bluuebunny/crossref_metadata_2025 huggingface dataset:
Research Relevant Background Lesions and Conditions: Ferrets, Dogs, Swine, Sheep, and Goats
Authors: Helke Kristi L , Meyerholz David K , Beck Amanda P , Burrough Eric R , Derscheid Rachel J , Löhr Christiane , McInnes Elizabeth F , Scudamore Cheryl L , Brayton Cory F
Published: January 2021

Animal models provide a valuable tool and resource for biomedical researchers as they investigate biological processes, disease pathogenesis, novel therapies, and toxicologic studies. Interpretation of animal model data requires knowledge not only of the processes/diseases being studied but also awareness of spontaneous conditions and background lesions in the model that can influence or even confound the study results. Species, breed/stock, sex, age, anatomy, physiology, diseases (noninfectious and infectious), and neoplastic processes are model features that can impact the results as well as study interpretation. Here, we review these features in several common laboratory animal species, including ferret, dog (beagle), pig, sheep, and goats.
A model of double descent for high-dimensional binary linear classification
Authors: Deng Zeyu , Kammoun Abla , Thrampoulidis Christos
Published: January 2021

We consider a model for logistic regression where only a subset of features of size $p$ is used for training a linear classifier over $n$ training samples. The classifier is obtained by running gradient descent on logistic loss. For this model, we investigate the dependence of the classification error on the ratio $\kappa =p/n$. First, building on known deterministic results on the implicit bias of gradient descent, we uncover a phase-transition phenomenon for the case of Gaussian features: the classification error of the gradient descent solution is the same as that of the maximum-likelihood solution when $\kappa <\kappa _\star $, and that of the support vector machine when $\kappa>\kappa _\star $, where $\kappa _\star $ is a phase-transition threshold. Next, using the convex Gaussian min–max theorem, we sharply characterize the performance of both the maximum-likelihood and the support vector machine solutions. Combining these results, we obtain curves that explicitly characterize the classification error for varying values of $\kappa $. The numerical results validate the theoretical predictions and unveil double-descent phenomena that complement similar recent findings in linear regression settings as well as empirical observations in more complex learning scenarios.
Predator–Prey Interactions Examined Using Lionfish Spine Puncture Performance
Authors: Galloway K A , Porter M E
Published: January 2021

Synopsis

Puncture mechanics can be studied in the context of predator–prey interactions and provide bioinspiration for puncture tools and puncture-resistant materials. Lionfish have a passive puncture system where venomous spines (dorsal, anal, and pelvic), the tool, may embed into a predator’s skin, the target material, during an encounter. To examine predator–prey interactions, we quantified the puncture performance of red lionfish, Pterois volitans, spines in buccal skin from two potential predators and porcine skin, a biological model for human skin. We punctured dorsal, anal, and pelvic lionfish spines into three regions of buccal skin from the black grouper (Mycteroperca bonaci) and the blacktip shark (Carcharhinus limbatus), and we examined spine macro-damage (visible without a microscope) post puncture. Lionfish spines were more effective, based on lower forces measured and less damage incurred, at puncturing buccal skin of groupers compared to sharks. Anal and dorsal spines incurred the most macro-damage during successful fish skin puncture trials, while pelvic spines did not incur any macro-damage. Lionfish spines were not damaged during porcine skin testing. Anal spines required the highest forces, while pelvic spines required intermediate forces to puncture fish skin. Dorsal spines required the lowest forces to puncture fish skins, but often incurred macro-damage of bent tips. All spine regions required similar forces to puncture porcine skin. These data suggest that lionfish spines may be more effective at puncturing humans such as divers than potential fish predators. These results emphasize that puncture performance is ultimately determined by both the puncture tool and target material choice. Lionfish puncture performance varies among spine region, when taking into account both the puncture force and damage sustained by the spine.
A feasibility study of inverse contrast-matching small-angle neutron scattering method combined with size exclusion chromatography using antibody interactions as model systems
Authors: Sato Nobuhiro , Yogo Rina , Yanaka Saeko , Martel Anne , Porcar Lionel , Morishima Ken , Inoue Rintaro , Tominaga Taiki , Arimori Takao , Takagi Junichi , Sugiyama Masaaki , Kato Koichi
Published: January 2021

Small-angle neutron scattering (SANS) and small- angle X-ray scattering (SAXS) are powerful techniques for the structural characterization of biomolecular complexes. In particular, SANS enables a selective observation of specific components in complexes by selective deuteration with contrast-matching techniques. In most cases, however, biomolecular interaction systems with heterogeneous oligomers often contain unfavorable aggregates and unbound species, hampering data interpretation. To overcome these problems, SAXS has been recently combined with size exclusion chromatography (SEC), which enables the isolation of the target complex in a multi-component system. By contrast, SEC–SANS is only at a preliminary stage. Hence, we herein perform a feasibility study of this method based on our newly developed inverse contrast-matching (iCM) SANS technique using antibody interactions as model systems. Immunoglobulin G (IgG) or its Fc fragment was mixed with 75% deuterated Fc-binding proteins, i.e. a mutated form of IgG-degrading enzyme of Streptococcus pyogenes and a soluble form of Fcγ receptor IIIb, and subjected to SEC–SANS as well as SEC–SAXS as reference. We successfully observe SANS from the non-deuterated IgG or Fc formed in complex with these binding partners, which were unobservable in terms of SANS in D2O, hence demonstrating the potential utility of the SEC–iCM–SANS approach.
Smooth-Transition Regression Models for Non-Stationary Extremes
Authors: Hambuckers Julien , Kneib Thomas
Published: January 2021

