bluuebunny/crossref_metadata_2025 huggingface dataset:
Regional anaesthesia
Authors: Love Shona , Bailes Ian
Published: October 2022

Regional anaesthesia is a valuable technique in oromaxillofacial surgery. The cranial nerves that supply the head and neck arise deep within the brainstem, following tortuous paths through the bony skull base, emerging as multiple small terminal branches with short courses, each supplying sensation to small, often variable, areas of skin or mucosa. For this reason, targeted nerve blocks are considerably less common than in other surgical specialties, though there are some exceptions, such as the inferior alveolar nerve block for dental procedures. More commonly, this multiplicity of small nerves means that the superficial tissues of the head and neck are generally amenable to a field block. Local subcutaneous or submucosal infiltration of local anaesthetic often provides good anaesthesia. When combined with vasoconstrictors this also helps optimize the surgical field and reduce bleeding. This chapter presents the head and neck as six functional units, consisting of the face, the scalp, the nasal cavity, the oral cavity, the pharynx, and the larynx, with the relevant anatomy and associated regional anaesthetic techniques described for each unit. Techniques for administering local anaesthesia to permit awake tracheal intubation are also discussed, as well as the potential complications associated with local anaesthetic infiltration, and strategies to mitigate these.
Dental anaesthesia
Authors: Gosling Jennifer , Myatt John
Published: October 2022

Dental anaesthesia is a challenging area of anaesthetic practice, involving significant heterogeneity in standards and delivery of services (hospital versus community settings), and substantial variability in levels of training and sedation practices by anaesthetists and non-anaesthetists, while meeting the demands of high-turnover day case operating lists and patients with potentially complex medical and nursing needs (namely paediatric patients and adults with learning disability). Operations involve a ‘shared airway’ and necessitate good communication between surgeon and anaesthetist, especially when sedation, rather than general anaesthesia, is being provided. Dental anaesthesia is also a constantly evolving subspecialty, with numerous recent advances in international guidance governing patient safety, practitioner training, vital sign monitoring standards, and preprocedural fasting.
Paediatric surgery
Authors: Wong Silky , Hui Theresa Wan-Chun
Published: October 2022

Anaesthesia for paediatric oromaxillofacial surgery ranges from simple dental procedures, cleft lip and palate, to the temporomandibular joint and ultra-major craniofacial surgeries. In this chapter, paediatric oromaxillofacial abnormalities and their association with congenital syndromes are outlined. In planning, anaesthetists should be aware of the possibility of difficult tracheal intubation and ventilation. Identification and management of the difficult airway in these children is discussed. Different strategies to allay perioperative anxiety including newer techniques such as intranasal dexmedetomidine are introduced. Updated guidelines on fasting, the choice of tracheal tubes, intraoperative concerns such as fluid management for prolonged procedures, blood conservation techniques, prophylaxis and management of postoperative nausea and vomiting, and perioperative pain management are discussed. Anaesthetic management of specific oromaxillofacial surgical procedures is also presented.
Non-technical skills
Authors: Lui Frances
Published: October 2022

Human factors are major contributors to patient safety as medical and technological advancements alone are inadequate in reducing adverse events. Non-technical skills encompass a set of attributes and behaviours that complement medical knowledge, clinical skills, and procedural skills. Anaesthetic non-technical skills (ANTS) comprises four categories (situation awareness, decision-making, task management, and team working), each with component elements, and examples of desirable and less desirable behaviours for each element. This chapter discusses the background and development of the ANTS framework, the different categories and elements of non-technical skills, application in the field of oral and maxillofacial surgery, crisis resource management and simulation training, the use of cognitive aids and checklists, and future direction of building a safety culture.
Left ventricular hypertrophy
Authors: Yano Yuichiro , Nadar Sunil K.
Published: October 2022

Left ventricular hypertrophy (LVH) is a well-known complication of long-standing hypertension, with the duration and severity of elevated blood pressure being the major predictive factors in its development. The renin–angiotensin–aldosterone system (RAAS) has been implicated as the main pathophysiological mechanism in the development of LVH. The presence of LVH in hypertensive patients is a poor prognostic factor, and those with LVH are at higher cardiovascular risk of future events. Regression of LVH with treatment of hypertension can lead to a corresponding reduction in cardiovascular risk. Antihypertensive agents acting on the RAAS appear to be best at regressing LVH and improving outcomes.
Non-pharmacological management of hypertension
Authors: Buckley Benjamin J. R. , Finnie Stephanie J.
Published: October 2022

The importance of a healthy lifestyle is well understood for primary and secondary prevention of cardiovascular disease. Numerous studies have emphasized the importance of lifestyle changes as an important component of lowering blood pressure in both patients with hypertension and pre-hypertension. Non-pharmacological interventions are an integral part of not only preventing and managing hypertension, but also reducing cardiovascular mortality and morbidity. The importance of physical activity, exercise training, and a healthy diet need to be re-emphasized as powerful primary and secondary preventive tools. Therefore, physicians and other healthcare practitioners must allow time with patients to discuss patient goals related to non-pharmacological and lifestyle modifications.
Beta blockers in hypertension
Authors: Al-Lawati Hatim
Published: October 2022

