bluuebunny/crossref_metadata_2025 huggingface dataset:
Regulation and Adaptive Markets
Authors: Lo Andrew W. , Zhang Ruixun
Published: March 2024

In Chapter 20 we propose a framework for regulatory reform that begins with the observation that financial manias and panics cannot be legislated away, and may be an unavoidable aspect of modern capitalism. Like hurricanes and other forces of nature, market bubbles and crashes cannot be entirely eliminated, but their most destructive consequences can be greatly mitigated with proper preparation. In fact, the most damaging effects of financial crises come not from loss of wealth, but rather from those who are unprepared for such losses, and panic in response. This perspective has several implications for regulatory reforms centred around the need for greater transparency, improved measures of systemic risk, more adaptive regulations, including counter-cyclical leverage constraints, and more emphasis on financial literacy starting in high school, including certifications for expertise in financial engineering for the senior management and directors of all financial institutions.
The dimorphic diaspore model Aethionema arabicum (Brassicaceae): Distinct molecular and morphological control of responses to parental and germination temperatures
Authors: Chandler Jake O , Wilhelmsson Per K I , Fernandez-Pozo Noe , Graeber Kai , Arshad Waheed , Pérez Marta , Steinbrecher Tina , Ullrich Kristian K , Nguyen Thu-Phuong , Mérai Zsuzsanna , Mummenhoff Klaus , Theißen Günter , Strnad Miroslav , Scheid Ortrun Mittelsten , Schranz M Eric , Petřík Ivan , Tarkowská Danuše , Novák Ondřej , Rensing Stefan A , Leubner-Metzger Gerhard
Published: March 2024

Plants in habitats with unpredictable conditions often have diversified bet-hedging strategies that ensure fitness over a wider range of variable environmental factors. A striking example is the diaspore (seed and fruit) heteromorphism that evolved to maximize species survival in Aethionema arabicum (Brassicaceae) in which external and endogenous triggers allow the production of two distinct diaspores on the same plant. Using this dimorphic diaspore model, we identified contrasting molecular, biophysical, and ecophysiological mechanisms in the germination responses to different temperatures of the mucilaginous seeds (M+ seed morphs), the dispersed indehiscent fruits (IND fruit morphs), and the bare non-mucilaginous M− seeds obtained by pericarp (fruit coat) removal from IND fruits. Large-scale comparative transcriptome and hormone analyses of M+ seeds, IND fruits, and M− seeds provided comprehensive datasets for their distinct thermal responses. Morph-specific differences in co-expressed gene modules in seeds, as well as in seed and pericarp hormone contents, identified a role of the IND pericarp in imposing coat dormancy by generating hypoxia affecting abscisic acid (ABA) sensitivity. This involved expression of morph-specific transcription factors, hypoxia response, and cell wall remodeling genes, as well as altered ABA metabolism, transport, and signaling. Parental temperature affected ABA contents and ABA-related gene expression and altered IND pericarp biomechanical properties. Elucidating the molecular framework underlying the diaspore heteromorphism can provide insight into developmental responses to globally changing temperatures.
Plant enhancers exhibit both cooperative and additive interactions among their functional elements
Authors: Jores Tobias , Tonnies Jackson , Mueth Nicholas A , Romanowski Andrés , Fields Stanley , Cuperus Josh T , Queitsch Christine
Published: March 2024

Enhancers are cis-regulatory elements that shape gene expression in response to numerous developmental and environmental cues. In animals, several models have been proposed to explain how enhancers integrate the activity of multiple transcription factors. However, it remains largely unclear how plant enhancers integrate transcription factor activity. Here, we use Plant STARR-seq to characterize 3 light-responsive plant enhancers—AB80, Cab-1, and rbcS-E9—derived from genes associated with photosynthesis. Saturation mutagenesis revealed mutations, many of which clustered in short regions, that strongly reduced enhancer activity in the light, in the dark, or in both conditions. When tested in the light, these mutation-sensitive regions did not function on their own; rather, cooperative interactions with other such regions were required for full activity. Epistatic interactions occurred between mutations in adjacent mutation-sensitive regions, and the spacing and order of mutation-sensitive regions in synthetic enhancers affected enhancer activity. In contrast, when tested in the dark, mutation-sensitive regions acted independently and additively in conferring enhancer activity. Taken together, this work demonstrates that plant enhancers show evidence for both cooperative and additive interactions among their functional elements. This knowledge can be harnessed to design strong, condition-specific synthetic enhancers.
A Lattice Formulation of Weyl Fermions on a Single Curved Surface
Authors: Aoki Shoto , Fukaya Hidenori , Kan Naoto
Published: March 2024

In the standard lattice domain-wall fermion formulation, one needs two flat domain-walls where both of the left- and right-handed massless modes appear. In this work we investigate a single domain-wall system with a nontrivial curved background. Specifically we consider a massive fermion on a 3D square lattice, whose domain-wall is a 2D sphere. In the free theory, we find that a single Weyl fermion is localized at the wall and it feels gravity through the induced spin connection. With a topologically nontrivial U(1) link gauge field, however, we find a zero mode with the opposite chirality localized at the center where the gauge field is singular. In the latter case, the low-energy effective theory is not chiral but vectorlike. We discuss how to circumvent this obstacle in formulating lattice chiral gauge theory in the single domain-wall fermion system.
Telerehabilitation in Physical Therapist Practice: A Clinical Practice Guideline From the American Physical Therapy Association
Authors: Lee Alan C , Deutsch Judith E , Holdsworth Lesley , Kaplan Sandra L , Kosakowski Heidi , Latz Robert , McNeary Lydia Lennox , O’Neil Jennifer , Ronzio Oscar , Sanders Kelly , Sigmund-Gaines Michelle , Wiley Michele , Russell Trevor
Published: March 2024