We introduce a smooth-transition generalized Pareto (GP) regression model to study the time-varying dependence structure between extreme losses and a set of economic factors. In this model, the distribution of the loss size is approximated by a GP distribution, and its parameters are related to explanatory variables through regression functions, which themselves depend on a time-varying predictor of structural changes. We use this approach to study the dynamics in the monthly severity distribution of operational losses at a major European bank. Using the VIX as a transition variable, our analysis reveals that when the uncertainty is high, a high number of losses in a recent past are indicative of less extreme losses in the future, consistent with a self-inhibition hypothesis. On the contrary, in times of low uncertainty, only the growth rate of the economy seems to be a relevant predictor of the likelihood of extreme losses.
Traversing: Familial Challenges for Escaped North Koreans
Authors: Lim Hyun-Joo
Published: January 2021

This research contributes to the development of migration theories by examining the challenges and opportunities faced by UK-resident migrants from North Korea in maintaining transnational family ties. Particularly, it reflects critically on the role played by ‘place’ as a regulatory apparatus in shaping the migrants’ experiences of family relationships in a transnational social space. The findings are drawn from thematic analysis of data from life history interviews with 14 North Korean defectors. In the light of the prevalence of back-and-forth stepwise migration for the defectors and their families across multiple nation states, I propose the concept of ‘traversing’ to describe the strenuous transnational familial experiences and complex mobility trajectories of North Korean escapees, which goes beyond a linear journey from the sending to the host place. While existing migration research has capitalized on the host place in selectively enabling and stratifying migrants’ access to transnational family rights, I argue that, instead of assuming forced migrants have free access to their home countries, it is important to consider the interplay between multiple places in understanding the challenges for vulnerable migrants to access essential family rights and maintain transnational family relationships.
Laparoscopic excision of a solitary fibrous tumor originating from the abdominal wall: a case report
Authors: Imaoka Kouki , Nishihara Masahiro , Yamaguchi Megumi , Kawasaki Yukari , Sugino Keizo
Published: January 2021

Solitary fibrous tumors (SFTs) are mesenchymal fibroblastic tumors, and forms of SFTs that originate from the abdominal wall are extremely rare. Here we report a case of a nonpalpable SFT along the abdominal wall. Abdominal magnetic resonance (MR) imaging showed a well-circumscribed mass measuring 5 cm in diameter with heterogeneous signal intensity on T2-weighted MR images; this mass was diagnosed as a benign abdominal tumor of unknown origin. Successful laparoscopic excision of the tumor was performed. Histological examination revealed a benign extrapleural SFT. No tumor recurrence was observed after 20-month follow-up. This is the first case of laparoscopic excision of an SFT originating from the abdominal wall. Our report highlights the safety and usefulness of laparoscopic excision of abdominal wall tumors such as SFTs. This approach is an underutilized surgical treatment that can be applied to select cases of SFT in the abdominal cavity.
Perforating duodenal ulcer with umbilical herniation as a metastatic complication of primary signet ring cell carcinoma of the breast
Authors: Principe Daniel R , Raicu Andreea , Cataneo Jose , Beverley Holly R , Hyser Matthew
Published: January 2021

Primary signet ring cell carcinoma (SRCC) of the breast is extremely rare, and the associated patterns of metastatic dissemination poorly described. Here, we report the case of a 61-year-old woman presenting with acute abdominal pain. Esophagogastroduodenoscopy revealed a non-bleeding erosive gastropathy, which was biopsied and found significant for a poorly differentiated, GATA3-positive SRCC. The patient was lost to follow up until re-presenting 6 months later with a perforating duodenal ulcer and umbilical herniation. Biopsies of umbilical hernia sack contents were significant for an estrogen receptor (ER) positive SRCC, and breast examination identified a right breast mass significant for an ER positive lobular carcinoma with signet ring features, thereby affirming the diagnosis of metastatic SRCC of the breast. This case offers insight into an advanced form of a rare clinical entity, and suggests that staining for breast markers such as GATA3 should be considered for all biopsies significant for SRCC.
Coherently updating degrees of belief: Radical Probabilism, the generalization of Bayes’ Theorem and its consequences on evidence evaluation
Authors: Taroni Franco , Garbolino Paolo , Bozza Silvia
Published: January 2021

