bluuebunny/crossref_metadata_2025 huggingface dataset:
Shadow Coaching Improves Patient Experience With Care, But Gains Erode Later
Authors: Quigley Denise D. , Elliott Marc N. , Slaughter Mary E. , Burkhart Q , Chen Alex Y. , Talamantes Efrain , Hays Ron D.
Published: August 2021

Background:

Health care organizations strive to improve patient care experiences. Some use one-on-one provider counseling (shadow coaching) to identify and target modifiable provider behaviors.

Objective:

We examined whether shadow coaching improves patient experience across 44 primary care practices in a large urban Federally Qualified Health Center.

Research Design:

Seventy-four providers with “medium” (ie, slightly below average) overall provider ratings received coaching and were compared with 246 uncoached providers. We fit mixed-effects regression models with random effects for provider (level of treatment assignment) and fixed effects for time (linear spline with a knot and “jump” at coaching date), patient characteristics and site indicators. By design, coached providers performed worse at selection; models account for the very small (0.2 point) regression-to-the-mean effects. We assessed differential effects by coach.

Subjects:

A total of 46,452 patients (from 320 providers) who completed the Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) Visit Survey 2.0.

Measures:

CAHPS overall provider rating and provider communication composite (scaled 0−100).

Results:

Providers not chosen for coaching had a nonsignificant change in performance during the period when selected providers were coached. We observed a statistically significant 2-point (small-to-medium) jump among coached providers after coaching on the CAHPS overall provider rating and provider communication score. However, these gains disappeared after 2.5 years; effects differed by coach.

Conclusions:

Shadow coaching improved providers’ overall performance and communication immediately after being coached. Regularly planned shadow coaching “booster” sessions might maintain or even increase the improvement gained in patient experience scores, but research examining additional coaching and optimal implementation is needed.
Third space endoscopy: the future of treating gastrointestinal dysmotility
Authors: Nabi Zaheer , Reddy D. Nageshwar
Published: August 2021

Purpose of review

Third space endoscopy (TSE) or submucosal endoscopy provides with the opportunity for minimally invasive management of various gastrointestinal disorders. TSE is a relatively new field and the knowledge on its utility continues to advance. The purpose of this review is to provide with updated evidence on the efficacy and utility of TSE in gastrointestinal motility disorders including achalasia and refractory gastroparesis.

Recent findings

Peroral endoscopic myotomy (POEM) is a safe procedure with emerging evidence on its durability as well. Major technical variations do not appear to impact the outcomes of POEM. Recent randomized trials suggest superiority of POEM over pneumatic dilatation and noninferiority over Heller's myotomy in idiopathic achalasia. With regard to gastric POEM (G-POEM), recent evidence confirms its efficacy in refractory gastroparesis. Although effective, the long-term outcomes of G-POEM are not well known. In addition, the criteria for patient selection remain elusive.

TSE has emerged as a new frontier in the endoscopic management of gastrointestinal motility disorders. While short-term outcomes are encouraging, the durability of TSE remains to be seen in achalasia as well as refractory gastroparesis. Insights regarding patient selection and predictors of outcomes may help optimizing the results of gastric POEM in refractory gastroparesis.
Clinical Phenotype and Genetic Analysis of Twins With Congenital Coagulation Factor V Deficiency
Authors: Wei Yanhui , He Yuzhuo , Guo Xuejun
Published: August 2021

Objective:

The aim was to investigate the clinical characteristics and molecular pathogenic mechanism of twins with congenital factor V (FV) deficiency.

Methods:

We comprehensively analyzed the clinical manifestations and laboratory test results of a set of twins and their parents and performed point mutation analysis with direct high-throughput exon sequencing.

Results:

The prothrombin time and activated partial thromboplastin time were prolonged for both probands, and the FV activity levels were 13.0% and 9.8%. Next-generation sequencing showed that the affected individuals harbored a paternal c.5113A>C (p.S1705R) and a maternal c.4949C>T (p.A1650V) heterozygous variants in the FV gene, which conformed to an autosomal recessive inheritance pattern. This is the first report of these point mutations. The older boy also had a congenital patent foramen ovale.

Conclusion:

In this set of twins, missense mutations of the FV gene were related to congenital FV deficiency but unrelated to the patent foramen ovale observed in the older boy.
Role of Cyclin D1 and BCOR Immunohistochemistry in Differentiating Clear Cell Sarcoma of Kidney From its Mimics
Authors: Singh Vikram , Gupta Kirti , Saraswati Aastha , Peters Nitin J. , Trehan Amita
Published: August 2021

Background and Aim:

Clear cell sarcoma of kidney (CCSK) is the second most common pediatric renal malignancy, constituting ∼3% of renal tumors. Due to its morphologic diversity, the diagnosis of CCSK is often challenging. Recent studies have identified internal tandem duplication of BCL6 corepressor (BCOR) gene in CCSKs which coupled with cyclin D1 immunoreactivity, is helpful in differentiating it from its mimics, particularly blastema-rich Wilms tumor (WT), malignant rhabdoid tumor (MRT), and congenital mesoblastic nephroma (CMN). We aimed to evaluate the utility of cyclin D1 and BCOR immunohistochemistry in differentiating CCSK from its morphologic mimics.

Materials and Methods:

Our cohort comprised of 38 pediatric renal tumors which included CCSK (n=18), WT (n=10), MRT (n=5), and CMN (n=5) cases. A detailed clinicopathologic analysis was performed, and tissue microarray were constructed for CCSK and WT, while MRT and CMN tumors were individually stained.

