bluuebunny/crossref_metadata_2025 huggingface dataset:
Correlation between the oxygenation status of extrasynovial tissue in the wrist and disease activity in rheumatoid arthritis: a photoacoustic imaging study
Authors: Huang Zhibin , Wu Huaiyu , Hong Xiaoping , Song Di , Liang Weiyu , Huang Qin , Ye Xia , Xu Wenyi , Hu Qiu , Liu Cuilian , Li Guoqiu , Xu Jinfeng , Dong Fajin
Published: January 2024

Objective

RA is characterized by hypoxia in the synovial tissue. While photoacoustic (PA) imaging offers a method for evaluating tissue oxygenation in RA patients, studies exploring the link between the oxygenation status of extrasynovial tissue in the wrist and disease activity remain scarce. We aimed to assess synovial oxygenation in RA patients using a multimodal photoacoustic-US (PA/US) imaging system and establish its correlation with disease activity.

Methods

A retrospective study was conducted on 111 patients with RA and 72 healthy controls from 2022 to 2023. Dual-wavelength PA imaging quantified oxygen saturation (So2) levels in the synovial membrane and peri-wrist region. Oxygenation states were categorized as hyperoxia, intermediate oxygenation, and hypoxia based on So2 values. The association between oxygenation levels and the clinical disease activity index was evaluated using a one-way analysis of variance, complemented by the Kruskal–Wallis test with Bonferroni adjustment.

Results

Of the patients with RA, 39 exhibited hyperoxia, 24 had intermediate oxygenation, and 48 had hypoxia in the wrist extrasynovial tissue. All of the control participants exhibited the hyperoxia status. Oxygenation levels in patients with RA correlated with clinical metrics. Patients with intermediate oxygenation had a lower disease activity index compared with those with hypoxia and hyperoxia.

Conclusion

A significant correlation was found to exist between wrist extrasynovial tissue oxygenation and disease activity in patients with RA.
Postpartum Treatment for Chronic Hepatitis C Virus Among People With Opioid Use Disorder: A Prospective Pilot Clinical Trial
Authors: Chappell Catherine A. , Stewart Ellen , Laird Hollis J. , Jonassaint Naudia , Kasula Katelyn , Patterson Maya , Krans Elizabeth E.
Published: January 2024

Objective

The objective of this study was to evaluate the feasibility and acceptability of postpartum hepatitis C virus (HCV) treatment integrated within a substance use treatment program for pregnant and postpartum people with opioid use disorder (OUD).

Methods

We conducted a prospective pilot clinical trial of sofosbuvir/velpatasvir (SOF/VEL) treatment among postpartum people with OUD and HCV. Feasibility outcomes included rates of HCV treatment utilization and completion, medication adherence, and sustained virologic response 12 weeks after treatment completion (SVR12). Acceptability was measured through self-reported adverse effects and medication adherence.

Results

From January 2018 to August 2021, 164 pregnant people received care for OUD at the study site. Among those, 64 (39.0%) were HCV antibody positive and 45 (27.4%) had active HCV infection. Among 45 eligible patients, 32 (71.1%) enrolled and 21 (46.7%) initiated HCV treatment. Of 21 participants who initiated treatment, 16 (76.2%) completed the SOF/VEL treatment, and 11 (52.4%) completed the SVR12. All participants who completed treatment were cured. Common reasons for dropout during the HCV clinical care cascade were OUD treatment discontinuation, illicit substance use recurrence, and lost to follow-up. Participants reported high satisfaction with HCV treatment, including minimal adverse effects, and no HCV treatment concerns.

Conclusions

Nearly half of pregnant people with HCV initiated postpartum treatment within an integrated care model of HCV treatment within a substance use treatment program. Postpartum SOF/VEL was efficacious, tolerable, and acceptable. Despite this, postpartum HCV treatment among people with OUD remains challenging, and many barriers remain.
Exploration Into Patterns of Cannabis Use Across Pregnancy and Postpartum
Authors: Eitel Anna E. , Witcraft Sara M. , McRae-Clark Aimee L. , Brady Kathleen , King Courtney , Guille Constance
Published: January 2024

Objectives

Peripartum cannabis use can be harmful to pregnant individual’s and children’s health, yet it is the most used illicit substance during the peripartum period. Despite the ability of some people to reduce and abstain from cannabis use during pregnancy, the first year postpartum is a high-risk time for returning to cannabis. However, characterization of cannabis use patterns in the peripartum period and risk factors for return to use postpartum are not well established. The aims of this exploratory study were to describe patterns of peripartum cannabis use and identify factors associated with increased frequency of postpartum cannabis use among individuals who reported reduced use during pregnancy.

Methods

An online survey identified 47 individuals who used cannabis during the peripartum period. Descriptive statistics characterized the sample and among those who reduced use during pregnancy, χ2 determined the frequency of postpartum cannabis use per preconception reasons for use.

Results

During preconception, 95.7% of individuals used cannabis, and of those who were presently postpartum, 65% resumed use after delivery. Anxiety and stress were the most common motivations for cannabis use throughout the peripartum period, but social motivations (ie, fun, relaxation) were the only preconception factors that increased frequency of return to cannabis use postpartum.