The Bayesian perspective is based on conditioning related to reported evidence that is considered to be certain. What is called ‘Radical Probabilism’ replaces such an extreme view by introducing uncertainty on the reported evidence. How can such equivocal evidence be used in further inferences about a main hypothesis? The theoretical ground is introduced with the aim of offering to the readership an explanation for the generalization of the Bayes’ Theorem. This extension—that considers uncertainty related to the reporting of evidence—also has an impact on the assessment of the value of evidence through the Bayes’ factor. A generalization for such a logical measure of the evidence is also presented and justified.
Massive black hole binary systems and the NANOGrav 12.5 yr results
Authors: Middleton H , Sesana A , Chen S , Vecchio A , Del Pozzo W , Rosado P A
Published: January 2021

The North American Nanohertz Observatory for Gravitational Waves (NANOGrav) recently reported evidence for the presence of a common stochastic signal across their array of pulsars. The origin of this signal is still unclear. One possibility is that it is due to a stochastic gravitational-wave background (SGWB) in the ∼1–10 nHz frequency region. Taking the NANOGrav observational result at face value, we show that this signal would be fully consistent with an SGWB produced by an unresolved population of in-spiralling massive black hole binaries (MBHBs) predicted by current theoretical models. Considering an astrophysically agnostic model, the MBHB merger rate is loosely constrained. Including additional constraints from galaxy pairing fraction and MBH–bulge scaling relations, we find that the MBHB merger rate is ${1.2\times 10^{-5}}{\rm -}{4.5\times 10^{-4}}\, \mathrm{Mpc}^{-3}\, \mathrm{Gyr}^{-1}$ , the MBHB merger time-scale is $\le 2.7\, \mathrm{Gyr}$, and the norm of the MBH−Mbulge relation is $\ge 1.2\times 10^{8}\, {\rm M}_\odot$ (all quoted at 90 per  cent credible intervals). Regardless of the astrophysical details of MBHB assembly, the NANOGrav result would imply that a sufficiently large population of massive black holes pair up, form binaries and merge within a Hubble time.
Rare Ameloblastic Carcinoma Metastasis to the Cervical Spine: A Case Report
Authors: Salehani Arsalaan , Mooney James , Lepard Jacob , Hackney James R , Harmon Daniel
Published: January 2021

BACKGROUND AND IMPORTANCE

Ameloblastic carcinoma (AC) is a malignant neoplasm of epithelial origin that typically arises from the mandible or maxilla. It represents approximately 2% of all odontogenic tumors. Gross total resection is the surgical goal given AC’s aggressiveness and propensity for recurrence. We present the first reported AC metastasis to the cervical spine.

CLINICAL PRESENTATION

A 61-yr-old African American female with a history of AC of bilateral mandibles and lung metastases presented with neck pain and right arm weakness progressive over several months. Cervical spine imaging demonstrated a cervical 3 pathological fracture with severe anterior vertebral body compression and resultant cervical 2-3 kyphotic deformity and bony retropulsion causing severe cord compression. The patient underwent a cervical 3 corpectomy and cervical 2-4 anterior fixation followed by a cervical 3 laminectomy and cervical 2-5 dorsal internal fixation and fusion. Postoperatively, the patient's neurological exam remained stable and imaging showed improved spinal alignment and appropriate anterior and posterior instrumentation. Unfortunately, the patient thereafter suffered a decline in performance status and progression of lung metastatic disease. Her oncology team is considering chemotherapy and stereotactic radiosurgery, but her prognosis remains grim.

CONCLUSION

AC is a rare and aggressive pathology with a poor prognosis despite multimodal therapy. We present the first case of AC metastatic spread to the spine. We aim to bring this pathology to the attention of our worldwide neurosurgical colleagues and share our surgical approach and multidisciplinary management to assist those who may encounter this pathology in the future.
SARS-CoV-2 Infection Among Health Care Workers Despite the Use of Surgical Masks and Physical Distancing—the Role of Airborne Transmission
Authors: Goldberg Lotem , Levinsky Yoel , Marcus Nufar , Hoffer Vered , Gafner Michal , Hadas Shai , Kraus Sraya , Mor Meirav , Scheuerman Oded
Published: January 2021

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is transmitted mainly via respiratory droplets. A key question in the coronavirus disease 2019 pandemic is whether SARS-CoV-2 could be transmitted via the airborne route as well. We report for the first time SARS-CoV-2 nosocomial infections despite using surgical masks and physical distancing. This report may provide possible evidence for airborne transmission of SARS-CoV-2.
White Matter Neurometabolic Signatures Support the Deficit and Nondeficit Distinction in Antipsychotic-Naïve First-Episode Psychosis Patients
Authors: Bryant James Edward , Lahti Adrienne Carol , Briend Frederic , Kraguljac Nina Vanessa
Published: January 2021

