bluuebunny/crossref_metadata_2025 huggingface dataset:
“Infantgram?” recruitment of infants to a clinical sleep study via social media
Authors: O’Connor Cathal , O’Leary Hannah , Murray Deirdre , Boylan Geraldine B
Published: October 2024

Study Objectives

This study aimed to outline the strategy and outcomes of a study team in recruiting participants for an infant sleep study via social media during the COVID-19 pandemic, to assess the feasibility of recruitment via social media, and to quantitatively and qualitatively explore parental satisfaction and perceptions of recruitment via social media.

Methods

The assessing sleep in infants with early-onset atopic dermatitis by longitudinal evaluation (SPINDLE) study recruited infants with and without atopic dermatitis for a longitudinal study assessing sleep. Infants were recruited via social media and their parents were interviewed to explore their experience of recruitment via social media.

Results

In total, 57 controls and 33 cases were recruited. Of the 45 controls recruited via social media, 43 (95.6%) were recruited via Instagram and 2 (4.4%) were recruited via Twitter. Of the seven cases recruited via social media, 6 (85.7%) were recruited via Facebook (via sharing of Instagram posts by third parties on Facebook) and 1 (14.3%) was recruited via Instagram. All (100%, n = 28) mothers recruited via social media who completed the full study were satisfied with this approach to recruitment. Specific reasons why mothers reported engaging following exposure to the social media posts included the benefit of additional health checks for their baby, the benefit to scientific advancement, and the opportunity for a stimulating outing following the COVID-19 lockdowns.

Conclusions

Our experience highlights parents’ acceptance of recruitment via social media, the optimization of time and financial resources, and the benefit of using internet-based recruitment during a pandemic.
The Right to Move a Private Member’s Bill in Uganda
Authors: Mujuzi Jamil Ddamulira
Published: October 2024

Under Article 94(4)(b) of the Constitution, ‘a member of Parliament has the right to move a private member’s bill [PMB]’. Under Article 94(4)(d), ‘the office of the Attorney-General shall afford the member moving the private member’s bill professional assistance in the drafting of the bill’. Article 93 prohibits Parliament from proceeding with a PMB that, inter alia, imposes a charge on the Consolidated Fund. Rule 121(3) of the Rules of Parliament provides ‘[t]he Clerk to Parliament shall, where necessary, afford the Member moving the’ PMB ‘professional assistance in the drafting of the Bill’. Under Rule 122(1), a PMB has to be introduced by way of motion which has to be carried for it to be passed. The right under Article 94(4)(b) is not one of the fundamental rights. The author relies on the drafting history of Articles 93 and 94 to demonstrate the nature of this right. He relies on the Hansard (2016–2024) to highlight how this right has been protected. He argues that Rules 121(3) and 122(2) are unconstitutional and that the Constitutional Court’s interpretation of Article 93(a)(ii) in one of its decisions  is contrary to the drafting history of that provision.
A twin transition in regulatory toxicology: moving toward Chemicals 2.0 and phasing out animal testing
Authors: Worth Andrew P , Berggren Elisabet
Published: October 2024

The European regulatory framework on chemicals is at a crossroads. There are calls for the framework to be more effective, by better protecting people and the environment. There is also room for it to be more efficient and cost-effective, by harmonizing assessment practices across sectors and avoiding the need for unnecessary testing. At the same time, there is a political commitment to phase out animal testing in chemical safety assessments. In this commentary, we argue that these needs are not at odds with each other. On the contrary, the European Commission’s roadmap to phase out animal testing could also be the transition pathway to a more efficient, effective, and sustainable regulatory ecosystem. Central to our proposal is a framework based on biological reasoning in which biological questions can be answered by a choice of methods, with non-animal methods progressively becoming the only choice. Within this framework, a tiered approach to testing and assessment allows for greater efficiency and effectiveness, while also introducing considerations of proportionality and cost-effectiveness. Testing strategies, and their component methods, should be developed in tandem and judged in terms of their outcomes, and the protection levels they inform, rather than their ability to predict the outputs of animal tests.
Initial stomatal conductance increases photosynthetic induction of trees leaves more from sunlit than from shaded environments: a meta-analysis
Authors: Kang Huixing , Yu Yuan , Ke Xinran , Tomimatsu Hajime , Xiong Dongliang , Santiago Louis , Han Qingmin , Kardiman Reki , Tang Yanhong
Published: October 2024

It has long been held that tree species/leaves from shaded environments show faster rate of photosynthetic induction than species/leaves from sunlit environments, but the evidence so far is conflicting and the underlying mechanisms are still under debate. To address the debate, we compiled a dataset for 87 tree species and compared the initial increasing slope during the first 2-min induction (SA) and stomatal and biochemical characteristics between sun and shade species from the same study, and those between sun and shade leaves within the same species. In 77% of between-species comparisons, the species with high steady-state photosynthetic rate in the high light (Af) exhibited a larger SA than the species with low Af. In 67% within-species comparisons, the sun leaves exhibited a larger SA than the shade leaves. However, in only a few instances did the sun species/leaves more rapidly achieve 50% of full induction, with an even smaller SA, than the shade species/leaves. At both the species and leaf level, SA increased with increasing initial stomatal conductance before induction (gsi). Despite exhibiting reduced intrinsic water-use efficiency in low light, a large SA proportionally enhances photosynthetic carbon gain during the first 2-min induction in the sun species and leaves. Thus, in terms of the increase in absolute rate of photosynthesis, tree species/leaves from sunlit environments display faster photosynthetic induction responses than those from shaded environments. Our results call for re-consideration of contrasting photosynthetic strategies in photosynthetic adaption/acclimation to dynamic light environments across species.
Brassica juncea Preseason Cover Crops Reduce Soybean Root Colonization by Macrophomina phaseolina, the Fungus Causing Charcoal Rot
Authors: Sassenrath Gretchen , Waite Natalie , Hsiao Che-Jen , Little Christopher R.
Published: October 2024

