bluuebunny/crossref_metadata_2025 huggingface dataset:
Experimental Performance Evaluation on PV-module
Authors: Muharam Azlan , Jalil Zarulrizam Ab , Nor Muhamad Asrul Affendi Mat , Ismail Noor Soudiqqin
Published: December 2023

Photovoltaic (PV) modules are among the most efficient, environmentally benign, and long-lasting systems. The amount of solar radiation impacting these modules that is converted to electricity is quite little. The remaining radiation is transformed into heat, which causes the PV module to overheat and lose efficiency. This experiment examines the effects of changing several operating parameters on the performance of PV modules, including irradiation intensity, and cooling fluid mass flow rate. To reduce cell temperature, a heat exchanger was placed on the PV module’s back surface. For PV modules, findings indicate that as solar cell temperature rises by 1.2°C, the module’s electrical efficiency falls by 5.64%. Meanwhile for PVT, as the temperature of module rises by 1.2°C, the electrical efficiency similarly drops by roughly 0.22%. The solar cell temperature rises by 0.7°C and the output power rise by 2.26W, yet the efficiency falls by 0.25%. In conclusion, the performance of PV modules is greatly influenced by temperature of the solar cell, intensity of solar radiation, and mass flow rate of cooling fluids.
Benchmark thermodynamic analysis of methylammonium lead iodide decomposition from first principles
Authors: Heine Douglas , Yu Hui-Chia , Blum Volker
Published: December 2023

Hybrid organic–inorganic perovskites (HOIPs) such as methylammonium lead iodide (MAPbI3) are promising candidates for use in photovoltaic cells and other semiconductor applications, but their limited chemical stability poses obstacles to their widespread use. Ab initio modeling of finite-temperature and pressure thermodynamic equilibria of HOIPs with their decomposition products can reveal stability limits and help develop mitigation strategies. We here use a previously published experimental temperature-pressure equilibrium to benchmark and demonstrate the applicability of the harmonic and quasiharmonic approximations, combined with a simple entropy correction for the configurational freedom of methylammonium cations in solid MAPbI3 and for several density functional approximations, to the thermodynamics of MAPbI3 decomposition. We find that these approximations, together with the dispersion-corrected hybrid density functional HSE06, yield remarkably good agreement with the experimentally assessed equilibrium between T = 326 K and T = 407 K, providing a solid foundation for future broad thermodynamic assessments of HOIP stability.
Stochastic gradient descent with random label noises: doubly stochastic models and inference stabilizer
Authors: Xiong Haoyi , Li Xuhong , Yu Boyang , Wu Dongrui , Zhu Zhanxing , Dou Dejing
Published: December 2023

Random label noise (or observational noise) widely exists in practical machine learning settings. While previous studies primarily focused on the effects of label noise to the performance of learning, our work intends to investigate the implicit regularization effects of label noise, under mini-batch sampling settings of stochastic gradient descent (SGD), with the assumption that label noise is unbiased. Specifically, we analyze the learning dynamics of SGD over the quadratic loss with unbiased label noise (ULN), where we model the dynamics of SGD as a stochastic differentiable equation with two diffusion terms (namely a doubly stochastic model). While the first diffusion term is caused by mini-batch sampling over the (label-noiseless) loss gradients, as in many other works on SGD (Zhu et al 2019 ICML 7654–63; Wu et al 2020 Int. Conf. on Machine Learning (PMLR) pp 10367–76), our model investigates the second noise term of SGD dynamics, which is caused by mini-batch sampling over the label noise, as an implicit regularizer. Our theoretical analysis finds such an implicit regularizer would favor some convergence points that could stabilize model outputs against perturbations of parameters (namely inference stability). Though similar phenomenon have been investigated by Blanc et al (2020 Conf. on Learning Theory (PMLR) pp 483–513), our work does not assume SGD as an Ornstein–Uhlenbeck-like process and achieves a more generalizable result with convergence of the approximation proved. To validate our analysis, we design two sets of empirical studies to analyze the implicit regularizer of SGD with unbiased random label noise for deep neural network training and linear regression. Our first experiment studies the noisy self-distillation tricks for deep learning, where student networks are trained using the outputs from well-trained teachers with additive unbiased random label noise. Our experiment shows that the implicit regularizer caused by the label noise tends to select models with improved inference stability. We also carry out experiments on SGD-based linear regression with ULN, where we plot the trajectories of parameters learned in every step and visualize the effects of implicit regularization. The results back up our theoretical findings.
Singly doped colloidal quantum dots as optically addressed nanopositionable qubits
Authors: Barrett Rachel M , Binks David J
Published: December 2023

Colloidal quantum dots (CQDs) are isolated semiconductor nanocrystals with a size-tunable bandgap that can be prepared and processed by well-established solvent-based chemistry, and are currently used for a number of optoelectronic applications. When doped with a single atom, they also have great potential as a platform for optically addressable spin qubits. This perspective first describes the process by which doped CQDs can be made and the electronic structure produced in them by doping with a single atom. The properties that make them particularly well-suited as a spin-photon interface are identified: a local environment for the dopant that is free of unwanted spins; an optical cross-section for the dopant that can be enhanced by orders of magnitude via an exchange interaction with the band edge exciton of the dot; and, as an isolated nanocrystal, the scope for nano-positioning and hence precise incorporation into device structures. Lastly, two areas for development are discussed which would enhance the impact of singly doped quantum dots on quantum technology. The first of these is a synthetic method that ensures deterministic doping with single atoms and the second is to expand the range of dopants available.
Process and outcomes from systemization of a longitudinal advanced pharmacy practice experience (LAPPE) program
Authors: Deyhim Niaz , Dunne Ian E , Nguyen Phuoc Anne , Fasoranti Oyejoke O , Crew Cassie M , Liebl Michael G
Published: December 2023

Purpose

Longitudinal models for completing advanced pharmacy practice experiences were implemented to enhance experiential training efficiency through extracurricular experiences and to offer high-quality learning continuously. Through multihospital expansion of an established single-site longitudinal advanced pharmacy practice experience (LAPPE) program, the expanded collaborative opportunities support the development of new concepts that enhance integrated learning.