A clinical practice guideline on telerehabilitation was developed by an American Physical Therapy Association volunteer guideline development group consisting of international physical therapists and physiotherapists, a physician, and a consumer. The guideline was based on systematic reviews of current scientific literature, clinical information, and accepted approaches to telerehabilitation in physical therapist practice. Seven recommendations address the impact of, preparation for, and implementation of telerehabilitation in physical therapist practice. Research recommendations identify current gaps in knowledge. Overall, with shared decision-making between clinicians and patients to inform patients of service delivery options, direct and indirect costs, barriers, and facilitators of telerehabilitation, the evidence supports the use of telerehabilitation by physical therapists for both examination and intervention. The Spanish and Chinese versions of this clinical practice guideline, as well as the French version of the recommendations, are available as supplementary material (Suppl. Materials).
‘Never trust a Philologist’: C. S. Lewis, J. R. R. Tolkien, and the Place of Philology in English Studies
Authors: Horobin Simon
Published: March 2024

This article brings to light seven poems by C. S. Lewis that have never been published before. These poems, composed during the 1920s, form part of a lengthy campaign against the study of philology at Oxford, and specifically against its most eminent exponent, H. C. Wyld. Drawing on entries in his diary and personal correspondence, the article shows how Lewis’s antipathy for the subject grew out of his undergraduate studies, his frustration with Wyld’s published scholarship and prescriptive attitude towards language study, as well as a dislike of the man and his lecturing style. It was the appointment of J. R. R. Tolkien to the Rawlinson and Bosworth Professorship of Anglo-Saxon in 1925, and their subsequent friendship, that was to convert Lewis to the study of philology and convince him of its centrality to the discipline of English Studies. The remainder of the article describes how the two men engineered revisions to the Oxford English syllabus, which resulted in a much more prominent role for philology, at the expense of nineteenth-century literature.
HHS Issues Revised Health Worker Conscience Rule
Authors: Roush Karen
Published: March 2024

The aim is to balance the rights of clinicians and patients.
Advancing Equity in Maternal Health Care
Authors: Polinard Elizabeth , Ricks Tiffany Nicole , Abbyad Chris
Published: March 2024

Actionable strategies nurses can implement at the bedside
Home-Based Nursing Practice
Authors: Harris Marilyn D. , Hinck Susan
Published: March 2024

These nurses provide care in a patient's home, wherever home may be.
The Occupational and Environmental Hazards of Uncovered Toilets
Authors: Eisenberg Seth , Walton AnnMarie , Connor Thomas Harry
Published: March 2024

Substantial evidence demonstrates that plumes from uncovered toilets potentially expose nurses and other health care workers to aerosols containing infectious agents and hazardous drugs, including antineoplastic drugs. Most hospitals in the United States utilize flushometer-type toilets, which operate under high pressure and do not have a permanently attached closure or lid, which is known to reduce the aerosols generated by flushing. This article aims to raise awareness among nurses of the potential exposure risks associated with toilet plume aerosols, so they can educate other health care workers and take part in initiatives to address these risks.
Simple Intervention Reduces Dosing Errors After Pediatric ED Discharge
Authors: Rosenberg Karen
Published: March 2024

According to this study:
The Early Morning Visit: A Visiting Nurse Remembers
Authors: Johnson Alice
Published: March 2024

A young nurse braves a dangerous situation.
Telehealth Potential in Pediatric Orthopaedics and Sports Medicine Care is Comparable to In-Person Care But Disparities Remain
Authors: Hogue Grant D. , Liu David S. , Kaushal Shankar G. , Tavabi Nazgol , Feldman Lanna , Stracciolini Andrea , Shore Benjamin , Hedequist Daniel , Bae Donald , Meehan William , Kim Young-Jo , Kocher Mininder , Murray Martha M. , Kiapour Ata M.
Published: March 2024

Background:

Understanding the challenges and potential of telehealth visits (THVs) in a large population can inform future practice and policy discussion for pediatric orthopaedic and sports medicine (OSM) care. We comprehensively assess telehealth challenges and potential in a large pediatric OSM population based on access, visit completion, patient satisfaction, and technological challenges.

Methods:

Demographics, address, insurance, visit information, patient feedback, experience with video visits, and technical challenges of all 2019 to 2020 visits at our hospital were assessed (3,278,006 visits). We evaluated the differences in rate of telehealth utilization, rate of patient adherence, disparities in care access and patient satisfaction, and technological issues.

Results:

Compared with in-person prepandemic visits, THVs had lower ratios of non-White patients (by 5.8%;P<0.001), Hispanic patients (by 2.8%;P<0.001) and patients with public insurance (by 1.8%;P<0.001), and a higher mean distance between the patient’s residence and clinic (by 18.8 miles;P<0.001). There were minimal differences in median household income (average $2297 less in THV;P<0.001) and social vulnerability index (average 0.01 points lower in THV;P<0.001) between groups. THVs had comparable patient satisfaction to in-person visits. Non-White patients, Hispanics, and those with public insurance had lower ratings for both in-person visits and THVs and had more technical difficulties during their THV.

Conclusions:

Telehealth is a viable method of care for a range of pediatric OSM conditions, providing a similar quality of care as in-person visits with a greater geographic reach. However, in its current format, reduced disparities were not observed in pediatric OSM THVs.