Macrophomina phaseolina (Tassi) Goid. is a soilborne fungus that causes charcoal rot in numerous crop plants, reducing yield and profits. This study assessed the efficacy of preseason mustard cover crops ( Brassica juncea), a chemical fungicide seed treatment, a combination of both, and a nontreated control in a set of varieties that ranged in maturity. In 2016 and 2017, ‘AG4135 RR2Y/SR’ consistently had a lower yield compared with other varieties. Early maturity varieties exhibited reduced yields relative to mid and late maturity pairs in 2016 and 2017. Root colonization was influenced by treatment, with the combined preseason cover crop and seed treatment exhibiting the lowest colonization rates in 2015, while all treatments had significantly reduced colonization in 2017 compared with untreated controls. Additionally, differences in root colonization were observed among soybean varieties, suggesting genotype-specific responses to disease management strategies. M. phaseolina soil populations showed a marked increase from pre-cover crop to post-soybean harvest, underscoring the pathogen's proliferation throughout the growing season. Correlation analyses revealed significant negative relationships between root colonization and yield for untreated controls, suggesting that higher root colonization adversely affected crop performance. These findings suggest that specific treatments may help mitigate M. phaseolina population build-up in roots and soil and indicate that the effectiveness of control measures may be influenced by pathogen variability in response to environmental conditions and management practices. These findings also contribute to our understanding of effective strategies for managing charcoal rot disease and highlights the importance of integrating chemical and biological control methods.
Sexual Orientation–Related Disparities in Neonatal Outcomes
Authors: Chakraborty Payal , Reynolds Colleen A. , McKetta Sarah , Soled Kodiak R. S. , Huang Aimee K. , Monseur Brent , Corman Jae Downing , Obedin-Maliver Juno , Eliassen A. Heather , Chavarro Jorge E. , Austin S. Bryn , Everett Bethany , Haneuse Sebastien , Charlton Brittany M.
Published: October 2024

OBJECTIVE:

To evaluate whether disparities exist in adverse neonatal outcomes among the offspring of lesbian, gay, bisexual, and other sexually minoritized (LGB+) birthing people.

METHODS:

We used longitudinal data from 1995 to 2017 from the Nurses' Health Study II, a cohort of nurses across the United States. We restricted analyses to those who reported live births (N=70,642) in the 2001 or 2009 lifetime pregnancy questionnaires. Participants were asked about sexual orientation identity (current and past) and same-sex attractions and partners. We examined preterm birth, low birth weight, and macrosomia among 1) completely heterosexual; 2) heterosexual with past same-sex attractions, partners, or identity; 3) mostly heterosexual; 4) bisexual; and 5) lesbian or gay participants. We used log-binomial models to estimate risk ratios for each outcome and weighted generalized estimating equations to account for multiple pregnancies per person over time and informative cluster sizes.

RESULTS:

Compared with completely heterosexual participants, offspring born to parents in all LGB+ groups combined (groups 2–5) had higher estimated risks of preterm birth (risk ratio 1.22, 95% CI, 1.15–1.30) and low birth weight (1.27, 95% CI, 1.15–1.40) but not macrosomia (0.98, 95% CI, 0.94–1.02). In the subgroup analysis, risk ratios were statistically significant for heterosexual participants with past same-sex attractions, partners, or identity (preterm birth 1.25, 95% CI, 1.13–1.37; low birth weight 1.32, 95% CI, 1.18–1.47). Risk ratios were elevated but not statistically significant for lesbian or gay participants (preterm birth 1.37, 95% CI, 0.98–1.93; low birth weight 1.46, 95% CI, 0.96–2.21) and bisexual participants (preterm birth 1.29, 95% CI, 0.85–1.93; low birth weight 1.24, 95% CI, 0.74–2.08).

CONCLUSION:

The offspring of LGB+ birthing people experience adverse neonatal outcomes, specifically preterm birth and low birth weight. These findings highlight the need to better understand health risks, social inequities, and health care experiences that drive these adverse outcomes.
Current opinion: antiretrovirals during pregnancy and breastfeeding
Authors: Nijboer Laura , van der Wekken-Pas Lena , Aebi-Popp Karoline , van Leeuwen Elisabeth , Colbers Angela
Published: October 2024

Purpose of review

To review the most important literature from the past 2 years on the pharmacokinetics of antiretrovirals in pregnancy, placental transfer, and breastmilk.

Recent findings

Concentrations of antiretrovirals frequently used in pregnancy and their placental transfer are described, together with infant exposure through breastmilk. Also, applications of ex-vivo and in-silico studies, such as placenta perfusion studies and PBPK models, are discussed.