Conclusions

Our exploratory study describes the characteristics of individuals using cannabis in the peripartum period and provides insight into correlates of resumption of cannabis use postpartum. These findings may inform future work to further determine temporal associations, confounding risk factors, and intervention techniques to prevent the return to cannabis use postpartum.
The Goutallier Classification System
Authors: Corazzelli Giuseppe , Meglio Vincenzo , Corvino Sergio , Leonetti Settimio , Ricciardi Francesco , D’Elia Alessandro , Pizzuti Valentina , Santilli Marco , Innocenzi Gualtiero
Published: January 2024

Study Design.

Retrospective, observational study.

Objective.

To determine the relationship between the Goutallier classification system (GS) and anthropometric, clinical, and radiologic features in 168 patients with lumbar spinal stenosis (LSS).

Background.

There is no agreement on a classification system that is both reliable and easy to use for describing the severity of fatty degeneration in the paravertebral muscles of the lower back in patients with symptomatic LSS. This study aimed to determine the statistical relationship between the GS and anthropometric, clinical, and radiologic factors in 168 patients with LSS.

Materials and Methods.

This study was conducted on 168 patients with LSS scheduled for elective decompressive surgery. A control group of 110 healthy individuals was enrolled. The study assessed paralumbar musculature fatty infiltration using GS on preoperative magnetic resonance imaging. The authors evaluated the statistical association between patient age, body mass index (BMI), preoperative Oswestry disability index (ODI) questionnaire, and cross-sectional areas (CSAs) of the dural sac and lumbar paraspinal muscles. Multivariate analysis was performed to adjust for confounding.

Results.

This study enrolled 168 patients with symptomatic LSS (95 men, 73 women); mean±SD age: 67.81±9.38 (range: 32.78–92.34) years; BMI: 28.29±3.36 (19.95–38.10) kg/m2. The control group was comprised of 110 healthy patients (61 men and 49 women). Age, sex, BMI, and erector spinae (ES)-CSA were not significantly different between the two groups. The authors found a direct relationship between GS grade and age and an inverse relationship between GS grade and dural sac-, multifidus lumbaris (LM)-, ES-, and psoas muscle (PM)-CSAs. Univariate analyses showed the variables statistically related to a higher GS grade included patient age (P<0.001), ODI (P=0.136), dural sac-CSA (P=0.011), LM-CSA (P< 0.001), ES-CSA (P<0.001), and PM-CSA (P<0.001). Multivariate least squares analysis showed the GS grade to be influenced by patient age (P=0.01), LM-CSA (P=0.002), ES-CSA (P=0.002), and PM-CSA (P=0.003).

Conclusions.

GS shows great potential as a tool for evaluating fat infiltration in the paralumbar muscles. This measure does not correlate with the ODI and BMI but is related to all radiologic parameters and patient age. Further prospective studies are required to establish a link between preoperative and postoperative outcomes in the setting of paraspinal fat infiltration.
A Mobile App for Comprehensive Symptom Management in People With Parkinson’s Disease
Authors: Lee JuHee , Suh Yujin , Kim Eunyoung , Yoo Subin , Kim Yielin
Published: January 2024

There is an increasing need for highly accessible health management platforms for comprehensive symptoms of Parkinson disease. Mobile apps encompassing nonmotor symptoms have been rarely developed since these symptoms are often subjective and difficult to reflect what individuals actually experience. The study developed an app for comprehensive symptom management and evaluated its usability and feasibility. A single-group repeated measurement experimental design was used. Twenty-two participants used the app for 6 weeks. Monitoring of nonmotor symptoms, games to address motor symptoms, and medication management were incorporated in the app. Quantitative outcomes were self-assessed through an online questionnaire, and one-on-one telephone interviews were conducted to understand the user's point of view. The successful experience of self-monitoring had improved participants' self-efficacy (Z= −3.634,P< .001) and medication adherence (Z= −3.371,P= .001). Facilitators included a simple-to-use interface, entertaining content, and medication helps. Barriers included simple forgetfulness and digital literacy, including unfamiliarity with mobile phone manipulation itself. The study suggested insight into the app use related to acceptability of mobile technology. The preliminary effects on self-efficacy and medication adherence will guide future nursing interventions using mobile health. Our approach will contribute to improving the continuum of care for Parkinson disease by promoting self-monitoring of symptoms.
Removal of Incidental Skin Cancer During Mohs Micrographic Surgery Indicated for a Different Primary Tumor
Authors: Darsha Adrija K. , Pousti Bobak T. , Loh Tiffany Y. , Hau Jennifer T. , Brian Jiang Shang I.
Published: January 2024

BACKGROUND

Mohs surgery is a tissue-sparing, microscopically controlled procedure used to treat biopsy-proven skin cancers. Because Mohs surgery allows for examination of the complete margin of each tissue layer removed, separate cancers can be treated concomitantly when identified. As early detection of skin cancer is beneficial for reducing morbidity, incidental tumors discovered during Mohs surgery are of significant interest.

OBJECTIVE

Our objective was to determine the prevalence and characteristics of incidental skin cancers found during Mohs surgery.

METHODS

A retrospective chart review of cases seen at University of California, San Diego, from 2014 to 2021 was performed.

RESULTS

Of 13,464 Mohs surgery cases, 4.53% (n = 610) had incidental skin cancers found during removal of the initially identified tumor. Of the 610 cases, 88.4% (n = 539) had basal cell carcinoma as the primary tumor and either squamous cell carcinoma (SCC) or SCC in situ as the incidental tumor. About 7.87% (n = 48) had SCC as the primary tumor and basal cell carcinoma as the incidental tumor. All tumors were removed with clear margins and without significant complications.

