bluuebunny/crossref_metadata_2025 huggingface dataset:
Experiences on the Use of Complementary and Alternative Medicine in Individuals Diagnosed With COVID-19
Authors: Doğan Uğur , Parlar-Kılıç Serap
Published: June 2023

The aim of this study was to examine past experiences related to the use of the complementary and alternative medicine (CAM) during the disease process by individuals diagnosed with COVID-19. Content analysis method was used for data analysis. The study consisted of 21 patients diagnosed with COVID-19, who applied to a family health center. The data were collected using an individual information form and a semistructured interview form consisting of open-ended questions. All interviews were recorded with audio recording and transcribed. Three main themes related to the use of CAM by COVID-19 patients and subthemes associated with these main themes were determined (1) while starting to use CAM; (2) experiences of CAM use; and (3) recommending CAM. During using the CAM methods, most of the participants were affected by their circle, they preferred the use of fruit/fruit juice containing vitamin C, they chose affordable and easily accessible methods, they found the methods they used useful, and recommended these methods to others. The CAM use of patients should be questioned in future studies related to COVID-19 by nurses. Nurses should inform patients with COVID-19 accurately about safety, efficacy, indications, and contraindications for CAM methods.
Consolation Management Aesthetics Within Holistic Nursing
Authors: Nilsson Håkan
Published: June 2023

The aim of this article is to elaborate on consolation management aesthetics in terms of literature, art, and music. This article will be centered on holistic nurses who come in daily contact with vulnerable patients in need of both medical treatment and consolation, as they continue their journey toward one or another outcome. Consolation management aesthetics enables the patients to shift their attention from something that appears intractable to something that motivates, bolsters existential resilience, and offers hope and optimism for the future. Holistic nursing aesthetics, involving psychological healing through literature, art, and music, can help anxious, troubled patients to once again find beauty and balance in their lives.
The Efficacy of Vestibular Rehabilitation Therapy for Mild Traumatic Brain Injury: A Systematic Review and Meta-analysis
Authors: Aljabri Ammar , Halawani Alhussain , Ashqar Alaa , Alageely Omar , Alhazzani Adel
Published: June 2023

Objective:

Mild traumatic brain injury (mTBI) or concussion is a common yet undermanaged and underreported condition. This systematic review and meta-analysis aim to determine the efficacy of vestibular rehabilitation therapy (VRT) as a treatment option for mTBI.

Method:

This review and meta-analysis was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. It included randomized controlled trials and pre-VRT/post-VRT retrospective chart reviews. Records meeting the inclusion criteria were extracted from the following databases: MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL).

Results:

Eight articles met the inclusion criteria, from which 6 randomized controlled trials were included in the meta-analysis. VRT demonstrated significant improvement in decreasing perceived dizziness at the end of the intervention program as shown by Dizziness Handicap Inventory (DHI) scores (standardized mean difference [SMD] = −0.33, 95% confidence interval [CI]: −0.62 to −0.03, P = .03, I
2 = 0%). However, no significant reduction in DHI was evident after 2 months of follow-up (SMD = 0.15, 95% CI: −0.23 to 0.52, P = .44, I
2 = 0%). Quantitative analysis also depicted significant reduction in both Vestibular/Ocular Motor Screening (SMD = −0.40, 95% CI: −0.60 to −0.20, P < .0001, I
2 = 0%) and Post-Concussion Symptom Scale (SMD= −0.39, 95% CI: −0.71 to −0.07, P = .02, I
2 = 0%) following the intervention. Finally, there was no significant difference between intervention groups on Balance Error Scoring System scores (SMD = −31, 95% CI: −0.71 to 0.10, P = .14, I
2 = 0%) and return to sport/function (95% CI: 0.32-30.80, P = .32, I
2 = 82%).

Conclusions:

Current evidence on the efficacy of VRT for mTBI is limited. This review and analysis provides evidence that supports the role of VRT in improving perceived symptoms following concussion. Although findings from this analysis suggest positive effects of VRT on included outcomes, the low certainty of evidence limits the conclusions drawn from this study. There is still a need for high-quality trials evaluating the benefit of VRT using a standardized approach.

PROSPERO registration number: CRD42022342473.
Factors Influencing Self-Esteem After a Traumatic Brain Injury
Authors: Downing Marina , Elliot Bridget , Ponsford Jennie
Published: June 2023

Objective:

Traumatic brain injury (TBI) and its consequences can significantly impact an individual's identity and self-esteem. However, there is limited research with respect to the trajectory of change over time and factors that may influence self-esteem levels. This study aimed to investigate: (1) changes in self-esteem over 3 years post-TBI; and (2) factors associated with self-esteem post-TBI.

Setting:

Outpatient.

Participants, Design, and Measures:

Self-esteem was measured in 1267 individuals with predominantly moderate to severe TBI (mean age = 36.38 years, mean days in posttraumatic amnesia = 26.16 days) using the Rosenberg Self-Esteem Scale at 1-, 2, and 3 years post-injury. Participants also completed the Structured Outcome Questionnaire and the Glasgow Outcome Scale-Extended (GOS-E).

Results:

Linear mixed modeling indicated that self-esteem significantly declined between 1 and 2 years but remained stable between 2 and 3 years post-injury. Higher self-esteem was significantly associated with better functional outcomes (as measured by the GOS-E), more years of education, more participation in leisure activities, and lower reported anxiety and depression levels.