The deficit syndrome is thought to be a more homogenous clinical subgroup within the syndrome of schizophrenia that is characterized by enduring negative symptoms. It is hypothesized that distinct pathophysiological processes underlie the subtypes, where the deficit syndrome reflects an early onset nonprogressive developmental process, and the nondeficit form of the illness is characterized by attenuated neuroplasticity secondary to elevated glutamate levels. We used single-voxel magnetic resonance spectroscopy (PRESS; TE: 30 ms) to measure left frontal white matter neurometabolite levels in 61 antipsychotic-naïve first-episode psychosis patients (39 who did not display deficit features, 22 who did display deficit features, assessed with the Schedule for the Deficit Syndrome) and 59 healthy controls. Metabolite levels were quantified with the LCModel. We used a MANCOVA to determine neurometabolite differences between healthy controls, deficit syndrome patients, and nondeficit patients. We report a significant group difference when all metabolites were considered jointly (F[10,208] = 2.16; P = .02). Post hoc analyses showed that patients presenting without deficit features had higher glutamate levels than patients with deficit features and controls. Patients presenting without deficit features also had significantly higher myoinositol levels than controls; myoinositol levels were trend-level higher in patients presenting with deficit features compared to controls. Our data support the idea that the pathophysiology of patients presenting without deficit features may differ from those presenting with deficit features.
Diagnosing Rickets in Early Modern England: Statistical Evidence and Social Response
Authors: Newton Gill
Published: January 2021

Seventeenth-century UK experienced an epidemic of the newly recognised disease rickets, its nutritional and environmental causes then unknown. This is evident from parish burial registers, the London Bills of Mortality, and contemporary medical descriptions and treatments. Rickets appeared to be killing 2–8 per cent of urbanites, especially wealthy children.

Rickets emerged as a threat to child health in early modern UK as a result of coal dependency and climate, and social differences in infant and child feeding. Physicians investigating rickets showed concern for rich children’s diets. Lack of breastfeeding promoted calcium deficiency among wealthy infants, while poorer children’s meagre childhood diet retarded recovery.

The seasonality and age incidence of rickets deaths corroborate this diagnosis, but after 1700 rickets deaths dwindled even as medical treatises and osteological evidence suggest rickets morbidity increased. Chronology and share of mortality of other causes relating to rickets morbidity are considered: scurvy, hydrocephalus and whooping cough.
Risk of neurodegenerative disease due to tau phosphorylation changes and arsenic exposure via drinking water
Authors: Pakzad Davoud , Akbari Vajihe , Sepand Mohammad Reza , Aliomrani Mehdi
Published: January 2021

It is estimated that around 140 million people are drinking highly contaminated water with arsenic (As) as a natural earth’s crust component. On the other hand, the prevalence of neurodegenerative disorders, especially Alzheimer’s disease, is constantly increasing. The aim of the present study was to investigate the correlation between oral arsenic trioxide exposure and its impact on tau protein phosphorylation at Ser262. Fifty-four male mice were randomly divided into three groups and were freely accessed to food and contaminated water of 1 and 10 ppm arsenic trioxide for 3 months, except for control subjects. At the end of each month, As concentration and tau phosphorylation were checked with graphite furnace atomic absorption spectrometer and western blot analysis, respectively. Surprisingly, it was observed that the amount of measured brain arsenic in 10 ppm-exposed subjects was significantly increased after 3 months (P-value ˂ 0.0001). The significant changes in tau phosphorylation were not seen in the 1 ppm-exposed subjects, and it was observed that Ser262 phosphorylation significantly increased after 2 and 3 months in the 10 ppm group (P-value < 0.05). Our results demonstrated that arsenic accumulated in the brain time-dependently and increased Ser262 tau phosphorylation, which is very important in several tauopathies. In conclusion, it could be inferred that environmental arsenic exposure even at very low concentrations could be considered as a reason for increasing the risk of developing neurodegenerative disease.
The effects of nutritional support baskets on growth parameters of under five years old children with malnutrition and low socio-economic status
Authors: Derakhshandeh-Rishehri PhD student Seyedeh-Masomeh , Shenavar MSc Razieh , Farmani BS Azam , Hemmati PhD Abdolrasoul , Faghih PhD Shiva
Published: January 2021

Background and objectives

Although malnutrition is globally widespread among children, there is no consensus on the most effective intervention for improving a child's growth. The present study is designed to investigate the effects of nutritional support basketson growth indices of malnourished children.

Methods

This is a field trial conducted on 3667 malnourished children (0–60 months) for 9months, between 2017 and 2018, in Fars province of Iran. Weight-for-age, height-for-age, weight-for-height and body mass index-for age indices were assessed before and after the intervention with nutritional support baskets, which contains 600 kcal/day.

Results

The baseline prevalence of moderate/severeunderweight, stunting and wasting were 31.5%, 33.3% and 28.9%, respectively. After the intervention, the prevalence non-significantly reduced to 25.5%, 31.7% and 20.35%, respectively (p > 0.05). The intervention is associated with a non-significant reduction in the prevalence of underweight and wasting in 0–23 months children, and a non-significant reduction in the prevalence of underweight, stunting and wasting in 24–60 months children. Furthermore, the intervention is associated with a non-significant reduction in the prevalence of underweight, stunting and wasting in girls, and a non-significant reduction in the prevalence of underweight and wasting in boys.