CONCLUSION

Diagnosis of incidental tumors during Mohs surgery enables early detection of skin cancer and circumvents the need for additional surgery, likely resulting in decreased morbidity and improved cost-effectiveness.
Comparison of Treatment Efficacy of Different Number of Botulinum Toxin Type A Injection Sites for Crow’s Feet Lines: A Single-Center Retrospective Clinical Study in Vietnam
Authors: Nguyen Quang Minh , Le Thi Mai , Duong Phuc Hieu , Vu Thai Ha , Le Huu Doanh
Published: January 2024

Objective:

Botulinum toxin type A is frequently used to treat crow’s feet lines. However, the optimal dose and injection sites are still controversial. The objective of this study was to compare the efficacy of different botulinum toxin type A injection patterns for the treatment of crow’s feet.

Methods:

This single-center, retrospective, clinical study was conducted at the National Hospital of Dermatology and Venereology from July 2020 to December 2020. Data on 60 patients with crow’s feet were collected and divided into 2 groups (3- or 4-point intramuscular injection) according to the intramuscular injection technique the patients received. The treatment efficacy was assessed based on the changes in the Crow’s Feet Grading Scale score at 1, 4, and 16 weeks after treatment. Repeated measures analysis of variance was used for the assessment of changes in scores over time between the two groups.

Results:

After treatment, the average Crow’s Feet Grading Scale score was significantly decreased compared with the pretreatment score at all timepoints (1, 4, and 16 weeks) in both states (dynamic: For 3-point intramuscular injection technique, 1 week: 1.90 ± 0.71 vs. 2.97 ± 0.56; 4 weeks: 1.87 ± 0.68 vs. 2.97 ± 0.56; 16 weeks: 2.60 ± 0.67 vs. 2.97 ± 0.56. For 4-point intramuscular injection technique, 1 week: 1.73 ± 0.83 vs. 3.03 ± 0.49; 4 weeks: 1.73 ± 0.74 vs. 3.03 ± 0.49; 16 weeks: 2.57 ± 0.68 vs. 3.03 ± 0.49, all P < 0.001. and static: For 3-point intramuscular injection technique, 1 week: 1.20 ± 0.89 vs. 2.20 ± 0.85; 4 weeks:1.20 ± 0.89 vs. 2.20 ± 0.85; 16 weeks: 1.87 ± 0.97 vs. 2.20 ± 0.85; For 4-point intramuscular injection technique, 1 week: 1.50 ± 0.86 vs. 2.30 ± 0.84; 4 weeks: 1.33 ± 0.84 vs. 2.30 ± 0.84; 16 weeks: 1.87 ± 0.97 vs. 2.30 ± 0.84. All P < 0.001). The average subjective patient-rated satisfaction scores after treatment were significantly higher in the 4-point injection group than in the 3-point injection group (P = 0.028). The adverse events were post-injection bruising in 3 patients and a feeling of eyelid tightness in 3 patients.

Conclusion:

Botulinum toxin type A injection is an effective treatment for crow’s feet. Adding a fourth injection maintains the same therapeutic effect and does not increase adverse effects. Patients with lower-fan crow’s feet patterns may benefit more from 4-point injection therapy. However, the present findings require confirmation in studies with larger sample sizes, longer follow-up times, and different botulinum toxin type A doses.
A Conversation with a Key Architect of Modern TCM in the West- Professor Ted Kaptchuk
Authors: Solos Ioannis , Buck Charles , Kaptchuk Ted
Published: January 2024

The interview was conducted on November 20, 2022 by Ioannis Solos and Charles Buck. Ted Kaptchuk (泰开阳) is a Professor of Medicine and a Professor of Global Health & Social Medicine at Harvard Medical School. In 1975, he graduated from the Macau Institute of Chinese Medicine, Macau, China. After returning to the West, Ted taught Chinese medicine throughout the States, Europe, Latin America, and Australia. Ted's book, The Web That Has No Weaver: Understanding Chinese Medicine is a groundbreaking explanation of East Asian medicine that continues to shape the discourse of the Chinese medicine profession in the West and has been translated into 13 languages. In 1990, Ted was recruited in Harvard Medical School to help research Chinese medicine. After encountering high placebo responses in multiple acupuncture clinical trials, Ted decided to switch his career to primarily studying placebo. He has published over 300 peer-reviewed articles. He has been awarded the Lifetime Achievement Award from the Society of Acupuncture Research (2015), the Lifetime Achievement Award from the Society for Interdisciplinary Placebo Studies (2021), and the William Silen Lifetime Achievement Award in Mentoring from Harvard Medical School (2022).
William Morris, Establishing the Foundation for the Advancement of TCM in the US
Authors: Solos Ioannis , Buck Charles , Morris William
Published: January 2024

