bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Morphine Analgesia in Ventilated Preterm Neonates
Authors: Mitra Souvik
Published: August 2024

Morphine infusion for pain control in ventilated preterm neonates is postulated to reduce neurological injury. A large, multicenter, blinded randomized controlled trial (RCT), NEOPAIN investigated whether preemptive (prophylactic) morphine analgesia, as compared with placebo, reduced early neurological injury in 898 ventilated preterm neonates. There was no difference in the primary composite outcome of neonatal death, severe intraventricular hemorrhage (IVH), or periventricular leukomalacia (PVL) between placebo and morphine groups (26% versus 27%). Post-hoc secondary analysis evaluated differences between enrolled infants who received open-label morphine and those who did not. This revealed worse outcomes among infants receiving open-label morphine.
A Randomized Trial of Prenatal Versus Postnatal Repair of Myelomeningocele
Authors: DeMauro Sara B.
Published: August 2024

The Management of Myelomeningocele Study (MOMS) trial compared prenatal versus postnatal repair of myelomeningocele, presenting evidence that expanded the range of fetal surgery beyond uniformly life-threatening conditions. The trial was stopped, after randomization of 183 women of a planned 200, for predefined efficacy measures at both 12-month and 30-month time points. Prenatal repair decreased the risk of death or need for cerebrospinal fluid shunt at 12 months (relative risk 0.70, 97.7% confidence interval 0.58 to 0.84, p <0.001) and improved motor function at 30 months. On balance, women treated with prenatal surgery had higher rates of pregnancy complications. Thirteen percent of women in the prenatal surgery group and no women in the postnatal surgery group delivered before 30 weeks of gestation.
Levetiracetam Versus Phenobarbital for Neonatal Seizures
Authors: Johansson Stefan
Published: August 2024

Efficacy and safety are not established for commonly used drugs for neonatal seizure control. The NEOLEV2 trial randomized infants 36 to 44 weeks’ gestation with seizures of any etiology, to treatment with phenobarbital or levetiracetam. For inclusion in the intention-to-treat analyses, neurophysiologists were to confirm seizures before treatment and validate seizure control after treatment. The primary outcome, freedom from seizures for 24 hours, was reached in 24 of 30 infants (80%) in the phenobarbital group versus 15 of 53 infants (28%) in the levetiracetam group (relative risk 0.35, 95% confidence interval 0.22 to 0.56, p <0.001). Side-effects such as hypotension and sedation were more common in the phenobarbital group, although risk estimates were not statistically significant in this small trial.
Substance Abuse in Healthcare Professionals
Authors: Sprintz Michael , McClain Vincent
Published: August 2024

The chapter provides an in-depth exploration of the complex and oft-neglected issue of substance use disorders (SUDs) within the healthcare workforce and demystifies common misconceptions surrounding SUDs, highlighting their neurobiological underpinnings and describing typical behaviors of healthcare professionals (HCPs) grappling with SUDs. Professional intervention can be life- and career-saving. Given the risks involved, it’s important to follow appropriate procedures when reporting and/or confirming suspicions of a colleague’s SUD. Using effective engagement strategies for confronting an individual suspected of having an active SUD are explored, including the potential risks and ethical considerations involved. Professionals Health Programs (PHPs) are vital resources for supportive monitoring of impaired HCPs and ongoing advocacy, while the controversial issue of returning to work post-treatment is also discussed, examining the necessary safety requirements, potential benefits of self-referring to a PHP, as well as the widespread and long-term success of PHPs helping HCPs return to work successfully. Offering a comprehensive and compassionate approach to a complex issue, this chapter serves as a valuable guide for healthcare professionals navigating the challenging landscape of SUDs within their ranks.
Addressing Patient Nonadherence
Authors: Adedeji Omowunmi , Ludi Daniel , Catalanotti Jillian S.
Published: August 2024