Level of Evidence:

Level III.
Renin Levels and Angiotensin II Responsiveness in Vasopressor-Dependent Hypotension*
Authors: See Emily J. , Chaba Anis , Spano Sofia , Maeda Akinori , Clapham Caroline , Burrell Louise M. , Liu Jasmine , Khasin Monique , Liskaser Grace , Eastwood Glenn , Bellomo Rinaldo
Published: March 2024

OBJECTIVES:

The relationship between renin levels, exposure to renin-angiotensin system (RAS) inhibitors, angiotensin II (ANGII) responsiveness, and outcome in patients with vasopressor-dependent vasodilatory hypotension is unknown.

DESIGN:

We conducted a single-center prospective observational study to explore whether recent RAS inhibitor exposure affected baseline renin levels, whether baseline renin levels predicted ANGII responsiveness, and whether renin levels at 24 hours were associated with clinical outcomes.

SETTING:

An academic ICU in Melbourne, VIC, Australia.

PATIENTS:

Forty critically ill adults who received ANGII as the primary agent for vasopressor-dependent vasodilatory hypotension who were included in the Acute Renal effects of Angiotensin II Management in Shock study.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

After multivariable adjustment, recent exposure to a RAS inhibitor was independently associated with a relative increase in baseline renin levels by 198% (95% CI, 36–552%). The peak amount of ANGII required to achieve target mean arterial pressure was independently associated with baseline renin level (increase by 46% per ten-fold increase; 95% CI, 8–98%). Higher renin levels at 24 hours after ANGII initiation were independently associated with fewer days alive and free of continuous renal replacement therapy (CRRT) (–7 d per ten-fold increase; 95% CI, –12 to –1).

CONCLUSIONS:

In patients with vasopressor-dependent vasodilatory hypotension, recent RAS inhibitor exposure was associated with higher baseline renin levels. Such higher renin levels were then associated with decreased ANGII responsiveness. Higher renin levels at 24 hours despite ANGII infusion were associated with fewer days alive and CRRT-free. These preliminary findings emphasize the importance of the RAS and the role of renin as a biomarker in patients with vasopressor-dependent vasodilatory hypotension.
Child Health Nurses' Acceptance and Use of a Novel Telehealth Platform
Authors: Goudswaard Liselot , Penny Robyn , Edmunds Janet , Arnautovska Urska
Published: March 2024

Telehealth appointments in the healthcare sector have increased since the COVID-19 pandemic, increasing patients' access to services. However, research exploring nurse perceptions of implemented telehealth services in the community sector is limited. Within the context of quality improvement, the current study aimed to understand child health nurses' acceptance and use of a novel telehealth platform using mixed methods. A total of 38 child health nurses completed an online survey that included multiple-choice questions based on an expanded Technology Acceptance Model and open-ended questions exploring barriers and facilitators to use. Results demonstrated that despite 70% of nurse users having completed less than three sessions with parents, perception and acceptance scores were high. Overall, 85% of variance in satisfaction with the platform and 46% of variance in intention to use the platform were predicted by perception scores. Three consistent themes generated from data were facilitators for use and five as barriers, which provided further understanding to findings. To ensure telehealth is adapted into routine clinical care, facilitators and barriers for implementation need to be identified and addressed. Nurses need to be engaged in implementation and ongoing maintenance to ensure the uptake and optimal use of technology within nursing care.
Real-world effectiveness of mineralocorticoid receptor antagonists in heart failure with reduced ejection fraction: a retrospective, non-interventional cohort analysis
Authors: Fu Michael , Pivodic Aldina
Published: March 2024

Background and purpose:

Mineralocorticoid receptor antagonists (MRAs) have been shown in clinical trials to improve outcomes in heart failure with reduced ejection fraction (HFrEF). Yet, it is still uncertain how effective they are in real-world patients with HFrEF. This study aimed to investigate the association between MRAs and outcomes in the overall population and a propensity score-matched cohort, based on patient-level data from the Swedish Heart Failure Registry (SwedeHF).

Methods:

Patients diagnosed with HFrEF were included from the SwedeHF spanning from 2003 to 2020. Enrollment was based on medication dispensation within 3 months before and 6 months after the index date recorded in the register. Endpoints included all-cause mortality, cardiovascular death, and hospital re-admissions, tracked from the index date until censoring or occurrence of an event.

Results:

Of 47,103 patients identified through the SwedeHF with HFrEF, 22,368 individuals were not treated with MRA (referred to as MRA naive patients), 21,893 were treated with MRA at a dosage of 25 mg, and 1,423 were treated with MRA at 50 mg once daily. In the overall cohort, the administration of MRA at 25 mg was associated with modest reductions in the risk of all-cause mortality (hazard ratio: 0.92 [0.89–0.95], P < 0.0001) and cardiovascular death (hazard ratio: 0.93 [0.89–0.98], P < 0.01) compared to the MRA naive group. However, both dosages of MRA (25 and 50 mg) were associated with a slight increase in the risk of hospital re-admissions due to heart failure 10% compared to MRA naive patients. These findings were consistent when examining a propensity score-matched cohort. Interaction analysis showed a significantly improved survival rate for patients receiving MRA at 25 mg compared to MRA naive individuals, particularly among those with an estimated glomerular rate ≥30 mL/min/1.73 m2 across all patients and in those aged 70 years and above.