Methods

An observational study was designed to describe the approach for constructing a LAPPE program integrated across a multihospital system, to assess the professional skills gained by the program graduates, and to evaluate program impact on graduates’ professional career. A questionnaire was developed for current students to assess the program’s impact across 5 domains. Value-added benefits for the health system and challenges to implementation of a systemized program were reviewed as guidance for institutions interested in implementing such a model.

Results

Expansion of a single-site LAPPE program across a multihospital health system requires significant coordination from leadership, especially during the recruitment and interview process. Additionally, integration of preceptors across sites bolsters student experiences for various professional activities offered in a LAPPE program. This program’s questionnaire results pointed toward an increase in students’ knowledge and skills in preparation for postgraduate training. For students entering the ASHP Resident Matching Program, there was a 100% residency match rate before and after program systemization.

Conclusion

The expansion of a LAPPE program across a multihospital system offers intangible benefits to an institution, expands self-reported competencies, and establishes a foundation for postgraduate success. This model may be utilized at institutions with similar interest to implement, expand, or systemize a LAPPE program.
Pharmacy-driven performance improvement initiative to increase compliance with intravenous smart pump drug error reduction systems at a large urban academic medical center
Authors: Abboudi Eliana , Baron Sarah W , Goriacko Pavel , Messing Emily , Sinnett Mark , Uwechia Uzoamaka
Published: December 2023

Purpose

Smart pump dose error reduction systems (DERS) reduce errors for intravenous (IV) administration medications by warning users of order, calculation, and programming errors. The purpose of this performance improvement initiative was to increase IV smart pump DERS usage from 77% to 95% at a large, urban academic medical center.

Methods

A pharmacy-led team with nurses, physicians, and quality improvement specialists executed interventions from July 2020 through April 2022 to increase DERS compliance. A discovery phase (phase I) was followed by 6 Plan-Do-Study-Act (PDSA) cycles created to address barriers to DERS utilization. Phase I revealed that problems involving the DERS library and bedside nurse training were the major drivers of noncompliance. Phase II consisted of 3 system-level PDSA cycles, and phase III included 3 focused group PDSA cycles. Data were collected monthly from the smart pump reporting software by the informatics pharmacist and analyzed by the team to assess compliance rates in response to the corresponding interventions.

Results

The median DERS compliance increased from 77% to 83% over the 2-year period, which correlates with approximately 109,000 additional infusions run on DERS each year within our institution. The implementation of a DERS problem reporting tool accessed through the medication administration record resulted in the most pronounced improvement.

Conclusion

DERS compliance improved following system-level sustainable interventions, although further PDSA cycles are needed to meet the goal DERS utilization rate of 95%. The results of this study may help other institutions attempting to improve DERS utilization create targeted interventions.
Scoring big: Aligning inpatient clinical pharmacy services through implementation of an electronic scoring system
Authors: Patel Nisha , To Long , Griebe Kristin , Efta Jessica , Knoth Nicole , Johnson Joey , Fitzmaurice Mary Grace , Bajwa Manisha , Stuart Misa , Procopio Vince , Stine John , MacDonald Nancy C , Peters Mike , Ratusznik Martin , Kalus Jamie
Published: December 2023

Purpose

Data are limited on utilizing a comprehensive scoring system in the electronic health record to help prioritize, align, and standardize clinical pharmacy services across multiple hospitals and practice models within a health system. The purpose of this article is to describe the development and implementation of an electronic scoring system to help inpatient pharmacists prioritize patient care activities and standardize clinical services across a diverse health system.

Inpatient pharmacists from all specialty areas across the health system partnered with health information technology pharmacists to develop a scoring system directly integrated into the electronic health record that would help triage patient care, identify opportunities for pharmacist intervention, and prioritize clinical pharmacy services. Individual variables were built based on documented patient parameters such as use of high-risk medications, pharmacy consults, laboratory values, disease states, and patient acuity. Total overall scores were assigned to patients based on the sum of the scores for the individual variables, which update automatically in real time. The total scores were designed to help inpatient pharmacists prioritize patients with higher scores, thus reducing the need for manual chart review to identify high-risk patients.