Poor adherence to medical treatment is common among patients in healthcare. This is a substantial barrier to effective care for patients and can lead to many adverse consequences, such as poor health outcomes, frivolous use of healthcare resources, and frustration among clinicians. Many factors lead to nonadherence among patients, such as financial constraints, fear of harm, mistrust of the healthcare system, and lack of health literacy. Clinicians need to understand and identify the underlying causes of nonadherence. By addressing these obstacles, both the clinician and patient can make changes to the treatment plan. This chapter examines reasons for nonadherence and strategies for caring for these patients. Motivational interviewing is a commonly used method to promote behavior change. The SIMPLE mnemonic (Simplify medication regimen, Impart knowledge, Modify patient beliefs, Patient and family communication, Leave the bias, Evaluate adherence) categorizes interventions for nonadherence and utilizes motivational interviewing principles. The “teach-back” method can be used to confirm understanding of their health information. Applying these communication techniques as well as others discussed in this chapter, the clinician will be better prepared to overcome adherence in more manageable ways.
Professional Pitfalls of the Electronic Health Record
Authors: Thomas James , Delgado Julia A. Gálvez
Published: August 2024

The American Recovery and Reinvestment Act and the Health Information Technology for Economic and Clinical Health (HITECH) Act defined the goals and established a roadmap for adoption and utilization of electronic health records (EHRs). Institutions and providers received financial incentives to adopt EHRs to offset the cost of implementation. The Institute of Medicine has outlined a list of core functionalities for EHRs. One of the central goals of EHRs was to increase patient access but widespread adoption of personal health record portals remains an elusive goal. In pediatric settings, breaches of confidentiality may occur when parents access their children’s health records. The use of EHRs does not eliminate the chance of medical errors, such as placing orders in the wrong record. Clinical decision support is an EHR feature that can lead to sustained practice change through recommendation of best practices. Implementation of clinical pathways may result in decreases in length of stay and improved outcomes. External and internal events may lead to system failure, and all institutions are required to have a back-up plan for system outages and downtime procedures. It is crucial that the documentation workflows are intuitive and designed to minimize redundancy to prevent physician frustration and burnout.
Social Media Sinkholes
Authors: Makar Katelyn G. , Vercler Christian J.
Published: August 2024

The birth of social media changed human interactions forever. Given its inherent ability to provide instantaneous connection, it has been applied extensively in the medical field to facilitate education, research collaboration, networking, career development, and even marketing and branding. While social media can be a powerful tool for physicians, it can also be a dangerous one. Physicians must understand the potential pitfalls of using social media, including breaches of patient confidentiality. The profession must be committed to higher standards than simply adhering to the Health Insurance Portability and Accountability Act (HIPAA). Physicians must carefully consider the appropriateness of content posted and the context in which it may be interpreted. Physicians must also maintain awareness of the physician–patient power differential and its impact on patients’ willingness to participate in social media engagement. Finally, it is critical for physicians to comprehend the unique risks of social media and fully disclose these risks to patients.
Conflicts of Interest and the Influence of Healthcare Companies
Authors: Keepers George A. , Stanley Sean
Published: August 2024

Conflicts of interest created by healthcare personnel involvement with the pharmaceutical and device manufacturing industry can adversely affect patient care by biasing research, distorting medical education, influencing prescribing practices, and shaping clinical guidelines. Companies have evolved multiple effective methods for creating influence in each of these areas. Despite research clearly demonstrating the impact of these practices, recommendations of the Institute of Medicine, and federal regulation, healthcare personnel continue to participate in industry-sponsored activities that will affect their decisions about patient care. Identifying events and practices that produce these conflicts of interest and learning to avoid and manage them is a critical skill for physicians, advance practice nurses, physician assistants, and others who determine the treatment that patients receive.
Improving Efficiency and Patient Safety While Reducing Cost Through a Quality Improvement Event
Authors: Liberman Justin S. , Weigel Wade A.
Published: August 2024