Conclusions:

The administration of MRA treatment at 25 mg once daily was linked to a modestly improved survival in a real-life HFrEF population, with even more pronounced benefits observed within a specific subgroup. This finding highlights the importance of personalized medicine in providing customized therapeutic advantages.
Chronic Radiation Dermatitis Secondary to Narrow-Band Ultraviolet B Therapy in a Patient With Primary Cutaneous CD8+ T-Cell Lymphoma With Cytotoxic Granules
Authors: Edelson Mia P. , Gay Jane J. , Thiel Robert W. , Grider Douglas J.
Published: March 2024

Conventional therapies for CD8+ cutaneous T-cell lymphoma include topical steroids, topical nitrogen mustard, topical bexarotene, ultraviolet B therapy, psoralen and ultraviolet A therapy, local radiotherapy, and interferon alfa; however, these treatments are often found to be ineffective. Presented is a case of CD8+ cutaneous T-cell lymphoma with near-complete response to narrow-band ultraviolet therapy because of chronic radiation dermatitis initially believed to be possible progression of a CD8+ cutaneous epidermotropic cytotoxic T-cell lymphoma.
Noninvasive Technique for Classification of Pulmonary Cancer Based on Computerized Tomography: Review and Analysis
Authors: Osman Mohammed O. , Hamza Alnazier O. , Mohamed Zeinab A. M. , Khider Mohamed O. , Ali Ali S. A.
Published: March 2024

Lung cancer is one of the leading causes of death in the United States and Europe. Most cancers that start in the lung, known as primary lung cancers, are carcinomas that derive from epithelial cells. The most common symptoms are coughing (including coughing up blood), weight loss, shortness of breath, and chest pains. Different diagnostic procedures have been followed in an attempt to differentiate between the benign and malignant tumors such as computed tomography or magnetic resonance imaging scans, angiogram, chest x-ray, and biopsy, which is the most accurate procedure that determines the pulmonary tumor type. Studies indicate that radiologists do not detect all abnormalities on images that are visible on retrospective review, and they do not always correctly characterized abnormalities that are found. In the clinical interpretation of medical images, limitations in the human eye-brain visual system, reader fatigue, distraction, the presence of overlapping structures that camouflage disease in images, and the vast number of abnormal cases seen in screening programs provide cause for detection and interpretation errors. A comprehensive review on the subject has been done to give an overview of the recent studies, their methodology, and the result of those studies, along with the authors' analysis of these studies.
Relationship Status and Quality Are Associated With Perceived Benefits of Caregiving for People With Heart Failure
Authors: Glickman Amanda , Mikulich-Gilbertson Susan , Abshire Saylor Martha , DeGroot Lyndsay , Bekelman David B.
Published: March 2024

Background

“Benefit finding” is a strengths-based strategy for coping with medical illness that may be particularly useful for caregivers of people with heart failure given the highly fluctuating disease course.

Objective

The aim of this study was to investigate benefit finding's association with the caregiver–care recipient relationship, depression, and burden at baseline and longitudinally.

Methods

This is a longitudinal observational study of caregivers' benefit finding, relationship quality, depression, and burden. Correlation and multiple regression analyses identify baseline associations and predictors of 12-month change in benefit finding.

Results

At baseline (n = 100; median, 60 years [interquartile range, 46–69]; 81% female, 70% partner/spouse), increased benefit finding correlated with higher relationship quality (r = 0.53; 95% confidence interval [CI], 0.38–0.67), lower depression (r = −0.33; 95% CI, −0.49 to −0.14), and lower burden (r = −0.31; 95% CI, −0.47 to −0.11). Twelve-month change in benefit finding was predicted by change in relationship quality (ß = 7.12; 95% CI, 0.62–13.61) but not depression or burden.

Conclusions

Relationship quality and benefit finding changed together over time. Interventions strengthening the caregiver–care recipient bond may be especially impactful for heart failure caregivers.
Physical Demands of Walking Football in Patients With Cardiovascular Risk Factors and Diseases
Authors: Egger Florian , Ditscheid Anja , Schwarz Markus , Meyer Tim
Published: March 2024

Objective:

To compare the exercise intensity of walking football (WF) with walking (WA) and to describe specific movement characteristics of WF.

Design:

Cross-sectional study.

Setting:

Sports facilities Saarland University, Germany.

Patients:

Eighteen patients with cardiovascular risk factors CVRFs and diseases (13 men and 5 women, age: 69 ± 10 years).

Independent variables:

Patients completed a WF match and WA session of 2 x 10 min each. Video analysis was used to characterize movements during WF.

Main Outcome Measures:

Rate of perceived exertion (RPE, Borg Scale 6-20), % maximum heart rate (HRmax), musculoskeletal pain on a visual analog scale (VAS, 1-100 mm) before and up to 72 hours after exercise, and movement patterns during WF.

Results:

The mean RPE during WF (12.1 ± 2.7) and WA (11.9 ± 3.0) did not differ (P = 0.63). The mean HR during WF (79 ± 12% of HRmax) was higher than during WA (71% ± 11%; P < 0.01). The HR variability coefficient of variation during WF (10.3% ± 5.8%) and WA (7.1 ± 5.5%) did not differ (P = 0.13). There was no influence of exercise mode (WF vs WA) on musculoskeletal pain perception (P = 0.96 for interaction). Injury-inciting activities such as lunges (median: 0.5 [interquartile range (IQR) 0-1.3]) and goal kicks (median: 4 [IQR: 1.8-5.3]) occurred rarely during WF.