Great efforts were made in the past 2 years to accelerate the availability of data on antiretrovirals during pregnancy and lactation. Bictegravir showed decreased but still sufficient concentrations during pregnancy, leading to a label change by the FDA. In-silico and clinical studies on long-acting cabotegravir and rilpivirine generated information leading to cautious use of these formulations in pregnancy. Low infant exposure to antiretrovirals through breastmilk is expected for most compounds. Despite the impact of these studies, more incentives are needed for earlier implementation, for instance, during the developmental phase of drugs, to provide women antenatally with proper information on their drugs.
Road-traffic noise exposure and coronary atherosclerosis in the Swedish CArdioPulmonary bioImage Study (SCAPIS)
Authors: Murzabekov Marat , Persson Åsa , Asker Christian , Kilbo Edlund Karl , Eriksson Charlotta , Jernberg Tomas , Molnar Peter , Oudin Anna , Pyko Andrei , Lindvall Jenny , Lõhmus Mare , Persson Waye Kerstin , Nilsson Sommar Johan , Stockfelt Leo , Spanne Mårten , Svartengren Magnus , Ögren Mikael , Pershagen Göran , Ljungman Petter
Published: October 2024

Background:

Road-traffic noise may influence the development of cardiovascular events such as stroke and myocardial infarction, but etiological mechanisms remain unclear. This study aimed to assess the relationship between long-term road-traffic noise exposure and coronary atherosclerosis in Sweden.

Methods:

In the Swedish CArdioPulmonary bioImage Study (SCAPIS) cohort, including 30,154 subjects aged 50–65 years, recruited between 2013 and 2018, coronary atherosclerosis was measured based on computer tomography (CT) scans as coronary artery calcium score, segment involvement score (SIS), and non-calcified plaques (NCP) at enrollment. Based on modified Nordic model, road-traffic noise exposure was modeled for 2000, 2013, and 2018 with interpolation for intermediate years. We investigated the association between time-weighted long-term exposure to road-traffic noise (Lden) and the prevalence of atherosclerosis using ordinal logistic regression models adjusting for potential socioeconomic, behavioral, and environmental confounders, including air pollution.

Results:

No clear associations were found between road-traffic noise and coronary atherosclerosis. The odds ratio for coronary artery calcium score was 1.00 (95% confidence interval [CI] = 0.96, 1.04), SIS 0.99 (0.96, 1.03), and NCP 0.98 (0.90, 1.03) per interquartile range (9.4 dB Lden) for road-traffic noise exposure during 10 years before enrollment. No consistent associations were observed in site-specific analyses or using shorter exposure periods. Furthermore, exposure-response analyses revealed no clear trends, and there were no strong interactions between road-traffic noise and cardiovascular risk factors in relation to the atherosclerosis markers.

Conclusions:

Long-term exposure to road-traffic noise was not linked to coronary atherosclerosis or calcification in relatively healthy, middle-aged populations in Sweden.
Waste not want not: the story of surgical trash
Authors: Woods Noe , Melnyk Alexandra I. , Moalli Pamela
Published: October 2024

Purpose of review

Our escalating reliance on disposable products in the operating room has generated a large amount of waste, cost, and environmental pollution. Heath damages from the pollution caused by the US healthcare industry cause as much harm, as measured by disability-adjusted life years, as total medical errors. Our response to our own environmental impact should be proportional to that harm. Understanding the waste streams we create and the factors that contribute to our large waste generation in the operating room can help us target solutions to our most harmful practices.

Recent findings

Recent studies within the field of medical waste in ObGyn have included a systematic review analyzing most effective practices for waste reduction and environmental life cycle analyses of specific medical procedures.

Operating room waste includes regulated medical waste, pathologic waste/chemotherapy, sharps, general municipal waste, recycling, linens, and anesthetic gases. The most effective way to reduce the environmental impact from medical waste is to reduce our use of disposable supplies in favor of durable reusable materials. Other important interventions include eliminating ‘overage’ of unused supplies, optimizing use of anesthetic gas, custom pack scale backs, and proper waste segregation. This review of operative waste is intended to aid healthcare facilities in understanding and addressing their own environmental impact.
Efficacy of the Posterior Accessory Saphenous Vein as a Vein Graft in Breast Reconstruction Using Profunda Artery Perforator Flap
Authors: Tanaka Nobuyuki , Tomita Koichi , Itani Yoshihito , Kusuhara Hirohisa , Nakao Hitomi , Sueyoshi Yu , Okuda Shinnosuke , Shimizu Yuta , Hayashi Riku
Published: October 2024