Conclusion

An electronic scoring system with a tiered point system developed for inpatient pharmacists creates a method to prioritize and align clinical pharmacy services across a health system with diverse pharmacy practice models.
Dysregulated iron homeostasis in dystrophin-deficient cardiomyocytes: correction by gene editing and pharmacological treatment
Authors: Andrysiak Kalina , Machaj Gabriela , Priesmann Dominik , Woźnicka Olga , Martyniak Alicja , Ylla Guillem , Krüger Marcus , Pyza Elżbieta , Potulska-Chromik Anna , Kostera-Pruszczyk Anna , Łoboda Agnieszka , Stępniewski Jacek , Dulak Józef
Published: December 2023

Aims

Duchenne muscular dystrophy (DMD)-associated cardiomyopathy is a serious life-threatening complication, the mechanisms of which have not been fully established, and therefore no effective treatment is currently available. The purpose of the study was to identify new molecular signatures of the cardiomyopathy development in DMD.

Methods and results

For modelling of DMD-associated cardiomyopathy, we prepared three pairs of isogenic control and dystrophin-deficient human induced pluripotent stem cell (hiPSC) lines. Two isogenic hiPSC lines were obtained by CRISPR/Cas9-mediated deletion of DMD exon 50 in unaffected cells generated from healthy donor and then differentiated into cardiomyocytes (hiPSC-CM). The latter were subjected to global transcriptomic and proteomic analyses followed by more in-depth investigation of selected pathway and pharmacological modulation of observed defects. Proteomic analysis indicated a decrease in the level of mitoNEET protein in dystrophin-deficient hiPSC-CM, suggesting alteration in iron metabolism. Further experiments demonstrated increased labile iron pool both in the cytoplasm and mitochondria, a decrease in ferroportin level and an increase in both ferritin and transferrin receptor in DMD hiPSC-CM. Importantly, CRISPR/Cas9-mediated correction of the mutation in the patient-derived hiPSC reversed the observed changes in iron metabolism and restored normal iron levels in cardiomyocytes. Moreover, treatment of DMD hiPSC-CM with deferoxamine (DFO, iron chelator) or pioglitazone (mitoNEET stabilizing compound) decreased the level of reactive oxygen species in DMD hiPSC-CM.

Conclusion

To our knowledge, this study demonstrated for the first time impaired iron metabolism in human DMD cardiomyocytes, and potential reversal of this effect by correction of DMD mutation or pharmacological treatment. This implies that iron overload-regulating compounds may serve as novel therapeutic agents in DMD-associated cardiomyopathy.
Tricuspid isthmus ablation with pulsed-field power by linear catheter: a case report
Authors: Li Xinzhong , Huang Long , Li Jianyong , Huang Senlin , Wang Yuegang
Published: December 2023

Background

Pulsed-field ablation using annular or petal-shaped catheters had been proven to be effective for achieving electrical isolation of pulmonary veins in patients with atrial fibrillation. However, the utilization of linear pulse-field power for treating atrial flutter has yet to been documented.

Case summary

In this report, we present a case involving the successful treatment of tricuspid isthmus–dependent atrial flutter treated with a linear pulsed-field catheter. The patient, a 71-year-old male, presents with an electrocardiogram indicating atrial flutter. Subsequent electrophysiological examination reveals typical atrial flutter that is dependent on the cavo-tricuspid isthmus (CTI). This condition is successfully terminated through the application of linear pulsed-field ablation.

Discussion

This case represents a pioneering instance of CTI-dependent atrial flutter ablation utilizing linear pulse-field power. The innovative approach not only effectively treats the patient but also serves as a valuable reference for future applications of linear treatment with pulsed-field ablation.
Impact of aortopulmonary collaterals on adverse events after total cavopulmonary connection
Authors: Osawa Takuya , Schaeffer Thibault , Borgmann Kristina , Schmiel Mervin , Staehler Helena , Di Padua Chiara , Heinisch Paul Philipp , Piber Nicole , Mutsuga Masato , Hager Alfred , Ewert Peter , Hörer Jürgen , Ono Masamichi
Published: December 2023

OBJECTIVES

Effects of aortopulmonary collaterals (APCs) on outcomes after the total cavopulmonary connection (TCPC) are unclear. This study evaluated the incidence of APCs before and after TCPC and analysed the impacts of APCs on adverse outcomes.

METHODS

A total of 585 patients, who underwent TCPC from 1994 to 2020 and whose preoperative angiographies were available, were included. Pre-TCPC angiograms in all patients were used for the detection of APCs, and post-TCPC angiograms were evaluated in selected patients. Late adverse events included late death, protein-losing enteropathy (PLE) and plastic bronchitis (PB).

RESULTS

The median age at TCPC was 2.3 (1.8–3.4) years with a body weight of 12 (11–14) kg. APCs were found in 210 patients (36%) before TCPC and in 81 (14%) after TCPC. The closure of APCs was performed in 59 patients (10%) before TCPC, in 25 (4.2%) at TCPC and in 59 (10%) after TCPC. The occurrences of APCs before and after TCPC were not associated with short-term or mid-term mortality. The APCs before TCPC were associated with chylothorax (P = 0.025), prolonged chest tube duration (P = 0.021) and PB (P = 0.008). The APCs after TCPC were associated with PLE (P < 0.001) and PB (P < 0.001). With APCs following TCPC, freedom from PLE and PB was lower than without (P < 0.001, P < 0.001).