This chapter provides a real-life example of a quality improvement event from its inception to completion. It reviews how to identify a quality gap, assemble an interprofessional team, create a SMART aim statement, perform process analysis, perform cause analysis, select metrics, and navigate organizational change. The chapter provides examples of quality improvement methodologies such as Lean, Six Sigma, the Institute for Healthcare Improvement (IHI) Model for Improvement, and the Plan-do-Study-Act (PDSA) cycle. The chapter describes Lean Management System concepts such as Type 1 and Type 2 waste, value-added and non–value-added processes, mistake-proofing, and Taiichi Ohno’s seven wastes. It reviews examples of cause analysis, including Pareto charts, Five Why’s, and the fishbone diagram. It discusses three types of metrics used to understand the success of quality improvement projects: process metrics, outcome metrics, and balancing metrics. Finally, this chapter discusses how to transform a quality improvement project into organizational change and provides insight on how to sustain these changes in your organization.
Leadership Styles for Influencing Change in Healthcare Systems
Authors: Steckler Nicole A. , Angele Theard M.
Published: August 2024

Leadership in a health professions context refers to how individuals influence what happens next, using a combination of different approaches or styles depending on their own strengths and on the needs of the situation. This chapter offers the case of a new leader seeking to influence change in a clinical unit’s existing culture and climate to explore the following questions:

How is leadership defined in a health professions context? What leadership style would be most effective for an individual taking on a new responsibility in a new institution? What leadership styles promote learning and professional development? What leadership behaviors contribute to increasing/decreasing psychological safety among diverse members of a healthcare team?

How might a physician leader’s perceptions of a preferred leadership style differ if this leader experiences one or more social identities (e.g., race, gender, ethnicity, sexual orientation, nationality) historically marginalized in healthcare settings?
Leadership Competencies
Authors: Otsuki J. Alan , Hedges Jerris R.
Published: August 2024

Although many leadership competencies are required to manage a disaster, it is important that the Chief Medical Officer develop and use skills related to anticipatory planning. Effective anticipatory planning requires an appreciation of the interconnections between people, organizations, and infrastructure within and external to a healthcare delivery system. Effective leadership in a time of crisis requires communication of the situation, responsibilities, and initial response steps to team members. Disasters often impact the homes of those working in the medical center as well. Thus, the leader may need to consider personal and staff members’ family and property concerns as well. A leader’s greatest asset will be the ability to influence and inspire others while displaying high emotional intelligence, self-awareness, and prompt and effective communication. The ability to manage complexity and uncertainty as well as assess which hospital service areas are expected to be in immediate demand for high-acuity patients or triage is crucial. Good conflict management and media relations are also essential for the success of the leadership response to a disaster.
Approaching Conflicts Between Clinical Teams and Families
Authors: Olszewski Aleksandra , Patneaude Arika , Kett Jennifer
Published: August 2024

In medicine, it is common for patients and families to be labeled “difficult.” Those who receive this label have been shown to have worse outcomes, and this challenging clinical relationship is associated with distress for clinical teams. Factors associated with the labeling of patients and families as “difficult” include those related to patients and their families, those related to clinicians, and those related to the environment in which they are interacting. By understanding each of the factors that influence this problem, clinicians can better address conflicts by recognizing their own internal biases, seeking to understand family perspectives (including any unmet needs), and adjusting clinician and family expectations.
Prescribing for Friends and Family
Authors: Escalante Enrique , Smith Karen
Published: August 2024

It is extremely common for physicians to receive requests to provide informal advice or undocumented care to family members, friends, neighbors, and colleagues who are not their patients. While attitudes toward this practice have shifted over time, and it is much less common than before, the guidelines pertaining to prescribing to friends and family are not clear. This chapter provides the most important guiding documents in current practice, the questions that providers should use to assess whether prescribing is necessary and appropriate depending on the scenario, how providers might avoid an ethically dubious situation, and the practice requirements for communication and documentation if choosing to prescribe for family and friends.
End-of-Life Decision-Making
Authors: Lewis-Newby Mithya , Berkman Emily , Clark Jonna D.
Published: August 2024