Beta blockers are not as effective as other classes of antihypertensive medications. Although, previously considered to be a first line agent in lowering blood pressure, a considerable body of evidence from randomized controlled trials and meta-analyses has consistently shown inferior results not only in attaining guideline-recommended blood pressure targets, but also in reducing overall cardiovascular and cerebrovascular event rates. Consequently, current practice guidelines on management of hypertension recommend this class of drugs only as a second-line add-on therapy when other agents have not been successful in lowering blood pressure. As monotherapy, they may however, be considered in special circumstances, especially in the presence of ischaemic heart disease, heart failure, or concurrent arrhythmias, or intolerance to other antihypertensive agents.
Improving medication adherence in hypertension
Authors: Al-Riyami Hassan , Lane Deirdre A.
Published: October 2022

Blood pressure control is strongly correlated with adherence to medications and lifestyle changes. Research has shown that up to half of all patients with hypertension remain non-adherent to medications. Assessment of medication adherence and lifestyle modifications to help control blood pressure are an important part of the management of hypertension. Assessment can be done by direct questioning of patients, use of structured questionnaires, pill count, or more sophisticated methods such as assessment of drug levels in blood and urine and use of electronic pill boxes. There are many socio-economic and healthcare-related factors that affect an individual patient’s adherence to medications. Understanding how these different factors affect each individual patient can help improve their level of adherence by devising strategies to improve medication adherence. Use of multidisciplinary teams and involving the patient and their caregivers in the decision-making process can also improve adherence.
Photometric redshift uncertainties in weak gravitational lensing shear analysis: models and marginalization
Authors: Zhang Tianqing , Rau Markus Michael , Mandelbaum Rachel , Li Xiangchong , Moews Ben
Published: October 2022

Recovering credible cosmological parameter constraints in a weak lensing shear analysis requires an accurate model that can be used to marginalize over nuisance parameters describing potential sources of systematic uncertainty, such as the uncertainties on the sample redshift distribution n(z). Due to the challenge of running Markov chain Monte Carlo (MCMC) in the high-dimensional parameter spaces in which the n(z) uncertainties may be parametrized, it is common practice to simplify the n(z) parametrization or combine MCMC chains that each have a fixed n(z) resampled from the n(z) uncertainties. In this work, we propose a statistically principled Bayesian resampling approach for marginalizing over the n(z) uncertainty using multiple MCMC chains. We self-consistently compare the new method to existing ones from the literature in the context of a forecasted cosmic shear analysis for the HSC three-year shape catalogue, and find that these methods recover statistically consistent error bars for the cosmological parameter constraints for predicted HSC three-year analysis, implying that using the most computationally efficient of the approaches is appropriate. However, we find that for data sets with the constraining power of the full HSC survey data set (and, by implication, those upcoming surveys with even tighter constraints), the choice of method for marginalizing over n(z) uncertainty among the several methods from the literature may modify the 1σ uncertainties on Ωm–S8 constraints by ∼4 per cent, and a careful model selection is needed to ensure credible parameter intervals.
Three-dimensional numerical simulations of ambipolar diffusion in NS cores in the one-fluid approximation: instability of poloidal magnetic field
Authors: Igoshev Andrei P , Hollerbach Rainer
Published: October 2022

We numerically model evolution of magnetic fields inside a neutron star under the influence of ambipolar diffusion in the weak-coupling mode in the one-fluid MHD approximation. Our simulations are 3D and performed in spherical coordinates. Our model covers the neutron star core and includes crust where the magnetic field decay is due to Ohmic decay. We discover an instability of poloidal magnetic field under the influence of ambipolar diffusion. This instability develops in the neutron star core and grows on a time-scale of 0.2 dimensionless times, reaching saturation by 2 dimensionless times. The instability leads to formation of azimuthal magnetic field with azimuthal wavenumber m = 14 (at the moment of saturation) which keeps merging and reaches m = 4 by 16 dimensionless times. Over the course of our simulations (16 dimensionless times) the surface dipolar magnetic field decays, reaching 20 per cent of its original value and keeps decaying. The decay time-scale for the total magnetic energy is six dimensionless times. The ambipolar diffusion induces electric currents in the crust where these currents dissipate efficiently. Strong electric currents in the crust lead to heating, which could correspond to luminosities of ≈1029 erg s−1 during hundreds of Myrs for an initial magnetic field of 1014 G. Ambipolar diffusion leads to formation of small-scale magnetic fields at the neutron star surface.
Echtvar: compressed variant representation for rapid annotation and filtering of SNPs and indels
Authors: Pedersen Brent S , de Ridder Jeroen
Published: October 2022

Germline and somatic variants within an individual or cohort are interpreted with information from large cohorts. Annotation with this information becomes a computational bottleneck as population sets grow to terabytes of data. Here, we introduce echtvar, which efficiently encodes population variants and annotation fields into a compressed archive that can be used for rapid variant annotation and filtering. Most variants, represented by chromosome, position and alleles are encoded into 32-bits-half the size of previous encoding schemes and at least 4 times smaller than a naive encoding. The annotations, stored separately within the same archive, are also encoded and compressed. We show that echtvar is faster and uses less space than existing tools and that it can effectively reduce the number of candidate variants. We give examples on germ-line and somatic variants to document how echtvar can facilitate exploratory data analysis on genetic variants. Echtvar is available at https://github.com/brentp/echtvar under an MIT license.
Structural basis for HflXr-mediated antibiotic resistance in Listeria monocytogenes
Authors: Koller Timm O , Turnbull Kathryn J , Vaitkevicius Karolis , Crowe-McAuliffe Caillan , Roghanian Mohammad , Bulvas Ondřej , Nakamoto Jose A , Kurata Tatsuaki , Julius Christina , Atkinson Gemma C , Johansson Jörgen , Hauryliuk Vasili , Wilson Daniel N
Published: October 2022