CONCLUSIONS

APCs before TCPC were associated with chylothorax, prolonged chest tube duration and PB. APCs after TCPC were associated with both PLE and PB. The presence of APCs might affect the lymph drainage system and increase the incidence of chylothorax, PLE and PB.
Habitat-related variability in the morphological and taxonomic diversity of microbial communities in two Hungarian epigenic karst caves
Authors: Lange-Enyedi Nóra Tünde , Borsodi Andrea K , Németh Péter , Czuppon György , Kovács Ivett , Leél-Őssy Szabolcs , Dobosy Péter , Felföldi Tamás , Demény Attila , Makk Judit
Published: December 2023

The physical and chemical characteristics of the bedrock, along with the geological and hydrological conditions of karst caves may influence the taxonomic and functional diversity of prokaryotes. Most studies so far have focused on microbial communities of caves including only a few samples and have ignored the chemical heterogeneity of different habitat types such as sampling sites, dripping water, carbonate precipitates, cave walls, cave sediment and surface soils connected to the caves. The aim of the present study was to compare the morphology, the composition and physiology of the microbiota in caves with similar environmental parameters (temperature, host rock, elemental and mineral composition of speleothems) but located in different epigenic karst systems. Csodabogyós Cave and Baradla Cave (Hungary) were selected for the analysis of bacterial and archaeal communities using electron microscopy, amplicon sequencing, X-ray diffraction, and mass spectroscopic techniques. The microbial communities belonged to the phyla Pseudomonadota, Acidobacteriota, Nitrospirota and Nitrososphaerota, and they showed site-specific variation in composition and diversity. The results indicate that morphological and physiological adaptations provide survival for microorganisms according to the environment. In epigenic karst caves, prokaryotes are prone to increase their adsorption surface, cooperate in biofilms, and implement chemolithoautotrophic growth with different electron-donors and acceptors available in the microhabitats.
The potential role of protein disulfide isomerases (PDIs) during parasitic infections: a focus on Leishmania spp
Authors: Dousti Majid , Hosseinpour Masoumeh , D Ghasemi Nadia , Mirfakhraee Hosna , Rajabi Shahin K , Rashidi Sajad , Hatam Gholamreza
Published: December 2023

Leishmaniasis is a group of vector-borne diseases caused by intracellular protozoan parasites belonging to the genus Leishmania. Leishmania parasites can employ different and numerous sophisticated strategies, including modulating host proteins, cell signaling, and cell responses by parasite proteins, to change the infected host conditions to favor the parasite persistence and induce pathogenesis. In this sense, protein disulfide isomerases (PDIs) have been described as crucial proteins that can be modulated during leishmaniasis and affect the pathogenesis process. The effect of modulated PDIs can be investigated in both aspects, parasite PDIs and infected host cell PDIs, during infection. The information concerning PDIs is not sufficient in parasitology; however, this study aimed to provide data regarding the biological functions of such crucial proteins in parasites with a focus on Leishmania spp. and their relevant effects on the pathogenesis process. Although there are no clinical trial vaccines and therapeutic approaches, highlighting this information might be fruitful for the development of novel strategies based on PDIs for the management of parasitic diseases, especially leishmaniasis.
Posttraumatic arteriovenous fistula of the lower extremity and the pathological characteristic—case series and literature review
Authors: He Changhuai , Ye Pin , Cai Xun , Li Yiqing , Cai Chuanqi
Published: December 2023

The clinical presentation, treatment history, and outcomes of two patients with posttraumatic arteriovenous fistula (PTAVF) were analyzed and compared with the pathological tissues of patients with hemodialysis arteriovenous fistula (HAVF). A search of the biomedical literature database (PubMed), using the keywords “ lower extremity” and “PTAVF,” was conducted to obtain results and review the data. Postoperative histological analysis of patients with PTAVF showed differences from that of HAVF. The literature screening and analysis revealed that PTAVF is a chronic progressive process, with 70% of patients diagnosed after 3 months. The choice of treatment revealed that 20% of patients had severe complications and all were treated endovascularly. Due to the abnormal fistula of PTAVF and its specific histopathological features, the disease is not self-limiting. It is unwise to wait for PTAVF to cause “failure.” We recommend early and timely cure of this disease by surgery to avoid serious complications.
Microfinance’s transformational potential: looking beyond average treatment effects
Authors: Cueva Ronald A , Osman Adam , Speer Jamin D
Published: December 2023

Hundreds of studies have examined the impacts of microfinance, finding mostly modest or disappointing results. In this article, instead of asking whether microfinance works on average, we study the varied impacts of microfinance. Using data from several prominent recent studies, we show that the heterogeneity in returns to microcredit, microsavings, and microinsurance is large. This means that even programmes that are not effective on average could be transformational for some people. We call for researchers and policy-makers to focus more on identifying those who will benefit from microfinance, and understanding why they do. Together this will improve the targeting of these interventions, increase their positive impact, and help improve the design of future products.
Selected microfinance crises: past, present, and future
Authors: Mendelson Sam , Rozas Daniel
Published: December 2023

The Covid-19 pandemic is the most recent—and most severe—crisis to face the microfinance/financial inclusion sector, but it was far from the first. From its earliest years, crises have appeared throughout the modern history of microfinance, and the responses they engendered have included some of the most significant reforms and innovations in the sector. In this paper, we describe selected historical crises—Peru in the 1980s, Grameen in the 1990s, and Andhra Pradesh and others in the 2007–2010 period—through their legacy and impact on the sector’s activities and priorities. We then examine some of the pressures on institutions during the pandemic, through interview data with MFI leaders from the Sentinel Project conducted during 2021–22. We argue that the resilience of the sector to the unprecedented pressures of the pandemic can be traced to many of these historical post-crisis reforms—and consider what this means for future crisis responses.
Global density-dependent α–nucleon interaction for α–nucleus elastic scattering
Authors: Furumoto T , Tsubakihara K , Ebata S , Horiuchi W
Published: December 2023