A clinician sometimes is faced with requests from patients or families for treatments that the clinician perceives as potentially inappropriate in the setting of a poor prognosis. Members of the healthcare team may be concerned that the requested treatment will not benefit the patient and may be excessively burdensome or be a poor use of scarce medical resources. The term “medical futility” was often used in the past to describe these scenarios. A landmark 2015 policy statement provides the most current guidance for addressing these cases. When withdrawal of life-sustaining therapies is agreed upon by patients/surrogates and the medical team as the best course of action, several ethical principles are relevant. Withholding and withdrawing life-sustaining therapies, including artificial nutrition and hydration, are ethically and legally permissible actions. Providing medical relief of symptoms of suffering can be challenging, particularly in the critical care setting where patients are often tolerant to typical medications used at the end of life. The doctrine of double effect guides clinicians to administer medications to relieve suffering in an appropriate way. Euthanasia remains illegal in all states in the United States. Neuromuscular blockade agents should not be used at the end of life. Finally, deep respect and compassion for the patient’s and family’s unique progression and needs through the dying process are paramount to high-quality end-of-life care.
Organ Donation After Circulatory Determination of Death
Authors: Siegman Ingrid J. , Turner Helen N.
Published: August 2024

Organ donation after circulatory determination of death (DCDD) is an approach increasingly utilized to address the gap between the availability of and demand for lifesaving transplantable organs. Healthcare systems are required to have protocols in place to address ethical concerns that arise from identifying a patient who may be a potential organ donor through the organ recovery process. Ethical issues surrounding end-of-life decisions, including recognizing patient autonomy and self-determination to donate and managing potential conflicts of interest are essential aspects to consider. Addressing ethical considerations in the practice of DCDD is crucial to respect and honor the patient-donor, family, and members of the healthcare team as they navigate the process of organ donation.
How to Design and Moderate an Effective Problem-Based Learning Discussion
Authors: Lalwani Kirk
Published: August 2024

Problem-based learning (PBL) is a learner-driven instructional method based on active learning in small groups, with clinical or professional problems used as the trigger for learning. PBL has become an integral part of curricula in various undergraduate and professional disciplines, including medicine. While more resource-intensive than a traditional lecture, several educational and psychological theories support PBL. The benefits of PBL compared to traditional lectures include better retention, enhanced ability to utilize and apply new knowledge to solve real-world problems, and greater learner engagement that may lead to enhanced communication and team-based performance. Many professional society meetings invite PBL submissions for attendees. This chapter provides an overview of the components of PBL and practical tips on designing and moderating an effective PBL program at a professional society meeting or a longitudinal curriculum.
Curriculum Development
Authors: Edgar Laura , Guralnick Susan
Published: August 2024

Curriculum development for medical education is a complex process that can be achieved in a variety of ways. Two commonly used methods are the Six-Step Approach and Competency-Based Approach. Both provide a step-by-step roadmap for curriculum developers to follow. The Six-Step Approach is descriptive and allows for dynamic steps that can be performed in the order identified, any order, or multiple steps at a time. The competency-based approach is more prescriptive; it always starts with the identification of a competency after which all other steps must follow. Although these methods differ, several of the steps overlap. The two approaches can be used alone or in combination to achieve a curriculum development goal.
Virtual Teaching and Learning
Authors: De Gagne Jennie C. , Green Katrina
Published: August 2024

Virtual teaching and learning has been a viable option for education and professional development for many decades; however, this pedagogy differs from traditional classroom teaching. During the COVID-19 pandemic, much has been learned about virtual learning, and educators have gained insight into the skill sets, training, strategies, and tools that contribute to its successful implementation. As educators transition from traditional to virtual learning, sometimes doing so quickly in response to circumstances, a critical evaluation of their efforts is essential to identify areas that can be improved to increase learner success. This chapter helps educators incorporate new strategies into their virtual teaching and learning, apply best practices, explore new resources, and provide successful virtual teaching in health professions education.
Healthcare Simulation
Authors: Rubin Jamie E. , Seropian Michael
Published: August 2024