HflX is a ubiquitous bacterial GTPase that splits and recycles stressed ribosomes. In addition to HflX, Listeria monocytogenes contains a second HflX homolog, HflXr. Unlike HflX, HflXr confers resistance to macrolide and lincosamide antibiotics by an experimentally unexplored mechanism. Here, we have determined cryo-EM structures of L. monocytogenes HflXr-50S and HflX-50S complexes as well as L. monocytogenes 70S ribosomes in the presence and absence of the lincosamide lincomycin. While the overall geometry of HflXr on the 50S subunit is similar to that of HflX, a loop within the N-terminal domain of HflXr, which is two amino acids longer than in HflX, reaches deeper into the peptidyltransferase center. Moreover, unlike HflX, the binding of HflXr induces conformational changes within adjacent rRNA nucleotides that would be incompatible with drug binding. These findings suggest that HflXr confers resistance using an allosteric ribosome protection mechanism, rather than by simply splitting and recycling antibiotic-stalled ribosomes.
CellMarker 2.0: an updated database of manually curated cell markers in human/mouse and web tools based on scRNA-seq data
Authors: Hu Congxue , Li Tengyue , Xu Yingqi , Zhang Xinxin , Li Feng , Bai Jing , Chen Jing , Jiang Wenqi , Yang Kaiyue , Ou Qi , Li Xia , Wang Peng , Zhang Yunpeng
Published: October 2022

CellMarker 2.0 (http://bio-bigdata.hrbmu.edu.cn/CellMarker or http://117.50.127.228/CellMarker/) is an updated database that provides a manually curated collection of experimentally supported markers of various cell types in different tissues of human and mouse. In addition, web tools for analyzing single cell sequencing data are described. We have updated CellMarker 2.0 with more data and several new features, including (i) Appending 36 300 tissue-cell type-maker entries, 474 tissues, 1901 cell types and 4566 markers over the previous version. The current release recruits 26 915 cell markers, 2578 cell types and 656 tissues, resulting in a total of 83 361 tissue-cell type-maker entries. (ii) There is new marker information from 48 sequencing technology sources, including 10X Chromium, Smart-Seq2 and Drop-seq, etc. (iii) Adding 29 types of cell markers, including protein-coding gene lncRNA and processed pseudogene, etc. Additionally, six flexible web tools, including cell annotation, cell clustering, cell malignancy, cell differentiation, cell feature and cell communication, were developed to analysis and visualization of single cell sequencing data. CellMarker 2.0 is a valuable resource for exploring markers of various cell types in different tissues of human and mouse.
Glycated albumin to glycated hemoglobin ratio and mortality in diabetic patients on dialysis: a new association
Authors: Hoshino Junichi , Abe Masanori , Hamano Takayuki , Hasegawa Takeshi , Wada Atsushi , Nakai Shigeru , Hanafusa Norio , Masakane Ikuto , Nitta Kosaku
Published: October 2022

Background

Hemoglobin A1c (A1c) and glycated albumin (GA) are two blood glycated proteins commonly used to monitor glycemic control in dialysis patients with diabetes. However, little is known about the association between the GA/A1c ratio and mortality in these populations. Here, we examine these associations using a nationwide cohort.

Methods

We enrolled 28 994 dialysis patients with diabetes who met our inclusion criteria (female, 32.9%; mean age, 67.4 ± 11.6 years; mean dialysis duration, 6.3 ± 5.8 years). After dividing the patients into groups based on GA/A1c quantiles and adjusting for 18 potential confounders, adjusted hazard ratios (HR) and 95% confidence limits were calculated for 3-year mortality and cause-specific mortalities. Additionally, propensity score matching analyses were used to compare mortalities between the low and high GA/A1c groups.

Results

After adjusting for possible confounders, significantly increased mortality was found in patients with GA/A1c ratios of 3.6–4.0 [HR 1.21 (1.10–1.34)] or higher [HR 1.43 (1.30–1.58)] than in those with GA/A1c ratios of 3.0–3.3. The risks of infectious and cardiovascular death were higher in these patients regardless of their nutritional status. In the propensity score matching analyses, significantly increased mortality was consistently found in those with a higher ratio (≥3.3) [HR 1.23 (1.14–1.33)] than in those with a lower ratio.

Conclusions

The GA/A1c ratio was significantly associated with 3-year mortality, especially infectious and cardiovascular mortality, in dialysis patients with diabetes. This ratio may be a promising new clinical indicator of survival in these patients, independent of their current glycemic control and nutritional markers.
Prenatal cannabis use and its impact on offspring neuro-behavioural outcomes: A systematic review
Authors: Thompson Mary , Vila Merima , Wang Li , Thabane Lehana , Shea Alison K
Published: October 2022

Introduction

Cannabis is a widely used substance in pregnancy, yet there is a paucity of literature addressing the neuro-behavioural consequences for prenatally exposed children. Our systematic review synthesizes currently available data for the impact of prenatal cannabis use on offspring intelligence and cognitive functioning.