Charles Buck and Ioannis Solos conducted this interview on the 2nd of March 2023. William Morris has sustained practice since 1980. He has served on the California, Texas and Massachusetts Professional Associations, as well as the National Association. He has tendered 20 years of service to the field through academic medicine, earning a master's degree in medical education to assist in developing Chinese medical doctoral programs and institutional review boards. He earned an OM.D. in 1988, a DAOM in 2002, and a Ph.D. focused on pulse diagnosis as clinical epistemology in 2009. He has published five books, including TCM Case Studies Dermatology, Li Shi-zhen Pulse Studies: An Illustrated Guide, Neoclassical Pulse Diagnosis, Cycles in Medical Astrology, and Transformation: Treating Trauma with Acupuncture and Herbs. (Fig. 1)
A clinical study on gastric cancer patients administered EN and PN versus PN alone in enhanced recovery after surgery
Authors: Fan Xin , Xu Yachen , Wan Rong , Zhang LiWen , Han He , Chen Jixiang
Published: January 2024

Background and objectives:

Enhanced recovery after surgery (ERAS) recommends avoiding enteral nutrition (EN) due to undesirable sequelae such as pulmonary aspiration and infections. Not using of EN in nongastric resections under ERAS pathways is often successful. However, parenteral nutrition (PN) alone followed by early postoperative oral feeding in gastric cancer patients, recommended by the ERAS guidelines, has unclear benefit and is only adopted after gastric resection. This study aimed to compute the postoperative outcomes of EN and PN compared to those of the ERAS-recommended nutritional pathway. Our secondary objective was to compare postoperative complications between the two groups.

Materials and methods:

Of 173 gastrectomy patients, 116 patients were in the combined group (EN and PN), whereas 57 patients were in the PN alone group. Statistical analysis was performed with the Statistical Package for the Social Sciences (SPSS) version 26.0.0 software. The data were analyzed by one-way ANOVA, the independent samplet-test, or, in the case of several independent samples, by the Kruskal–Wallis test. Categorical data were analyzed by Pearson’s χ2test or Fisher’s exact test.

Results:

The observed indices included C-reactive protein (CRP), platelet (PLT), white blood cells (WBC), hemoglobin (Hb), albumin, and PRE-albumin. The secondary outcomes included length of hospital stay (LOS), cost, incidence of pulmonary infection, and total incidence of infection.

Conclusion:

The combined mode of nutrition is feasible and is not associated with postoperative complications in gastric cancer patients under ERAS.
Worse Depression Profiles Are Associated With Higher Symptom Burden and Poorer Quality of Life in Patients With Gynecologic Cancer
Authors: Calvo-Schimmel Alejandra , Hammer Marilyn J. , Wright Alexi A. , Blank Stephanie V. , Cohen Bevin , Harris Carolyn , Shin Joosun , Conley Yvette , Paul Steven , Cooper Bruce , Levine Jon D. , Miaskowski Christine
Published: January 2024

Background

Depression is a pervasive symptom in patients with gynecological cancer undergoing chemotherapy.

Objectives

Purposes were to identify subgroups of patients with distinct depression profiles and evaluate for differences in demographic and clinical characteristics, severity of common symptoms, and quality of life (QOL) outcomes among these subgroups.

Methods

Patients with gynecological cancer (n = 231) completed the Center for Epidemiologic Studies–Depression Scale 6 times over 2 cycles of chemotherapy. All of the other measures were completed prior to the second or third cycle of chemotherapy. Latent profile analysis was done to identify the distinct depression profiles. Differences were evaluated using parametric and nonparametric tests.

Results

Three distinct profiles were identified: low (60.1%), high (35.1%), and very high (4.8%). Compared with low class, the other 2 classes had lower functional status and were more likely to self-report a diagnosis of depression. Patients in the 2 worse profiles reported a higher comorbidity burden, higher levels of trait and state anxiety, sleep disturbance, and fatigue, as well as lower levels of cognitive function and poorer QOL. State and trait anxiety, evening fatigue, and sleep disturbance scores exhibit a “dose-response effect” (ie, as the depression profile worsened, the severity of these symptoms increased).

Conclusions

Almost 40% of our sample experienced high or very high levels of depression across 2 cycles of chemotherapy.

Implications for Practice

Clinicians can use the identified risk factors to identify high patients risk and provide tailored psychological interventions aimed to decrease symptom burden and prevent decrements in QOL.
Magnet Recognition® and Pathway to Excellence®, Complementary Programs
Authors: Lal M. Maureen
Published: January 2024

The American Nurses Credentialing Center® (ANCC) provides healthcare organizations with 2 complementary programs: Magnet Recognition Program® and Pathway to Excellence®. Both programs support nurses in providing the best care. Understanding each program's framework and focus allows organizations to choose which program is the best fit.

Nursing is searching for solutions, the ANCC's Magnet Recognition®, and the Pathway to Excellence® programs offer evidence-based frameworks to support professional nursing practice. The frameworks result in improved nurse engagement, retention, interprofessional collaboration, nurse and patient safety, and patient outcomes.
Transformational and Unifying Leadership
Authors: Ferren Melora D.
Published: January 2024

In this column, the recently retired American Nurses Association Enterprise Chief Executive Officer, Loressa Cole, DNP, MBA, RN, NEA-BC, FAAN, shares how her career journey shaped her into the healthcare executive she is today. As a transformational and unifying leader, she emphasizes the creation of cohesive environments that support nursing excellence and positively impact the profession. Dr Cole encourages nurse leaders to maintain a positive attitude, strong work ethic, and supportive networks while being patient-centered.
Honoring Nurse Educators
Authors: Zimmermann Deborah
Published: January 2024

Celebrating the faculty and educators who profoundly impact the profession is tied to purpose. Gratitude and recognition from students, colleagues, and educational leaders can be powerful tools in maintaining not only the well-being of clinical nurses but also that of educators.
Moral Distress and Intention to Leave During COVID
Authors: Karakachian Angela , Hebb Abigail , Peters Joy , Vogelstein Eric , Schreiber James B. , Colbert Alison
Published: January 2024

OBJECTIVE

The aim of this study was to investigate how the experience of caring for COVID-19 patients, nurses' moral distress, and the current practice environment impact nurses' intention to leave.