Simulation recreates aspects of real events for the purpose of analysis, learning, and training. It offers the opportunity to learn technical, cognitive, and behavioral skills and rehearse performance without risking harm to a real patient. Many considerations underpin successful implementation of simulation and a simulation program. Healthcare simulation is not just a manikin. Simulation consists of a spectrum of activities, ranging in intent and fidelity. This chapter provides an overview of the benefits and limitations of simulation as a teaching technique. Establishing psychological safety for participants is key and can be accomplished via a pre-brief conversation. Post-scenario feedback is critical to effective learning, usually as part of a structured debrief held at the conclusion of the scenario. Evaluation of both learners and the simulation program is critical for continued success.
Quality Improvement Science
Authors: Reynolds Staci
Published: August 2024

Providing high-quality patient care is the cornerstone of modern healthcare and is a major priority and area of focus among healthcare settings. This requires healthcare settings to continuously monitor quality metrics and improve care. Quality improvement science is an applied science that includes a formal approach to the analysis of practice performance and efforts to improve quality. Several models and frameworks are available to guide multidisciplinary teams through the quality improvement process. This chapter provides a case study example of the quality improvement process undertaken by a multidisciplinary team to improve quality of patient care at a large academic health system. This chapter provides an overview of the process, including how to prioritize quality improvement efforts, implement tests of change, measure and monitor progress over time, and sustain improvements made.
Medical Malpractice
Authors: Soelberg Cobin D. , Street Jeffrey R.
Published: August 2024

An expert witness is a critical component of the majority of medical malpractice cases. A witness is required to determine the prevailing community medical standard of care at issue in the case. Without an expert, one of the four pillars necessary to establish malpractice fails. The courts have established standards for expert testimony including scientific testing, verifiability, and acceptance by medical specialty societies. Medical specialty societies have professional oversight of member’s sworn testimony. While members can be sanctioned through medical boards or specialty societies for especially egregious testimony, the legal system strongly protects the expert witness. An expert works with either the plaintiff’s or defendant’s attorneys, reviewing the medical record and the facts of the case and providing an expert opinion on the medical care provided. An expert must be impartial, truthful and willing to have her testimony reviewed.
Humans and Nonhuman Primates
Authors: Konopka Geneviève , Caglayan Emre
Published: August 2024

Human brain evolution is marked by an enlarged brain and unparalleled cognitive capabilities. Additionally, the human brain has higher susceptibility for certain brain disorders (e.g., schizophrenia) that can be characterized as human-enriched, if not human-specific, disorders. Many human-specific molecular changes at the level of DNA sequence and gene regulation underlie the observed phenotypic divergence of humans. This chapter discusses past research that characterized the molecular divergence of the human brain at various levels (e.g., genome, transcriptome, epigenome comparisons across brain regions and cell types) and how molecular divergence relates to phenotypic divergence. Studies focusing on the association of molecular features driving evolutionary divergence and disease susceptibility will also be reviewed at each level. Collectively, these studies show that human brain evolution and human brain diseases display overlapping phenotypic and genotypic features, although evolutionarily conserved molecular features may be overall more associated with diseases than non-conserved features.
An Evolutionary Psychoneuroimmunological Approach to Major Depressive Disorder
Authors: Rantala Markus J. , Borráz-León Javier I.
Published: August 2024

Major depressive disorder (MDD) is not a unitary disorder. From an evolutionary perspective, it should be divided into different subtypes based on triggering factors. Some of the symptoms of depression are adaptations to solve adaptive problems that trigger mood swings, while some others are maladaptive. MDD has become more common in societies that have adopted modern “Western” lifestyles. The evolutionary mismatch hypothesis suggests that this is because the human mind and body are not adapted to live under the characteristics of modern “Western” lifestyles. The evolutionary psychoneuroimmunological approach suggests that modern lifestyles increase the prevalence of systemic low-grade inflammation and chronic stress, which underlies neuroinflammation. Neuroinflammation triggers sickness behavior symptoms, many of which are the same as those observed in MDD, likely changing the previously adaptive mood into a maladaptive state of MDD.
Schizophrenia
Authors: Allen John S.
Published: August 2024