Results:

The age ranged from 2 months to 16 years with male:female ratio of 3:1. Strong, diffuse nuclear immunoreactivity for cyclin D1 and BCOR was noted in 61% (n=11/18) and 83% (n=15/18) of CCSK, respectively, while it was significantly less in WT (n=3/10 for cyclin D1) (n=2/10 for BCOR). None of the MRT and CMN examples demonstrated any immunoreactivity. Interestingly, only the blastemal component of WTs showed distinct, rare nuclear immunoreactivity for cyclin D1 or BCOR and the combination of these was never positive in a given case.

Conclusion:

Our results provide evidence that concurrent immunopositivity with cyclin D1 and BCOR is helpful in distinguishing CCSK from its morphologic mimics.
Two Cases of Acute Direct Oral Anticoagulant Overdose Without Adverse Effect
Authors: Ha Catherine J. , Harmouche Elie , Howland Mary Ann , Su Mark K.
Published: August 2021

We report 2 pediatric patients who had acute overdoses of the direct oral anticoagulants medications. Both patients were managed conservatively; neither required reversal agents or blood products nor had any major or minor bleeding events. With therapeutic usage of direct oral anticoagulants, routine coagulation studies typically are considered insufficient measures of anticoagulation and the preferred chromogenic anti-Factor Xa assay is recommended but not widely available. Using a routine hybrid heparin anti-Factor Xa assay, 1 patient demonstrated a strong linear correlation up to a serum rivaroxaban concentration of 940 ng/mL.
Hemophagocytic Lymphohistiocytosis Associated With Hemolytic Uremic Syndrome in a Child: A Case Report and Systematic Literature Review
Authors: Tas Nesrin , Gokceoglu Arife U. , Yayla Burcu C.C. , Ozcan Ayşegul , Sac Rukiye U. , Vezir Emine , Alioglu Bulent
Published: August 2021

Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening disorder resulting from excessive activation and nonmalignant proliferation of T-lymphocytes and macrophages. Hemolytic uremic syndrome (HUS) is a disease characterized by microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure. Reports pertaining to the association between HLH and HUS are rarely published; however, we report on a 4-year-old boy who was diagnosed with both conditions and treated successfully with high-dose steroid and intravenous immunoglobulin. Differentiating HUS from HLH can be challenging because of their clinical similarities. Therefore, prompt diagnosis and immunosuppressive treatment are essential and life-saving to these patients.
Bleomycin-induced Pneumonitis in a Child Treated With Nintedanib: Report of the First Case in a Childhood
Authors: Gundogan Begumhan D. , Taskinlar Simge , Arikoglu Tuba , Balci Yuksel , Citak Elvan C.
Published: August 2021

Pulmonary fibrosis caused by bleomycin-induced pneumonia (BIP) is the most important side effect limiting the use of bleomycin and is mainly treated with corticosteroids. However, 1% to 4% of patients do not respond to corticosteroid therapy. Idiopathic pulmonary fibrosis and BIP develop by similar pathophysiological mechanisms. Nintedanib is a tyrosine kinase inhibitor used successfully in the treatment of idiopathic pulmonary fibrosis and there is no information about its use in BIP treatment. Here, we would like to present a 13-year-old boy with Hodgkin lymphoma who developed BIP after 2 cycles of ABVD (Adriamycin, bleomycin, vinblastine, and dacarbazine) and 4 cycles of BAECOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone), whose respiratory failure impaired despite corticosteroid therapy, but was successfully treated with nintedanib.
Acute Myeloid Leukemia Presenting as a Posterior Fossa Tumor
Authors: Vanan Magimairajan Issai , Li Jie , Bunge Martin , Serletis Demitre , Almiski Muhamad , Israels Sara J.
Published: August 2021

Extramedullary leukemia in pediatric acute myeloid leukemia can manifest as a myeloid sarcoma (MS), also known as granulocytic sarcoma or chloroma, in a variety of sites, or as leukemic blasts in the cerebrospinal fluid. Isolated MS of the central nervous system is rare. We report a case of acute myeloid leukemia with central nervous system-MS presenting as a posterior fossa mass mimicking a primary intracranial tumor.
A Case of Pheochromocytoma as a Subsequent Neoplasm in a Survivor of Childhood Embryonal Rhabdomyosarcoma
Authors: Rodwin Rozalyn L. , Janardan Sanyukta K. , Hofstatter Erin W. , Kadan-Lottick Nina S.
Published: August 2021

Childhood cancer survivors are at risk for subsequent neoplasms. We describe the clinical presentation and genetic testing of a 29-year-old woman diagnosed with a pheochromocytoma 22 years post-treatment for childhood embryonal rhabdomyosarcoma of the bladder. Genetic testing for cancer predisposition revealed a pathogenic variant in BRCA2 and a variant of uncertain significance in MSH2. Pathogenic variants associated with deafness were also identified in GJB2. This article reports a novel subsequent neoplasm following childhood embryonal rhabdomyosarcoma, and discusses the potential contribution of genetic cancer predisposition to this case as well as the clinical implications of genetic testing.
Juvenile Xanthogranuloma of the Pancreas in a Pediatric Patient Mimicking Pancreatic Neoplasm With High CA 19-9: Case Report and Literature Review
Authors: Al-Antary Eman , Gupte Avanti , Poulik Janet , Klein Justin , Gorsi Hamza S.
Published: August 2021

