSC were included. 90 eyes had a manifest CSC (group 1) while 51 fellow-eyes (group 2) did not show signs of CSC. There were no significant differences of qAF values between these two groups: mean qAF values were 241.3 (IN8) and 212.8 (MID) in group 1 and 235.9 (IN8) and 210.0 (MID) in group 2 (p=1.0 and 1.0). We compared these eyes to healthy controls comprising 39 eyes. QAF signals (IN8: 164.7; MID:148.9) differed significantly compared to both CSC manifest (p<0.001) and fellow eyes (p<0.001).

Conclusions:

Our results show that patients with CSC have increased qAF values in both eyes with manifest CSC and asymptomatic, clinically unremarkable fellow-eyes in comparison to healthy controls. This finding suggests that qAF alterations are present even before clinical signs can be observedand might therefore serve as an early biomarker.
Secondary Data Analysis of Inflammation-Related mRNAs in Conjunctival Impression Cytology Samples of Aniridia Patients
Authors: Stachon Tanja , Latta Lorenz , Fries Fabian N. , Seitz Berthold , Szentmáry Nóra
Published: December 2023

Purpose:

Aniridia is a rare corneal disease that is often associated with aniridia-associated keratopathy (AAK). In AAK, the conjunctival tissue crosses the limbal border, forming a corneal pannus that extends into the corneal center. With increasing AAK severity, corneal pannus formation, vascularization, and ocular surface inflammation increase. The purpose of this study was to investigate inflammation-related mRNA expression in conjunctival epithelial cells in AAK and its relationship with AAK severity.

Methods:

Using impression cytology, bulbar conjunctival cells were sampled from 20 subjects with congenital aniridia and 20 age-matched and sex-matched healthy control subjects. RNA was extracted, and mRNA analyses were performed using microarray, which was evaluated for inflammatory markers.

Results:

In the analyzed aniridia subjects, 70 deregulated mRNAs encoding proinflammatory or antiinflammatory cytokines or factors associated with chronic inflammation, including increased IL-1, IL-8, and MIP3A/CCL20 mRNA. The most downregulated mRNA was TIMP3, and the most upregulated mRNA was Protein c-Fos.

Of the 70 mRNAs, 14 inflammation-related genes were altered only in the mild AAK forms, whereas only 2 mRNAs were altered only in the severe AAK forms (TLR4 and PPARG).

Conclusions:

The expression of numerous proinflammatory and antiinflammatory cytokines is deregulated at the ocular surface of aniridia subjects with mild AAK. Thus, early antiinflammatory treatment may prevent or slow down corneal scarring and pannus formation in aniridia subjects.
Black Henna Deposits Masquerading a Melanoma of the Plica Semilunaris
Authors: Kiratli Hayyam , Rustamova Nargiz , Koç Irem , Babaoğlu Berrin Büyükeren
Published: December 2023

Purpose:

The aim of this study was to describe a rare case of conjunctival black henna accumulation that was clinically misdiagnosed as melanoma.

Methods:

This retrospective case report reviewed the clinical findings and histopathologic features of a pigmented plica semilunaris lesion excised from a 63-year-old woman. The patient had a history of regular use of black henna in her childhood. The conjunctival pigmentation was present since her early teenage years but started to grow only recently.

Results:

There was a darkly pigmented mass mainly covering the plica semilunaris of the right eye with additional irregularly scattered pigmentation in the medial bulbar conjunctiva. Excisional biopsy of the plical tumor revealed nodular pigment deposits with lymphocytic infiltration. There were no neoplastic cells. The specimen stained negative for pan-keratin, CD68, and CD34. Melanin bleaching was also negative.