Schizophrenia is a complex behavioral and cognitive phenotype that overlaps significantly in its expression with other clinical and non-clinical phenotypes. Evolutionary analyses of schizophrenia have been predicated on the following characteristics of the condition: high heritability, relatively low fertility in individuals with schizophrenia compared to the general population, the absence of an environmental or exogenous triggering agent (e.g., a virus), and subclinical phenotypic continuity between those with schizophrenia and their close relatives. With the advent of genome-wide association studies and the identification of more than 100 schizophrenia-risk loci, each of small effect, older balanced polymorphism models are now much less tenable. Instead, evolutionary modelers are focusing on schizophrenia phenotypes as being an emergent quality of human brain and behavior evolution. Evidence suggests that genes important in human neuro-evolution may be overrepresented among the population of schizophrenia-risk alleles. Schizophrenia may therefore be a fundamental aspect of human behavioral evolution.
Memory
Authors: Harris James C. , Coyle Joseph T.
Published: August 2024

A memory system can be defined as an organized relationship among brain structures involving processes that make possible memory acquisition, consolidation/retention, and utilization. Memory has been referred to in a general way to describe the ability to conserve and later remember experiences. Memory may be categorized in several ways. General classifications have included (a) by the subprocesses used in storage (i.e., ultra-short-term, short-term, and long-term), (b) by the process used in retrieving memories (through thought, action, or perception), and (c) by the modality of cognitive memory that is lost in amnesia (i.e., global, partial, or specific). This chapter discusses the current classification of multiple memory systems. It reviews specific definitions in the classification of memory, reviews the neuroanatomy and synaptic basis of memory, discusses animal models, highlights the relationship of sleep and memory, discusses emotional and autobiographical memory, and considers how disturbances of memory might be pertinent to neurodevelopmental disorders.
Attachment Security Disorders
Authors: Harris James C. , Coyle Joseph T.
Published: August 2024

Attachment theory has important implications not only for typically developing children but also for children with neurodevelopmental disorders. Attachment relationships, secure and insecure, influence adaptation in neurodevelopmental disorders by interacting with other risk factors. When attachment is secure, it reduces risk; when it is insecure, it may increase vulnerability to stressors. Attachment security paradigms, particularly the Strange Situation procedure, must be used for the development of internal working models about the applicability of the disorganized attachment category to people with neurodevelopmental disorders and the use of the term “attachment other” in reference to children raised in institutions with limited social engagement and physical stimulation. This chapter discusses both the impact of severe early deprivation on attachment in typically developing children and attachment issues in those with neurodevelopmental disorders.
Comparison Between Dexmedetomidine and Midazolam-Fentanyl Combination in Flexible Bronchoscopy
Authors: Magazine Rahul , Elenjickal Vrinda Mariya , Padukone Ambika M. , Bhat Anup , Chogtu Bharti
Published: August 2024

Background:

Dexmedetomidine has acceptable clinical utility for inducing sedation during flexible bronchoscopy. Reducing its dose may not only ameliorate its cardiovascular side effects, but also maintain its clinical usefulness.

Methods:

Patients between 18 and 65 years were randomized to either dexmedetomidine (0.75 µg/kg) or the midazolam-fentanyl group (0.035 mg/kg midazolam and 25 mcg fentanyl). The primary outcome measure was the composite score. Other parameters noted were: oxygen saturation, hemodynamic variables, Modified Ramsay Sedation Score, Numerical Rating Scale (NRS) for pain intensity and distress, Visual Analog Scale score for cough, rescue medication doses, ease of doing bronchoscopy, and patient response 24 hours after bronchoscopy.