Methods

MEDLINE, EMBASE, PsychINFO, CINAHL, and Clinicaltrials.gov were searched. Observational studies comparing prenatal cannabis use to controls were included. Offspring neuro-behavioural outcomes were grouped in prespecified domains of (1) intelligence and (2) cognitive functioning. Random-effect models were performed for meta-analyses when at least three studies reported the same outcome. All others were summarized qualitatively. GRADE (Grading of Recommendations, Assessment, Development and Evaluations) framework was used to assess evidence certainty.

Results

Of the 1982 reviewed studies (n = 523,107 patients), 28 were included. Significant heterogeneity and cohort redundancy limited meta-analysis. Very low-quality evidence from pooled analyses showed no significant associations between prenatal cannabis exposure and attention [standardized mean difference = −0.27 (95% CI = −0.60 to 0.07)], global intelligence quotient [−0.16 (−0.42 to 0.10)], reading [−0.05 (−0.29 to 0.20)], written comprehension [−0.09 (−0.40 to 0.22)], spelling [−0.04 (−0.26 to 0.17)], and mathematics [−0.01 (−0.15 to 0.13)]. No significant associations were found between prenatal cannabis exposure for all other outcomes. Individual studies reported significant differences between the heavy use groups and non-exposed, although this did not prove to be significant when outcomes were pooled.

Conclusions

The current review did not find a clear association between prenatal cannabis use and offspring neuro-behavioural outcomes. However, evidence was low quality and heterogenous. Further prospective investigation is needed to elucidate any potential association between prenatal cannabis use and long-term neuro-developmental outcomes.
Chung Un Lee: The trailblazer of tropical medicine in China
Authors: Liu Huan , Wei Yifan , Gao Wanying , Cheng Hao
Published: October 2022

Chung Un Lee, (李宗恩, 1894–1962) was a pioneer of tropical medicine research in China, serving as the president of Guiyang Medical College, the dean of Peking Union Medical College, the vice president of the Chinese Medical Association, a member of the British Medical Association and the Far Eastern Tropical Medical Association (Fig. 1) (Lu, 1992). Chung Un Lee spent his life in medical education and scientific research, with outstanding achievements in research on filariasis, schistosomiasis, malaria, and kala-azar, confirming the reservoir of filariasis in China, innovating the application of plasmochin to combat malaria, proving that sandflies and dogs are sources of infection in human kala-azar, and making a clinical diagnosis of the early manifestations of kala-azar in China. Chung Un Lee is a distinguished medical scientist and medical educator, one of the founders of Chinese Tropical Medicine, who fought for forty years for the prevention and treatment of tropical diseases in China and conducted pioneering research in Chinese Tropical Medicine.
Expectant vs Medical Management for Retained Products of Conception After Medical Termination of Pregnancy: A Randomized Controlled Study
Authors: Tzur Yossi , Berkovitz Shperling Roza , Goitein Inbar Tamar , Bar-On Shikma , Gil Yaron , Levin Ishai , Cohen Aviad
Published: October 2022

(Abstracted from Am J Obstet Gynecol 2022;227:599.e1–599.e9)

There has been an increase in the use of medical treatments for the termination of pregnancy. However, no prospective trials have evaluated the efficacy of misoprostol in treating retained products of conception following induced termination of pregnancy.
Prediction of Admission Costs Following Anterior Cervical Discectomy and Fusion Utilizing Machine Learning
Authors: Gowd Anirudh K. , Agarwalla Avinesh , Beck Edward C. , Derman Peter B. , Yasmeh Siamak , Albert Todd J. , Liu Joseph N.
Published: October 2022

Study Design.

Retrospective case series.

Objective.

Predict cost following anterior cervical discectomy and fusion (ACDF) within the 90-day global period using machine learning models.

Background.

The incidence of ACDF has been increasing with a disproportionate decrease in reimbursement. As bundled payment models become common, it is imperative to identify factors that impact the cost of care.

Materials and Methods.

The Nationwide Readmissions Database (NRD) was accessed in 2018 for all primary ACDFs by the International Classification of Diseases 10th Revision (ICD-10) procedure codes. Costs were calculated by utilizing the total hospital charge and each hospital’s cost-to-charge ratio. Hospital characteristics, such as volume of procedures performed and wage index, were also queried. Readmissions within 90 days were identified, and cost of readmissions was added to the total admission cost to represent the 90-day healthcare cost. Machine learning algorithms were used to predict patients with 90-day admission costs >1 SD from the mean.

Results.

There were 42,485 procedures included in this investigation with an average age of 57.7±12.3 years with 50.6% males. The average cost of the operative admission was $24,874±25,610, the average cost of readmission was $25,371±11,476, and the average total cost was $26,977±28,947 including readmissions costs. There were 10,624 patients who were categorized as high cost. Wage index, hospital volume, age, and diagnosis-related group severity were most correlated with the total cost of care. Gradient boosting trees algorithm was most predictive of the total cost of care (area under the curve=0.86).

Conclusions.