Conclusions:

Findings suggest that functional impacts of injury and emotional functioning influence self-esteem increasingly between 1 and 2 years post-injury. This highlights the importance of timely psychological interventions to maximize self-esteem in individuals with TBI post-injury.
Long-term survival after female pelvic organ-sparing radical cystectomy versus standard radical cystectomy: a multi-institutional propensity score-matched analysis
Authors: Zhong Wenlong , Xia Kun , Liu Libo , Cheng Sida , Peng Hong , He Wang , Dong Wen , Liu Hao , Lai Yiming , Han Hao , Liu Cheng , Zhang Hongxian , Li Xinfei , Ding Guangpu , Li Xuesong , Ma Lulin , Zhou Liqun , Lin Tianxin , Huang Jian
Published: June 2023

Background:

The application of pelvic organ preserving-radical cystectomy (POPRC) in female patients with bladder cancer has attracted more and more attention in recent years. In current study, we aim to compare the long-term oncological outcomes of pelvic organ preserving-radical cystectomy (POPRC) versus standard radical cystectomy (SRC) in a large multicenter retrospective cohort.

Patients and methods:

Data on female patients with bladder cancer who underwent POPRC or SRC in January 2006 and April 2018 were included from three Chinese urological centers. The primary outcome was overall survival (OS). Secondary outcomes were cancer-specific survival (CSS) and recurrence-free survival (RFS). To decrease the effect of unmeasured confounders associated with treatment selection, 1:1 propensity score matching (PSM) was performed.

Results:

Among 273 enrolled patients, 158 underwent POPRC (57.9%), and 115 underwent SRC (42.1%). The median follow-up time was 38.6 (15.9–62.5) months. After PSM, each cohort included 99 matched patients. The OS (P=0.940), CSS (P=0.957), and RFS (P=0.476) did not differ significantly from the two matched cohorts. Subgroup analysis confirmed that the OS was similar between the patients treated with POPRC and SRC across all subgroups examined (all P > 0.05). In multivariable analysis, the surgical method (SRC vs. POPRC) was not an independent risk factor for OS (HR 0.874, 95% CI 0.592–1.290; P=0.498).

Conclusions:

The results showed that no significant difference in long-term survival was determined between female patients undergoing SRC and those undergoing POPRC.
Comparison of blood pressure measurements on the bare and sleeved arms – what does it uncover?
Authors: Tal-Ben Ishay Rotem , Leiba Adi , Rappoprt Vladimir , Angel-Korman Avital , Katzir Zeev
Published: June 2023

Accurate office blood pressure (BP) measurement remains crucial in diagnosing and managing hypertension. In this study, we aimed to compare BP measurements done over a bare arm versus a sleeved arm, while controlling all other possible sources of variance. We collected BP measurements of 100 hypertensive patients visiting a nephrology and hypertension clinic between January 2019 and December 2023. Measurements were taken by a single operator and according to the updated guidelines. BP measurements were performed first with one arm bare, and the other arm sleeved, with measurements taken simultaneously. Then, measurements were again taken simultaneously after exposing the arm which was first sleeved, and dressing the arm which was bare at first. a nonparametric Wilcoxon was performed to compare each patient’s measurements on each arm. No statistically significant differences were found between the sleeved and the bare arm measurements, with one exception of SBP measured on the left arm (slightly lower SBP on the bare arm). While looking at the absolute value of differences, the median difference was impressive with a 7–8 mmHg systolic difference and 5.5 mmHg diastolic difference. Our study revealed a robust and unpredicted effect of clothing on BP; in some patients, BP was increased while in others decreased. Therefore, we believe there is importance in measuring BP on bare skin, regardless of clothing or sleeve type.
Detection of the gene mutation of epidermal growth factor receptor in lung adenocarcinoma by radiomic features from a small amount of PET data
Authors: Zhang Tianyou , Liu Zefeng , Lin Liying , Han Tao , Long Fenghua , Guo Hongyu , Han Li
Published: June 2023

Objective

The purpose of this work was to identify the potential mutation of epidermal growth factor receptor in nonsmall cell adenocarcinoma by noninvasive method, and to explore whether the same or better effect can be achieved using a small amount of single-mode PET image data.

Method

A total of 115 patients were recruited and the results of their 18F-FDG PET images and gene detection after resection were obtained; 117 original radiation features and 744 wavelet transform features were extracted from PET images. Several methods were used to reduce the dimension of the data, and four classifier models were established to classify it. The above process was repeated to reduce the total amount of data and the area under the receiver operating characteristic curve (AUC) value that changed with the reduction of the data and the stability of the results was recorded.

Results

The classifier with the best comprehensive performance under this dataset was logistic regression, whose AUC value is 0.843. And similar results can be obtained from only 30 cases of data.

Conclusion

A similar or better result could be achieved using a small number of single-mode PET images. In addition, significant results could be obtained using only the PET images of 30 patients.
How reliable is the high-volume definition in prostate cancer patients: the potential game-changing role of PSMA
Authors: Güven Osman , Karyağar Savaş , Arici Serdar , Özülker Tamer , Can Orçun
Published: June 2023

Purpose

To evaluate whether metabolic and volumetric data from 68Ga-PSMA PET/CT performed during staging of de-novo high-volume mCSPC patients who received docetaxel could be used to predict survival.