Conclusions:

Long-term exposure to black henna as a hair dye may lead to subconjunctival accumulation and mimic melanoma.
Evaluation and Comparison of the Effectiveness of Atropine Eye Drops, Ipratropium Bromide Nasal Spray, and Amitriptyline Tablet in the Management of Clozapine-Associated Sialorrhea in Patients With Refractory Schizophrenia: A Randomized Clinical Trial
Authors: Mohammad-Gholizad Fatemeh , Karimzadeh Iman , Moghimi-Sarani Ebrahim , Arshadi Mahdi , Mortazavi Negar
Published: December 2023

Purpose

Clozapine, a second-generation antipsychotic medication, is mainly indicated for managing treatment-resistant schizophrenia. Among all the nonthreatening adverse effects of clozapine, sialorrhea is a stigmatizing complication occurring in approximately 31.0% to 97.4% of patients. In this study, 2 topical agents (atropine eye drop and ipratropium nasal spray) and a systemic medication (amitriptyline) were compared simultaneously for the management of clozapine-associated sialorrhea.

Methods

We conducted a randomized, single-blinded, non–placebo-controlled clinical trial from June 2022 to January 2023. Eligible patients were randomly allocated into 3 mentioned groups. Patients were monitored for sialorrhea weekly based on scales, including the Toronto Nocturnal Hypersalivation Scale, Clinical Global Impression-Improvement, and Clinical Global Impression-Severity for 1 month. Possible adverse drug reactions and adherence were also recorded.

Results

Twenty-four patients, including 6, 10, and 8 individuals in ipratropium bromide nasal spray, atropine eye drop, and amitriptyline groups, completed the study, respectively. The cohort's demographic, baseline clinical, and sociocultural characteristics were comparable among the 3 groups. Within-group comparisons, between times baseline and week 4, demonstrated that significant differences were in groups atropine and amitriptyline based on Toronto Nocturnal Hypersalivation Scale, in 3 groups based on Clinical Global Impression-Improvement, and also in only-atropine group based on Clinical Global Impression-Severity. Likewise, between-group comparisons showed that atropine was significantly more effective in clozapine-associated sialorrhea management than amitriptyline and ipratropium, in the first 2 weeks and second 2 weeks of study, respectively. Regarding safety, the interventions were tolerated relatively well.

Conclusions

Conclusively, atropine is more efficacious than amitriptyline, within the first 2 weeks of study and also relative to ipratropium, overall. As time effect was significant between atropine and amitriptyline, according to analysis of covariance test, further investigation with longer follow-up duration would be prudent. In addition, expanding patient population with larger sample size should be conducted for more precision.
Redesigning the First Prenatal Visit: A Quality Improvement Initiative
Authors: Christopher Diane , Fresia Joellen , Alexander Jennifer , Krenz Kristin , Aldrich Heather , Hampanda Karen
Published: December 2023

Background/Purpose:

In an era of rising maternal mortality, a thorough first prenatal visit is essential; however, in our clinic we confirmed that many important topics were not being addressed. To rectify this problem, we redesigned the first prenatal visit to improve the coverage of topics, collect social determinants of health, increase patient access, and maintain patient satisfaction.

Methods:

We designed a quality improvement project to improve the first prenatal visit in a faculty obstetrics and gynecology clinic. To assess effectiveness, data before and after the implementation were compared. The intervention divided the first prenatal visit into two patient encounters: a nurse-led telemedicine visit and an in-person visit with an obstetric clinician.

Results:

The median percentage of topics covered in the first prenatal visit increased from 70.0% to 95.6%, and improvements were observed for all key themes (p< .001). Social determinants of health was routinely collected postintervention (98.8%). A reduction in no-shows (9.9%–4.2%) improved patient access for all patients. Patient satisfaction for the first prenatal visit remained unchanged (p= .370).

Conclusions:

Significant improvements in addressing important topics at the first prenatal visit are achievable by separating one prenatal visit into two visits while increasing patient access and maintaining high patient satisfaction.
Black Applicants' Self-reported Reasons for Applying to a Doctor of Physical Therapy Program
Authors: Tombers Nicole , Pfeifer Rachel
Published: December 2023

Introduction.

Lack of access for minoritized groups to health care providers with a similar background negatively affects health outcomes. Adequate representation in the workforce begins with representation in health care education. The purpose of this study was to describe Black applicants' primary reasons for pursuing physical therapist education.

Review of Literature.