BACKGROUND

Caring for COVID-19 patients has been associated with an increase in nurses' moral distress and an increase in nurses' turnover. To date, research has focused on nurses' moral distress, the practice environment, and intentions to leave during the pandemic's peak. The current workplace climate, including those who stayed in their positions, has not been adequately assessed.

METHODS

This cross-sectional correlational study was conducted in a Magnet® hospital.

RESULTS

Moral distress related to team/system (B = 0.64, t = 3.86, P < 0.001), nurses' participation in hospital affairs (B = −2.21, t = −3.52, P < 0.001), and staffing (B = −1.91, t = −5.48, P < 0.001) are strongest predictors for nurses' intention to leave postpandemic.

CONCLUSIONS

Nurses in practice still report experiencing COVID-related moral distress; however; issues related to resources and staffing have the most substantial impact on intention to leave among the current nursing workforce.
An Intervention to Enhance Recognition of Nursing Assistant Roles and Enhance Information-Sharing
Authors: Saiki Masatoshi , Takemura Yukie , Kunie Keiko
Published: January 2024

This column describes a quasi-experimental trial that examined the effects of an intervention in which both nurses and nursing assistants shared their perceptions of the nursing assistant role on the frequency of information-sharing behaviors. In the intervention group, the frequency of nurses' linguistic responses in the intervention group increased in the nursing assistants' evaluations. The frequency of nursing assistants' linguistic response and feedback in the intervention group increased in self-evaluation and nurses' evaluation, respectively.
Dissemination, Utilization, and Satisfaction With Emergency Medicine Resident Simulation Curriculum for Pediatrics (EM ReSCu Peds) by North American Residency Programs
Authors: Yee Jennifer , Auerbach Marc A. , Wong Kei U. , Kaur Snimarjot , Burns Rebekah A.
Published: January 2024

Objectives

Our research team's primary objective was to investigate how a custom standard simulation curriculum for teaching emergency medicine residents about pediatrics was being used by programs across North America. We also wanted to know if program directors were satisfied with the curriculum and whether they had challenges with implementing it. Our long-term goal is to promote the Emergency Medicine Resident Simulation Curriculum for Pediatrics for use by all programs in the United States.

Methods

We distributed an electronic questionnaire to individuals who have downloaded the Emergency Medicine Resident Simulation Curriculum for Pediatrics in the form of an e-book from the Academic Life in Emergency Medicine Web site. The curriculum was marketed through national emergency medicine (EM) and pediatric emergency medicine (PEM) groups, PEM listserv, and through the International Network for Simulation-Based Pediatric Innovation, Research, and Education. We asked survey recipients how they used the curriculum, plans for future maintenance, satisfaction with curriculum use, and whether they had any challenges with implementation. Finally, we asked demographic questions.

Results

Most survey respondents were EM or PEM health care physicians in the United States or Canada. Respondents' primary goal of using the curriculum was resident education. Through assessment with the Net Promoter Score, satisfaction with the curriculum was net positive with users largely scoring as curriculum promoters. We found COVID-19 and overall time limitations to be implementation barriers, whereas learner interest in topics was the largest cited facilitator. Most responders plan to continue to implement either selected cases or the entire curriculum in the future.

Conclusions

Of those who responded, our target audience of EM physicians used our curriculum the most. Further investigation on implementation needs, specifically for lower resource emergency programs, is needed.
A comparative electromyographic study of scapular stabilizing muscles during five main rehabilitation exercises
Authors: Mendez-Rebolledo Guillermo , Araya-Quintanilla Felipe , Guzmán-Muñoz Eduardo , Salazar-Mendez Joaquín , Cruz-Montecinos Carlos , Berckmans Kelly R. , Calatayud Joaquín
Published: January 2024

Objective

To compare the surface electromyographic (sEMG) amplitude, activation ratio, and onset latency of the main scapular stabilizing muscles between five typical rehabilitative exercises.

Design

Twenty-seven healthy participants performed five scapular exercises [wall-slide (WS), wall push-up plus, prone horizontal abduction with external rotation (PHABER), external rotation in side-lying (ERSL), and low row] while simultaneously recording sEMG of serratus anterior (SA), middle trapezius (MT), lower trapezius (LT), and upper trapezius (UT). sEMG amplitudes, onset latencies, and activation ratios were calculated.

Results

PHABER showed an excellent UT/MT (0.43) and UT/LT (0.30) muscle balance with high (> 50% MVIC) MT and LT amplitudes, a low (< 20% MVIC) UT amplitude, and an early activation of the scapular stabilizing muscles (-474.7 to 89.9 ms) relative to UT. ERSL showed excellent UT/SA (0.26), UT/MT (0.32), and UT/LT (0.21) activation ratios; and along with LR and WS, showed early activation of the scapular stabilizing muscles (-378.1 to -26.6 ms).