Juvenile xanthogranuloma (JXG) is a rare, non–Langerhans cell histiocytosis. It is usually a benign and self-limiting condition. The most common sites are skin and soft tissue. Pancreatic involvement is extremely rare. We present an unusual case of a 13-month-old female child with JXG of the pancreas and elevated cancer antigen 19-9. JXG should always be considered as a differential diagnosis for pediatric patients presenting with a pancreatic mass, solid and/or cystic in nature. Therefore, avoiding unnecessary invasive diagnostic procedures.
Ewing Sarcoma of the 9th Rib Subsequent to Pediatric Leukemia: A Case Series
Authors: Vandenheuvel Julia , Elliott Leighton , Zinn Daniel , Miller Michal , Troutman Jacob
Published: August 2021

Ewing sarcoma is an aggressive malignancy of bone and soft tissue that accounts for ∼2% of cases of childhood cancer. It has been rarely reported as a secondary neoplasm. Data from the Childhood Cancer Survivor Study has evaluated secondary sarcomas in 5-year survivors of childhood cancer. We report 2 pediatric patients in northeast Pennsylvania, who developed secondary Ewing sarcoma of the 9th rib within 5 years of primary childhood leukemia diagnoses.
Relationship of Circadian Rhythm and Psychological Health in Adolescents and Young Adults With Cancer
Authors: Li Lijun , Duan Yinglong , Sun Qian , Xiao Panpan , Wang Lu , He Shiwen , Liu Xiangyu , Zhou Jianda , Xie Jianfei , Cheng Andy S.K.
Published: August 2021

Background

Evidence shows that adolescent and young adult (AYA) cancer patients have an increasing survival rate but experience psychological distress and circadian rhythm dysregulation. Little is known about the effect of circadian rhythm on psychological distress.

Objective

To investigate the type of circadian rhythm in Chinese AYA cancer survivors and examine the associations among chronotype, demographic characteristics, psychological distress, anxiety and depression, character strengths, and medical coping in this group.

Methods

This cross-sectional study enrolled 800 AYA cancer participants, 728 of whom completed the Chinese version of the Morningness-Eveningness Questionnaire, the Distress Thermometer, the Hospital Anxiety and Depression Scale, the Three-Dimensional Inventory of Character Strengths, and the Medical Coping Modes Questionnaire.

Results

Evening- and morning-type participants accounted for 35.0% and 19.1%, respectively, among participants, which was significantly higher than those found in the general population. The prevalence of psychological distress was 84.9% among AYA cancer participants. Exercise, Distress Thermometer, and depression were important predictive factors for the circadian rhythm.

Conclusions

Circadian rhythm disorder and psychological distress were common among AYA cancer survivors. Evening-type participants performed worse on character strength, confrontation, and avoidance of medical coping.

Implications for practice

Healthcare professionals need to understand the circadian rhythm and psychological health of AYA cancer survivors. Psychological rehabilitation guidance, especially within the 6 months after diagnosis, may benefit AYA survivors according to their chronotype. Character strengths can also be used during rehabilitation to properly guide AYA survivors.
Rates of Adverse Events in Hospitalized Patients After Summer-Time Resident Changeover in the United States: Is There a July Effect?
Authors: Metersky Mark L. , Eldridge Noel , Wang Yun , Eckenrode Sheila , Galusha Deron , Jaser Lisa , Mathew Jasie , Angus Steven , Nardino Robert
Published: August 2021

Objectives

This study aimed to determine whether patients in teaching hospitals are at higher risk of suffering from an adverse event during the summer trainee changeover period.

Methods

We performed a retrospective analysis of data from the Medicare Patient Safety Monitoring System, a medical-record abstraction-based database in the United States. Hospital admissions from 2010 to 2017 for acute myocardial infarction, heart failure, pneumonia, or a major surgical procedure were studied. Admissions were divided into nonsurgical (acute myocardial infarction, heart failure, or pneumonia) and surgical. Adverse event rates in July/August were compared with the rest of the year. Hospitals were stratified into major teaching, minor teaching, or nonteaching. Results were adjusted for patient demographics, comorbidities, and hospital characteristics. Outcomes were the adjusted odds of having at least 1 adverse event in July/August versus the rest of the year.

Results

We included 185,652 hospital admissions. The adjusted odds ratios (ORs) of suffering from at least one adverse event in a major teaching hospital in July/August was 0.83 (95% confidence interval [CI], 0.69–0.98) for nonsurgical patients and 1.09 (95% CI, 0.84–1.40) for surgical patients. In minor teaching hospitals, the adjusted ORs were 0.96 (95% CI, 0.88–1.04) for nonsurgical patients and 0.99 (95% CI, 0.87–1.12) for surgical patients. In nonteaching hospitals, the adjusted ORs were 0.98 (95% CI, 0.91–1.06) for nonsurgical patients and 1.10 (95% CI, 0.96–1.24) for surgical patients.

Conclusions

Patients admitted to teaching hospitals in July/August are not at increased risk of adverse events. These findings should reassure patients and medical educators that patients are not excessively endangered by admission to the hospital during these months.
Alveolar Bone Graft Timing in Patients With Cleft Lip & Palate
Authors: Mundra Leela S. , Lowe Kristen M. , Khechoyan David Y.
Published: August 2021