The profunda artery perforator (PAP) flap, commonly used for small- to medium-sized breast reconstructions, offers easy harvest and inconspicuous donor-site scars. However, its shorter vascular pedicle compared with the deep inferior epigastric perforator flap limits its reach to lateral recipient vessels. This often requires strategic placement of perforators at the flap’s edge to extend reach, potentially causing congestion in the distal part of the flap. To address these challenges, using the posterior accessory saphenous vein (pASV) has proven effective. Using the pASV as a vein graft significantly extends the pedicle length of the PAP flap, enhancing anastomosis success with recipient vessels. Additionally, in cases of flap congestion, the proximal segment of the pASV can be used as an additional venous outflow pathway, while grafting the distal segment further extends its length. This dual approach improves overall flap viability and reduces venous congestion risks. This discussion highlights two cases demonstrating the innovative use of the pASV within the PAP flap. In case 1, the pASV extended the pedicle length, enhancing the flap’s placement flexibility and facilitating anastomosis with thoracodorsal vessels. In case 2, the pASV served as a secondary venous outflow pathway, with the distal segment grafted to extend the proximal portion. This adaptation provided additional venous drainage and effectively managed positioning constraints imposed by recipient vessel locations. These examples illustrate the significant benefits of utilizing the pASV in PAP flap breast reconstructions, offering a novel strategy to improve viability and expand its use in complex scenarios requiring extended vascular reach.
Anatomical Analysis of the Superior Gluteal Artery in 100 Women for Superior Gluteal Artery Perforator Flap Breast Reconstruction
Authors: Aoki Hironobu , Kamegai Mina , Inoue Mariko , Taga Marie , Hokazono Yu , Mitsuwa Hideyuki , Kurita Tomoko , Takei Hiroyuki , Ogawa Rei
Published: October 2024

Background:

The superior gluteal artery (SGA) perforator (SGAP) flap is used more rarely for breast reconstruction with autologous tissue than other flaps because the SGA is often narrow, and the SGAP can be short. However, it provides ample fat, including in lean women. To improve its safety and utility, the preoperative SGA course in women who underwent autologous breast reconstruction was determined with three-dimensional computed tomography angiography.

Methods:

Consecutive deep inferior epigastric perforator, profunda artery perforator, and SGAP flap cases in 2019–2023 were identified. Frequencies of the following favorable preoperative SGA-anatomy variables were determined: branching of the main-SGA trunk on top/posterior of the greater sciatic foramen (designated M1/2), which allows access to a sufficiently wide SGA artery; superolateral perforating location of the superficial-SGA branch (SP3), which means the perforator is sufficiently long for uncomplicated flap placement; and nonbranching of the deep-SGA branch (D1/D2), which means this branch can used a venous and an arterial graft to extend an insufficiently long perforator.

Results:

A total of 100 cases of deep inferior epigastric perforator (n = 80), profunda artery perforator (n = 13), and SGAP flap-based breast reconstructions (n = 7) were identified. Out of 200 buttocks, 89%, 91.5%, and 62% had the favorable M1/2, SP3, and D1/D2 variables, respectively. An atypical descending branch feeding the lower buttocks (DES1/2) was observed in 34%.

Conclusions:

The branching position of the main-SGA trunk, perforating location of the SGAP, and the shape of the deep branch were classified in detail in 100 patients. By creating a surgical plan that understands the anatomy taking preoperative three-dimensional computed tomography angiography, the SGAP flap can accommodate many patterns, increasing the possibility of safe execution.
Investigation of the Optimal Age in Months for Initiation of Conservative Treatment for Congenital Auricular Deformities
Authors: Takada Asuka , Kuwahara Hiroaki , Tsuge Takuya , Ogawa Rei , Akaishi Satoshi
Published: October 2024

Background:

The effectiveness of conservative treatment for congenital auricular deformities depends primarily on the plasticity of the auricular cartilage. However, the effect remains uncertain due to various confounding factors such as differences in the characteristics of the deformity and timing of treatment initiation. In this study, we investigated the optimal timing for initiation of conservative treatment.

Methods:

We investigated the age at treatment initiation and surgical avoidance rate among 158 children with congenital auricular deformities who were treated with corrective devices at our hospital. In addition, we conducted and analyzed questionnaires containing items assessing treatment satisfaction and characteristics.

Results:

Surgical avoidance rates decreased markedly among those starting treatment after 5 months of age, and satisfaction was significantly higher in the surgical avoidance group. Multivariate analysis showed that the only factor affecting the treatment effect was the age at treatment initiation.

Conclusions:

This study suggests that the initiation of conservative treatment with corrective devices within 5 months of age for congenital auricular deformities may lead to avoidance of surgery and increased satisfaction. However, we should not judge the indication for conservative treatment solely based on age in months. Bearing in mind the effectiveness of initiating treatment within the first 5 months of age, we should initiate treatment at the earliest appropriate age with consideration of the individual patient's type and severity of deformity and cartilage elasticity.
Pilot Study: Single-depth Superficial Ultrasound with Subdermal Injections of Diluted Calcium Hydroxylapatite for Improving Lower Face Skin Quality
Authors: Ramirez Sylvia , Scherz Gunther , Leprince Rémi
Published: October 2024

Background:

The lower face can be challenging to treat. We assessed the effectiveness of combining single-depth superficial microfocused ultrasound with visualization (MFU-V, Ultherapy; Merz North America, Inc. Raleigh, N.C.) and subdermal injections of diluted calcium hydroxylapatite (CaHA, Radiesse; Merz North America, Inc. Raleigh, N.C.) in a single session for improving skin quality in the lower face.

Methods:

This study enrolled women with moderate-to-severe fine lines and skin unevenness on the lower face who desired nonsurgical intervention. Single-depth MFU-V treatment (10 MHz/1.5 mm) was followed by subdermal injections of diluted (1:1) CaHA. Subjects were followed up for 24 weeks posttreatment. Objective skin quality assessments (Rv: wrinkle depth; R3z: skin unevenness) were performed using LifeViz Micro (QuantifiCare, Sophia Antipolis, France). Subjective assessments included the modified Fitzpatrick Wrinkle Scale visual analog scale, Global Aesthetic Improvement Scale, and global satisfaction scale.