Conclusions

Nutrition support was effective in improving malnutrition indices of children; however, the results were non-significant. Further studies with longer period and control group areneeded to support the effectiveness of nutrition support in children.
Comparative Secretome Analyses of Toxigenic and AtoxigenicRathayibacterSpecies
Authors: Tancos Matthew A. , McMahon Michael B. , Garrett Wesley M. , Luster Douglas G. , Rogers Elizabeth E.
Published: January 2021

Phytopathogenic Rathayibacter species are unique bacterial plant pathogens because they are obligately vectored by plant parasitic anguinid nematodes to the developing seedheads of forage grasses and cereals. This understudied group of plant-associated Actinomycetes includes the neurotoxigenic plant pathogen R. toxicus, which causes annual ryegrass toxicity in grazing livestock. R. toxicus is currently endemic to Australia and is listed as a plant pathogen select agent by the U.S. Department of Agriculture-Animal and Plant Health Inspection Service. The complex Rathayibacter disease cycle requires intimate interactions with the nematode vector and plant hosts, which warrants an increased understanding of the secretory and surface-associated proteins that mediate these diverse eukaryotic interactions. Here we present the first comparative secretome analysis for this complex, nematode-vectored Rathayibacter genus that compares the three agronomically damaging toxigenic and atoxigenic Rathayibacter species, R. toxicus, R. iranicus, and R. tritici. The exoproteomic comparison identified 1,423 unique proteins between the three species via liquid chromatography-tandem mass spectrometry, leading to the identification of putative pathogenicity-related proteins and proteins that may mediate nematode attachment. Of the uniquely identified proteins, 94 homologous proteins were conserved between the three Rathayibacter exoproteomes and comprised between 43.4 and 58.6% of total protein abundance. Comparative analyses revealed both conserved and uniquely expressed extracellular proteins, which, interestingly, had more similarities to extracellular proteins commonly associated with bacterial animal pathogens than classic plant pathogens. This comparative exoproteome analysis will facilitate the characterization of proteins essential for vector attachment and host colonization and assist in the development of serological diagnostic assays.
New Drugs 2021, Part 1
Authors: Hussar Daniel A.
Published: January 2021

This article reviews seven drugs recently approved by the FDA, including indications, precautions, adverse reactions, and nursing considerations.
Coping with moral distress during COVID-19
Authors: Godshall Maryann
Published: January 2021

Nurses and other healthcare professionals across the US have experienced and are still experiencing different types of moral anguish during the COVID-19 pandemic. This article discusses moral distress and the other forms of moral anguish that nurses experience, how the COVID-19 pandemic has exacerbated moral distress among nurses, and coping strategies.
Determining the level of evidence
Authors: Glasofer Amy , Townsend Ann B.
Published: January 2021

To support evidence-based nursing practice, the authors provide guidelines for appraising research based on quality, quantity, and consistency. This article, the second of a three-part series, focuses on nonexperimental research designs.
Xanthomatous Dermal Changes in a Patient With Locally Advanced Basal Cell Carcinoma Treated Using Vismodegib
Authors: Smith Shane D. B. , Clarke Callisia N. , Clark Melanie A. , Harker-Murray Amy K. , Sokumbi Olayemi
Published: January 2021

Basal cell carcinoma (BCC) is the most commonly diagnosed cutaneous cancer in the United States with more than 2.5 million treated annually. Genetic studies have revealed that approximately 90% of BCCs have a mutation in the hedgehog-signaling pathway. Patients with BCC usually have an excellent prognosis with surgical modalities, however, patients with locally advanced BCC may potentially experience significant cosmetic or functional impairment, with only surgical intervention. Vismodegib is a hedgehog pathway inhibitor that has been successful in treating patients with locally advanced BCC. We report a patient with BCC with a good response to vismodegib and a novel xanthomatous change in the excision specimen.
Cutaneous Metastasis From Parotid Tumors: A Report of 2 Cases and Literature Review
Authors: del Puerto Constanza , Jaque Alejandra , Gonzalez-Bombardiere Sergio , Molgó Montserrat
Published: January 2021

Cutaneous metastases from parotid tumors are uncommon and imply a poor prognosis. In this article, we report 2 new cutaneous metastasis cases from 2 different parotid malignancies and 42 additional cases from a literature review. Clinical manifestations, localization, and outcomes of skin metastasis from parotid tumors are described. Although infrequent, parotid neoplasms may develop skin metastasis many years after the initial diagnosis, mostly in the head and neck region. Therefore, long-term follow-up and periodic skin examination of these patients is mandatory. Dermatologists and surgeons must have a high index of suspicion when evaluating any skin lesion arising on these patients because cutaneous metastasis from parotid neoplasms generally implies a poor prognosis.
Atypical Cellular Blue Nevus With Necrosis Mimicking Melanoma Ex-Blue Nevus
Authors: Henning Ania , Billings Steven , Ko Jennifer , Weaver Joshua
Published: January 2021

Histologic distinction between melanoma ex-blue nevus and cellular blue nevus (CBN) can often be difficult, but features supporting melanoma include infiltrative growth pattern, frequent mitoses, cytologic atypia and pleomorphism, cell crowding, and tumor necrosis. Unfortunately, these features are not constantly dependable and frequently borderline lesions exist, so-called atypical CBN, which lack explicit malignant features. Furthermore, some CBN and atypical CBN show an assortment of features, which may lead to their misdiagnosis as melanoma, but to date necrosis is generally absent. We present an unusual case of an atypical cellular blue nevus with extensive necrosis mimicking melanoma ex-blue nevus.
Autism and General Developmental Screening Practices Among Primary Care Providers
Authors: Mazurek Micah O. , Kuhlthau Karen , Parker Robert A. , Chan James , Sohl Kristin
Published: January 2021

Objective:

Using standardized screening tools increases accuracy in early identification of autism. The American Academy of Pediatrics recommends systematic developmental screening at all 9-, 18-, and 24- or 30-month well-child visits (WCVs) and autism-specific screening at all 18- and 24-month WCVs. The study objectives were to examine the extent to which these guidelines have been adopted in practice among primary care providers (PCPs) and to identify potential provider-level factors associated with screening practices.