Prior surveys of enrolled Doctor of Physical Therapy (DPT) students have categorized factors influencing the decision to pursue physical therapy, with consideration of student demographics.

Subjects.

One thousand eight hundred nine Black applicants who applied to DPT programs through the Physical Therapist Centralized Application Service (PTCAS).

Methods.

In this retrospective holistic narrative analysis, essay responses from the 2020–2021 PTCAS application cycle (n = 17,801) were categorized by 2 reviewers into one of 9 categories based on the primary reason for applying to a DPT program. Interrater reliability was almost perfect (Kappa 0.946) based on a sample of 48 essays. Racial demographics were compared with US Census and DPT program acceptance and enrollment data from the same year.

Results.

Black individuals are underrepresented among both applicants to and enrollees in DPT programs when compared with US census data from the same year. Black applicants indicated personal experience with the field (33%, n = 597), observation in the field (28.7%, n = 520), and alignment with personal values and interests (27.6%, n = 500) as the most common reasons for applying.

Discussion and Conclusion.

Experience with the field and alignment with values and interest were the most commonly cited reasons among Black applicants for pursuing physical therapist education. Understanding why Black students apply to a DPT program is important for developing strategies to increase the number of Black students enrolled in physical therapy programs and ultimately the workforce.
Framboesiform Facial Lesions and Chorioretinopathy as Presenting Signs of Syphilis in an Immunocompetent Patient
Authors: Johnson Alex W. , Bloomquist Ryan F. , Fowler Teresa E. , Bloomquist Doan T.
Published: December 2023

Syphilis has long been considered the “great masquerader,” notorious for its varying presentations and ability to affect most organ systems in the body. We report the case of a 41-year-old immunocompetent man who presented to ophthalmology with rapidly progressive visual complaints from bilateral panuveitis and concomitant verrucous facial lesions initially disregarded by the patient as acne. Serum testing for syphilis was positive, and he was admitted for 14 days of intravenous (IV) penicillin with multiservice care from dermatology, ophthalmology, and infectious disease. We present photographic documentation showing his stepwise resolution of his facial and retinal involvement with penicillin treatment course. This case is unusual in the concomitant presentation of ocular and facial syphilitic findings in an immunocompetent patient and highlights the need to include syphilis in the differential for unusual appearances.
Validation of the Back-table Graft Arterial Anastomosis between the Splenic Artery and Superior Mesenteric Artery
Authors: Ferrer-Fàbrega Joana , Cárdenas Gabriel , Sapena Víctor , García-Criado Ángeles , Barrufet Marta , Pérez Carles , García-Pérez Rocío , Rull Ramón , López-Boado Miguel Ángel , Folch-Puy Emma , Torroella Alba , Ventura-Aguiar Pedro , Cofan Federico , Esmatjes Enric , Amor Antonio , Diekmann Fritz , Fernández-Cruz Laureano , García-Valdecasas Juan Carlos , Fuster Josep
Published: December 2023

Objective:

To determine the role of the arterial splenomesenteric anastomosis (ASMA) vascular reconstruction technique in terms of arterial vascular complications in pancreas transplant (PT) recipients.

Summary Background Data:

The ASMA technique was first described in 1992 by Hospital Clínic Barcelona group. Regardless that the iliac Y-graft technique is the most frequently used worldwide, evidence of arterial complications and implications of using a different back-table reconstruction is conspicuously absent in the literature.

Methods:

Descriptive review of 407 PTs performed at a single center (1999-2019) by analyzing the type of arterial reconstruction technique, focusing on ASMA. The endpoints were the management of arterial complications and long-term patient and graft survival.

Results:

ASMA was performed in 376 cases (92.4%) and a Y-graft in 31 cases (7.6%). A total of 34 arterial complications (8.3%) were diagnosed. In the ASMA group (n=30, 7.9%) they comprised: 15 acute thrombosis; 4 stenosis; 1 pseudoaneurysm and 10 diverse chronic arterial complications while in the Y-graft group (n=4, 12.9%) 3 acute thrombosis and 1 chronic artery-duodenal fistula occurred. Graft salvage was achieved in 16 patients (53.3%) from the ASMA group and in 2 (50%) from the Y-graft. After a median follow-up of 129.2 (IQR 25-75%, 77.2 –182) months the overall graft and patient survival for the whole cohort at 1, 5, and 10 years was 86.7%, 79.5%, 70.5%, and 98.5%, 95.3%, 92.5%, respectively.