Methods

Forty-two de-novo high-volume mCSPC patients, who received ADT + Docetaxel and underwent 68Ga-PSMA PET/CT for staging, were included in the study. The association between patients’ pathological data, all PSA measurements, treatments they received, the data obtained from 68Ga-PSMA PET/CT and progression-free and overall survival were examined.

Results

In the multivariate analysis, PSMA-TV (primary) and PSMA-TV (WB) variables were shown to be independent negative predictors of overall survival. For the threshold value of 19.91 cm3 obtained for PSMA-TV (primary), HR was calculated as 6.31, the 95% confidence interval (CI): 1.01–39.18, P = 0.048. For the threshold value of 1226.5 cm3 obtained for PSMA-TV (WB) variable, HR was calculated as 58.62, the 95% CI: 2.55–1344.43, P = 0.011. In our study, SUVmax (WB) variable was found to be an independent and negative predictor of progression-free survival. For the determined threshold value of 17.74, HR was calculated as 16.24, 95% CI: 1.18–22.76, P = 0.037.

Conclusion

Metabolic and volumetric data obtained from 68Ga-PSMA PET/CT can be used to predict survival in de-novo high-volume mCSPC. Our results show that in ADT + Docetaxel receiving patients, a subgroup with higher PSMA-TV (WB) values have a significantly worse prognosis. This situation suggests that the high-volume disease definition in the literature may be insufficient for this group, and that 68Ga-PSMA PET/CT can play an essential role in demonstrating the heterogeneity within the group.
Gaps in Postnatal Support for Intended Parents
Authors: Salera-Vieira Jean
Published: June 2023

Purpose:

To identify gaps in postnatal depression screening and support services for intended parents (parents who are intended to receive the baby from a gestational surrogacy pregnancy), also known as commissioned parents.

Study Design and Methods:

This descriptive study used quantitative and free-text survey questions designed to assess postnatal depression screening and postnatal services available for all parents and, more specifically, for intended parents.

Sample:

The survey was sent to 2,000 randomly selected postpartum nurses in the United States who are members of the Association of Women's Health, Obstetric and Neonatal Nurses.

Results:

Completion of the survey was offered to the 125 nurses who responded that they provided care for intended parents. Thirty-seven percent of respondents indicated that postpartum support services are available for both parents. Free-text responses describe a gap in postnatal services for intended parents. Although 85% of survey respondents reported that postpartum depression screening occurs in their setting, nurses reported neither fathers nor intended parents are screened for postnatal depression.

Clinical Implications:

This study expands the known gap in postnatal support services for intended parents, including postnatal depression screening. Recommendations for nurses working in the perinatal setting include providing consistent support for all parents as they transition to parenthood. Creating standardized policies and practices reflecting the diverse needs and cultures of intended parents can help direct all clinicians toward providing more significant support. Adapting current postnatal screening and support systems could provide a continuum of support for all families.
Splenic Lymphatic Malformation With Papillary Endothelial Proliferation
Authors: Slack Jonathan C. , Putra Juan , Callahan Michael J. , Church Alanna J. , Teot Lisa A. , Eng Whitney , Perez-Atayde Antonio R.
Published: June 2023

Lymphatic malformations (LMs) are congenital anomalies of the lymphatic system due to abnormalities that occur during the development of the lymphovascular system. Also known as lymphangiomas, they are usually multifocal, affect multiple organ systems, and are seen in a variety of developmental or overgrowth syndromes. Splenic lymphangiomas are uncommon and usually occur in the context of multiorgan lymphangiomatosis. Within the spleen, 7 prior cases have been reported of LMs with unusual papillary endothelial proliferations (PEPs), which can mimic more aggressive splenic lymphovascular tumors. It is not currently known if splenic LM-PEP represents a unique entity, or is simply an unusual, site-specific, morphologic variant of LM. To address this question, we conducted a retrospective, single-institutional review of this rare entity and systematically evaluated its clinical, histologic, radiologic, electron microscopical, and molecular features. In all 3 splenic LM-PEPs, the clinical course was benign, imaging demonstrated subcapsular lesions with characteristic “spoke-and-wheel” appearance, histology showed distinctive PEPs within lymphatic microcysts, immunohistochemistry confirmed a lymphatic endothelial phenotype and electron microscopy demonstrated lesional endothelial cells, rich in mitochondria and intermediate filaments with prominent cytoplasmic lumina and vacuoles and lacking Weibel-Palade granules. Occasional lymphothelial cells were situated within the cytoplasm of another lesional cell, appearing to be engulfed. Next-generation sequencing identified a PIK3CA mutation in 1 patient, while in 2 others no molecular alterations were identified. We conclude with a summary of all prior published cases and discuss key diagnostic elements that distinguish this benign entity from its more aggressive mimickers.
Tuberous Breast: A Wide Spectrum of Features of the Same Disorder—13-Year Experience-Based Classification and Reconstructive Algorithm
Authors: Innocenti Alessandro , Melita Dario
Published: June 2023

Background:

A multitude of variants of tuberous breast exist, and a reconstructive algorithm could help in assessment of all features that affect the breast and planning the most appropriate surgical correction strategy. Although several efficient techniques have been described in the literature, the authors propose their experience to help standardize a diagnostic and therapeutic approach. The aim of this article is to assess the pathologic hallmarks of each type of tuberous breast and to propose a one-step reconstructive algorithm tailored to the patient characteristics based on the use of three different adipo-glandular flaps.