Method:

Participants included 94 PCPs (79% pediatricians) from 13 states enrolled in a study of an autism training program. Self-report and chart-review data collected before training were examined. Screening practices were assessed through chart review of all 9-, 18-, and 24-month WCVs within a 30-day window.

Results:

Sixty-four percent of PCPs administered developmental screening tools at all 9-month WCVs, and 62% at all 18-month WCVs. Fifty-one percent administered autism screening tools at all 18-month WCVs, and 41% at all 24-month WCVs. Screening practices varied by provider type (pediatrician vs other PCP), self-efficacy in screening and identification, and previous autism training (autism screening only), but not by years of experience.

Conclusion:

Overall, general developmental and autism-specific screenings are not being consistently administered across recommended WCVs in primary care practices. Provider self-efficacy in autism identification and screening and previous autism training were associated with increased autism screening. As such, these results suggest a need for increased training and dissemination of information on screening implementation for practicing PCPs.
Bereavement Needs of Critical Care Nurses
Authors: Omran Taline , (Browning) Callis Annette M.
Published: January 2021

Background/Introduction

Bereavement and grief in critical care nurses remain an understudied phenomenon. As a way of self-protection, nurses may compartmentalize their own feelings and need assistance and support in processing feelings of bereavement. Nurses spend much of their time caring for patients and their family members, while guiding them through the dying process; however, they may not take adequate time to address their own bereavement needs.

Objective/Aims

The aims of this study were to explore the bereavement needs of critical care nurses after experiencing the expected or unexpected death of a patient and, from their lived experiences, gain insight as to how nurses perceive, process, and cope with the death of a patient.

Methodology

A qualitative, phenomenological focus group was conducted with critical care nurses (N = 10) after gaining institutional review board approval. The group discussion was audio-recorded and transcribed. Content analysis was performed to identify common themes.

Results

Seven themes emerged: (a) emotional distress, leading to compassion fatigue, burnout, and moral distress, (b) empathy, (c) resurfacing personal loss leading to secondary traumatic stress in the workplace, (d) unrealistic expectations placed on the nurse, (e) detachment leading to compartmentalization, (f) lack of formal education, and (g) self-care and available resources.

Discussion/Conclusion

More education for nurses in undergraduate and continuing education programs is needed to assist nurses in the bereavement process. More interventional studies are needed to explore programs of nurses' self-care both in the workplace and in nurses' personal lives to more effectively support their emotional needs.
Environmental Factors Affecting Early Mobilization and Physical Disability Post–Intensive Care
Authors: Potter Kelly , Miller Sarah , Newman Susan
Published: January 2021

Background

Early mobilization (EM) is one of few potential protective factors associated with reduced physical disability post–intensive care (PD PIC). However, only 45% of intensive care units (ICUs) in the United States routinely practice EM despite its recognized benefits.

Objectives

To analyze the evidence on the relationship between critical care EM, PD PIC, and environmental factors, using the theoretical lens of the World Health Organization's (WHO's) International Classification of Functioning, Disability, and Health (ICF).

Method

The Whittemore and Knafl methodology for integrative reviews and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines were followed. Qualitative, quantitative, and mixed-methods studies (n = 38) that evaluated EM and 1 or more domains of the WHO ICF were included. Quality was appraised using the Mixed-Methods Appraisal Tool. Study characteristics were evaluated for common themes and relationships. The ICF domains and subdomains pertaining to each study were synthesized.

Results

Early mobilization was related to improved functioning on the disability continuum of the WHO ICF. Early mobilization was influenced by several WHO ICF environmental factors. Dedicated physical and occupational therapy teams in the ICU, interdisciplinary rounds, and positive family and staff perception of EM facilitated intervention delivery. However, poor staffing levels, negative unit culture, perceived workload burden, and lack of equipment, education, and financial support impeded delivery of EM.

Discussion

Early mobilization is a promising intervention that may reduce PD PIC. However, environmental factors negatively influence delivery of EM in the ICU. Several gaps in EM research limit its acceptability in ICU practice. Existing EM research is challenged by poor methodological quality. Further study is necessary to better understand the role of EM on PD PIC and improve patient outcomes following critical illness.
Use of a Multidisciplinary Mechanical Ventilation Weaning Protocol to Improve Patient Outcomes and Empower Staff in a Medical Intensive Care Unit
Authors: Gunther Ingrid , Pradhan Deepak , Lubinsky Anthony , Urquhart Annie , Thompson Julie A. , Reynolds Staci
Published: January 2021

Background

Prolonged duration of mechanical ventilation is associated with higher mortality and increased patient complications; conventional physician-directed weaning methods are highly variable and permit significant time that weaning is inefficient and ineffective.