Results:

Twelve subjects completed the study. The mean Rv value, mean R3z value, and mean modified Fitzpatrick Wrinkle Scale visual analog scale score improved significantly from baseline to week 24 (mean differences: −0.0321 mm, −0.0684 mm, −1.1667; all P < 0.001). All subjects were rated by the investigators as having demonstrated improvement in their overall aesthetic appearance as early as week 4. All subjects were “very satisfied” or “satisfied” with their treatment from week 12 onwards. No unexpected adverse events were reported.

Conclusions:

Combination treatment with single-depth superficial MFU-V and diluted CaHA in a single session significantly improved lower facial skin quality, as assessed by both objective and subjective outcome measures.
Is it feasible to treat atrial fibrillation at the time of minimally invasive coronary artery bypass grafting?
Authors: Waterford Stephen D. , Ad Niv
Published: October 2024

Purpose of review

Coronary artery bypass grafting remains the most common operation performed by cardiac surgeons. As a result, a cardiac surgeon with a typical practice will most commonly encounter atrial fibrillation when performing coronary artery bypass grafting. In this review, we first emphasize the importance of treating atrial fibrillation in patients undergoing coronary bypass grafting. We review benefits of concomitant surgical ablation and its importance relative to complete coronary revascularization. We then discuss options to treat atrial fibrillation in a more minimally invasive manner in these patients, while still preserving treatment efficacy.

Recent findings

Surgical ablation at the time of coronary artery bypass grafting surgery could be as important as complete revascularization. Bi-atrial ablation provides superior rhythm control compared to left-sided ablation only.

We highlight various options for surgical ablation at the time of coronary artery bypass grafting surgery, and provide an algorithm for ablation in individual patients.
Validation of a French Version of the Visual Function and Corneal Health Status Instrument and Correlation With Vision and Glare Measurements in Fuchs Endothelial Corneal Dystrophy
Authors: Mullie Guillaume A. , Juarez Alejandro , Etcheverry Antoine , Natchev Paul , Taleb Nassima , Boutin Tanguy , Choremis Johanna , Mabon Michèle , Talajic Julia , Giguère Charles-Édouard , Brunette Isabelle
Published: October 2024

Purpose:

To validate a French version of the Visual Function and Corneal Health Status (V-FUCHS) instrument in Fuchs endothelial corneal dystrophy (FECD) and to correlate questionnaire scores with objective measurements of best-corrected visual acuity (BCVA) and intraocular straylight.

Methods:

The original V-FUCHS 15-item instrument was designed to assess VA and glare in patients with FECD. It was translated from English to French and back translated to English by independent translators. The questionnaire was administered on 2 occasions (4 weeks apart), and BCVA, modified Krachmer grade, and straylight were measured. Construct validity, internal consistency, test–retest reliability, and predictive validity were assessed.

Results:

A total of 159 subjects, aged 41 to 86 years, were prospectively recruited from July 2019 to October 2020 and classified into 6 groups: mild, moderate, or advanced FECD; unilateral or bilateral Descemet membrane endothelial keratoplasty for FECD; and healthy controls (n = 35). Construct validity was confirmed by item response theory model. Cronbach alpha demonstrated excellent internal consistency (VA: 0.91, glare: 0.88), and intraclass correlations showed good test–retest reliability (VA: 0.75 and glare: 0.82). Significant correlations were observed between both VA and glare factors and the modified Krachmer grade, BCVA, and straylight.

Conclusions:

The proposed French version of the V-FUCHS instrument provides a valid and reliable tool for the assessment of visual disability in patients with FECD. This questionnaire bridges the gap between self-reported FECD symptoms and objective clinical measurements, which may prove useful to optimize the timing of surgery and to assess postoperative improvement in symptoms.
New Nurse Turnover Intention and Related Factors in Japan and China: Focusing on Nursing Practice Environment and Burnout
Authors: JIANG Dan , KIRA Junko
Published: October 2024

Background

With rapidly declining birth rates and aging populations worldwide, the demand for nursing care has increased in recent years. High turnover, an important cause of nurse staffing shortages, directly affects the quality of nursing care. However, no comparison studies on turnover intention in East Asia have been published.

Purpose

The purpose of this study was to clarify the relationships among turnover intention, the work environment, and related factors among new nurses in Japan and China.

Methods

A self-administered questionnaire survey was used to collect data from nurses employed for < 2 years. This questionnaire included participant characteristics, assessment of desire to become a nurse at the start of employment, current turnover intention, the Practice Environment Scale of the Nursing Work Index, and the Maslach Burnout Inventory-Human Services Survey. The relationship between current turnover intention and, respectively, number of hospital beds, strength of desire to become a nurse at the start of employment, level of participation in hospital affairs, emotional exhaustion (EE), personal achievement, and demographic variables was assessed.