Results:

In each arm, 31 patients were enrolled. The composite score at the nasopharynx was in the ideal category in 26 patients in dexmedetomidine and 21 in the midazolam-fentanyl group (P=0.007). At the tracheal level, the corresponding values were 24 and 16 (P=0.056). There was no significant difference between the 2 groups regarding the secondary outcome measures except hemodynamic parameters. The mean heart rate in the dexmedetomidine and midazolam-fentanyl groups, respectively, was as follows: at 10 minutes after start of FB (90.10±14.575, 104.35±18.48; P=0.001), at the end of FB (98.39±18.70, 105.94±17.45; P=0.016), and at 10 minutes after end of FB (89.84±12.02, 93.90±13.74; P=0.022). No patient developed bradycardia. Two patients (P=0.491) in the dexmedetomidine group developed hypotension.

Conclusion:

Low-dose dexmedetomidine (0.75 μg/kg single dose) appears to lead to a better composite score compared with the midazolam-fentanyl combination.
A Single-center Experience With >200 Lung Transplant Recipients With COVID-19 Infection
Authors: Kehara Hiromu , Johnson-Whiting Ashley , Yanagida Roh , Krishan Kewal , Zhao Huaqing , Mishkin Aaron , Cordova Francis , Criner Gerard J. , Toyoda Yoshiya , Shigemura Norihisa
Published: August 2024

Background.

Although COVID-19 is no longer a declared global health emergency, data remain limited on the impact of COVID-19 in lung transplant recipients.

Methods.

We identified lung transplant recipients who were diagnosed with COVID-19 from March 2020 through August 2022 in our institutional database and investigated clinical outcomes. We then analyzed outcomes based on date of COVID-19 diagnosis (first wave March 2020–October 2020; second wave November 2020–2021; third wave December 2021–September 2022) and compared these results.

Results.

Of the 210 lung transplant recipients (median age 67; 67% men) enrolled, 140 (67%) required hospital admission. Among admitted recipients, 35 (25%) were intubated and 7 (5%) were placed on extracorporeal membrane oxygenation. Overall survival was 67.1% at 1 y and 59.0% at 2 y post-COVID-19 diagnosis. COVID-19 led to mortality in all 5 patients diagnosed during their index admission for lung transplantation. Although overall survival was significantly better in recipients with COVID-19 during the third wave, in-hospital mortality remained high (first wave 28%, second wave 38%, and 28% third wave). Vaccination (partially vaccinated versus none and fully vaccinated versus none) was the only significant protective factor for hospital admission, and age 70 y and older and partially vaccinated (versus none or fully vaccinated) were independent risk factors for in-hospital mortality.

Conclusions.

Overall survival after COVID-19 infection in lung transplant recipients continues to improve; however, in-hospital mortality remains remarkably high. Vaccination appears to have been impactful in preventing hospital admission, but its impact on in-hospital mortality is still unclear. Further research is needed to better identify lung transplant recipients at high risk for mortality from COVID-19.
Safety and Efficacy of a Preemptive Mycophenolate Mofetil Dose Reduction Strategy in Kidney Transplant Recipients
Authors: Yatim Karim , Al Jurdi Ayman , El Mouhayyar Christopher , Morena Leela , Hullekes Frank E. , Verhoeff Ruchama , Ribas Guilherme T. , Pearson Daniel S. , V. Riella Leonardo
Published: August 2024

Background.

There are no high-quality data to guide long-term mycophenolate mofetil (MMF) dosing in kidney transplant recipients (KTRs) to balance the long-term risks of allograft rejection with that of infections and malignancy. At our center, KTRs are managed with either a “preemptive” dose reduction strategy, where the MMF dose is reduced after the first year before the development of adverse events, or with a “reactive” dosing strategy, where they are maintained on the same MMF dose and only reduced if they develop an adverse event. We hypothesized that a preemptive MMF dosing strategy after the first year of transplantation is associated with decreased infections without increasing alloimmune complications.

Methods.

We conducted a retrospective cohort study of all KTRs receiving MMF from January 1, 2015, to December 31, 2020. The primary outcome was the incidence of infections requiring hospitalization.

Results.