Objectives

The primary objective of this quality improvement project was to implement a registered nurse (RN)– and respiratory therapist (RT)-driven mechanical ventilation weaning protocol in a medical intensive care unit (ICU) at a tertiary care academic medical center.

Methods

This quality improvement project used a quasi-experimental design with a retrospective usual care group who underwent physician-directed (conventional) weaning (n = 51) and a prospective intervention group who underwent protocol-directed weaning (n = 54). Outcomes included duration of mechanical ventilation, ICU length of stay, reintubation rates, and RN and RT satisfaction with the weaning protocol.

Results

Patients in the RN- and RT-driven mechanical ventilation weaning protocol group had significantly lower duration of mechanical ventilation (74 vs 152 hours; P = .002) and ICU length of stay (6.7 vs 10.2 days; P = .031). There was no significant difference in reintubation rates between groups. Staff surveys indicate that both RN and RTs were satisfied with the process change.

Discussion

Implementation of a multidisciplinary mechanical ventilation weaning protocol is a safe and effective way to improve patient outcomes and empower ICU staff.
Characteristics of Pulmonary Rehabilitation Programs Following an Exacerbation of Chronic Obstructive Pulmonary Disease
Authors: Wageck Bruna , Cox Narelle S. , Lee Joanna Y. T , Romero Lorena , Holland Anne E.
Published: January 2021

Purpose:

Early pulmonary rehabilitation (PR) has beneficial impacts on people with chronic obstructive pulmonary disease (COPD) when delivered after an exacerbation; however, program characteristics are diverse. This systematic review aimed to determine the impact of PR program characteristics (mode, length, commencement, frequency, location, and supervision) on clinical outcomes following an exacerbation of COPD.

Methods:

Studies were screened from Medline, Medline in progress, Embase, CINAHL, SCOPUS, CENTRAL, and PEDro. Included studies were randomized controlled trials of early PR after an exacerbation of COPD (commenced during hospital stay or ≤4 wk of hospital discharge). The primary outcomes were hospital readmissions and mortality.

Results:

Thirty studies were included. Exercise training alone was delivered in 43% of studies. Program duration varied from length of inpatient stay to 12 wk. The interventions commenced as early as ≤24 hr of hospitalization for acute exacerbation, and up to 2 wk after discharge. Early PR was compared to usual care, and no studies made a direct comparison of the program characteristics of interest. Program characteristics associated with reduced risk of hospital admission were commencement after hospital discharge, duration longer than 3 wk, and programs that included exercise training and education (relative risk of readmission range 0.6-0.79); however, it was not possible to determine which of these characteristics made the most important contribution. Mortality risk did not vary according to PR program characteristics.

Conclusion:

Programs >3 wk, started after hospital discharge or including an educational component in addition to exercise, were most effective at reducing hospital readmissions.
Predictors of Cardiac Rehabilitation Participation
Authors: Khadanga Sherrie , Savage Patrick D. , Gaalema Diann E. , Ades Philip A.
Published: January 2021

Purpose:

Participation in cardiac rehabilitation (CR) is low despite proven benefits. The aim of this study was to assess medical, psychosocial, and behavioral predictors of participation in a phase 2 CR.

Methods:

This was a prospective observational study. Participants hospitalized for an acute cardiac event and eligible for CR completed in-hospital assessments, and the primary outcome was CR participation over a 4-mo follow-up. Measures included age, sex, educational attainment, smoking status, medical diagnosis, ejection fraction, and electronic referral to CR. Data included General Anxiety Disorder, Patient Health Questionnaire, Medical Outcomes Study Short Form-36, Behavioral Rating Inventory of Executive Function, and Duke Social Support Index. Logistic regression and Classification and Regression Tree analysis were performed.

Results:

Of 378 hospitalized patients approached, 294 (31% females) enrolled in the study and 175 participated in CR. The presence of electronic referral, surgical diagnosis, non/former smoker, and strength of physician recommendation (all Ps < .02) were independent predictors for CR participation. No differences were seen in participation by measures of anxiety, depression, or executive function. Males with a profile of electronic referral to CR, high school or higher education, ejection fraction >50%, and strong physician recommendation were the most likely cohort to participate in CR (89%). Patients not referred to CR were the least likely to attend (20%).