Conclusions:

Walking football might represent an alternative to WA for health prevention programs in patients with CVRF and diseases as it is characterized by a manageable cardiocirculatory strain, moderate RPE, low pain induction, and a low number of injury-inciting activities.
Integration of a nurse practitioner and physician associate leadership structure within an academic cancer center
Authors: Jackson Heather J. , West Olivia , Harrell Shelton , Skotte Emily , Hande Karen
Published: March 2024

Background:

Nurse practitioners and physician associates are an essential part of the multidisciplinary cancer care team with expanding and evolving roles within cancer specialties.

Local problem:

As these clinicians flourish, a parallel need for leadership rises to optimize scope of practice, mentor, and retain this crucial workforce. The purpose of this quality improvement project was to development a nurse practitioner and physician associate leadership structure within an academic cancer center.

Methods:

Development of this nurse practitioner and physician associate leadership structure was guided by transformational leadership theory. In collaboration with nursing, business, and physician leadership, a quad structure was supported.

Interventions:

Implementation of a leadership structure included the establishment of eight team leaders and two managers. These leaders identified multiple opportunities for improvement including improved communications, offload of nonbillable work, development of incentive programs, provision of equipment, specialty practice alignment, hematology/oncology fellowship, and professional development.

Results:

Overall, a nurse practitioner and physician associate leadership structure allowed for representation across the cancer center. Such inclusion supported multiple quality improvement projects developed in partnership with nursing, business, and physician leaders. Cumulatively, these interventions yielded efficient workflows and expansion of services. Consistent with reported evidence, these efforts contributed to nurse practitioner and physician associate retention as well as improved job satisfaction.

Conclusions:

Advanced practice leadership is essential to recruiting, developing, supporting, and retaining nurse practitioner and physician assistant colleagues in cancer care.
Sequelae Treatment Needs Following Peripheral Facial Palsy: Retrospective Analysis of 525 Patients
Authors: Ohm Rebecka , Stark Birgit , Brännström Fredrik , Marsk Elin
Published: March 2024

Objective

This study uses retrospective longitudinal data from a large unselected cohort of patients with peripheral facial paralysis to determine the prevalence and patient characteristic predictors of sequelae receiving intervention.

Study Design

Retrospective case review.

Setting

Karolinska University Hospital in Stockholm Sweden serves as the only tertiary facial palsy center in the region. Here, patients are diagnosed, are followed up, and undergo all major interventions.

Patients

All adult patients presenting with peripheral facial palsy due to idiopathic, zoster, or Borrelia origin at Karolinska, January 1, 2010 to December 31, 2011 with follow-up until December 2022.

Interventions

Patient charts were studied to identify patient characteristics, etiology, initial treatment, severity of palsy, and treatments targeting sequelae.

Main Outcome Measures

Types of initial and late treatments were noted. Sunnybrook and/or House–Brackmann scales were used for palsy grading.

Results

Five hundred twenty-five patients were included. Thirty-three patients (6.3%) received botulinum toxin injections and/or surgical treatment. In this subgroup, 67% received corticosteroids compared to 85% of all patients (p = 0.005), cardiovascular disease prevalence was higher (23 and 42%, respectively, p = 0.009). For 81 patients (15%), follow-up was discontinued although the last measurement was Sunnybrook less than 70 or House–Brackmann 3 to 6.

Conclusions

Of patients with peripheral facial palsy, 6.3% underwent injections and/or surgical treatment within 12 years. However, due to a rather large proportion not presenting for follow-up, this might be an underestimation. Patients receiving late injections and/or surgical treatment had more comorbidities and received corticosteroid treatment to a significantly lower extent in the acute phase of disease.
Standard and Extend High-Frequency Audiometry in Sudden Sensorineural Hearing Loss: Impacts on Tinnitus and Mental Health
Authors: Tomaz Andreza , Peron Kelly Abdo , Suzuki Flavia Alencar de Barros , Monteiro Silvia Roberta Gesteira , Chandrasekhar Sujana S. , Penido Norma Oliveira
Published: March 2024

Objective

To analyze the results of auditory assessment in standard (SA) and extended high-frequency (EHF) audiometry, associating the findings with sudden tinnitus and mental health of patients with unilateral sudden sensorineural hearing loss (SSNHL).

Study Design

Prospective, cohort study.

Setting

Outpatient otology clinic in a tertiary care hospital.

Subjects and Methods

Patients experiencing unilateral SSNHL were evaluated with pure-tone audiometry performed at frequencies of 250 to16,000 Hz, tinnitus pitch and loudness matching tests, Tinnitus Handicap Inventory (THI), Analog and Visual Scale (AVS) for bothersome tinnitus, and the Hospital Anxiety and Depression Scale (HADS).

Results

Eighteen patients with unilateral SSNHL were assessed. After starting treatment, there was a significant improvement in the SA (71.1 dB to 50 dB; p < 0.001*) and EHF audiometry (64.5 dB to 54.4 dB; p < 0.001*) thresholds at 15 days, and this persisted at 30 days of follow-up. Significant improvements were seen for tinnitus in loudness, VAS, and THI and for mental health in the realms of anxiety and depression by HADS. Despite improvements in SA, persistent EHF hearing loss was accompanied by persistent tinnitus, but it was of diminished loudness.