Bundled payment models utilize wage index and diagnosis-related groups to determine reimbursement of ACDF. However, machine learning algorithms identified additional variables, such as hospital volume, readmission, and patient age, that are also important for determining the cost of care. Machine learning can improve cost-effectiveness and reduce the financial burden placed upon physicians and hospitals by implementing patient-specific reimbursement.
Predicting Bone Health using Machine Learning in Patients undergoing Spinal Reconstruction Surgery
Authors: Shen Yong , Sardar Zeeshan M. , Chase Herbert , Coury Josephine R. , Cerpa Meghan , Lenke Lawrence G.
Published: October 2022

Study Design.

Retrospective study of data collected prospectively.

Objective.

The goal of this study is to create a predictive model of preoperative bone health status in adult patients undergoing adult spinal reconstructive (ASR) surgery using machine learning (ML).

Summary of Background Data.

Despite understanding that bone health impacts spine surgery outcomes, spine surgeons lack the tools to risk stratify patients preoperatively to determine who should undergo bone health screening. An ML approach mines patterns in data to determine the risk for poor bone health in ASR patients.

Methods.

211 subjects over the age of 30 with DEXA scans, who underwent spinal reconstructive surgery were reviewed. Data was collected by manual and automated collection from the EHRs. The Weka software was used to develop predictive models for multi-class classification of healthy, osteopenia (OPE), and osteoporosis (OPO) bone status. Bone status was labeled according to the WHO criteria using DEXA T-scores. The accuracy, sensitivity, specificity, and area under the receiver-operating-curve (AUC) were calculated. The model was evaluated on a test set of unseen data for generalizability.

Results.

The prevalence of OPO was 23.22% and OPE was 52.61%. The random forest model achieved optimal performance with an average sensitivity of 0.81, specificity of 0.95, and AUC of 0.96 on the training set. The model yielded an averaged sensitivity of 0.64, specificity of 0.78, and AUC of 0.69 on the test set. The model was best at predicting osteoporosis in patients. Numerous patient features exhibited predictive value, such as BMI, insurance type, serum sodium level, serum creatinine level, history of bariatric surgery, and the use of medications such as selective serotonin reuptake inhibitors.

Conclusion.

Predicting bone health status in ASR patients is possible with an ML approach. Additionally, data mining using ML can find unrecognized risk factors for bone health in ASR surgery patients.
Identification of Persister Drug Combination Clinafloxacin + Cefuroxime + Gentamicin That Eradicates Persistent Pseudomonas aeruginosa Infection in a Murine Cystic Fibrosis Model
Authors: Yuan Yuting , Yee Rebecca , Gour Naina , Dong Xinzhong , Feng Jie , Shi Wanliang , Zhang Ying
Published: October 2022

Pseudomonas aeruginosa can cause persistent infections, such as biofilm infections, in cystic fibrosis (CF) patients, which are difficult to cure due to non-growing persister bacteria that are not effectively killed by the current treatments. While antibiotic activity against growing P. aeruginosa is well documented, their activity against non-growing stationary phase cultures is less clear. Here, we evaluated six major classes of antibiotics, including cell wall and cell membrane inhibitors, protein synthesis inhibitors, DNA synthesis inhibitors, RNA synthesis inhibitors, sulfa drugs and nitrofurantoin, for their activity against growing and non-growing P. aeruginosa. We found that cell wall and cell membrane inhibitors (cefuroxime and colistin), DNA synthesis inhibitors (clinafloxacin) and sulfa drugs (sulfamethoxazole) had good activity against stationary-phase bacteria, while protein synthesis inhibitors (gentamicin), RNA synthesis inhibitor (rifampin) and nitrofurantoin showed relatively poor activity. Clinafloxacin was the only drug able to completely eradicate stationary-phase bacteria within 4 days. The cefuroxime + gentamicin + clinafloxacin combination was able to kill all bacteria from a biofilm within 2 days, whereas the clinically used drug combination cefuroxime + gentamicin/colistin only partially killed the biofilm bacteria. In a murine persistent CF lung infection model, only the cefuroxime + gentamicin + clinafloxacin drug combination eradicated all bacteria from the lungs, whereas clinafloxacin alone, cefuroxime + clinafloxacin, or the currently recommended drug combination cefuroxime + gentamicin failed to do so. The complete eradication is a property of the clinafloxacin combination, as the otherwise identical levofloxacin combination did not clear the bacterial loads from the lungs. Our findings offer new therapeutic options for more effective treatment of persistent P. aeruginosa infections, with possible implications for treating other persistent infections.
Experiences of COVID-19-Related Stigma: A Qualitative Study on Nurses Caring for Patients With COVID-19
Authors: TSUKUDA Makoto , KAYANO Tomonori , ITO Yoshiyasu
Published: October 2022

Background

Healthcare workers caring for patients with Coronavirus Disease 2019 (COVID-19) have been a primary target of stigmatization and discrimination during the COVID-19 outbreak. Thus, there is an urgent need to develop a support system for Asian healthcare workers who care for patients with COVID-19.

Purpose

This study was designed to understand the characteristics of COVID-19-related stigma experienced by nurses caring for patients with COVID-19.

Methods

A qualitative content analysis methodology was used. This study was conducted between April 2020 and March 2021. The participants were 10 female registered nurses working at three medical facilities that accepted patients with COVID-19. The data included specific narratives on the instances of stigma experienced when caring for patients with COVID-19, including connected situations and ideas. The data were collected using focus group interviews with three or four participants in each group. Data analysis was conducted based on the inductive qualitative analysis approach of Krippendorff.