Methods:

From September of 2006 to December of 2019, 118 patients were treated for tuberous breast in a one-step procedure using tailored local flaps according to the preoperatively assessed clinical variant. Minimum follow-up was 12 months. All the procedures were performed under local anesthesia.

Results:

A total of 220 tuberous breasts (98 hypoplastic and 122 normoplastic) were treated. Mean patient age was 20.2 years. Mean follow-up was 36.5 months. Six minor complications (capsular contracture and nipple-areola complex hypesthesia) but no major complications were reported. In 9% of cases, minor secondary procedures, including lipofilling, scar revisions, and breast implant substitution, were performed.

Conclusion:

The proposed algorithm, including a comprehensive classification, preoperative planning, and surgical approach derived from the authors’ experience, presents a tailored surgical approach for each type of tuberous breast.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
99mTc-MIBI SPECT/CT Evaluation of a Renal Collision Tumor
Authors: Ali Adil A. , Sivathapandi Thangalakshmi , Gupta Ritu , Master Viraj A. , Marcus Charles
Published: June 2023

Preoperative differentiation of oncocytomas from renal cell carcinoma (RCC) is often challenging. 99mTc-MIBI imaging could play a potential role in differentiating oncocytoma from RCC, which in turn could guide surgical decision-making. We present the use of 99mTc-MIBI SPECT/CT to characterize a renal mass in a 66-year-old man with a complex medical history, including history of bilateral oncocytomas. 99mTc-MIBI SPECT/CT showed features suspicious of a malignant tumor, which was confirmed postnephrectomy as a chromophobe and papillary RCC collision tumor. This case supports 99mTc-MIBI imaging for preoperative differentiation of benign versus malignant renal tumors.
FDG-Avid But Pentixafor-Negative in EBV-Associated T-Cell Lymphoproliferative Disorders
Authors: Shu Qiaoqiao , He Xubing , Chen Yue , Cai Liang
Published: June 2023

An 18-year-old woman with intermittent fever, pancytopenia, abnormal liver function, and enlarged lymph nodes and hepatosplenomegaly was clinically suspected as hemophagocytic lymphohistiocytosis. 18F-FDG PET/CT showed increased metabolism in multiple lymph nodes, which were highly suggestive of lymphoma. No increased CXCR4 expression in lymph nodes was demonstrated on 68Ga-pentixafor PET/CT. Subsequent right neck lymph node biopsy pathology revealed EBV-associated lymphoproliferative disorders. Our case shows that 68Ga-pentixafor PET/CT may have potential value in differentiating EBV-associated lymphoproliferative disorders from lymphomas.
The Use of Conventional Lower-Frequency Color Doppler Ultrasound for Flap Planning in the Lower Extremity
Authors: Chim Harvey , Sullivan Brianne
Published: June 2023

Background

Handheld Doppler is often inaccurate in localization of perforators for pedicled and free flaps. Color Doppler ultrasound (CDU), in contrast, allows more accurate mapping and characterization of perforators to facilitate rapid flap harvest.

Methods

Forty-seven flaps harvested from the lower extremity were evaluated preoperatively with CDU by a single surgeon with a conventional low-frequency ultrasound device (Philips Sparq, Cambridge, Mass). Flaps evaluated included profunda artery perforator flaps (n = 36), anterolateral thigh flaps (n = 2), pedicled propeller perforator flaps (n = 7), and toe transfers (n = 2).

Results

In all cases where a free profunda artery perforator or anterolateral thigh flap was used, the location of the dominant perforator visualized preoperatively correlated exactly with intraoperative findings. In cases where CDU was used preoperatively to locate a large perforator close to a lower extremity defect for reconstruction with a propeller perforator flap, all perforators could be used, and all flaps were successful.

Conclusions

Preoperative CDU is particularly useful for flap planning where knowledge of the location of the dominant perforator is critical. This includes planning of thin and superthin free flaps, as well as freestyle perforator flaps. Our clinical experience suggests that this technology should be routinely adopted in certain aspects of reconstructive microsurgery.
The Mechanism of Cannabichromene and Cannabidiol Alone Versus in Combination in the Alleviation of Arthritis-Related Inflammation
Authors: Grogan Graham , Stephens Kristen , Chou Jesse , Timko Michael P. , Cottler Patrick , DeGeorge Brent R.
Published: June 2023

Background

Patients suffering from arthritis have limited treatment options for nonoperative management. In search of pain relief, patients have been taking over-the-counter cannabinoids. Cannabidiol (CBD) and cannabichromene (CBC) are minor cannabinoids with reported analgesic and anti-inflammatory properties and have been implicated as potential therapeutics for arthritis-related pain. To this end, we utilized a murine model to investigate the effectiveness of and mechanism by which CBC alone, CBD alone, or CBD and CBC in combination may provide a reduction in arthritis-associated inflammation.

Methods

Forty-eight mice were included in the study, which were separated into 4 groups: control group (n = 12), treatment with CBD alone (n = 12), treatment with CBC alone (n = 12), and treatment with CBD + CBC (n = 12). We induced inflammation in each mouse utilizing the collagen-induced arthritis model. At scheduled timepoints, mice were clinically assessed for weight gain, swelling, and arthritis severity. In addition, inflammation-associated serum cytokine levels were analyzed for each animal.