Conclusion

Despite improvement in pure-tone thresholds by SA, a subset of unilateral SSNHL patients did not experience hearing recovery in EHF thresholds and reported persistent tinnitus. We postulate that their diminished anxiety and better mental health may be related to both hearing improvement in standard audiometry and reduction in tinnitus loudness. This pilot prospective study investigates the utility of performing EHF audiometry to better understand outcomes in patients with SSNHL.
Auditory Outcomes Following Cochlear Implantation in Children with Unilateral Hearing Loss
Authors: Wu Shannon S. , Dunn-Johnson Camille , Zeitler Daniel M. , Schwartz Seth , Sutliff Suzanne , Appachi Swathi , Jamis Carmen , Petter Karen , Vovos Rachel , Goldberg Donald , Anne Samantha
Published: March 2024

Objective

Unilateral hearing loss (UHL) in children is associated with speech and language delays. Cochlear implantation (CI) is currently the only rehabilitative option that restores binaural hearing. This study aims to describe auditory outcomes in children who underwent CI for UHL and to determine the association between duration of hearing loss and auditory outcomes.

Study Design

Retrospective case series.

Setting

Three tertiary-level, academic institutions.

Patients

Children <18 years with UHL who underwent CI between 2018 and 2021.

Intervention

Cochlear implantation.

Main Outcome Measures

Speech perception and Speech, Spatial and Qualities of Hearing Scale (SSQ) were assessed postimplantation. Scores >50% on speech perception and SSQ scores >8 points were considered satisfactory. Associations between duration of UHL and implantation age and outcomes were assessed using Spearman’s rank correlation.

Results

Of the 38 children included, mean age at CI was 7.9 ± 3.2 years and mean UHL duration was 5.0 ± 2.8 years. Mean datalogging was 8.1 ± 3.1 hours/day. Mean auditory testing scores were SSQ, 7.9 ± 1.2; BABY BIO, 68.1 ± 30.2%; CNC, 38.4 ± 28.4%; WIPI, 52.5 ± 23.1%. Scores >50% on CNC testing were achieved by 40% of patients. SSQ scores >8 points were reported by 78% (7/9) of patients. There were no significant correlations between UHL duration and auditory outcomes.

Conclusion

Overall, children with UHL who undergo CI can achieve satisfactory speech perception scores and SSQ scores. There were no associations between duration of hearing loss and age at implantation with auditory outcomes. Multiple variables may impact auditory outcomes, including motivation, family support, access to technology, and consistent isolated auditory training postactivation and should be taken into consideration in addition to age at implantation and duration of UHL in determination of CI candidacy.
Outcomes of Soft Versus Bony Canal Wall Reconstruction with Mastoid Obliteration
Authors: Vesole Adam Samuel , Doyle Edward J. , Sarkovics Katelyn , Gharib Michael , Samy Ravi N.
Published: March 2024

Objective

To compare recidivism rates, audiometric outcomes, and postoperative complication rates between soft-wall canal wall reconstruction (S-CWR) versus bony-wall CWR (B-CWR) with mastoid obliteration (MO) in patients with cholesteatoma.

Study Design

Retrospective chart review.

Setting

Tertiary neurotologic referral center.

Patients

Ninety patients aged ≥18 years old who underwent CWR with MO, either S-CWR or B-CWR, for cholesteatoma with one surgeon from January 2011 to January 2022. Patients were followed postoperatively for at least 12 months with or without second-look ossiculoplasty.

Intervention(s)

Tympanomastoidectomy with CWR (soft vs. bony material) and mastoid obliteration.

Main Outcome Measure(s)

Recidivism rates; conversion rate to CWD; pre- versus postoperative pure tone averages, speech reception thresholds, word recognition scores, and air-bone gaps; postoperative complication rates.

Results

Middle ear and mastoid cholesteatoma recidivism rates were not significantly different between B-CWR (17.3%) and S-CWR (18.4%, p = 0.71). There was no significant difference in pre- versus postoperative change in ABG (B-CWR, −2.1 dB; S-CWR, +1.6 dB; p = 0.91) nor in the proportion of postoperative ABGs <20 dB (B-CWR, 41.3%; S-CWR, 30.7%; p = 0.42) between B-CWR and S-CWR. Further, there were no significant differences in complication rates between B-CWR and S-CWR other than increased minor TM perforations/retractions in B-CWR (63% vs. 40%, p = 0.03).

Conclusions

Analysis of recidivism rates, audiometric outcomes and postoperative complications between B-CWR with MO versus S-CWR with MO revealed no significant difference. Both approaches are as effective in eradicating cholesteatoma while preserving relatively normal EAC anatomy and hearing. Surgeon preference and technical skill level may guide the surgeon’s choice in approach.
Comparison of Mixed Venous Oxygen Saturation and Premembranous Venous Oxygen Saturation in Patients on Peripheral Venous-Arterial Extracorporeal Membrane Oxygenation
Authors: John Kevin J. , Belani Dinesh J. , Kapur Navin K. , Lussier Leslie , Chweich Haval
Published: March 2024

In patients on veno-arterial extracorporeal membrane oxygenation (ECMO) premembranous venous oxygen saturation (Spm-vO2) is continuously displayed on the ECMO console. However, the concordance between Spm-vO2 and mixed venous oxygen saturation (SvO2) remains largely unexplored. Our single-center retrospective study included adult patients who had paired SvO2 and Spm-vO2 readings within 15 minutes of each other, on peripherally cannulated Vf ivc-A ECMO and a pulmonary artery using catheter (PAC). The 82 pairs of observations showed a mean difference of 11.37% (95% limits of agreement −6.0 to 28.74, p < 0.001) between Spm-vO2 and SvO2. Although the two values correlated with each other (r = 0.51, p < 0.01), the difference between the paired measurements was larger at lower values of SvO2 (3.72 ± 6.38% when SvO2 >80%, 11.79 ± 7.46% when SvO2 between 60% and 80%, and 18.81 ± 12.09% when SvO2 <60%). The equation SvO2 = 1.2* Spm-vO2 – 28.03 was obtained by Passing Bablok regression. Cardiac index calculated by Spm-vO2 and SvO2 differed by 0.8 L/minute/m2 (95% limits of agreement −0.52 to 2.17, p < 0.001). In peripheral VA-ECMO, Spm-vO2 is consistently higher than SvO2, with more discordance at lower saturation levels. Using Spm-vO2 to estimate cardiac output using Fick method yields inaccurate results.
Weaving Diversity, Equity, Inclusion, and Belonging for Organizational Sustainability
Authors: Mitchell Crystal , Parchment Joy , Taylor Angela
Published: March 2024