Results

The content analysis identified two categories and seven subcategories of stigma experienced by clinical nurses. The category “directly experienced prejudice and discrimination” included the subcategories “being avoided,” “being treated as dirty,” “discrimination toward family members,” and “others prying.” The category “self-imposed coping behavior” included the subcategories “keeping oneself apart,” “feeling guilty,” and “nondisclosure.”

Conclusions/Implications for Practice

The participants internalized their experiences of stigma, as Japanese culture emphasizes keeping such things to oneself. Therefore, there is an urgent need to strengthen the support system for nurses who care for patients with COVID-19. This study addressed the problem of the stigmatization of these nurses and their families by others as well as their colleagues. The main findings were that stigma was directly experienced as discrimination and prejudice and often resulted in self-imposed coping behavior. The major implication of these findings is the need to establish systematic, active, and ongoing organizational support programs for nurses who are discriminated against because of COVID-19-related stigma.
Nurse practitioner practice under the COVID-19 public health emergency: Did policy change persist?
Authors: Klein Tracy A. , Bindler Ross , Kaplan Louise
Published: October 2022

The COVID-19 public health emergency (PHE) offers opportunities to study legislative and policy changes to nurse practitioner (NP) practice limitations, including factors that affect persistence. We evaluated states with restricted or reduced practice as identified by the American Association of Nurse Practitioners. This analysis 1) identified and correlated key changes in policy during the PHE with state regulatory, governmental, and practice variables; 2) modeled predictive characteristics that facilitate or impede policy persistence; and 3) explored the lived experience of NPs working in eligible states with policy changes during the PHE. Focus group interviews with NP leaders and bivariate correlations with regression analysis from the 2019 to 2021 legislative sessions were conducted. Nurse practitioner identified three types of persistence during the PHE: the power differential between MDs and NPs; the existing day-to-day environment; and barriers to change. In 2019, significantly more legislation was passed in states with sunset laws (Spearman rho: −0.38; p-value = .046). During 2020, 15 states introduced a total of 22 bills focused on NP practice, although only four passed one bill each. In 2021, states with an independent board structure introduced more NP legislation than did those states with a nonindependent board structure (Spearman rho: −0.406; p-value = .032). Few PHE policies persisted, despite robust predictions that this was likely to occur. Independent board structure and sunset laws were associated with legislation introduction and passage. Policy persistence is complex and based on multiple state and environmental variables. We urge persistence in NP advocacy strategies.
Selection criteria and triage in extracorporeal membrane oxygenation during coronavirus disease 2019
Authors: Nardelli Pasquale , Scandroglio Anna Mara , De Piero Maria Elena , Mariani Silvia , Lorusso Roberto
Published: October 2022

Purpose of review

Coronavirus disease 2019 (COVID-19) pandemic changed the way we had to approach hospital- and intensive care unit (ICU)-related resource management, especially for demanding techniques required for advanced support, including extracorporeal membrane oxygenation (ECMO).

Recent findings

Availability of ICU beds and ECMO machines widely varies around the world. In critical conditions, such a global pandemic, the establishment of contingency capacity tiers might help in defining to which conditions and subjects ECMO can be offered. A frequent reassessment of the resource saturation, possibly integrated within a regional healthcare coordination system, may be of help to triage the patients who most likely will benefit from advanced techniques, especially when capacities are limited.

Indications to ECMO during the pandemic should be fluid and may be adjusted over time. Candidacy of patients should follow the same prepandemic rules, taking into account the acute disease, the burden of any eventual comorbidity and the chances of a good quality of life after recovery; but the current capacity of healthcare system should also be considered, and frequently reassessed, possibly within a wide hub-and-spoke healthcare system.

Video Abstract

http://links.lww.com/COCC/A43.
Addressing population health inequities: investing in the social determinants of health for children and families to advance child health equity
Authors: Thornton Rachel L.J. , Yang Tracy J.
Published: October 2022

Purpose of review

This review provides a critical assessment of recent pediatric population health research with a specific focus on child health equity. The review addresses: the role of the healthcare sector in addressing fundamental social drivers of health, challenges within healthcare organizations in addressing health-related social needs and the social determinants of health, and the rationale for incorporating race and racism in pediatric population health research and practice.

Recent findings

The coronavirus disease 2019 pandemic brought greater attention to the disparities and inequities in American health and healthcare. In response to these stark inequities, many health systems are adopting efforts and initiatives to address social needs, social determinants of health, racism, and health equity. However, empirical evaluation detailing the effectiveness of these interventions and initiatives is limited.