Conclusions

PHABER presented optimal scapular neuromuscular control. Although ERSL, low row, and WS did not meet all the criteria associated with optimal scapular neuromuscular control, these exercises could be used in early stages of shoulder rehabilitation because they favor early activation of the scapular stabilizing muscles.
Introduction to Disability and Antiableist Health Care
Authors: Smeltz Lydia , Carpenter Sandra , Benedetto Lauren , Newcomb Nora , Rubenstein Dana , King Tonya , Lunsford Christopher , Shaw Tanya , DeWaters Ami L.
Published: January 2024

Physical medicine and rehabilitation physicians often care for disabled patients, who comprise America’s largest marginalized population. Despite medical students’ and physicians’ discomfort with caring for disabled patients and the pervasiveness of ableism in health care, medical education lacks disability-focused education. Kern’s approach to curriculum development and disability community input were used to design a three-part, elective curriculum for first-year medical students. Part one introduced disability models and language. Part two described how to perform a comprehensive history and physical examination for a disabled patient using ADEPT-CARE. Part three provided an overview of disability history and the disability rights movement. The curriculum’s goal was to improve students’ attitudes regarding disability health and self-perceived knowledge and confidence in caring for patients with disabilities. The curriculum was evaluated through presurvey and postsurvey. Students favorably reviewed the curriculum. One hundred percent of students (n = 21) agreed or strongly agreed that the curriculum improved their knowledge of disability health, increased their perceived confidence in caring for patients with disabilities, and enhanced their medical education. There were no statistically significant differences in students’ attitudes toward patients with disabilities after curriculum completion. Our asynchronous module provides one potential curriculum for increasing preclinical medical students’ self-perceived knowledge of disability health.
Impact of Urine Culture Reflex Policy Implementation in a Large County Hospital Inpatient Rehabilitation Unit – A Pilot Study
Authors: Pham Diana , Hopkins Brian J. , Chavez Audrie A. , Brown L. Steven , Barshikar Surendra , Prokesch Bonnie C.
Published: January 2024

Objective

To promote antimicrobial stewardship, many institutions have implemented a policy of reflexing to a urine culture based on a positive urinalysis result. The rehab patient population, including individuals with brain and spinal cord injuries, may have atypical presentations of UTIs. The study objective is to determine the effects of implementing a urine culture reflex policy in this specific patient population.

Design

In an inpatient rehabilitation unit, 348 urinalyses were analyzed from August 2019 to June 2021. Urinalysis with greater than or equal to ten white blood cells per high power field (WBC/HPF) was automatically reflexed to a urine culture in this prospective study. Primary outcome was return to acute care related to urinary tract infection. Secondary outcomes included adherence to reflex protocol, antibiotic utilization and appropriateness, adverse outcomes related to antibiotic use, and reduction in urine cultures processed and the associated reduction in healthcare costs.

Results

There was no statistically significant difference pre- and post-intervention related to the primary outcome. Urine cultures processed were reduced by 58% post-intervention.

Conclusions

Urine culture reflex policy is likely an effective intervention to reduce the frequency of urine cultures without significantly affecting the need to transfer patients from inpatient rehab back to the acute care setting.
A 23-year-old with chronic pain and fainting spells – A clinical vignette
Authors: Ploeg Allegra Noëlle , Courseault Jacques , Lekshminarayanan Anusha
Published: January 2024

Care for and clinical presentation of patients with connective tissue disorders, specifically Hypermobile Ehlers-Danlos Syndrome, is poorly understood. Diagnosis can often take years, and comprehensive care can be difficult to coordinate for these patients. This vignette aims to show the clinical characteristics of a young female with Hypermobile Ehlers-Danlos, as well as the evaluation of her diagnostic presentation and subsequent treatment. The demographic data of this population is yet to be established, and as it can vary widely between individuals, it is important to recognize symptoms that distinguish this disorder from others with similar presentations. Education of physicians on this syndrome will allow earlier recognition of symptoms and lead to better outcomes of these patients overall.
Association Between Health Service Systems and Pressure Injury Problems of Individuals With Chronic Spinal Cord Injury in Malaysia, Indonesia, and Thailand: A Cross-sectional Study
Authors: Kammuang-lue Pratchayapon , Pattanakuhar Sintip , Engkasan Julia Patrick , Wahyuni Luh K. , Fauzi Aishah Ahmad , Chotiyarnwong Chayaporn , Kovindha Apichana
Published: January 2024

Objective

The aim of the study is to determine whether a health service system is an independent influencing factor of having pressure injury problems in individuals with chronic spinal cord injury living in three countries

Design

This is a cross-sectional study.

Methods

Data from the International Spinal Cord Injury Community Survey were analyzed. The pressure injury problems were assessed using the Spinal Cord Injury Secondary Condition Scales (dichotomized to “having problem” and “not having problem”). Health service systems were categorized as an inpatient-oriented spinal cord injury–specialized system and a primary care–oriented system. A directed acyclic graph was applied to create a multivariable logistic regression model to determine the independent influencing factors of pressure injury problems.