Conclusions:

The ASMA proves to be a safe and more easily reproducible technique and should therefore be considered for first-line back-table reconstruction in the PT population.
Maintaining a whole blood-centered transfusion improves survival in hemorrhagic resuscitation
Authors: Feinberg Griffin J. , Tillman Anastasia C. , Paiva Marcelo L. , Emigh Brent , Lueckel Stephanie N. , Hynes Allyson M. , Kheirbek Tareq
Published: December 2023

BACKGROUND

Whole blood (WB) transfusion has been shown to improve mortality in trauma resuscitation. The optimal ratio of packed red blood cells (pRBC) to WB in emergent transfusion has not been determined. We hypothesized that a low pRBC/WB transfusion ratio is associated with improved survival in trauma patients.

METHODS

We analyzed the 2021 Trauma Quality Improvement Program (TQIP) database to identify patients who underwent emergent surgery for hemorrhage control and were transfused within 4 hours of hospital arrival, excluding transfers or deaths in the emergency department. We stratified patients based on pRBC/WB ratios. The primary outcome was mortality at 24 hours. Logistic regression was performed to estimate odds of mortality among ratio groups compared with WB alone, adjusting for injury severity, time to intervention, and demographics.

RESULTS

Our cohort included 17,562 patients; of those, 13,678 patients had only pRBC transfused and were excluded. Fresh frozen plasma/pRBC ratio was balanced in all groups. Among those who received WB (n = 3,884), there was a significant increase in 24-hour mortality with higher pRBC/WB ratios (WB alone 5.2%, 1:1 10.9%, 2:1 11.8%, 3:1 14.9%, 4:1 20.9%, 5:1 34.1%, p = 0.0001). Using empirical cutpoint estimation, we identified a 3:1 ratio or less as an optimal cutoff point. Adjusted odds ratios of 24-hour mortality for 4:1 and 5:1 groups were 2.85 (95% confidence interval [CI], 1.19–6.81) and 2.89 (95% CI, 1.29–6.49), respectively. Adjusted hazard ratios of 24-hour mortality were 2.83 (95% CI, 1.18–6.77) for 3:1 ratio, 3.67 (95% CI, 1.57–8.57) for 4:1 ratio, and 1.97 (95% CI, 0.91–4.23) for 5:1 ratio.

CONCLUSION

Our analysis shows that higher pRBC/WB ratios at 4 hours diminished survival benefits of WB in trauma resuscitation. Further efforts should emphasize this relationship to optimize trauma resuscitation protocols.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level III.
Genomic Medicine Guidance: A Point-of-Care App for Heritable Thoracic Aortic Diseases
Authors: Patil Rohan , Ashraf Fatima , Dayeh Samer Abu , Prakash Siddharth K.
Published: December 2023

Genetic testing can determine familial and personal risks for heritable thoracic aortic aneurysms and dissections (TAD). The 2022 ACC/AHA guidelines for TAD recommend management decisions based on the specific gene mutation. However, many clinicians lack sufficient comfort or insight to integrate genetic information into clinical practice. We therefore developed the Genomic Medicine Guidance (GMG) app, an interactive point-of care tool to inform clinicians and patients about TAD diagnosis, treatment, and surveillance. GMG is a REDCap-based app that combines publicly available genetic data and clinical recommendations based on the TAD guidelines into one translational education tool. TAD genetic information in GMG was sourced from the Montalcino Aortic Consortium, a worldwide collaboration of TAD centers of excellence, and the NIH genetic repositories ClinVar and ClinGen. The app streamlines data on the 13 most frequently mutated TAD genes with 2,286 unique pathogenic mutations that cause TAD so that users receive comprehensive recommendations for diagnostic testing, imaging, surveillance, medical therapy, preventative surgical repair, as well as guidance for exercise safety and management during pregnancy. The app output can be displayed in a clinician view or exported as an informative pamphlet in a patient-friendly format. The overall goal of the GMG app is to make genomic medicine more accessible to clinicians and patients, while serving as a unifying platform for research. We anticipate that these features will be catalysts for collaborative projects that aim to understand the spectrum of genetic variants that contribute to TAD.
Toward Precision Medicine in Aortopathies: Genetic Insights from a Brazilian Cohort Through Targeted Next-Generation Sequencing
Authors: Ferreira Juliana R. , Perreira Julia P. , Botelho Anna Paula A. , Aprijo Daniele N. , Melo Marcelo M. , Rey Helena C. V. , Dias Glauber M
Published: December 2023