Results

The number of nurses who intended to leave the hospital was higher in Japan (74.1%) than in China (42.4%). However, of those expressing intention to leave, 46.6% of the nurses in China and only 5.0% of those in Japan indicated intention to quit the nursing profession altogether. In Japan, collegial nurse–physician relations and EE were related to turnover intention, whereas in China, number of hospital beds, strength of desire to become a nurse at the start of employment, participation in hospital affairs, EE, and personal achievement were all related to turnover intention.

Conclusions

To enhance retention and reduce turnover intention among nurses, the strength of desire to become a nurse in China and the nurse–physician relationship and EE in Japan should be taken into particular consideration when designing retention strategies and nurse education programs.
Joint line convergence angle should be considered when constitutional alignment is predicted based on arithmetic hip-knee-ankle angle: a retrospective cross-sectional observational study
Authors: Gao Yu-Hang , Qi Yu-Meng , Huang Pei-Hong , Zhao Xing-Yu , Qi Xin
Published: October 2024

Few studies have illustrated the role of the joint line convergence angle (JLCA) in the correlation between the arithmetic hip-knee-ankle angle (aHKA) and mechanical hip-knee-ankle angle (mHKA). We aimed to determine this role and to evaluate the effect of the JLCA in predicting constitutional alignment using the aHKA. A total of 107 normal participants (214 knees) and 246 patients (477 knees) with osteoarthritis (OA) were retrospectively examined using long-leg radiographs. The formula was calculated geometrically on plain radiographs of the knee based on the relationships among the mHKA, aHKA, and JLCA, and the distribution of the JLCA between the groups was determined. The effect of the JLCA on the prediction of constitutional alignment using the aHKA was evaluated. The geometric formula was determined to be ‘mHKA=180°+aHKA−JLCA’, and was verified. The median (quartile 1, quartile 3) JLCA was 2.0° (1.0°, 3.5°) and 2.5° (1.0°, 4.5°) in the normal and OA groups, respectively. The JLCA affected the prediction of constitutional alignment based on the aHKA. It should be considered when constitutional alignment is predicted based on the aHKA in patients with high JLCA values.
Opportunities to Improve Recognition of Diabetic Ketoacidosis in Pregnancy
Authors: Corlin Tiffany , Nashif Sereen K. , Tessier Katelyn M. , Kristan Megan , Rogers W. Kirke , Wernimont Sarah A.
Published: October 2024

The presence of ketosis and anion gap metabolic acidosis in individuals with diabetes indicates diabetic ketoacidosis (DKA). The incidental detection of such laboratory abnormalities in persons with diabetes should trigger an intentional evaluation for DKA. The objective of this retrospective cohort study was to assess the frequency with which pregnant individuals with diabetes and a laboratory abnormality potentially indicative of DKA underwent a complete laboratory assessment and to identify factors associated with completion of the appropriate laboratory testing. Clinical characteristics were evaluated for patients with complete and incomplete workups. Workup for DKA was completed in only 30.0% of individuals with laboratory evidence of acidosis or ketosis; 64.0% (57/89) of those with complete workups did not meet criteria for DKA. This study highlights opportunities to ensure complete laboratory workup for DKA, especially in patients with non–type 1 diabetes, obstetric conditions such as labor, and lower glucose on presentation.
Lethal Self-Administration of Atracurium: A Rarely Reported Case with Review of Literature
Authors: Galoria Darshan , Shukla Srushti , Datta Arijit , Das Abhishek , Goswami Dhara , Rana Pradip , Tiwari Preeti
Published: October 2024

Atracurium besylate is a nondepolarizing skeletal muscle relaxant first introduced in 1980. It is used during endotracheal intubation. It causes muscle relaxation during surgery or mechanical ventilation. When people consider suicide, they employ drugs found in their surroundings but not usually injectable muscle relaxants, which are not widely available. Studies on their use in suicide are rarely reported worldwide. This was a case of a 34-year-old male nursing staff, working in the general surgery department's operation theater complex, who was found unconscious in bed in his room in the morning with an empty syringe by the bedside. He was declared dead when brought to the emergency department. Forensic autopsy was conducted, and during the external examination, a needle puncture wound was found over the left cubital fossa. No other external other injuries were observed throughout the body. The toxicological analysis report indicated the presence of laudanosine in the vitreous humor, blood, urine, and skin from the puncture site and underneath vein. Also, the toxicological analysis of the empty syringe found at the crime scene revealed the presence of atracurium, confirming that the victim had administered a lethal dose of atracurium.
What Has the Sudden Unexpected Infant Death and Sudden Death in the Young Case Registry Learned About Consenting Families for DNA Banking and/or Genomic Research?
Authors: MacLeod Heather , Buczkowski Erik , Faulkner Meghan , Felzke Krisha , Burns Kristin M.
Published: October 2024