We provide a global density-dependent 4He–nucleon (DD-αN) interaction to construct the α–nucleus optical model potential (OMP) across a wide range of incident energies. The global parametrization for the DD-αN interaction is obtained based on the proton–4He OMP, which reproduces the elastic scattering cross-section data very well in the incident energies of 12.04–500 MeV per nucleon. Using the present DD-αN interaction, we derive the α–nucleus potential by a folding procedure with the point-nucleon density obtained by a microscopic mean-field model. The density dependence of the DD-αN interaction is fixed phenomenologically to reproduce the α–nucleus elastic scattering cross-section data obtained from 16O, 40Ca, 58Ni, 90Zr, and 208Pb targets at E/A = 10–342.5 MeV. We also show the total reaction cross sections, which are helpful in fixing one free parameter, the renormalization factor for the imaginary part of the α–nucleus potential. Lastly, we show some examples, which clearly demonstrate the validity and power of the present DD-αN approach.
Physeal Fractures of the Distal Ulna: Incidence and Risk Factors for Premature Growth Arrest
Authors: Lee Julianna , Värk Pille-Riin , Mendenhall Shaun D. , Chang Benjamin , Buttrick Eliza , Shah Apurva S.
Published: December 2023

Background:

The aim of this study is to assess the rate of distal ulnar growth arrest following physeal fracture and to identify specific risk factors for premature physeal closure.

Methods:

A retrospective review of patients with a distal ulnar physeal fracture was performed at a single United States children’s hospital. Patients without 6-month follow-up were excluded. Patient demographics, injury characteristics, treatment, and outcomes were abstracted. Fractures were classified by the Salter-Harris (SH) system. All follow-up radiographs were reviewed for changes in ulnar variance or signs of premature physeal arrest.

Results:

Fifty-six children with distal ulnar physeal fracture at a mean age of 10.7±3.3 years were included with a mean follow-up of 1.9 years. The most common fracture pattern was a SH II (52.7%), versus SH I (29.1%), SH III (9.1%), and SH IV (9.1%). Of displaced fractures (41.1%), the mean translation was 40.2±38.3% the and mean angulation was 24.8±20.9 degrees. Eleven fractures (19.6%) demonstrated radiographic signs of growth disturbance, including 3 patients (5.4%) with growth disturbance but continued longitudinal growth and 8 patients (14.3%) with complete growth arrest. The average ulnar variance was −3.4 mm. Three patients underwent subsequent surgical reconstruction including ulnar lengthening with an external fixator, distal ulna completion epiphysiodesis with distal radius epiphysiodesis, and ulnar corrective osteotomy. Patients with displaced fractures and SH III/IV fractures were more likely to develop a growth disturbance (34.8% vs. 3.2%, P=0.003; 50.0% vs. 11.1%, P=0.012, respectively). Children with less than 2 years of skeletal growth remaining at the time of injury had a higher risk of growth disturbance (46.2% vs. 9.5%, P=0.007).

Conclusions:

SH III and IV fractures are more common injury patterns in the distal ulna compared with the distal radius. Growth disturbance or growth arrest occurs in ~20% of distal ulnar physeal fractures. Displaced fractures, intra-articular fractures, fractures requiring open reduction, and older children are at increased risk of distal ulnar growth arrest and should be followed more closely.

Level of Evidence:

Level IV—-case series.
Blinded Intraoperative Quantitative Indocyanine Green Metrics Associate With Intestinal Margin Acceptance in Colorectal Surgery
Authors: Adams Evan D. , Salem Jean F. , Burch Miguel A , Fleshner Phillip R , Zaghiyan Karen N.
Published: December 2023

BACKGROUND:

Indocyanine green is a useful tool in colorectal surgery. Quantitative values may enhance and standardize its application.

OBJECTIVE:

To determine if quantitative indocyanine green metrics correlate with standard subjective indocyanine green perfusion assessment in acceptance or rejection of anastomotic margins.

DESIGN:

Prospective single arm, single institution cohort study. Surgeons viewed subjective indocyanine green images but were blinded to quantitative indocyanine green metrics.

SETTING:

Tertiary academic center.

PATIENTS:

Adults undergoing planned intestinal resection.

MAIN OUTCOME MEASURES:

Accepted perfusion and rejected perfusion of the intestinal margin were defined by absence or presence of ischemia by subjective indocyanine green and gross inspection. The primary outcomes were quantitative indocyanine green values, maximum fluorescence and time to maximum fluorescence in accepted compared to rejected perfusion. Secondary outcomes included maximum fluorescence and time to maximum fluorescence values in anastomotic leak.

RESULTS:

There were 89 perfusion assessments, comprising 156 intestinal segments. Nine segments were subjectively assessed to have poor perfusion by visual inspection and subjective indocyanine green. Maximum fluorescence (% intensity) exhibited higher intensity in accepted perfusion [accepted perfusion 161% (82-351) vs. rejected perfusion 63% (10 – 76); p = 0.03]. Similarly, time to maximum fluorescence (seconds) was earlier in accepted compared to rejected perfusion [10s (1 – 40) vs. 120s (90 – 120); p < 0.01]. Increased body mass index associated with higher maximum fluorescence. Anastomotic leak did not correlate with maximum fluorescence or time to maximum fluorescence.