Thoracic aortic diseases (or aortopathies) result from complex interactions between genetic and hemodynamic factors. Often clinically silent, these diseases can lead to lethal complications like aortic dissection or rupture. This study focused on a Brazilian cohort of 79 individuals with thoracic aortic diseases, exploring genetic factors through targeted next-generation sequencing (tNGS) of 15 priority genes. The majority of individuals had non-syndromic aortopathy, with eight diagnosed with Marfan syndrome (MFS). Pathogenic or likely pathogenic variants (PV/LPV) were found in five genes, including FBN1, ACTA2, TGFBR2, MYLK, and SMAD3. Notably, novel variants in FBN1 were identified, contributing to Marfan-like phenotypes. The diagnostic yield for isolated aortopathies was 7.1%, rising to 55.5% for syndromic cases. Variants of uncertain significance (VUS) were identified, emphasizing the need for further research and familial investigations to refine variant classifications. This study provides valuable insights into the genetic landscape of aortopathies in Brazil, aiding early diagnosis and personalized management.
Situational judgment test in A Sample of Iraqi Doctors
Authors: Raoof Dounia Ahmed , Kadhim Hawraa Haitham , Fadhil Dalal Ali , Al-mothaffar Ali Mohammed Jawad
Published: December 2023

Study Rationale

Health Authorities expect physicians to behave professionally with serious lapses in conduct that adversely impact the patients, the public and the profession.

Objectives

To explore the behavior and attitude towards complex, real-life situations met in the workplace in a sample of Iraqi doctors .The question was, is there any difference in the score between rotator doctors and senior resident doctors?

Methods

A cross sectional study conducted for rotators and senior residents selected randomly and the questionnaire was via face to face interview.. The questionnaire contains 10 Case Scenarios taken from the UK foundation program, medical school council 2012. Each question has eight choices, and only three choices must be answered. Each correct choice is given 4 marks and the maximum mark for each question is 12, the wrong answer does not cancel the correct answer. Analysis was done using SPSS 25.0

Results

A sample of 125 individuals participated in this study in which 51% are males while 49% are females, and 48% of them are rotators and 52% are senior residents. The priority of patient care had the highest mean score of 7.26 out of 12 while “Communication skills” had a lower mean score of 3.74. Females tended to score higher in “Conflicts between professional and personal concerns” than males, with a mean score of 4.98 compared to 3.69.Rotators have a mean score of 57.6 out of 120 compared to 53.6 for senior residents (p = 0.048).

Conclusion

This study tried to explore behavior and attitude toward complex and real time situations in work place. Mean score of conflicts between professional and personal concerns was higher for females. On the other hand regarding training level, there were two items significantly different, namely conflicts between personal and professional concerns and ensuring patient safety. Communication skills had low score for both genders and training level.
TaNF-Y-PRC2 orchestrates temporal control of starch and protein synthesis in wheat
Authors: Chen Jinchao , Zhao Long , Li Haoran , Yang Changfeng , Wang Dongzhi , Lin Xuelei , Lin Yujing , Zhang Hao , Bie Xiaomin , Zhao Peng , Xu Shengbao , Zhang Xiansheng , Zhang Xueyong , Yao Yingyin , Xiao Jun
Published: December 2023