Cleft lip with or without cleft palate (CLP) is the most common craniofacial condition. Alveolar clefts are present in approximately 75% of patients with a cleft lip or CLP and often do not have sufficient support of surrounding teeth. Alveolar bone graft is commonly performed to reconstruct alveolar ridge in patient with osseous defects. Objective of this review is to critically analyze the literature to provide recommendations on appropriate timing for orthodontic preparation and surgical correction of alveolar clefts in the setting of unilateral or bilateral CLP. Search of PubMed database, MEDLINE, and EMBASE was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 15 studies were included. Majority of studies used chronological age to classify patients versus dental age. Most studies reported orthodontic treatment concomitant with surgery (12/15; 80.0%), and used orthodontics before alveolar bone grafting (8/12; 66.7%). No consensus on the best method to evaluate the success of alveolar bone grafting. Alveolar bone grafting with pre- and post-operative orthodontics is currently the standard of care for treatment of alveolar defects in patients with CLP. Authors recommend grafting during early mixed dentition phase, just before the eruption of the permanent central incisors, typically between 6 and 8 years old. Preoperative orthodontics for appropriate incisor alignment around cleft, and may be resumed 6 months postoperative.
Orbital Metastasis From Gastric Cancer Presenting as Orbital Cellulitis With Ptosis
Authors: Kim Jonghyun , Kim Joohyun , Baek Sehyun
Published: August 2021

We report a rare case of orbital metastasis that originated from gastric carcinoma, which presented as orbital cellulitis with ptosis. Orbital metastasis accounts for about only 1% to 13% of orbital tumors. Orbital metastasis in orbital soft tissue or bony structures is very uncommon.

A female patient with advanced gastric cancer with multiple metastases was referred to our clinic. She showed mild swelling and ptosis in her left eye. Contrast enhanced computed tomography imaging suggested orbital metastasis from gastric cancer in the superolateral aspect of the orbit. Based on her general condition and after consulting with an oncologist, we determined that fine needle biopsy and excisional biopsy for pathological diagnosis should not be performed as a therapeutic treatment.

It is important to distinguish orbital metastasis from orbital cellulitis with ptosis especially for patients with family or personal history of cancer. Clinicians should collect a through medical history from patients and suggest contrast enhanced computed tomography for appropriate diagnosis. Assessing quality of life and aggressive treatment options is crucial for determining the best treatment for orbital metastasis.
Clinical Anatomy Research Association in Oral and Maxillofacial Surgery
Authors: Iwanaga Joe , Matsushita Yuki , Watanabe Koichi , Kageyama Ikuo , Tubbs R. Shane , Ibaragi Soichiro
Published: August 2021

Sufficient knowledge of anatomy is critical for oral and maxillofacial surgeons to provide the best treatment to their patients. The authors have recently established the “Clinical Anatomy Research Association in Oral and Maxillofacial Surgery.” There is no doubt as to the benefits of collaboration between oral and maxillofacial surgeons/radiologists and anatomists. In this article, we share what was accomplished at the first annual online conference and discuss our mission for the future.
Combined Nasal Endoscopic and Subfrontal Craniotomy for Resection Tumors of Anterior Skull Base
Authors: Ngo Cong Van , Nguyen Hoang , Aklinski Joseph , Nguyen Khang Ngoc , Nguyen Dung Huu , Le John M. , Le Hoang Huy , Nguyen Chi , Tran Truong Minh
Published: August 2021

Objective:

Sinonasal tumors invading anterior skull base is difficult to treat in Otorhinolaryngology and Neurosurgery. Treatment requires the collaboration of ear, nose and throat (ENT) and neurosurgeon to remove the tumor completely. This study was to evaluate the outcome of combined technique nasal endoscopic and subfrontal approach in case of sinonasal tumors involving anterior skull base

Methods:

Retrospective cross-sectional study

Results:

The study was a cross-sectional study that had taken place at Otorhinolaryngology and Neurosurgery Department of Cho Ray Hospital, Vietnam. All 45 patients were enrolled and underwent the surgery. 71.1% of these cases were malignant tumors. The ratio of sinonasal malignant tumor is squamous cell carcinoma and esthesioneuroblastoma were 24.4% and 11.1%, respectively. All the cases were diagnosed as sinonasal tumor invading anterior skull base and successfully removed by combining nasal endoscopic approach with subfrontal craniotomy.

Conclusions:

The combined nasal endoscopic with subfrontal craniotomy for resection nasoethmoid tumor invading the brain show a good result. This technique is an important adjunct that contribute to the treatment of anterior skull base tumor involving the brain.
Red Cell Distribution Width at Admission Predicts the Frequency of Acute Kidney Injury and 28-Day Mortality in Patients With Acute Respiratory Distress Syndrome
Authors: Cai Nan , Jiang Min , Wu Chao , He Fei
Published: August 2021

Objectives:

To determine the association of red cell distribution width (RDW) at admission with frequency of acute kidney injury (AKI) and 28-day mortality in acute respiratory distress syndrome (ARDS) patients.

Methods:

Two hundred fifty-eight ARDS patients were investigated in retrospective and prospective studies. The primary outcome was frequency of AKI. The secondary outcome was 28-day mortality.

Results:

The retrospective study included 193 ARDS patients, of which 67 (34.7%) were confirmed AKI and 76 (39.4%) died within 28 days. The RDW level in the AKI group was significantly higher than in the non-AKI group ([15.15 ± 2.59]% vs. [13.95 ± 1.89]%). Increased RDW was a significant predictor of frequency of AKI (odds ratio: 1.247, 95% confidence interval [CI]: 1.044, 1.489). The area under the receiver operating characteristic curve of RDW for predicting AKI was 0.687 (95%CI: 0.610, 0.764) and the cut-off value was 14.45 (sensitivity, 56.7%; specificity, 72.8%). In addition, the proportion of patients with RDW ≥ 14.45% in the non-survival group was notably higher compared with the survival group (48.7% vs. 29.1%). Furthermore, cox regression analysis revealed that RDW ≥ 14.45% was associated with 28-day mortality (hazard ratio: 1.817, 95%CI: 1.046, 3.158), while Kaplan–Meier analysis showed patients with RDW ≥ 14.45% had a significantly lower survival rate than those with RDW < 14.45%. The prospective study, on the other hand, included 65 ARDS patients, with frequency of AKI and 28-day mortality in the RDW ≥ 14.45% group significantly higher than in RDW < 14.45%.