Results

Of 790 included participants, 277 (35%) had pressure injury problems. Being recruited from countries with inpatient-oriented spinal cord injury–specialized systems (model 1) and visiting rehabilitation medicine/spinal cord injury physicians at least once a year (model 2) is an independent negative correlating factor of pressure injury problems (odds ratio = 0.569 [95% confidence interval = 0.374–0.866] and 0.591 [95% confidence interval = 0.405–0.864], respectively).

Conclusions

Spinal cord injury–specialized health service systems might be a protective factor of pressure injury problems in middle-income country contexts. This result suggests the importance of having spinal cord injury–specialized services in middle-income countries to reduce the prevalence of pressure injury problems.

To Claim CME Credits

Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME

CME Objectives

Upon completion of this article, the reader should be able to: (1) Identify the best strategy for managing pressure injury problems in people with spinal cord injury. (2) Describe common methods for determining health service utilization and evaluating secondary health conditions in people with spinal cord injury. (3) Discuss the advantage of having a SCI-specialized rehabilitation system in middleincome countries as a protective factor from having pressure injury problems.

Level

Advanced

Accreditation

The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Unlocking the Black Box? A Comprehensive Exploration of Large Language Models in Rehabilitation
Authors: Bonnechère Bruno
Published: January 2024

Rehabilitation is a vital component of healthcare, aiming to restore function and improve the well-being of individuals with disabilities or injuries. Nevertheless, the rehabilitation process is often likened to a 'black box', with complexities that pose challenges for comprehensive analysis and optimization. The emergence of Large Language Models (LLMs) offers promising solutions to better understand this ‘black box’. LLMs excel at comprehending and generating human-like text, making them valuable in the healthcare sector. In rehabilitation, healthcare professionals must integrate a wide range of data to create effective treatment plans, akin to selecting the best ingredients for the 'black box'. LLMs enhance data integration, communication, assessment, and prediction.

This paper delves into the ground-breaking use of LLMs as a tool to further understand the rehabilitation process. LLMs address current rehabilitation issues, including data bias, contextual comprehension, and ethical concerns. Collaboration with healthcare experts and rigorous validation is crucial when deploying LLMs. Integrating LLMs into rehabilitation yields insights into this intricate process, enhancing data-driven decision-making, refining clinical practices, and predicting rehabilitation outcomes. Although challenges persist, LLMs represent a significant stride in rehabilitation, underscoring the importance of ethical use and collaboration.
Surgical Sabermetrics
Authors: Howie Emma E. , Ambler Olivia , Gunn Eilidh GM , Dias Roger D. , Wigmore Stephen J. , Skipworth Richard JE , Yule Steven J.
Published: January 2024

Objective:

To evaluate the current evidence for surgical sabermetrics: digital methods of assessing surgical non-technical skills and investigate the implications for enhancing surgical performance.

Background:

Surgeons need high-quality, objective, and timely feedback to optimise performance and patient safety. Digital tools to assess non-technical skills have potential to reduce human bias and aid scalability. However, we do not fully understand which of the myriad of digital metrics of performance assessment have efficacy for surgeons.

Methods:

A systematic review was conducted by searching PubMed, EMBASE, CINAHL, and PSYCINFO databases following PRISMA-ScR guidelines. MeSH terms and keywords included “Assessment” “Surgeons” and “Technology”. Eligible studies included digital assessment of non-technical skills for surgeons, residents, and/or medical students within an operative context.

Results:

From 19,229 articles screened, 81 articles met inclusion criteria. The studies varied in surgical specialities, settings, and outcome measurements. A total of 122 distinct objective, digital metrics were utilized. Studies digitally measured at least one category of surgical non-technical skill using single(n=54) or multiple objective measures(n=27). The majority of studies utilised simulation(n=48) over live operative settings (n=32). Surgical Sabermetrics has been demonstrated to be beneficial in measuring cognitive load(n=57), situation awareness(n=24), communication(n=3), teamwork(n=13), and leadership(n=2). No studies measured intraoperative decision-making.

Conclusions:

The literature detailing the intersection between surgical data science and operative non-technical skills is diverse and growing rapidly. Surgical Sabermetrics may provide a promising modifiable technique to achieve desirable outcomes for both the surgeon and the patient. This study identifies a diverse array of measurements possible with sensor devices and highlights research gaps, including need for objective assessment of decision-making. Future studies may advance the integration of physiological sensors to provide holistic assessment of surgical performance.
Change in absolute neutrophil count after COVID-19 infection in patients using clozapine versus other antipsychotics
Authors: Jeong Seong Hoon , Lee Mi Gyung , Kim Yong Sik , Chung In Won
Published: January 2024

It was reported that patients who contracted COVID-19 while taking clozapine exhibited a distinct hematological response. However, the absence of control groups made it difficult to attribute it to clozapine. The changes in absolute neutrophil counts (ANCs) during the 4 weeks after COVID-19 infection were compared between the two groups of patients with severe mental illnesses (SMIs) (49 patients using clozapine and 54 using other antipsychotics) using generalized additive modeling. Although the pattern of a transient drop in ANC followed by gradual recovery could be demonstrated in both groups, it was more pronounced in the clozapine group (P = 0.00025). Nevertheless, overall ANC remained at a higher level in the clozapine group. The results suggested potential interaction between clozapine and COVID-19 at the level of hematological dynamics. However, it did not necessarily indicate that such interaction is inevitably harmful or dangerous. It was more of a concern that some patients using other antipsychotics exhibited decreased ANC, which did not easily recover. Traditionally, clinicians have been concerned about the worsening of hematological side effects in clozapine patients after COVID-19 infection. However, the obtained result highlighted the necessity of hematological monitoring in patients using any type of antipsychotics for SMIs.
Structural and functional characterization of siadenovirus core protein VII nuclear localization demonstrates the existence of multiple nuclear transport pathways
Authors: Athukorala Ajani , Donnelly Camilla M. , Pavan Silvia , Nematollahzadeh Sepehr , Djossou Victoria Atalie , Nath Babu , Helbig Karla J. , Di Iorio Enzo , McSharry Brian P. , Alvisi Gualtiero , Forwood Jade K. , Sarker Subir
Published: January 2024