Within the intricate tapestry of healthcare, the threads of diversity, equity, inclusion, and belonging (DEIB) are paramount. These elements enrich the fabric and strengthen its resilience, ensuring it stands the test of time. This article describes the origins of the American Organization for Nursing Leadership (AONL) DEIB Toolkit, its DEIB Guiding Principles, its significance in nursing leadership, and the broader implications for the evolution of nursing practice. AONL aims to transform healthcare throughout various levels of nursing practice, ensuring diverse, equitable, inclusive, and belonging-centric care environments.
A Culture of Inquiry
Authors: Schmidt Anne , Marshall David , Raso Rosanne , Sintich Maureen , Poch Nicholas , Joseph M. Lindell
Published: March 2024

A culture of inquiry has not traditionally been associated with nursing leadership. As healthcare evolves, leaders must reevaluate barriers to improving healthcare outcomes. One noted barrier has been a need for more inquisitiveness to innovate. Through an American Organization for Nursing Leadership workgroup, the authors advanced the understanding of a “culture of inquiry,” applying a practice-based learning approach for knowledge development. Three recommended foundational elements are psychological safety, building connections, and using design thinking at all organizational levels.
Soft Skills
Authors: Bundy Henry , Sunkara Padageshwar , Sitammagari Kranthi , Hetherington Tim , Hole Colleen , Murphy Stephanie
Published: March 2024

OBJECTIVE

To assess the role of soft skills in the work of Hospital at Home (HaH) nurse navigators.

BACKGROUND

In HaH programs that employ them, nurse navigators are often responsible for identifying, assessing, referring, and educating potential HaH patients. The experiences of these navigators have gone understudied.

METHODS

Researchers conducted semistructured interviews and observations with nurse navigators (n = 7) who collectively cover 14 North Carolina–based HaH sites. Navigators were asked to keep diaries of responses to directed questions.

RESULTS

In their capacity as navigators, interviewees said they served several roles: intermediaries between hospital and HaH staff, interpreters of clinical knowledge for patients, and champions of, and educators for, the home-based program. The navigators noted that the interpersonal soft skills of building rapport, clear communication, and gentle persuasion were of the utmost importance in this work.

CONCLUSIONS

The job descriptions of nurse navigators in HaH programs should fully reflect the breadth of their responsibilities, including time performing soft skilled labor. Also, training for these roles should include techniques to develop and refine these skills.
Persistence of analgesic usage and opioid consumption in sarcopenic patients undergoing neuraxial anesthesia: a nationwide retrospective cohort study
Authors: Yang Yitian , Chen Wan-Ming , Wu Szu-Yuan , Zhang Jiaqiang
Published: March 2024

Introduction:

This study investigates the association between chronic postsurgical pain (CPSP) and long-term postsurgical analgesic usage in patients undergoing neuraxial anesthesia, with a specific focus on the presence or absence of sarcopenia.

Objectives:

To assess the rate of analgesic prescription, including opioids, at 3 and 6 months postsurgery for patients with and without preoperative sarcopenia, and to determine the impact of sarcopenia on analgesic use after neuraxial anesthesia surgery.

Methods:

Patients undergoing surgery under neuraxial anesthesia were categorized into sarcopenic and nonsarcopenic groups based on preoperative diagnosis using the ICD-10-CM code M62.84. Propensity score matching in a 1:4 ratio was applied for group matching. Analgesic prescription rates were evaluated at 3 and 6 months postsurgery, and multivariable logistic regression was used to analyze analgesic use, comparing patients with and without preoperative sarcopenia.

Results:

Among 3805 surgical patients, 761 had sarcopenia, while 3044 did not. At 3 months postsurgery, 62.3% of sarcopenic patients received analgesics, with 2.9% receiving opioids, compared to 57.1% of nonsarcopenic patients receiving analgesics and 0.8% receiving opioids. At 6 months postsurgery, 30.8% of sarcopenic patients received analgesics (1.7% opioids), while 26.3% of non-sarcopenic patients received analgesics (0.3% opioids). Multivariable logistic regression analysis revealed that preoperative sarcopenia was significantly associated with higher analgesic prescription rates at both 3 months (adjusted odds ratio [aOR], 1.27; 95% confidence interval [CI], 1.05–1.53) and 6 months (aOR, 1.17; 95% CI, 1.07–1.42) postsurgery. Furthermore, sarcopenic patients exhibited significantly higher opioid prescription rates at 3 months (aOR, 1.11; 95% CI, 1.05–2.45) and 6 months (aOR, 1.89; 95% CI, 1.12–4.96) postsurgery.

Conclusion:

Sarcopenia emerges as an independent risk factor for prolonged analgesic use after neuraxial anesthesia surgery and significantly elevates the risk of developing CPSP.
Chronic widespread pain and cause of death: a 25-year follow-up study
Authors: Dahlqvist Annika Janina , Andersson Maria , Bergman Stefan
Published: March 2024

Introduction:

Chronic widespread pain (CWP) has been suggested as a risk factor for mortality in cardiovascular diseases and malignancies. Different definition of CWP makes it difficult to compare previous studies.