Conclusion:

RDW was a significant, independent predictor for frequency of AKI and 28-day mortality in ARDS patients.
MEF2D Participates in Microglia-Mediated Neuroprotection in Cerebral Ischemia-Reperfusion Rats
Authors: Shi Likai , Li Baowei , Chen Guoqing , Huang Yingsi , Tian Zhenpu , Zhang Lifeng , Tian Li , Fu Qiang
Published: August 2021

Objective:

Microglial activation is a vital process in the neuroinflammatory response induced by I/R injury. It has been reported that myocyte enhancer factor (MEF)2D expression in activated microglia is associated with microglia-induced inflammatory responses and plays an important role in neuronal survival. This research aimed to investigate the role and mechanism of MEF2D in microglial activation and neuroinflammation in cerebral I/R in vitro and in vivo.

Methods:

A cerebral I/R model was established. In vitro, neuronal, or microglial cells were exposed to oxygen-glucose deprivation and reoxygenation to mimic I/R. MEF2D overexpression was induced, and siRNA was administered in vitro and in vivo. Microglial polarization; MEF2D, nuclear transcription factor (NF)-κb, TLR4, and cytokine levels; neuronal injury; mitochondrial function; brain injury and cognitive function were detected in the different groups in vitro and in vivo.

Results:

We found that oxygen-glucose deprivation increased MEF2D expression in a time-dependent manner in BV2 cells and primary microglia. MEF2D overexpression inhibited microglial activation, the expression of NF-κb and TLR, cytokine levels, and neuronal injury in microglia exposed to oxygen-glucose deprivation and reoxygenation. In the middle cerebral artery occlusion model, microglial activation, the neuroinflammatory response, mitochondrial dysfunction, brain injury, and cognitive function were improved by MEF2D overexpression and aggravated by MEF2D siRNA treatment.

Conclusion:

These results indicate that MEF2D is a necessary molecule for neuroinflammation regulation and neuronal injury in cerebral ischemia.
The Development of an Assessment Rubric for the Core and Contingency Team Interaction Among Rapid Response Teams
Authors: Singh Maninder , Moss Hillary , Thomas Gifty M. , Dadario Nicholas B. , Mirante Doreen , Ellsworth Kelly , Shulman Jodi , Bellido Simon , Amicucci Bernadette , Jafri Farrukh N.
Published: August 2021

Introduction

Teamwork training is critical in the development of high-functioning rapid response teams (RRT). Rapid response teams involve interactions between a patient's core care team and a hospital contingency team, which can lead to disorganized and unsafe resuscitations, largely due to problems with communication and information dissemination. An extensive literature search found no assessment tools specific to the unique communicative challenges of an RRT, and thus, this study sought to develop an assessment rubric validated for training RRTs.

Methods

This study elucidates the development, implementation, and testing of an RRT rubric based on Kane's framework for validating testing instruments. Twenty-four inpatient code teams underwent team training using a Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) didactic, an online module on the TeamSTEPPS RRT program, and a subsequent presimulation and postsimulation experience. Two raters were randomized to give a bedside assessment for each team using the proposed RRT rubric. Simulation scores were assessed with Wilcoxon signed-rank tests. Interrater reliability was assessed using intraclass correlation coefficients. These analyses were then used to argue Kane's scoring, generalization, and extrapolation inferences.

Results

All teams significantly improved from the presimulation to postsimulation scenarios across all TeamSTEPPS domains. Content validity was obtained from 5 resuscitation experts with a scale-level content validity index of 0.9, with individual content validity index of 0.8 to 1.0. Intraclass correlation coefficient for “pre” scores were 0.856 (n = 24, P < 0.001), “post” scores of 0.738 (n = 24, P < 0.001), and a total of 0.890 (n = 48, P < 0.001).

Conclusions

The authors argue for the validity of a new RRT rubric based off Kane's framework, with a specific focus on teamwork training to improve coordination and function of core and contingency teams. A follow-up study with longitudinal data along with external validation of this rubric is needed.
Development and External Validation of a Model to Predict Overall Survival in Patients With Resected Gallbladder Cancer
Authors: de Savornin Lohman Elise A.J. , de Bitter T.J.J. , Hannink G. , Wietsma M.F.T. , Vink-Borger E. , Nagtegaal I.D. , Hugh T.J. , Gill A.J. , Bhimani N. , Ahadi M. Seyed , van der Post R.S. , de Reuver Philip R.
Published: August 2021

Objective:

The aim of this study was to develop and validate a clinical prediction model to predict overall survival in patients with nonmetastatic, resected gallbladder cancer (GBC).

Background:

Although several tools are available, no optimal method has been identified to assess survival in patients with resected GBC.

Methods:

Data from a Dutch, nation-wide cohort of patients with resected GBC was used to develop a prediction model for overall survival. The model was internally validated and a cohort of Australian GBC patients who underwent resection was used for external validation. The performance of the American Joint Committee on Cancer (AJCC) staging system and the present model were compared.