Since 2015, the Sudden Unexpected Infant Death (SUID) and Sudden Death in the Young (SDY) Case Registry has characterized sudden and unexpected deaths among young people (0–20 years). Families may provide informed consent to save biospecimens for banking and/or genomic research. We reviewed all consent-eligible cases to describe the frequency, time from death to consent, type (paper, phone, or electronic), and staffing method (Medical Examiner Office–based bereavement counselor vs outsourced genetic counselor). Of 5438 cases from January 2015 to January 2022, 3498 (64%) were eligible for consent and 391 (11%) were successfully consented. Half (54%) were obtained within 60 days of the death, 39% within 48 hours. Most were paper based (73%); 23% were obtained by phone, and 4% electronically. Consent rates varied by site from 3% to 66%. Higher consent rates were achieved within a Medical Examiner Office by a social worker or death investigator. Only 3% of consents attempted by a contracted genetic counselor were successful. Identified barriers include lack of available contact information, inability to reach family using the collected information, and lack of response when contacted. Consent rates were highest shortly after death when families were contacted by the Medical Examiner Office as part of bereavement outreach.
Gender, Racial, and Ethnic Diversity in Plastic Surgery
Authors: Krivanek Taylor J. , Quick Joseph D. , Brahmbhatt Haley , Powell Lauren , Ozed-Williams Bethel , Nguyen Minh-Doan
Published: October 2024

Women and racial and ethnic minorities have historically been underrepresented in medicine, making up a minority of all physicians and a smaller subset of plastic surgeons. Furthermore, these groups represent an even smaller fraction of plastic surgeons in research and leadership roles. Parallel to the general recognition of the importance of increasing diversity in the medical field, there has been a surge in the literature detailing current issues and highlighting potential areas for intervention within plastic surgery. Various initiatives have been piloted to address the underrepresentation of certain demographic groups in the field. These have largely targeted the medical student level, with a focus on increasing mentorship, targeted recruitment, exposure to the field, and scholarly opportunities. With the growing body of research conducted in this realm, this review seeks to synthesize our understanding of the modern landscape of gender, racial, and ethnic diversity within plastic surgery, with an emphasis on identifying successful initiatives that have positively impacted representation and inclusivity.
Postoperative Otoplasty Care With ChatGPT-4: A Study on Artificial Intelligence (AI)-Assisted Patient Concern and Education
Authors: Albehairi Sahar A. , Alsahli Ohoud M. , Bander Leen F. , Albilasi Thamer M. , Aljardan Eyad S.
Published: October 2024

Background:

Otoplasty is a cosmetic surgery that is performed to alter the size, shape, or position of the ear by using permanent stitches. Its main purpose is to correct protruding ears, a condition known as prominauris. After the surgery, it is crucial to provide proper care to ensure successful recovery. However, obtaining timely medical advice can be difficult, especially in remote areas or places with limited resources. To address this issue, incorporating advanced artificial intelligence (AI) tools like Chat Generative Pre-trained Transformer (ChatGPT)-4 into postsurgical care could help fill the gap in patient education and support.

Aim:

This study aims to assess whether ChatGPT4 can be a reliable, accurate, and effective method for answering the most common patient questions and concerns post-otoplasty. The main objective was to assess the AI chatbot’s capacity to deliver precise, concise, and pertinent information, especially in situations where health care professionals are limited in availability.

Materials and Methods:

In this study, over 50 patients were engaged, and ChatGPT4 was employed to present the same 5 common postoperative questions post-otoplasty surgery care. The AI chatbot’s responses were analyzed for accuracy, response time, clarity, and relevance.

Results:

The chatbot could potentially provide timely assistance, answer questions, and address concerns related to postsurgical care in otoplasty. The responses exhibited a perfect accuracy rate of 100%, closely corresponding to existing medical guidelines.

Conclusion:

This study explores the potential of AI-driven solutions to enhance patient education and support, especially in areas where access to health care professionals may be limited. However, professional medical advice is crucial in postoperative care and cannot be replaced by ChatGPT-4. By leveraging AI tools like chatbots, individuals in remote or resource-limited settings can potentially receive valuable information and guidance, contributing to successful rehabilitation and overall health care outcomes. Ethical considerations around the use of AI in health care must also be carefully addressed to ensure patient privacy, data security, and appropriate clinical oversight.
The Stress Effects of Mandibular Movements on the Temporomandibular Joint With Sagittal Split Ramus Osteotomy
Authors: Turgut Altay Hilal , Ertem Sinan Yasin
Published: October 2024

Purpose:

The aim of this study was to evaluate the stress changes in the temporomandibular joint (TMJ) after sagittal split ramus osteotomy (SSRO) with finite element analysis (FEA).

Material and Methods:

5 and 10 mm mandibular setback and advancement were applied to models by using SSRO and a control model without osteotomy evaluated. The articular disc was modeled as superelastic, and the stresses on the articular fossa, disc, and condyle were evaluated.

Results:

The stresses on the cartilage were 1.150 MPa on the 5 mm advancement model and 1.506 MPa on the 10 mm advancement model. The stresses on the disc were 11.56 MPa on the 5 mm advancement model, 7.94 MPa on the 10 mm advancement model and the amount were significantly higher than other models. The stress, especially in the cartilage, increased with the amount of advancement. In the setback models, the stresses on the condylar cartilage and the disc were higher than in the control model, and the stress in the condylar cartilage increased with the amount of setback.

Conclusion:

SSRO increases the stresses in the TMJ components and stresses increase depending on the amount of advancement and setback and may cause the development of joint problems.
Crista Galli Morphology in Fetuses
Authors: Çalişir Ebru Sena , Öztürk Cansu , Şencan Zeynep , İnce Rümeysa , Cihan Ömer Faruk , Alpergin Baran Can , Beger Orhan
Published: October 2024

Objective:

To determine alterations in the crista galli (CG) size in fetuses with advancing weeks.