Results

Thirty-five of 48 mice survived the duration of the study resulting in the following group numbers: control group (n = 8), treatment with CBD alone (n = 9), treatment with CBC alone (n = 9), and treatment with CBD + CBC (n = 9). Animals treated with CBC and CBD + CBC showed significant weight gain between 3 and 5 weeks. Irrespective of treatment, regression analysis comparing all cytokine measurement and physical outcomes found a significant positive correlation between levels of 5 individual cytokines and both arthritis scores and swelling. Animals treated with CBD + CBC showed a significant decrease in swelling between 3 and 5 weeks compared with the control group. Cannabinoid treatment selectively affected the gene expression of eotaxin and lipopolysaccharide-induced CXC chemokine with combined treatment of CBC + CBD.

Conclusion

Treatment with cannabinoids resulted in decreased clinical markers of inflammation. Further, the anti-inflammatory effect of CBC and CBD in conjunction was associated with a greater anti-inflammatory effect than either minor cannabinoid alone. Future work will elucidate the possibility of synergistic or entourage effects of minor cannabinoids used in combination for the treatment of arthritis-related pain and inflammation.
APPRAISE-HRI: AN ARTIFICIAL INTELLIGENCE ALGORITHM FOR TRIAGE OF HEMORRHAGE CASUALTIES
Authors: Stallings Jonathan D. , Laxminarayan Srinivas , Yu Chenggang , Kapela Adam , Frock Andrew , Cap Andrew P. , Reisner Andrew T. , Reifman Jaques
Published: June 2023

Background: Hemorrhage remains the leading cause of death on the battlefield. This study aims to assess the ability of an artificial intelligence triage algorithm to automatically analyze vital-sign data and stratify hemorrhage risk in trauma patients. Methods: Here, we developed the APPRAISE–Hemorrhage Risk Index (HRI) algorithm, which uses three routinely measured vital signs (heart rate and diastolic and systolic blood pressures) to identify trauma patients at greatest risk of hemorrhage. The algorithm preprocesses the vital signs to discard unreliable data, analyzes reliable data using an artificial intelligence–based linear regression model, and stratifies hemorrhage risk into low (HRI:I), average (HRI:II), and high (HRI:III). Results: To train and test the algorithm, we used 540 h of continuous vital-sign data collected from 1,659 trauma patients in prehospital and hospital (i.e., emergency department) settings. We defined hemorrhage cases (n = 198) as those patients who received ≥1 unit of packed red blood cells within 24 h of hospital admission and had documented hemorrhagic injuries. The APPRAISE-HRI stratification yielded a hemorrhage likelihood ratio (95% confidence interval) of 0.28 (0.13–0.43) for HRI:I, 1.00 (0.85–1.15) for HRI:II, and 5.75 (3.57–7.93) for HRI:III, suggesting that patients categorized in the low-risk (high-risk) category were at least 3-fold less (more) likely to have hemorrhage than those in the average trauma population. We obtained similar results in a cross-validation analysis. Conclusions: The APPRAISE-HRI algorithm provides a new capability to evaluate routine vital signs and alert medics to specific casualties who have the highest risk of hemorrhage, to optimize decision-making for triage, treatment, and evacuation.
High-risk Prescribing Following Surgery Among Payer Types for Patients on Chronic Opioids
Authors: Sharif Limi , Gunaseelan Vidhya , Lagisetty Pooja , Bicket Mark , Waljee Jennifer , Englesbe Michael , Brummett Chad M.
Published: June 2023

Objective:

Among those on chronic opioids, to determine whether patients with Medicaid coverage have higher rates of high-risk opioid prescribing following surgery compared with patients on private insurance.

Summary Background Data:

Following surgery, patients on chronic opioids experience gaps in transitions of care back to their usual opioid prescriber, but differences by payer type are not well understood. This study aimed to analyze how new high-risk opioid prescribing following surgery compares between Medicaid and private insurance.

Methods:

In this retrospective cohort study through the Michigan Surgical Quality Collaborative, perioperative data from 70 hospitals across Michigan were linked to prescription drug monitoring program data. Patients with either Medicaid or private insurance were compared. The outcome of interest was new high-risk prescribing, defined as a new occurrence of: overlapping opioids or benzodiazepines, multiple prescribers, high daily doses, or long-acting opioids. Data were analyzed using multivariable regressions and a Cox regression model for return to usual prescriber.

Results:

Among 1,435 patients, 23.6% (95% CI: 20.3%-26.8%) with Medicaid and 22.7% (95% CI: 19.8%-25.6%) with private insurance experienced new, postoperative high-risk prescribing. New multiple prescribers was the greatest contributing factor for both payer types. Medicaid insurance was not associated with higher odds of high-risk prescribing (OR: 1.067, 95% CI: 0.813–1.402).

Conclusion:

Among patients on chronic opioids, new high-risk prescribing following surgery was high across payer types. This highlights the need for future policies to curb high-risk prescribing patterns, particularly in vulnerable populations that are at risk of greater morbidity and mortality.
Causal viewpoint and ensemble interpretation: from physics to the social sciences
Authors: Athalye Vikram , Haven Emmanuel
Published: June 2023

In this article, we assert that, for the construction of quantum
physics
-analogous (as opposed to quantum
math
-analogous) probabilistic models of the social (e.g. economics–financial) reality, the use of the notion of causality and the idea of an ensemble of similarly prepared systems in a socially analogous manner could be essential. We give plausibility arguments in favour of this assertion by considering two social situations describable in terms of discrete-time stochastic (i.e. Markov) processes. The first one is an arbitrary economics/financial context expressed as a temporal sequence of actualized social states (e.g. decisions, choices, preferences, etc.). The other one is more specific, involving a generic supply chain context.