Results:

In total, 446 patients were included; 380 patients in the development cohort and 66 patients in the validation cohort. In the development cohort median survival was 22 months (median follow-up 75 months). Age, T/N classification, resection margin, differentiation grade, and vascular invasion were independent predictors of survival. The externally validated C-index was 0.75 (95%CI: 0.69–0.80), implying good discriminatory capacity. The discriminative ability of the present model after internal validation was superior to the ability of the AJCC staging system (Harrell C-index 0.71, [95%CI: 0.69–0.72) vs. 0.59 (95% CI: 0.57–0.60)].

Conclusion:

The proposed model for the prediction of overall survival in patients with resected GBC demonstrates good discriminatory capacity, reasonable calibration and outperforms the authoritative AJCC staging system. This model can be a useful tool for physicians and patients to obtain information about survival after resection and is available from https:// gallbladderresearch.shinyapps.io/Predict_GBC_survival/.
Effects of Subnormothermic Regulated Hepatic Reperfusion on Mitochondrial and Transcriptomic Profiles in a Porcine Model
Authors: Kim Joohyun , Zimmerman Michael A. , Shin Woo Young , Boettcher Brent T. , Lee Ju-Seog , Park Jong-In , Ali Muhammed , Yang Meiying , Mishra Jyotsna , Hagen Catherine E. , McGraw Joseph E. , Mathison Angela , Woehlck Harvey J. , Lomberk Gwen , Camara Amadou K. S. , Urrutia Raul A. , Stowe David F. , Hong Johnny C.
Published: August 2021

Objective:

We sought to investigate the biological effects of pre-reperfusion treatments of the liver after warm and cold ischemic injuries in a porcine donation after circulatory death model.

Summary of Background Data:

Donation after circulatory death represents a severe form of liver ischemia and reperfusion injury that has a profound impact on graft function after liver transplantation.

Methods:

Twenty donor pig livers underwent 60 minutes of in situ warm ischemia after circulatory arrest and 120 minutes of cold static preservation prior to simulated transplantation using an ex vivo perfusion machine. Four reperfusion treatments were compared: Control-Normothermic (N), Control- Subnormothermic (S), regulated hepatic reperfusion (RHR)-N, and RHR-S (n = 5 each). The biochemical, metabolic, and transcriptomic profiles, as well as mitochondrial function were analyzed.

Results:

Compared to the other groups, RHR-S treated group showed significantly lower post-reperfusion aspartate aminotransferase levels in the reperfusion effluent and histologic findings of hepatocyte viability and lesser degree of congestion and necrosis. RHR-S resulted in a significantly higher mitochondrial respiratory control index and calcium retention capacity. Transcriptomic profile analysis showed that treatment with RHR-S activated cell survival and viability, cellular homeostasis as well as other biological functions involved in tissue repair such as cytoskeleton or cytoplasm organization, cell migration, transcription, and microtubule dynamics. Furthermore, RHR-S inhibited organismal death, morbidity and mortality, necrosis, and apoptosis.

Conclusion:

Subnormothermic RHR mitigates IRI and preserves hepatic mitochondrial function after warm and cold hepatic ischemia. This organ resuscitative therapy may also trigger the activation of protective genes against IRI. Sub- normothermic RHR has potential applicability to clinical liver transplantation.
Modulation of Xenogeneic T-cell Proliferation by B7 and mTOR Blockade of T Cells and Porcine Endothelial Cells
Authors: Li Shu , Xu He , Kirk Allan D.
Published: August 2021

Background.

Activation of porcine endothelial cells (PECs) is the mechanistic centerpiece of xenograft rejection. This study sought to characterize the immuno-phenotype of human T cells in response to PECs and to explore the immuno-modulation of B7 and mammalian target of rapamycin blockade of T cells and/or PECs during xeno-responses.

Methods.

Rapid memory T-cell (TM) responses to PECs were assessed by an intracellular cytokine staining. T-cell proliferation to PEC with or without belatacept or rapamycin was evaluated by a mixed lymphocyte-endothelial cell reaction (MLER). Additionally, rapamycin-pretreated PECs were used in MLER. Cell phenotypes were analyzed by flow cytometry.

Results.

Tumor necrosis factor-α/interferon-γ producers were detected in CD8+ cells stimulated by human endothelium but not PECs. MLER showed proliferation of CD4+ and CD8+ cells with predominantly memory subsets. Purified memory and naive cells proliferated following PEC stimulation with an increased frequency of TM in PEC-stimulated naive cells. Proliferating cells upregulated programmed cell death-1 (PD-1) and CD2 expression. Belatacept partially inhibited T-cell proliferation with reduced CD2 expression and frequency of the CD8+CD2highCD28− subset. Rapamycin dramatically inhibited PEC-induced T-cell proliferation, and rapamycin-preconditioned PECs failed to induce T-cell proliferation. PD-1 blockade did not restore T-cell proliferation to rapamycin-preconditioned PECs.

Conclusions.

Humans lack rapid TM-mediated responses to PECs but induce T-cell proliferative responses characterized largely as TM with increasing CD2 and PD-1 expression. B7-CD28 and mammalian target of rapamycin blockade of T cells exhibit dramatic inhibitory effects in altering xeno-proliferating cells. Rapamycin alters PEC xeno-immunogenicity leading to inhibition of xeno-specific T-cell proliferation independent of PD-1–PD ligand interaction.
EEG Biomarkers of Repository Corticotropin Injection Treatment
Authors: Tanritanir Ahmet , Vieluf Solveig , Jafarpour Saba , Wang Xiaofan , Loddenkemper Tobias
Published: August 2021

Purpose:

Hypsarrhythmia is one of the major diagnostic and treatment response criteria in infantile spasms (IS). The clinical and electrophysiological effect of repository corticotropin injection treatment on IS was evaluated using electrophysiological biomarkers.