Conclusions:

Lack of CR referral, lower educational attainment, nonsurgical diagnosis, current smoking, and reduced ejection fraction can predict patients at a highest risk of CR nonparticipation. Specific interventions such as electronic referral and a strong in-person recommendation from a medical provider may enhance CR participation rates.
Prehabilitation Coming of Age
Authors: Myers Jonathan , Niebauer Josef , Humphrey Reed
Published: January 2021

While cardiac and pulmonary rehabilitation programs traditionally involve exercise therapy and risk management following an event (eg, myocardial infarction and stroke), or an intervention (eg, coronary artery bypass surgery and percutaneous coronary intervention), prehabilitation involves enhancing functional capacity and optimizing risk profile prior to a scheduled intervention. The concept of prehabilitation is based on the principle that patients with higher functional capabilities will better tolerate an intervention, and will have better pre- and post-surgical outcomes. In addition to improving fitness, prehabilitation has been extended to include multifactorial risk intervention prior to surgery, including psychosocial counseling, smoking cessation, diabetes control, nutrition counseling, and alcohol abstinence. A growing number of studies have shown that patients enrolled in prehabilitation programs have reduced post-operative complications and demonstrate better functional, psychosocial, and surgery-related outcomes. These studies have included interventions such as hepatic transplantation, lung cancer resection, and abdominal aortic aneurysm (repair, upper gastrointestinal surgery, bariatric surgery, and coronary artery bypass grafting). Studies have also suggested that incorporation of prehabilitation before an intervention in addition to traditional rehabilitation following an intervention further enhances physical function, lowers risk for adverse events, and better prepares a patient to resume normal activities, including return to work. In this overview, we discuss prehabilitation coming of age, including key elements related to optimizing pre-surgical fitness, factors to consider in developing a prehabilitation program, and exercise training strategies to improve pre-surgical fitness.
Genetically Modified Organisms Can Be Organic
Authors: Tijerino Maria Belen Salazar , Darbishire Lily C. , Chung Monique Mi Song , Esler Grace C. E. , Liu Alexander Chang , Savaiano Dennis Alan
Published: January 2021

Genetically modified organisms (GMOs) or genetically modified technology is currently considered an “excluded method” not allowed to be used in, or added to, organic agricultural products under the US Code of Federal Regulations. Despite evidence that GMOs may serve as a safe alternative to conventional crops, they are frequently associated with harmful and unsustainable agricultural practices. We discuss the economic, environmental, nutritional, and food safety concerns of GMOs in organic agriculture, and how GMO technology could benefit it. We propose (1) allowing the use of genetic modification in organic agriculture and (2) an enhanced effort to disseminate science-based information to consumers.
Addressing Fall Risk From the Emergency Department
Authors: Hill April , Evans Dian Dowling
Published: January 2021

The Research to Practice column focuses on improving the research critique skills of emergency nurses and advanced practice providers to assist with the translation of research into practice. In this issue, we discuss the findings of a secondary data analysis conducted by K. Davenport, M. Alazemi, J. Sri-On, and S. Liu (2020) that examined emergency department provider identification of modifiable risk factors when assessing older adults who present after a fall. The results found that providers frequently miss identifying and intervening in modifiable risk factors that contribute to adverse outcomes and readmissions following discharge. The results suggest future research needs and have implications for emergency nurse practitioner educational preparation.
Takotsubo Cardiomyopathy
Authors: Davis Kristina A.
Published: January 2021

Takotsubo cardiomyopathy (TC), a rare syndrome often preceded by an emotional or physical trigger, which earned the nickname broken heart syndrome, was first diagnosed in 1990. Takotsubo cardiomyopathy can mimic an ST-elevation myocardial infarction (STEMI). Originally, TC was thought to be self-limiting and benign. However, there is a 4%–5% mortality rate, which is associated with serious complications. The majority of people diagnosed with TC are postmenopausal women, but it can affect all ages. Patients will often present to the emergency department with chest pain and dyspnea. An electrocardiogram (ECG) often demonstrates ST elevation. There is no definitive way to differentiate between TC and STEMI on an ECG. Therefore, all patients need to have emergent coronary angiography with left ventriculography.
Improving Outpatient Follow-Up Through Innovative Appointment Scheduling at Emergency Department Discharge
Authors: Tessitore Ashley , Brennan-Cook Jill
Published: January 2021

This quality improvement (QI) project evaluates a comprehensive, patient-centered plan to reduce the emergency department (ED) revisit rate by improving outpatient follow-up after initial ED visits. Patients with low-acuity complaints discharged from the ED are often instructed to schedule a follow-up appointment with their primary care team or a specialty service after leaving the ED. In this QI project, patients either had a follow-up visit scheduled at the time of ED discharge or received a phone call within 2 days of discharge to schedule outpatient follow-up visit. The number of ED visits per patient was significantly reduced following implementation of scheduling at the time of ED discharge.
Do avian species survive better on islands?
Authors: Beauchamp Guy
Published: January 2021

Island species are often predictably different from their mainland counterparts. Milder climates and reduced predation risk on islands have been involved to explain shifts in body size and a suite of life-history traits such as clutch size and offspring growth rate. Despite the key role of adult survival on risk taking and reproduction, the prediction that living on islands increases adult survival has yet to be tested systematically. I gathered data on adult annual apparent survival from the island and mainland year-round resident species of birds from around the world. With this large dataset (697 species), I found that species of birds living on islands showed higher apparent survival than their mainland counterparts in the two Hemispheres and at all latitudes, controlling for several known predictors of adult survival, including body size, clutch size and breeding system. These results shed light on the ecological factors that influence survival on islands and extend the life-history island syndrome to adult survival.