Objectives:

The aim was to study whether mortality and certain causes of death were increased among people with CWP and whether the definition of CWP influenced outcome.

Methods:

This 25-year follow-up study included 2425 people from the general population, at baseline divided into 3 pain groups: CWP, chronic regional pain, and no chronic pain (NCP). Chronic widespread pain was defined according to the ACR1990 (CWPACR1990) and the more stringent WP2019 (CWPWP2019) criteria. Causes of death were derived from official national register. Mortality, adjusted for age, sex, socioeconomic status, and smoking habits were analyzed with Cox regression.

Results:

Overall mortality was not higher in people with CWPACR1990 (hazard ratio [HR] 1.08, P = 0.484) compared with NCP but significantly higher when using CWPWP2019 (HR 1.32, P = 0.033). People with CWPWP2019 had a higher mortality in diseases of the circulatory system (HR 1.32, P = 0.033) but not for neoplastic diseases. CWPACR1990 showed an increased mortality in malignancies of digestive organs. An increased mortality in influenza, pneumonia, acute kidney failure, and chronic kidney disease was observed for the CWPWP2019 definition.

Conclusion:

The more stringent WP2019 definition of CWP showed an excess risk for death, especially within diseases of the circulatory system. The results suggest that WP2019 defines a more vulnerable group in the population. Chronic widespread pain should be acknowledged in the clinic as a risk factor for increased mortality.
Codeveloping theories of change for improved community-based violence intervention evaluation
Authors: Schleimer Julia P. , Lyons Vivian H. , Smith Dominique , Ali Fatima , Averett Latasha , Baugh Marcel , Benson Lina R. , Colon Jacques , Cook Jaclyn , Davis Dominique , Diandy Marie , Fox Aaron , Gonzalez Elaine , Johnson Aaron , Lowe Alvin Boomer , Marshall Marvin , Maryman Bridgette , McLaurin Vicky , Nehra Deepika , Orozco Alfredo , Palmer Katoya , Serrano Rafael , Shrader Zoe , Thurston Carolyn , Watlington Erin , Waszkewitz Laura , Westlake Emily , Jones Kristian , Rowhani-Rahbar Ali
Published: March 2024

BACKGROUND

Community-based violence intervention (CVI) programs are considered important strategies for preventing community violence and promoting health and safety. Mixed and inconclusive results from some prior CVI evaluations, as well as our general lack of understanding about the reasons for such varied findings, may be explained in part by misalignment of program theories of change and evaluation measures. Furthermore, most prior evaluations have focused solely on deficit-based outcomes; this narrow focus is inconsistent with the premise of CVI and may fail to capture improvements in health and well-being that are on the hypothesized pathway from intervention to violence reduction.

METHODS

This article describes the process and results of codeveloping a theory of change for community-based youth firearm violence intervention and prevention programs in Washington state through a community-researcher partnership. We followed a multistep iterative process, involving (1) CVI program documentation review, (2) individual meetings, and (3) a day-long workshop.

RESULTS

The theory of change included six key domains: (1) root causes, (2) promotive factors, (3) activities, (4) intermediate outcomes, (5) longer-term outcomes, and (6) multilevel context (youth/family, staff/organizational, community, and societal). Root causes were social and structural drivers of community violence. Promotive factors were assets and resources among the community, youth/their families, and community organizations that promote health and safety. Activities were supports and services the program provided to youth and their families, staff, and, potentially, the broader community. Intermediate and longer-term outcomes were the changes among youth, their families, staff, and the community that resulted from program activities. Intermediate outcomes may be felt within 6 months to 1 year, and longer-term outcomes may be felt after 1 to 2 years and beyond.

CONCLUSION

The theory of change we codeveloped provides a common lens to conceptualize, compare, and evaluate CVI programs in Washington state and may support more rigorous and equity-centered evaluations.

LEVEL OF EVIDENCE

Diagnostic Test/Criteria; Level V.
Overcoming Barriers: Sex Disparity in Surgeon Ergonomics
Authors: Jacovides Christina L , Guetter Camila R , Crandall Marie , McGuire Kandace , Slama Eliza M , Plotkin Anastasia , Kashyap Meghana V , Lal Geeta , Henry Marion C ,   for the Association of Women Surgeons Publications Committee
Published: March 2024

BACKGROUND:

Musculoskeletal discomfort is widely experienced by surgeons across multiple surgical specialties. Developing technologies and new minimally invasive techniques add further complexity and ergonomic stressors. These stressors differentially affect male and female surgeons, but little is known about the role these sex disparities play in surgical ergonomic stress. We reviewed existing literature to better understand how ergonomic stress varies between male and female surgeons.

STUDY DESIGN:

A literature search was performed via PubMed including but not limited to the following topics: ergonomics, surgeons, female surgeons, women surgeons, pregnancy, and operating room. A review of available quantitative data was performed.

RESULTS:

Female surgeons endure more pronounced ergonomic discomfort than their male counterparts, with added ergonomic stress associated with pregnancy.

CONCLUSIONS:

A 4-fold method is proposed to overcome ergonomic barriers, including (1) improved education on prevention and treatment of ergonomic injury for active surgeons and trainees, (2) increased departmental and institutional support for ergonomic solutions for surgeons, (3) partnerships with industry to study innovative ergonomic solutions, and (4) additional research on the nature of surgical ergonomic challenges and the differential effects of surgical ergonomics on female surgeons.