Methods:

Consecutive infants (<24 months) treated with repository corticotropin injection for IS were included in this retrospective descriptive study. Inclusion criteria were (1) clinical IS diagnosis, (2) repository corticotropin injection treatment, and (3) consecutive EEG recordings before and after repository corticotropin injection treatment. Patients with tuberous sclerosis complex were excluded. Response to treatment was defined as freedom from IS for at least 7 consecutive days during the treatment and resolution of hypsarrhythmia. The authors defined “relapse” as the recurrence of seizures after an initial response. Electrophysiological biomarker assessment included evaluation of semiautomatic spike counting algorithm, delta power, and delta coherence calculation during non-REM sleep EEG.

Results:

One hundred fifty patients (83 males; 55%; median age of IS onset: 5.9 months) with complete data were included, including 101 responders (67%, 71 with sustained response, and 30 relapses). Fifty patients (33%) with complete EEG data also underwent advanced EEG analysis. Baseline delta coherence was higher in sustained responders than in nonresponders or patients who relapsed. Greater decreases in semiautomatic spike counting algorithm, delta power, and delta coherence were found in sustained responders compared with nonresponders or patients who relapsed.

Conclusions:

Repository corticotropin injection treatment was associated with a 67% response rate in patients with IS. Computational biomarkers beyond hypsarrhythmia may provide additional information during IS treatment, such as early determination of treatment response and outcome assessment.
Fundamental mechanics of tooth fracture and wear: implications for humans and other primates
Authors: Borrero-Lopez Oscar , Rodriguez-Rojas Fernando , Constantino Paul J. , Lawn Brian R.
Published: August 2021

Until recently, there had been little attempt in the literature to identify and quantify the underlying mechanics of tooth durability in terms of materials engineering concepts. In humans and most mammals, teeth must endure a lifetime of sustained occlusal mastication—they have to resist fracture and wear. It is well documented that teeth are resilient, but what are the unique features that make this possible? The present article surveys recent materials engineering research aimed at addressing this fundamental question. Elements that determine the mechanics and micromechanics of tooth fracture and wear are analysed: at the macrostructural level, the geometry of the enamel shell and cuspal configuration; and at the microstructural level, interfacial weakness and property gradients. Inferences concerning dietary history in relation to evolutionary pressures are discussed.
The cranial biomechanics and feeding performance ofHomo floresiensis
Authors: Cook Rebecca W. , Vazzana Antonino , Sorrentino Rita , Benazzi Stefano , Smith Amanda L. , Strait David S. , Ledogar Justin A.
Published: August 2021

Homo floresiensisis a small-bodied hominin from Flores, Indonesia, that exhibits plesiomorphic dentognathic features, including large premolars and a robust mandible, aspects of which have been considered australopith-like. However, relative to australopith species,H. floresiensisexhibits reduced molar size and a cranium with diminutive midfacial dimensions similar to those of laterHomo, suggesting a reduction in the frequency of forceful biting behaviours. Our study uses finite-element analysis to examine the feeding biomechanics of theH. floresiensiscranium. We simulate premolar (P3) and molar (M2) biting in a finite-element model (FEM) of theH. floresiensisholotype cranium (LB1) and compare the mechanical results with FEMs of chimpanzees, modern humans and a sample of australopiths (MH1, Sts 5, OH5). With few exceptions, strain magnitudes in LB1 resemble elevated levels observed in modernHomo. Our analysis of LB1 suggests thatH. floresiensiscould produce bite forces with high mechanical efficiency, but was subject to tensile jaw joint reaction forces during molar biting, which perhaps constrained maximum postcanine bite force production. The inferred feeding biomechanics ofH. floresiensisclosely resemble modern humans, suggesting that this pattern may have been present in the last common ancestor ofHomo sapiensandH. floresiensis.
The influence of jaw-muscle fibre-type phenotypes on estimating maximum muscle and bite forces in primates
Authors: Holmes Megan , Taylor Andrea B.
Published: August 2021

Numerous anthropological studies have been aimed at estimating jaw-adductor muscle forces, which, in turn, are used to estimate bite force. While primate jaw adductors show considerable intra- and intermuscular heterogeneity in fibre types, studies generally model jaw-muscle forces by treating the jaw adductors as either homogeneously slow or homogeneously fast muscles. Here, we provide a novel extension of such studies by integrating fibre architecture, fibre types and fibre-specific tensions to estimate maximum muscle forces in the masseter and temporalis of five anthropoid primates:Sapajus apella(N= 3),Cercocebus atys(N= 4),Macaca fascicularis(N= 3),Gorilla gorilla(N= 1) andPan troglodytes(N= 2). We calculated maximum muscle forces by proportionally adjusting muscle physiological cross-sectional areas by their fibre types and associated specific tensions. Our results show that the jaw adductors of our sample ubiquitously express MHC α-cardiac, which has low specific tension, and hybrid fibres. We find that treating the jaw adductors as either homogeneously slow or fast muscles potentially overestimates average maximum muscle forces by as much as approximately 44%. Including fibre types and their specific tensions is thus likely to improve jaw-muscle and bite force estimates in primates.
Estimating the effects of accelerated partner therapy (APT) on reinfection of index cases with chlamydia: a mathematical modelling study
Authors: Althaus Christian L. , Estcourt Claudia S. , Low Nicola
Published: August 2021

Objectives

The expected effects of accelerated partner therapy (APT) on the reinfection of treated index cases by untreated partners withChlamydia trachomatis(chlamydia) remain unclear. We analyzed data from the LUSTRUM cluster cross-over randomised controlled trial (RCT) using a mathematical model and quantified the effects of offering APT on the probability of successful partner treatment.