Methods:

Skull bases of 32 fetuses (11 males/21 females) aged 17 to 32 weeks in utero were included in the study. The width (width of CG), height (height of CG), and length (length of CG) of CG were measured, and also olfactory fossa depth (OFD) was measured to determine the relation of CG with OFD.

Results:

Width of CG, height of CG, length of CG, and OFD were measured as 1.77 ± 0.59 mm, 5.10 ± 1.70 mm, 12.32 ± 2.25 mm, and 1.56 ± 0.56 mm, respectively. No significant difference was observed between the measurements in terms of sex and side (P> 0.05). Apart from OFD, the parameters were greater in the third-trimester fetuses than in the second-trimester fetuses (P< 0.001). Olfactory fossa depth was similar in both trimester fetuses (P= 0.798). Olfactory fossa depth did not alter with advancing gestational weeks (P= 0.077), but the others increased (P< 0.01). Only one configuration regarding Keros types was observed. Type 1 was detected in all fetuses (100%). A linear function was calculated as y=1.442+0.455×age for the length of CG, y=−2.566+0.321×age for the height of CG, y=0.641+0.039×age for OFD, and y=−1.088+0.119×age for the width of CG.

Conclusions:

Crista galli size increased with advancing fetal weeks. The authors detected Keros type 1 in all fetuses. The authors' linear functions representing the growth pattern of CG and OFD in fetuses may be useful in estimating their dimensions.
A Low Prognostic Nutritional Index Level, an Independent Predictor for Postoperative Intra-abdominal Abscess After Laparoscopic Appendectomy
Authors: Yuan Yijian , Tang Yanhua , Liu Yubin , Ren Pengcheng
Published: October 2024

Background:

Intra-abdominal abscess (IAA) is a very common postoperative complication after laparoscopic appendectomy and is associated with poor prognosis.

Materials and Methods:

This study retrospectively analyzed elderly patients who underwent laparoscopic appendectomy from 2015 to 2024, examining demographic, clinical, and laboratory data to identify IAA risk factors. Independent risk factors for IAA were screened and finally identified by multivariate logistic regression analysis.

Results:

A total of 37 patients developed IAA within postoperative 30 days, with an incidence of 9.6% (37/385). Receiver operating characteristic (ROC) curve analysis indicated white blood cell (cut-off value: 13.35, sensitivity: 54.60%, specificity: 70.27%, P=0.003) and Prognostic Nutritional Index (PNI) (cut-off value: 41.95, sensitivity: 72.41%, specificity: 59.46%, P<0.0001) were 2 predictors for IAA with an area under the curve of 0.649 and 0.727, respectively. Based on the multivariate analysis, perforated appendicitis (odds ratio: 2.48, 95% CI: 1.15-5.32, P=0.021) and a lower PNI score (odds ratio: 3.44, 95% CI: 1.49-7.58, P=0.002) were 2 independent risk factors for IAA in elderly patients after laparoscopic appendectomy.

Conclusions:

Elderly patients with perforated appendicitis and a PNI score <41.95 have higher risks for IAA after laparoscopic appendectomy.
Effect of Antibiotic Administration on Blastocystis Persistence and Gut Microbiome-Metabolome Dynamics in Irritable Bowel Syndrome

Authors: Newton Jamie M. , Edwards William JS , Thompson Gary S. , Gentekaki Eleni , Tsaousis Anastasios D.
Published: October 2024

Background: Blastocystis, the most prevalent microbial eukaryote in humans, has a global distribution. Studies have linked its presence with distinct gut microbiome and metabolome profiles compared to those where the organism is absent. However, the interplay of antibiotics administration, Blastocystis and the surrounding gut microbiome remains understudied. This case study aimed to explore antibiotic consumption and the presence of Blastocystis with subsequent changes in the gut microbiome and metabolome of an individual diagnosed with irritable bowel syndrome (IBS). Methods: Stool samples from an IBS patient, collected at 12 time points, were tested for Blastocystis presence using RT-PCR targeting the SSUrRNA gene, followed by sequencing of positive samples. Illumina sequencing determined the gut microbiome composition, while one-dimensional proton NMR spectroscopy was used to analyse the metabolome composition. Statistical analyses were conducted to identify relationships between antibiotic consumption, bacterial diversity, metabolome composition, and Blastocystis presence. Results: Antibiotics significantly impacted the gut microbiome, with diversity declining early in the antibiotic course, then recovering later and post-course. Blastocystis was detected early, late, and post-course but not mid-course, coinciding with the decline in bacterial diversity. Significant differences were observed between Blastocystis-positive and Blastocystis-negative samples with bacterial composition significantly changing between samples collected before, early, and after the antibiotic course compared to those collected mid-course. Metabolite groups, including short-chain fatty acids, amino acids, and succinate, exhibited changes throughout the antibiotic course, indicating that gut metabolite composition is affected by antibiotic consumption. Discussion/Conclusion: While antibiotics did not significantly impact Blastocystis colonisation, they did cause a mid-course decline in microbial diversity and Blastocystis presence. The study also revealed significant alterations in important metabolites such as SCFAs and amino acids throughout the antibiotic course, with an altered metabolome observed post-course. This case study underscores the complex interactions between antibiotics, gut microbiota, and metabolites, highlighting the resilience of Blastocystis in the gut ecosystem.