The endosperm in cereal grains is instrumental in determining grain yield and seed quality, as it controls the production of starch and protein. In this study, we identified a specific TaNF-Y trimeric complex, consisting of TaNF-YA3-D, TaNF-YB7-B, and TaNF-YC6-B, exhibiting robust expression within endosperm during grain filling stage in wheat. Knock-down of eitherTaNF-YA3orTaNF-YC6led to less starch but more gluten proteins. Detailed analyses have unveiled that the TaNF-Y indirectly boosts starch biosynthesis genes by reducing TaNAC019, a repressor ofTaAGPS1a, TaSuS2, thereby regulating starch biosynthesis. Conversely, the TaNF-Y directly inhibits the expression of gliadin and low molecular weight (LMW)-GS coding genes, includingTaGli-γ-700andTaLMW-400. Furthermore, the TaNF-Y components interact with TaSWN, the histone methyltransferase subunit of Polycomb repressive complex 2 (PRC2), to repress the expression ofTaNAC019,TaGli-γ-700, andTaLMW-400through H3K27me3 modification. Notably, weak mutation ofTaFIE, core subunit of PRC2, has reduced starch but elevated gliadin and LMW-GS levels. Intriguingly, DNA variations of TaNF-Y components are widely associated with seed developmental traits. In particular, variation within the coding region ofTaNF-YB7-Bis linked to differences in starch and protein content. Distinct haplotypes ofTaNF-YB7-Baffect its interaction with TaSWN, influencing the repression of targets likeTaNAC019andTaGli-γ-700. Our findings illuminate the intricate molecular mechanisms governing epigenetic regulation by the TaNF-Y-PRC2 for wheat endosperm development. Manipulating the TaNF-Y complex holds potential for optimizing grain yield and enhancing quality.
LGBTIQ+ staff and shifting client power within professional services firms
Authors: Egan Matthew , Voss Barbara de Lima
Published: December 2023

Purpose

Big 4 professional services firms increasingly lay claim to recruiting and including staff of diverse genders, cultures, ages and sexualities. Drawing on Foucauldian insights, this study explores how LGBTIQ+ staff navigated shifting technologies of client power, at the time marriage equality was legislated in Australia.

Design/methodology/approach

This article explores changing experiences of LGBTIQ+ staff and allies, through 56 semi-structured interviews undertaken through 2018–2019.

Findings

Technologies of client power were central to shaping workplace experiences for LGBTIQ+ staff. However, each firm was also keen to carve unique and bold responses to changing societal attitudes regarding sexuality and gender. These progressive moves did not sit comfortably with all clients, and so this article provides insight into the limitations of client privilege within professional services firms. For staff, this increasing complexity of sometimes opaque, contradictory and shifting technologies of client and firm power, enabled agency to explore a sense of self for some, but continued to exclude others.

Originality/value

Little attention has been directed to exploring challenges for staff of sexual and gendered diversity within professional services firms, or to exploring how staff navigate changing perceptions of client power.
Are board attributes and ownership structure value relevant in developing economies: new institutionalist perspective
Authors: Rahman Md. Atiqur
Published: December 2023

Purpose

The author aims to find value relevance of board characteristics and ownership structures in the banking industry of Bangladesh, an emerging economy with absence of good governance.

Design/methodology/approach

Pooled Ordinary Least Square (OLS), fixed effect and generalized method of moments (GMM) methods have been utilized to analyse 5-year data of 28 listed banks.

Findings

All governance indicators except institutional ownership have insignificant impact on return on asset (ROA) and return on equity (ROE). Institutional ownership has significant negative impact indicating that institutional investors can worsen bank performance in unregulated environments. Additional analysis shows significant positive impact of higher institutional ownership ratios.

Research limitations/implications

Small sample from a single industry of one country may limit the applicability of the findings to all developing economies.

Practical implications

During the fast growth periods of developing economies, institutional investors with small stakes may become value destructive due to speculative behaviour.

Originality/value

This is one of the pioneering studies to suggest that governance mechanisms have insignificant, in some instances adverse, impact on firm value in emerging economies.