This article is part of the theme issue ‘Thermodynamics 2.0: Bridging the natural and social sciences (Part 1)’.
A thermodynamic basis for teleological causality
Authors: Deacon Terrence W. , García-Valdecasas Miguel
Published: June 2023

We show how distinct terminally disposed self-organizing processes can be linked together so that they collectively suppress each other's self-undermining tendency despite also potentiating it to occur in a restricted way. In this way, each process produces the supportive and limiting boundary conditions for the other. The production of boundary conditions requires dynamical processes that decrease local entropy and increase local constraints. Only the far-from-equilibrium dissipative dynamics of self-organized processes produce these effects. When two such complementary self-organizing processes are linked by a shared substrate—the waste product of one that is the necessary ingredient for the other—the co-dependent structure that results develops toward a self-sustaining target state that avoids the termination of the whole, and any of its component processes. The result is a perfectly naturalized model of teleological causation that both escapes the threat of backward influences and does not reduce teleology to selection, chemistry or chance.

This article is part of the theme issue ‘Thermodynamics 2.0: Bridging the natural and social sciences (Part 1)’.
An unusual presentation of Pseudomonas citronellolis bacteraemia and Campylobacter gastroenteritis infection in a human – a case report and literature review
Authors: Hwang Catherine S. , Rahmati Elham , Gerbino Anthony J. , Rose Tracie M. , Verma Punam , Schwartz Margot A.
Published: June 2023

Introduction.

Pseudomonas citronellolis

is an unusual pathogen in humans and has not been extensively described in the scientific literature. Herein, we present a case of bacteremia and septic shock due to

Pseudomonas citronellolis

following

Campylobacter

species gastroenteritis in a patient with immunosuppression.

Case Presentation. An 80-year-old man with myeloproliferative disorder on ruxolitinib presented with several days of worsening abdominal pain, which rapidly developed into septic shock with multi-organ failure and explosive diarrhea. Gram-negative bacilli observed on Gram staining of his blood culture broth were later identified as

Pseudomonas citronellolis

and

Bacteroides thetaiotaomicron

. Repeated abdominal imaging revealed no evidence of intestinal perforation or megacolon. In addition, stool PCR was positive for

Campylobacter

species. His clinical course improved after 14 days of meropenem with complete resolution of his symptoms and organ failure.

Conclusion.

P. citronellolis

is a rare infection in humans. We postulate that Janus Associated Kinase (JAK) inhibition in myeloproliferative disorders heightened this patient’s risk of bacterial translocation and severe illness in the setting of

Campylobacter

gastroenteritis.

P. citronellolis

may be identified more frequently as a pathogen in humans as more advanced diagnostic technologies become increasingly available in clinical microbiology.
Diagnostic and therapeutic challenges of isolated genital tuberculosis and drug resistant urogenital tuberculosis- case series
Authors: Bala Kiran , Xess Ashit , Das Rojaleen , Singla Neeta , Seth Amlesh , Singh Urvashi B
Published: June 2023

Genitourinary tuberculosis (GUTB) has varied presentation such as recurrent urinary tract infection, sterile pyuria with/without hematuria, irritating voiding symptoms, infertility, hydronephrosis and renal failure. Genital tuberculosis usually associated with renal TB but isolated cases may occur. Very few case reports of isolated tuberculous epididymo-orchitis have been published in literature. Epididymal TB may be the only clinically evident location of infection in rare cases of GUTB. Epididymal TB presents with non-specific local insidious  and  progressive symptoms   which are difficult to differentiate with cysts, tumours and other infections. Suspicion of tubercular etiology becomes stronger with bilateral epididymal  involvement along with testicular lesion and  resistant to multiple courses of antibiotics. Tuberculous epididymo-orchitis    has    significant impact on fertility, as sperm count and motility may be reduced by blockage of the vas and/or secondary atrophy. Timely diagnosis and treatment will prevent late sequaele of disease such as non-functioning kidney and thimble bladder and infertility. We are presenting three cases of GUTB, two cases (Case 1 & 3) were isolated case of tuberculous epididymo-orchitis in a 20 year old male and a 35 year old male and one case (case 2) of complicated drug resistant genitourinary tuberculosis in a 29 year old male. These rare cases were managed successfully with diagnostic and therapeutic challenges.
Case Report: Kingella kingae causing prosthetic joint infection in an adult
Authors: Wensley Katherine , McClelland Damian , Grocott Natalie , Manoharan Gopikanthan , Desai Seema
Published: June 2023