While attention to identifying social needs among pediatric populations is increasing, there is limited evidence regarding the effectiveness of these interventions in producing sustained reductions in health disparities. To advance child health equity, researchers should move beyond individual behavior modification and directly examine fundamental drivers of health inequities. These drivers include government and health policies as well as societal forces such as systemic racism.
Keep Going and Growing! The Best Is Yet to Come
Authors: Ferren Melora D.
Published: October 2022

In this column, Dr Robin P. Newhouse, PhD, RN, NEA-BC, FAAN, discusses her journey to become the Dean for the Indiana University School of Nursing, engaging patients in research, and advancing nursing science through relationships. She has published extensively on health services improvement interventions, acute care quality issues, and evidence-based practice.
Cesarean Section Escape Room for a Perinatal Nurse Residency Program
Authors: Dunne Bridget M.
Published: October 2022

This article describes the development and implementation of an escape room concept applied to cesarean section surgery education for one health system’s perinatal nurse residency program. The escape room allows for small-group, interactive learning that fosters collaboration and critical thinking. The rise in popularity of gamification in learning and lack of literature about cesarean section escape rooms presented the opportunity for a novel method of learning for perinatal nurses.
Relationship Between Opioid Prescriptions and Number of Chronic Pain Conditions in Women With Interstitial Cystitis
Authors: Duncan Jordann-Mishael , Hong Christopher X. , Harvie Heidi S. , Brown Lily A. , Arya Lily A. , Kim Edward K.
Published: October 2022

(Abstracted from Urogynecology 2022;28:547–553)

Up to 8 million women in the United States are affected by interstitial cystitis (IC), which is a chronic condition characterized by coexisting urinary and pelvic pain conditi0ons. Managing the condition frequently proves challenging due to its chronic nature and a lack of effective IC treatments, but several medical organizations (such as the American Urological Association, Canadian Urological Association, the European Association of Urology, and the Royal College of Obstetricians and Gynecologists) have issued guidelines for management.
Prospective single-center paradigm shift of surgical stabilization of rib fractures with decreased length of stay and operative time with an intrathoracic approach
Authors: Tay-Lasso Erika , Alaniz Leonardo , Grant William , Hovis Gabrielle , Frank Madelyn , Kincaid Colin , Brynn Sargent , Pieracci Fredric M. , Nahmias Jeffry , Barrios Cristobal , Rockne Wendy , Chin Theresa , Swentek Lourdes , Schubl Sebastian D.
Published: October 2022

INTRODUCTION

Intrathoracic surgical stabilization of rib fractures allows for a novel approach to rib fracture repair. This approach can help minimize muscle disruption, which may improve patient recovery compared with traditional extrathoracic plating. We hypothesized patients undergoing intrathoracic plating (ITP) to have a shorter length of stay (LOS) and intensive care unit (ICU) LOS compared with extrathoracic plating (ETP).

METHODS

A prospective observational paradigm shift study was performed from November 2017 until September 2021. Patients 18 and older who underwent surgical stabilization of rib fractures were included. Patients with ahead Abbreviated Injury Scale score ≥3 were excluded. Patients undergoing ETP (July 2017 to October 2019) were compared with ITP (November 2019 to September 2021) with Pearson χ2 tests and Mann-Whitney U tests, with the primary outcome being LOS and ICU LOS.

RESULTS

Ninety-six patients were included, 59 (61%) underwent ETP and 37 (38%) underwent ITP. The most common mechanism of injury was motor vehicle collision (29%) followed by falls (23%). There were no differences between groups in age, comorbidities, insurance, discharge disposition and injury severity score (18 vs. 19, p = 0.89). Intrathoracic plating had a shorter LOS (10 days vs. 8 days, p = 0.04) when compared with ETP but no difference in ICU LOS (4 days vs. 3 days, p = 0.12) and ventilator days. Extrathoracic plating patients more commonly received epidural anesthesia (56% vs. 24%, p < 0.001) and intercostal nerve block (56% vs. 29%, p = 0.01) compared with ITP. However, there was no difference in median morphine equivalents between cohorts. Operative time was shorter for ITP with ETP (279 minutes vs. 188 minutes, p < 0.001) after adjusting for numbers of ribs fixed.

CONCLUSION

In this single-center study, patients who underwent ITP had a decreased LOS and operative time in comparison to ETP in patients with similar injury severity. Future prospective multicenter research is needed to confirm these findings and may lead to further adoption of this minimally invasive technique.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level IV.
Mapping, clustering, and analysis of research in psychiatric genomics
Authors: Yadav Sabita , Chhabra Ayushi , Mahesh G.
Published: October 2022

Introduction

The distribution pattern and knowledge structure of psychiatric genomics were surveyed based on literature dealing with both psychiatry and genomics/genetics. Coword analysis and bibliographic coupling of the records retrieved from Scopus and PubMed for 2016–2020 revealed the subsurface research aspects.

Method

The data were analyzed using coword analysis and clustering methods using Sci2 and VOSviewer.

Result

Analysis of ~3800 records showed that psychiatric genomics is, as expectedly, covered largely under biomedical subjects with a visible interest in other disciplines such as humanities and ethics. A coword analysis was done for all the years, followed by a year-wise analysis based on the keywords, and then a bibliographic coupling based on the cited references. This led to the generation of different clusters of prevalent research areas. The centrality values described the position of each component.