Methods

We extended a previously developed mathematical model to compute the probability of chlamydia reinfection of index cases by their untreated partners with chlamydia. We fitted the model to data from the RCT and estimated the probability of successful treatment of the partner of index cases using a Bayesian framework.

Results

We estimated the median probability of reinfection with chlamydia at 16.3% (50% credible interval, CrI: 12.7-20.0%) without partner treatment and 2.3% (50% CrI: 1.7-3.6%) when partner treatment is 100% successful. The observed rates of reinfection in the RCT were 6.7% (95% confidence interval, CI: 5.6-8.0%) during the control period (standard partner notification (PN)) and 4.8% (95% CI: 3.7-5.9%) during the intervention period where APT was offered in addition to standard PN. These rates correspond to a median probability of successful partner treatment of 63% (50% CrI: 47-76%) during the control period and 78% (50% CrI: 65-87%) during the intervention period.

Conclusions

Our study suggests that the observed reduction in reinfection with chlamydia when offering APT is consistent with a higher probability of successful partner treatment.
COVID-19 in Connecticut institutions of higher education during the 2020-2021 academic year
Authors: Schultes Olivia , Clarke Victoria , Paltiel A. David , Cartter Matthew , Sosa Lynn , Crawford Forrest W.
Published: August 2021

Background

During the 2020-2021 academic year, many institutions of higher education reopened to residential students while pursuing strategies to mitigate the risk of SARS-CoV-2 transmission on campus. Reopening guidance emphasized PCR or antigen testing for residential students and social distancing measures to reduce the frequency of close interpersonal contact. Connecticut colleges and universities employed a variety of approaches to reopening campuses to residential students.

Methods

We used data on testing, cases, and social contact in 18 residential college and university campuses in Connecticut to characterize institutional reopening strategies and COVID-19 outcomes. We compared institutions’ fall 2020 COVID-19 plans, submitted to the Connecticut Department of Public Health, and analyzed contact rates and COVID-19 outcomes throughout the academic year.

Results

In census block groups containing residence halls, fall student move-in resulted in a 475% (95% CI 373%-606%) increase in average contact, and spring move-in resulted in a 561% (441%-713%) increase in average contact. The relationship between test frequency and case rate per residential student was complex: institutions that tested students infrequently detected few cases but failed to blunt transmission, while institutions that tested students more frequently detected more cases and prevented further spread. In fall 2020, each additional test per student per week was associated with a reduction of 0.0014 cases per student per week (95% CI: -0.0028, -0.000012). Residential student case rates were associated with higher case rates in the town where the school was located, but it is not possible to determine whether on-campus infections were transmitted to the broader community or vice versa.

Conclusions

Campus outbreaks among residential students might be avoided or mitigated by frequent testing, social distancing, and mandatory vaccination. Vaccination rates among residential students and surrounding communities may determine the necessary scale of residential testing programs and social distancing measures during the 2021-2022 academic year.
Development and use analysis of ‘gestioemocional.cat’, a web app for promoting emotional self-care and access to professional mental health resources during the covid-19 pandemic
Authors: Fidel-Kinori SG , Carot-Sans G , Cuartero-Barbanoj A , Valero-Bover D , Piera-Jimenez J , Romà-Monfà R , Garcia-Ribatallada E , Perez-Sust P , Blanch-Andreu J , Ramos-Quiroga JA
Published: August 2021

Background

Quarantines and nationwide lockdowns dictated for containing the spread of the COVID-19 pandemic may lead to distress and increase the frequency of anxiety and depression symptoms among the general population. During the national lockdown of the first wave of the COVID-19 outbreak in Spain, we developed and launched a Web App (Gestioemocional.cat) to promote emotional self-care in the general population and facilitate contact with healthcare professionals.

Methods

Gestioemocional.cat targeted all individuals aged 18 years or more and was designed by adapting the contents of a mobile App for adjuvant treatment of post-traumatic stress disorder (i.e., the PTSD Coach App) to the general population and the pandemic/lockdown scenario. We retrospectively assessed the utilization pattern of the Web App using data systematically retrieved from Google Analytics. Data were grouped into three time periods, defined using a join point analysis of COVID-19 incidence in our area: first wave, between-wave period, and second wave.

Results

The resulting Web App, maintains the navigation structure of the PTSD Coach App, with three main modules: tools for emotional self-care, a self-assessment test, and professional resources for on-demand contact. The self-assessment test combines the Patient Health Questionnaire-2 (PHQ-2) and the 7-item Generalized Anxiety Disorder Scale (GAD-7) and offers professional contact in the advent of a high level of depression and anxiety; contact is prioritized according to a screening questionnaire administered at the time of obtaining individual consent to be contacted. The tools for emotional self-care can be accessed either on-demand or symptom-driven. The utilization analysis showed a high number of weekly accesses during the first wave. In this period, press releases regarding critical events of the pandemic progression and government decisions on containment measures were followed by a utilization peak, irrespective of the sense (i.e., positive or negative) of the information. Positive information pieces (e.g., relaxation of containment measures due to a reduction of COVID-19 cases) resulted in a sharp increase in utilization immediately after information release, followed by a successive decline in utilization. The second wave was characterized by a lower and less responsive utilization of the Web App.

Conclusions

mHealth tools may help the general population coping with stressful conditions associated with the pandemic scenario. Future studies shall investigate the effectiveness of these tools among the general population―including individuals without diagnosed mental illnesses―and strategies to reach as many people as possible.