Introduction: Kingella kingae is a gram-negative microorganism that is rarely isolated as a pathogen in the adult population.  Although widely reported to affect prosthetic heart valves, there have been no previously reported cases of K. kingae infecting prosthetic joints in adults.
Case Presentation: A 61 year-old patient with a history of rheumatoid arthritis, presented with insidious onset of pain and swelling in her right shoulder, which had progressed to a discharging sinus. The patient had undergone a total shoulder replacement 11 years previously and had not developed any prior post-operative infections.  She had been taking Anti-TNF medication for 5 years prior to review for her rheumatoid disease.  The patient underwent a two-stage revision replacement procedure including implant removal, sinus excision and debridement. Deep tissue samples grew K. kingae post-operatively. The patient was commenced on intravenous ceftriaxone for 14 days, followed by a further 28 days of oral ciprofloxacin.  A second stage custom shoulder replacement was undertaken 10 months following the first stage and the patient made a good functional recovery.
Conclusion: The authors suggest that clinicians should be attuned to K. kingae as a potential pathogen for prosthetic joint infection, particularly in patients who are immunosuppressed. Two stage revision procedures can ensure favourable outcome and eradication of this pathogen from the joint. Beta lactams remains the main stay for antibiotic choices.
A comparison of qPCR and microscopy for the detection and enumeration of Cryptosporidium oocysts from drinking water
Authors: Robinson Guy , Elwin Kristin , Jones Matthew , Chalmers Rachel M.
Published: June 2023

A corrigendum of this article has been published full details can be found at 10.1099/jmm.0.001926

Introduction.
Cryptosporidium presents one of the main waterborne public health threats due to its resistance to chlorine disinfection and ability to cause large-scale outbreaks. The standard method used in the UK water industry for detection and enumeration of Cryptosporidium is based on fluorescence microscopy and is laborious and expensive. Molecular methods such as quantitative polymerase chain reaction (qPCR) can be more amenable to streamlining through automation, improving workflows and standardizing procedures.

Hypothesis. The null hypothesis was that there was no difference in the detection or enumeration between the standard method and a qPCR.

Aim. We aimed to develop and evaluate a qPCR for the detection and enumeration of Cryptosporidium in drinking water, and to compare the assay with the standard method used in the UK.

Methodology. We first developed and evaluated a qPCR method by incorporating an internal amplification control and calibration curve into a real-time PCR currently used for Cryptosporidium genotyping. Then we compared the qPCR assay with the standard method of immunofluorescent microscopy for the detection and enumeration of 10 and 100 Cryptosporidium oocysts in 10 l of artificially contaminated drinking water.

Results. The results demonstrated that detection of Cryptosporidium by this qPCR was reliable at low numbers of oocysts; however, enumeration was less reliable and more variable than immunofluorescence microscopy.

Conclusions. Despite these results, qPCR offers practical advantages over microscopy. There is potential for the use of PCR-based methods for Cryptosporidium analysis if parts of the upstream sample preparation are revised, and alternative technologies for enumeration (such as digital PCR) are also explored to improve analytical sensitivity.
Socioeconomic inequity in access to care among older people in Japan
Authors: Okamoto Shohei , Yamada Atsuhiro , Kobayashi Erika , Liang Jersey
Published: June 2023

Background

Equity in access to long-term care (LTC) enables older people to maintain their well-being after they undergo a decline in their intrinsic capacity.

Methods

We used data from Wave 6 (2002) through Wave 10 (2021) of the National Survey of the Japanese Elderly to assess gradients by income and education in access to medical care and LTC among Japanese individuals aged 60 years and above. Specifically, we assessed self-reported unmet needs for medical care and LTC, and public LTC use, and estimated the concentration indices (CI) to measure the degree of inequality and inequity. We standardised public LTC use by need and non-need variables. We analysed data derived from up to 1,775 person-wave observations from 1,370 individuals.

Findings

The pooled incidence across waves of forgone medical care, self-reported unmet support for activities of daily living (ADL) or instrumental ADL (IADL), and those not certified for LTC services even with ADL or IADL limitations were 4.6%, 15.5%, and 62.5%, respectively. Public LTC use demonstrated pro-higher education and pro-rich distribution, whereas the gaps decreased for need-predicted use. Based on the CI estimates, no explicit inequality was found for forgone medical care. However, we observed inequity in standardised LTC use across education, indicating pro-higher education inequality, particularly among women and those aged ≥80 years.

Conclusion

Improving the understanding of available resources and strengthening the functions of health centres and communities are required to detect the needs of citizens and facilitate their access to necessary care.
Mitigating the psychological impacts of COVID-19 restrictions on older people: The UK Behavioural Activation in Social Isolation (BASIL+) COVID-19 Urgent Public Health (UPH) trial and living systematic review
Authors: Gilbody Simon , Littlewood Elizabeth , McMillan Dean , Atha Lucy , Bailey Della , Baird Kalpita , Brady Samantha , Burke Lauren , Chew-Graham Carolyn A. , Coventry Peter , Crosland Suzanne , Fairhurst Caroline , Henry Andrew , Hollingsworth Kelly , Newbronner Elizabeth , Ryde Eloise , Shearsmith Leanne , Wang Han-I , Webster Judith , Woodhouse Rebecca , Clegg Andrew , Dexter-Smith Sarah , Gentry Tom , Hewitt Catherine , Hill Andrew , Lovell Karina , Sloan Claire , Traviss-Turner Gemma , Pratt Steven , Ekers David
Published: June 2023

Background

Older adults were more likely to be socially isolated during the COVID-19 pandemic, with risk of depression and loneliness. Behavioural Activation (BA) could feasibly maintain mental health in the face of COVID isolation.