LIMITATIONS:

Small cohort study, not powered to measure the association between quantitative indocyanine green metrics and anastomotic leak.

CONCLUSION:

We demonstrate blinded quantitative values reliably correlate with subjective indocyanine green perfusion assessment. Time to maximum intensity is an important metric in perfusion evaluation. Quantitative indocyanine green metrics may enhance intraoperative intestinal perfusion assessment. Future studies may attempt to correlate quantitative indocyanine green values with anastomotic leak.
Inter-session repeatability of reading performance measures in patients with neovascular AMD
Authors: Boscia Giacomo , Ricardi Federico , Gelormini Francesco , Marica Valentina , Conte Fabio , Ghilardi Andrea , Viggiano Pasquale , Marolo Paola , Bandello Francesco , Borrelli Enrico , Reibaldi Michele
Published: December 2023

Purpose:

To assess the inter-session repeatability of reading performance measures in patients with previously treated neovascular age-related macular degeneration (AMD) and good best-corrected visual acuity (BCVA) (≥ 20/40 Snellen).

Methods:

Ninety-one patients (91 eyes) with a diagnosis of previously treated neovascular age-related macular degeneration (AMD) and good BCVA (≥ 20/40 Snellen) were prospectively enrolled. Reading performance metrics were assessed using Radner charts and these measurements were repeated after 7 days in order to obtain the inter-session repeatability. To test repeatability, we calculated the intraclass correlation coefficient (ICC), the 95% coefficient of repeatability (CR) and the coefficient of variation (CV) for each reading parameter: (i) reading acuity (RA - LogRAD); (ii) maximal reading speed (max RS - words per minute); (iii) reading acuity score (RA score - LogRAD); and (iv) critical print size (CPS - LogRAD).

Results:

Mean±SD BCVA was 0.129±0.0098 LogMAR [range: 0.00-0.30 LogMAR]. The ICC values indicated a good reliability for all the analyzed metrics (0.901 for RA; 0.859 for max RS; 0.906 for RA score; and 0.868 for CPS). The CR was 0.2 LogRAD for RA, 63.2 words per minute for max RS, 0.2 LogRAD for RA score, and 0.2 LogRAD for CPS. CV was 5.5% for RA, 8.9% for max RS, 5.8% for RA score and 6.9% for CPS.

Conclusion:

Reading performance metrics are characterized by good values of inter-session repeatability in neovascular AMD patients with good BCVA. Our findings may grant the employment of such measures in trials assessing the visual outcome in these patients.
Differences in the Progression between Myopic Maculoschisis Eyes with and without Macular Detachment in the Natural Course of the Disease: A Retrospective Longitudinal Study based on the New Myopic Traction Maculopathy Staging System
Authors: LI Jun , Lian Ping , Huang Xia , Liu Bingqian , Chen Shida , Lu Lin
Published: December 2023

Purpose:

To investigate the pace of visual acuity (VA) loss in myopic maculoschisis eyes with or without macular detachment (MD) and identify associated risk factors.

Methods:

1334 eyes of 991 patients with high myopia were reviewed. A new myopic traction maculopathy (MTM) staging system classified four retinal stages and three foveal stages. To the MTM eyes with normal fovea, maculoschisis with and without MD was defined as stage 3a and stage 1a,2a respectively.

Results:

110 (8.25%) eyes with maculoschisis were included, with a follow-up of 24.00 ± 17.47 months. Of them, 84 (76.36%) were stage 1a,2a, and 26 (23.64%) were stage 3a. The VA loss per year during the follow-up period was similar between eyes with stage 1a,2a and stage 3a (3.13 ± 12.21 VS. 3.41 ± 18.42 letters, P = 0.930). Multivariate analyses revealed that vitreomacular interface factors (VIFs) were significantly associated with VA loss during the follow-up, no matter in stage 1a,2a or stage 3a (P = 0.039 and P = 0.038, respectively). In the stage 1a,2a group, the percentage of eyes that lost at least 10 letters at the final visit compared with the baseline visual acuity was higher in eyes with VIFs than in those without VIFs (13 eyes, 50.00% VS. 14 eyes, 24.14%, P = 0.019).

Conclusion:

No differences were found in VA loss pace between stage 1a,2a and stage 3a. Surgical intervention or at least more intensive follow-up should be considered for stage 1a,2a eyes with VIFs, to promote a more favorable visual outcome.
Building Clinical Leadership Competencies When Caring for Hospitalized Adults Experiencing Dementia
Authors: Bilski Patricia B. , Hudson Shawna , MacLellan Margaret
Published: December 2023

Purpose and Objectives

Attempting to improve the experience of hospitalized adults with dementia and reduce patient attendant costs, we addressed hospital nursing staff confidence managing responsive behaviors through education, mentorship, and individualized patient care planning for adults with dementia.

Responsive behaviors (such as pacing, calling out) is a term used to describe behaviors demonstrated by a person with dementia as a way of responding to something negative, frustrating, or confusing in their social and physical environment.

Description of Project

Under time restraints, we performed a rapid environmental scan and developed internal clinical resources and a learning strategy that informed a quality improvement initiative that focused on dementia care of hospitalized patients.