Adenovirus protein VII (pVII) plays a crucial role in the nuclear localization of genomic DNA following viral infection and contains nuclear localization signal (NLS) sequences for the importin (IMP)-mediated nuclear import pathway. However, functional analysis of pVII in adenoviruses to date has failed to fully determine the underlying mechanisms responsible for nuclear import of pVII. Therefore, in the present study, we extended our analysis by examining the nuclear trafficking of adenovirus pVII from a non-human species, psittacine siadenovirus F (PsSiAdV). We identified a putative classical (c)NLS at pVII residues 120–128 (120PGGFKRRRL128). Fluorescence polarization and electrophoretic mobility shift assays demonstrated direct, high-affinity interaction with both IMPα2 and IMPα3 but not IMPβ. Structural analysis of the pVII-NLS/IMPα2 complex confirmed a classical interaction, with the major binding site of IMPα occupied by K124 of pVII-NLS. Quantitative confocal laser scanning microscopy showed that PsSiAdV pVII-NLS can confer IMPα/β-dependent nuclear localization to GFP. PsSiAdV pVII also localized in the nucleus when expressed in the absence of other viral proteins. Importantly, in contrast to what has been reported for HAdV pVII, PsSiAdV pVII does not localize to the nucleolus. In addition, our study demonstrated that inhibition of the IMPα/β nuclear import pathway did not prevent PsSiAdV pVII nuclear targeting, indicating the existence of alternative pathways for nuclear localization, similar to what has been previously shown for human adenovirus pVII. Further examination of other potential NLS signals, characterization of alternative nuclear import pathways, and investigation of pVII nuclear targeting across different adenovirus species is recommended to fully elucidate the role of varying nuclear import pathways in the nuclear localization of pVII.
Bridging the resolution-sectioning gap in stimulated emission depletion microscopy: theory and experiment
Authors: Belsley Michael , Soares-de-Oliveira Joana , Pereira António J.
Published: January 2024

Microscopes generally exhibit superior performance in 2D compared to 3D. Fluorescence super-resolution imaging often intensifies this discrepancy, such as with the gold-standard vortex-based stimulated emission depletion (STED) microscope, which narrows the point-spread function only laterally. In this study, we developed a semi-analytical theory based on the Nijboer-Zernike expansion, conducted simulations and performed experiments to establish the merits of the alternative bivortex-based STED. We find that this mode reduces the axial-lateral resolution mismatch and effectively emulates noisier multi-beam approaches by providing access to point-spread function geometries that are strictly forbidden to the two conventional single-beam modes, 2D-STED and z-STED. Notably, theory and experiment indicate that, besides filling the gap, bivortex STED delivers a higher signal-to-background than the two modes it bridges.
Identification of type 2 diabetes- and obesity-associated human β-cells using deep transfer learning
Authors: Roy Gitanjali , Syed Rameesha , Lazaro Olivia , Robertson Sylvia , McCabe Sean D. , Rodriguez Daniela , Mawla Alex M. , Johnson Travis S. , Kalwat Michael A.
Published: January 2024

Diabetes affects >10% of adults worldwide and is caused by impaired production or response to insulin, resulting in chronic hyperglycemia. Pancreatic islet β-cells are the sole source of endogenous insulin and our understanding of β-cell dysfunction and death in type 2 diabetes (T2D) is incomplete. Single-cell RNA-seq data supports heterogeneity as an important factor in β-cell function and survival. However, it is difficult to identify which β-cell phenotypes are critical for T2D etiology and progression. Our goal was to prioritize specific disease-related β-cell subpopulations to better understand T2D pathogenesis and identify relevant genes for targeted therapeutics. To address this, we applied a deep transfer learning tool, DEGAS, which maps disease associations onto single-cell RNA-seq data from bulk expression data. Independent runs of DEGAS using T2D or obesity status identified distinct β-cell subpopulations. A singular cluster of T2D-associated β-cells was identified; however, β-cells with high obese-DEGAS scores contained two subpopulations derived largely from either non-diabetic or T2D donors. The obesity-associated non-diabetic cells were enriched for translation and unfolded protein response genes compared to T2D cells. We selected DLK1 for validation by immunostaining in human pancreas sections from healthy and T2D donors. DLK1 was heterogeneously expressed among β-cells and appeared depleted from T2D islets. In conclusion, DEGAS has the potential to advance our holistic understanding of the β-cell transcriptomic phenotypes, including features that distinguish β-cells in obese non-diabetic or lean T2D states. Future work will expand this approach to additional human islet omics datasets to reveal the complex multicellular interactions driving T2D.