Methods

We undertook a multicentre randomised controlled trial [BASIL+ISRCTN63034289] of BA to mitigate depression and loneliness among older people. BA was offered by telephone to intervention participants (n=218). Control participants received usual care, with existing COVID wellbeing resources (n=217).

Findings

Participants engaged with 5.2 (SD 2.9) of 8 remote BA sessions. Adjusted mean difference (AMD) for depression (PHQ-9) at 3 months [primary outcome] was -1.65 (95% CI -2.54 to -0.75, p<0.001). There was an effect for BA on emotional loneliness at 3 months (AMD -0.37, 95% CI -0.68 to -0.06, p=0.02), but not social loneliness (AMD -0.05, 95% CI -0.33 to 0.23, p=0.72). Other secondary outcomes at 3 months were anxiety (GAD-7: AMD -0.67, 95% CI -1.43 to 0.09, p=0.08) and quality of life (SF12 mental component: AMD 1.99, 95% CI 0.22 to 3.76, p=0.03; physical component: AMD - 0.50, 95% CI -2.14 to 1.10, p=0.53).

BASIL+ trial results were incorporated into a living systematic review [PROSPERO CRD42021298788], and we found strong evidence of an impact of behavioural and/or cognitive strategies on depression [random effects pooled standardised mean difference -0.32, 95% CI -0.48 to -0.16, 10 studies, n=1,210 participants] and loneliness [random effects pooled standardised mean difference -0.44, 95%CI -0.64 to -0.24, 13 studies, n=1,421 participants] in the short-term (<6 months).

Interpretation

BA is an effective intervention that reduces depression and some aspects of loneliness in the short term. This adds to the range of strategies to improve population mental health, particularly among older adults with multiple long-term conditions. These results will be helpful to policy makers in preventing depression and loneliness beyond the pandemic.

Funding

NIHR RP-PG-0217-20006
Analysis of the Clinical Incidence and Correlation between Colorectal Cancer and Microorganisms
Authors: Koutouvalis Kalia , Bejarano Pablo A
Published: June 2023

In this single institution retrospective medical record review, patients diagnosed with colorectal cancer from the years 2018-2022 were evaluated to distinguish an associative linear relationship between diagnosed colorectal cancer and a positive result for the presence of a microorganism. Based on the clinical incidence of this occurrence, it was observed patients with tumors in the left side of the colon had a higher incidence of a positive test result with a dominant microorganism. Species evaluation within this cohort found similarity to microorganisms identified as colorectal cancer biomarkers. These findings support clinical relevance and warrant further consideration for prospective study regarding microorganism involvement in colorectal cancer.
Molecular tuning of sea anemone stinging
Authors: He Lily S , Qi Yujia , Allard Corey AH , Valencia-Montoya Wendy A , Krueger Stephanie P , Weir Keiko , Seminara Agnese , Bellono Nicholas W
Published: June 2023

Jellyfish and sea anemones fire single-use, venom-covered barbs to immobilize prey or predators. We previously showed that the anemoneNematostella vectensisuses a specialized voltage-gated calcium (CaV) channel to trigger stinging in response to synergistic prey-derived chemicals and touch (Weir et al., 2020). Here we use experiments and theory to find that stinging behavior is suited to distinct ecological niches. We find that the burrowing anemoneNematostellauses uniquely strong CaVinactivation for precise control of predatory stinging. In contrast, the related anemoneExaiptasia diaphanainhabits exposed environments to support photosynthetic endosymbionts. Consistent with its niche,Exaiptasiaindiscriminately stings for defense and expresses a CaVsplice variant that confers weak inactivation. Chimeric analyses reveal that CaVβ subunit adaptations regulate inactivation, suggesting an evolutionary tuning mechanism for stinging behavior. These findings demonstrate how functional specialization of ion channel structure contributes to distinct organismal behavior.
Age-Related Modifications of Muscle Synergies during Daily-Living Tasks: A Scoping Review
Authors: Dussault-Picard Cloé , Havashinezhadian Sara , Turpin Nicolas A , Moissenet Florent , Turcot Katia , Cherni Yosra
Published: June 2023

Purpose

Aging is associated with changes in neuromuscular control that can lead to difficulties in performing daily-living tasks. Based on electromyography, muscle synergy analysis provides a valuable tool for assessing neuromuscular control strategies. However, the age-related changes of muscle synergies during daily living tasks are scattered throughout the literature. This review aimed to synthesize the existing literature on muscle synergies in elderly people during daily-living tasks and examine how they differ from those exhibited by young adults.

Methods

A search was conducted across the Medline, CINHAL, and Web of Science databases. Studies were included if they focused on muscle synergies in elderly people during walking, sit-to-stand or stair ascent, and if muscle synergies were obtained by a matrix factorization algorithm.

Results

The research strategy identified 4849 studies, of which 17 studies were included after the screening process. The muscle synergies of 295 elderly people and 182 young adults were reported. Results suggest that: 1) elderly people and young adults retain similar muscle synergies’ number, 2) elderly people have higher muscles contribution during walking, and 3) an increased inter and intra-subject variability during specific tasks (i.e., walking and stair ascent, respectively) was reported in elderly people compared to young adults.

Conclusion

This review provides a comprehensive understanding of age-related changes in neuromuscular control during daily-living tasks. Our findings suggested that although the number of synergies remains similar, metrics such as spatial and temporal structures of synergies are more suitable to identify neuromuscular control deficits between young adults and elderly people.