Discussion

‘Schizophrenia’, ‘depression’, ‘pharmacogenomics’, and ‘immunopathogenesis’ were the research topics of overarching interest. ‘Gut-brain axis’ and ‘gene-environment interaction’ were the emerging topics, whereas certain topics such as ‘child and adolescent psychiatry’ remained priorities when compared to earlier studies. The keywords and research focus were diverse. They ranged from genetics to transcriptomics and epigenetics to proteomics of psychiatric disorders. We found a stagnation of science communication in the field with only 0.2% of the articles from the entire corpus relevant to it. The research categories identified in this study reflect the current publication and research trends in psychiatric genomics.
Vaccinia virus BTB-Kelch proteins C2 and F3 inhibit NF-κB activation
Authors: Zhang Rui-Yao , Pallett Mitchell A. , French Jamie , Ren Hongwei , Smith Geoffrey L.
Published: October 2022

Vaccinia virus (VACV) encodes scores of proteins that suppress host innate immunity and many of these target intracellular signalling pathways leading to activation of inflammation. The transcription factor NF-κB plays a critical role in the host response to infection and is targeted by many viruses, including VACV that encodes 12 NF-κB inhibitors that interfere at different stages in this signalling pathway. Here we report that VACV proteins C2 and F3 are additional inhibitors of this pathway. C2 and F3 are BTB-Kelch proteins that are expressed early during infection, are non-essential for virus replication, but affect the outcome of infection in vivo. Using reporter gene assays, RT-qPCR analyses of endogenous gene expression, and ELISA, these BTB-Kelch proteins are shown here to diminish NF-κB activation by reducing translocation of p65 into the nucleus. C2 and F3 are the 13th and 14th NF-κB inhibitors encoded by VACV. Remarkably, in every case tested, these individual proteins affect virulence in vivo and therefore have non-redundant functions. Lastly, immunisation with a VACV strain lacking C2 induced a stronger CD8+ T cell response and better protection against virus challenge.
mgpB genotyping and genetic diversity for antimicrobial resistance of Mycoplasma genitalium
Authors: Seo Yumi , Park Heeyoon , Lee Gilho
Published: October 2022

Introduction. Antimicrobial resistance (AMR) among

Mycoplasma genitalium

is a global issue. Understanding the transmission dynamics of infection is an important factor in reducing the occurrence of AMR.

Hypothesis/Gap Statement. There is limited information on the genotyping and AMR traits of

M. genitalium

.

Aims. Single-locus sequence-based (SLSB) mgpB sequence typing and genetic diversity analyses of AMR

M. genitalium

isolated from patients in the Republic of Korea were performed to clarify the transmission dynamics and eludicate proper management.

Methodology. Sanger sequencing of mgpB, 23S rRNA, parC and gyrA genes from a total of 103

M

.

genitalium

-positive specimens from 89 patients was carried out.

Results. Twenty-seven different mgpB genotypes (GTs) were identified; 12 had been reported previously and 15 had not. GT7 and GT8 occurred frequently (n=38, 36.89 %, and n=16, 15.53 %, respectively). The genetic diversity of the AMR-determining sites was randomly dispersed among the different GTs. However, these GTs were classified into two phylogenetically distinct clusters that were significantly correlated with patient age and genetic diversity at positions 2058 and 2059 in the 23S rRNA gene. The GTs of 20 consecutive samples from 6 patients were compared to investigate temporal changes in GTs. One specimen changed its GT during follow-up, suggesting a new infection.

Conclusions. mgpB sequence typing can be a reliable tool for epidemiological studies. Two clusters have different characteristics in terms of genetic diversity. The cluster with genetic diversity in the AMR-determining site may be explained by the high prevalence of the specimens and subsequent antimicrobial exposure during the study period.
Comparative genomics and pangenomics of vancomycin-resistant and susceptible Enterococcus faecium from Irish hospitals
Authors: Leigh Robert J. , McKenna Chloe , McWade Robert , Lynch Breda , Walsh Fiona
Published: October 2022

Introduction.

Enterococcus faecium

has emerged as an important nosocomial pathogen, which is increasingly difficult to treat due to the genetic acquisition of vancomycin resistance. Ireland has a recalcitrant vancomycin-resistant bloodstream infection rate compared to other developed countries.

Hypothesis/Gap statement. Vancomycin resistance rates persist amongst

E. faecium

isolates from Irish hospitals. The evolutionary genomics governing these trends have not been fully elucidated.

Methodology. A set of 28 vancomycin-resistant isolates was sequenced to construct a dataset alongside 61 other publicly available Irish genomes. This dataset was extensively analysed using in silico methodologies (comparative genomics, pangenomics, phylogenetics, genotypics and comparative functional analyses) to uncover distinct evolutionary, coevolutionary and clinically relevant population trends.

Results. These results suggest that a stable (in terms of genome size, GC% and number of genes), yet genetically diverse population (in terms of gene content) of

E. faecium

persists in Ireland with acquired resistance arising via plasmid acquisition (vanA) or, to a lesser extent, chromosomal recombination (vanB). Population analysis revealed five clusters with one cluster partitioned into four clades which transcend isolation dates. Pangenomic and recombination analyses revealed an open (whole genome and chromosomal specific) pangenome illustrating a rampant evolutionary pattern. Comparative resistomics and virulomics uncovered distinct chromosomal and mobilomal propensity for multidrug resistance, widespread chromosomal point-mutation-mediated resistance and chromosomally harboured arsenals of virulence factors. Interestingly, a potential difference in biofilm formation strategies was highlighted by coevolutionary analysis, suggesting differential biofilm genotypes between vanA and vanB isolates.

Conclusions. These results highlight the evolutionary history of Irish

E. faecium

isolates and may provide insight into underlying infection dynamics in a clinical setting. Due to the apparent ease of vancomycin resistance acquisition over time, susceptible

E. faecium

should be concurrently reduced in Irish hospitals to mitigate potential resistant infections.