Outcome

Using quantitative and qualitative evaluation methods, the interventions increased confidence, competency, and leadership in clinical nursing leaders and improved person-centered care planning practices. The cost of patient attendant usage for this patient population decreased by 28% in 1 year.

Conclusion

This intervention, which was not a copyrighted program associated with administration costs, improved hospital-based dementia care and staff confidence in dementia care and reduced annual costs associated with patient attendant useage.
Food Insecurity, Neighborhood Disadvantage, and Hospital Readmission in Health System Adults
Authors: S. Distelhorst Karen , Adams Kristine , Lopez Rocio
Published: December 2023

Purpose

The purpose of the study was to examine the relationship between food insecurity, neighborhood disadvantage, and hospital readmission within 90 days of discharge for health system patients.

Design

The study used a retrospective, correlational design with a single cohort.

Methods

Records of adult patients with a health system primary care provider and discharged from hospital to home were included. Data were obtained from health system billing database, medical record, and publicly available population databases. A time-to-readmission analysis was conducted with a Kaplan-Meier plot, log-rank test, and Cox regression analysis.

Results

The final sample included 41 566 records; the rate of food insecurity was 1.45%, and 90-day readmission rate was 16.7%. The mean area deprivation index score was 54.4 (SD, 26.0). After adjusting for patient demographics, comorbidity, and length of stay, food insecurity resulted in 1.94 times higher risk of readmission (hazard ratio, 1.94; 95% confidence interval, 1.69–2.23; P < .001). Neighborhood disadvantage and lower food access were not significant in final models.

Conclusions

Food insecurity should be identified and addressed as part of transitional care to improve patient outcomes. Future research should focus on models of care that ensure connection to community resources to resolve food insecurity and evaluate the impact on patient outcomes.
Gastrointestinal Ewing Sarcoma
Authors: Yin Tangchen , Shao Mengyuan , Sun Meng , Zhao Lu , Lao I. Weng , Yu Lin , Wang Jian
Published: December 2023

Occurrence of extraskeletal Ewing sarcoma (ES) in the gastrointestinal (GI) tract is extremely rare. Here, we report 25 cases of ES arising primarily in the GI tract with a focus on the clinicopathological and molecular features, differential diagnosis, and biological behavior. Thirteen patients (52%) were male, and 12 (48%) were female with age ranging from 9 to 59 years (mean: 36.2 years; median: 38 years). Twenty-one tumors (84%) occurred in the small intestine, 3 (12%) in the stomach, and 1 (4%) in the anal canal. At operation, 8/18 (44.4%) patients presented with abdominopelvic disseminated disease. Tumor size measured from 2 to 25 cm (mean: 8.2 cm; median: 6 cm) in maximum size. Microscopically, the tumors were composed of infiltrative small round, ovoid, or short spindle cells arranged mostly in lobular and solid sheet-like patterns with a rich capillary vasculature. Focal formation of Homer Wright–type rosettes and pseudoalveolar architecture was noted each in 2 (8%) cases and 3 (12%) cases. Besides CD99 (25/25; 100%), Fli-1 (15/15, 100%), and NKX2.2 (14/16; 87.5%), the tumor cells also showed variable staining of CD117 (14/17; 82.4%). Of 25 cases, 23 (92%) demonstrated EWSR1 rearrangement by fluorescence in situ hybridization analysis. The 2 cases with negative fluorescence in situ hybridization results were found to harbor EWSR1::ERG and EWSR1::FLI1 fusion by further RNA sequencing, respectively, with a median follow-up of 12 months (range: 1 to 42 months), 5/19 (26.3%) patients developed visceral metastasis and 12/19 (63.2%) patients died of the disease (range:1 to 33 months; median: 9 months). This study showed that GI ES had a predilection for the small intestine, although other sites of the GI tract could also be involved. GI ES had a poor prognosis with a high rate of mortality, particularly in patients with abdominopelvic disseminated disease. In light of appropriate therapeutic strategies and prognostic considerations, it is essential not to misdiagnose GI ES as gastrointestinal stromal tumor owing to the expression of aberrant CD117.
Later Brain Death Declaration Correlates to Favorable Donor Characteristics but Decreased Heart Acceptance
Authors: Greenberg Jason W. , Kantemneni Eashwar C. , Kulshrestha Kevin , Clothier Jessica S. , Desai Mallika V. , Winlaw David S. , Zafar Farhan , Morales David L.S.
Published: December 2023

Background.

With rates of potential donor heart discard as high as 66% nationally, quality improvement efforts must seek to optimize donor utilization. Whether the timing of donor brain death declaration (BDD) influences organ acceptance is understudied. The authors sought to characterize the impacts of time between donor hospital admission and BDD on heart utilization and posttransplant outcomes.

Methods.

All potential heart donors and recipients in the United Network for Organ Sharing database were identified (2006–2021). Admission-to-BDD cohorts were: 1 to 2 d (n = 52 469), 3 to 4 d (n = 44 033), 5 to 7 d (n = 24 509), and 8 to 10 d (n = 8576). Donor clinical characteristics were compared between cohorts, and donor acceptance was assessed using multivariable binary logistic regression. Recipient posttransplant survival was assessed with the Kaplan-Meier method.

Results.

Donor demographics and comorbidity profiles (diabetes and hypertension) were comparable across cohorts. Anoxia/overdose deaths were more common (10% > 21% > 24% > 18%, respectively) and cardiopulmonary resuscitation requirements were higher (37% > 52% > 58% > 47%) when BDD occurred longer after admission. Renal dysfunction (44% > 44% > 35% > 29%) and inotrope requirements (52% > 25% > 36% > 29%) were lower in the later BDD cohorts. Proportions of hepatic dysfunction (18%–21%) and left ventricular ejection fraction <50% (13%–16%) were clinically equivalent. Donor acceptance differed by admission-to-BDD cohort (36% [1–2 d], 34% [3–4 d], 30% [5–7 d], and 28% [8–10 d]). Admission-to-BDD >4 d was independently associated with lower odds of acceptance on multivariable analysis (odds ratio 0.79, P < 0.001). Recipients experienced equivalent posttransplant survival for all donor admission-to-BDD cohorts (P = 0.999 adults and P = 0.260 pediatrics).

Conclusions.

Heart donors with later BDD were disproportionately discarded despite similar-to-favorable overall clinical profiles, resulting in nearly 3000 fewer transplants during the study. Increased utilization of donors with later BDD and “high-risk” characteristics (eg, anoxia/overdose, cardiopulmonary resuscitation requirement) can improve rates of transplantation without compromising outcomes.
New Frontier: The First Year of an Adult Neurodevelopmental Disabilities Clinic
Authors: Sanders Jessica S. , Mabry Moriah , Scarbro Sharon , Filley Christopher M.
Published: December 2023

Background:

As patients with neurodevelopmental disorders (NDDs) transition from pediatric to adult health care systems, they often have difficulty finding physicians to address their NDD-related needs. In response to this care gap, we established a new consultation clinic within a behavioral neurology clinic in an adult neurology department to address the neurodevelopmental concerns of these adult patients.

Objective:

To characterize the population of adult patients with NDDs seen in the adult NDD clinic in its first year.

Method:

Data were obtained by a retrospective chart review of all patients with NDDs seen in the adult NDD clinic from September 2020 through December 2021.

Results:

Of the 86 patients who were seen in the adult NDD clinic, the average age was 34 years (SD = 15, range = 18–74 years). Developmental diagnoses included intellectual disability (63%), autism spectrum disorder (47%), Down syndrome (15%), cerebral palsy (9%), and other genetic disorders (26%). Comorbidities addressed included behavioral concerns (34%), anxiety (29%), seizure disorders (22%), and depression (15%). Behavioral and/or mental health concerns prompted 65% of the initial clinic visits. The most common recommendation made was to begin or increase exercise (59%), followed by facilitating connection to community, social, and employment resources.

Conclusion:

Adults with NDDs have diagnoses, comorbidities, and concerns that are similar to, but also distinct from, those addressed in other adult neurology clinics. This study addresses the need for, and feasibility of, caring for the diverse population of adults with NDDs in an adult neurology setting.
ICTV Virus Taxonomy Profile: Leishbuviridae 2023
Authors: Adkins Scott , Brown Katherine , de la Torre Juan Carlos , Digiaro Michele , Hughes Holly R. , Junglen Sandra , Lambert Amy J. , Maes Piet , Marklewitz Marco , Palacios Gustavo , Sasaya (笹谷孝英) Takahide , Turina Massimo , Zhang (张永振) Yong-Zhen , Kuhn Jens H.
Published: December 2023

Leishbuviridae is a family of negative-sense RNA viruses with genomes of about 8.0 kb that have been found in protists. The leishbuvirid genome consists of three monocistronic RNA segments with open reading frames (ORFs) that encode a nucleoprotein (NP), a glycoprotein (GP), and a large (L) protein containing an RNA-directed RNA polymerase (RdRP) domain. This is a summary of the International Committee on Taxonomy of Viruses (ICTV) Report on the family Leishbuviridae, which is available at ictv.global/report/leishbuviridae.
Internalization of rabies virus glycoprotein differs between pathogenic and attenuated virus strains
Authors: Almasoud Ibrahim , Charlton Frank W. , Finke Stefan , Barr John N. , Mankouri Jamel
Published: December 2023

The zoonotic rabies virus (RABV) is a non-segmented negative-sense RNA virus classified within the family Rhabdoviridae, and is the most common aetiological agent responsible for fatal rabies disease. The RABV glycoprotein (G) forms trimeric spikes that protrude from RABV virions and mediate virus attachment, entry and spread, and is a major determinant of RABV pathogenesis. A range of RABV strains exist that are highly pathogenic in part due to their ability to evade host immune detection. However, some strains are disease-attenuated and can be cleared by host defences. A detailed molecular understanding of how strain variation relates to pathogenesis is currently lacking. Here, we reveal key differences in the trafficking profiles of RABV-G proteins from the challenge virus standard strain (CVS-11) and a highly attenuated vaccine strain SAD-B19 (SAD). We show that CVS-G traffics to the cell surface and undergoes rapid internalization through both clathrin- and cholesterol-dependent endocytic pathways. In contrast, SAD-G remains resident at the plasma membrane and internalizes at a significantly slower rate. Through engineering hybrids of CVS-G and SAD-G, we show that the cytoplasmic tail of CVS-G is the key determinant of these different internalization profiles. Alanine scanning further revealed that mutation of Y497 in CVS-G (H497 in SAD-G) could reduce the rate of internalization to SAD-G levels. Together, these data reveal new phenotypic differences between CVS-G and SAD-G proteins that may contribute to altered in vivo pathogenicity.