One hundred forty-two KTRs met the inclusion criteria, of whom 44 (31%) were in the preemptive group and 98 (69%) were in the reactive group. The median follow-up was 4 y (interquartile range, 3.8–4.0). Multivariable analysis showed that a preemptive MMF dose reduction strategy was associated with a lower risk of infections requiring hospitalization (adjusted hazard ratio = 0.39; 95% confidence interval, 0.16-0.92). There was no difference in graft loss, rejection, or estimated glomerular filtration rate slope.

Conclusions.

Preemptive MMF dose reduction in KTRs may be an effective strategy to prevent infections without increasing the risk of allograft rejection. Randomized clinical trials are needed to confirm these findings.
Genome-based reclassification of Kineococcus aureolus Xu et al. 2017 as a later heterotypic synonym of Kineococcus terrestris Xu et al. 2017
Authors: Huang Jie , Li Shuai , Liu Jun , Lu Chun-Yan , Manzoor Sadia , Dong Lei , Li Wen-Jun
Published: August 2024

We aimed to elucidate the relationship between Kineococcus terrestris and Kineococcus aureolus through whole-genome-based analysis. The genome-derived 16S rRNA gene sequences of K. terrestris KCTC 39738T and K. aureolus KCTC 39739T shared a 100% similarity. Phylogenetic trees based on 16S rRNA gene and whole-genome sequences revealed that K. terrestris KCTC 39738T and K. aureolus KCTC 39739T formed a robust clade, indicating a close relationship between them. Genomic comparison showed that the two strains shared 99.1% average nucleotide identity, 92.0% digital DNA–DNA hybridization and 98.9% average amino acid identity values, all of which exceeded the recommended threshold values for species classification. Most phenotypic characteristics between the two species were almost identical. Based on the above evidence, we propose the reclassification of Kineococcus aureolus Xu et al. 2017 as a later heterotypic synonym of Kineococcus terrestris Xu et al. 2017. Since these two species were proposed in the same article, the principle of priority does not apply. Our proposal is supported by the fact that the nomenclatural authorities first described Kineococcus terrestris.
Arginyltransferase 1 (ATE1)-mediated proteasomal degradation of viral haemagglutinin protein: a unique host defence mechanism
Authors: Shokeen Kamal , Baroi Malay Kumar , Chahar Manjeet , Das Debapratim , Saini Harimohan , Kumar Sachin
Published: August 2024

Graphical abstract

Schematic representation of arginyltransferase 1 (ATE1)-mediated arginylation of cellular and haemagglutinin-neuraminidase (HN) protein.
Optimizing Electroporation Parameters for Efficient Delivery of Large Molecules into Pig Zygotes Using Fluorescent Dextrans from 3 to 2000 kDA
Authors: Fernández Juan Pablo , Kielau Paul , Hassel Petra , Kues Wilfried A.
Published: August 2024

Electroporation has revolutionized gene transfer and gene editing, enabling efficient delivery of molecules into embryos, with significant implications for developmental biology and biomedical research. This study aimed to optimize electroporation parameters for enhancing the delivery of large molecules into pig zygotes. We investigated the effects of fluorescence-coupled dextran reporters (FDs) of sizes ranging from 3 to 2000 kiloDalton (kDA) along with the impact of poring and transfer polarity settings during electroporation, on molecule permeability. Additionally, we assessed the influence of voltage and the number of poring pulses on the delivery of 2000 kDa FDs and examined the permeability of pre-IVF embryos and zona pellucida-weakened post-IVF embryos to this FD.

Our findings highlighted size-dependent effects on FD uptake, with reversing poring polarity increasing the influx of small molecules (3 kDa FDs). The delivery of 2000 kDa FDs was not influenced by increased poring number but it was significantly influenced by voltage, reaching its optimum at 40 V. Electroporation in pre-IVF embryos did not show significant variation across different voltages. However, voltages higher than 20 V negatively affected blastocyst development rates. Zona-weakening did not improve permeability for the 2000 kDa FD.

This study offers valuable insights into refining electroporation techniques for delivering large molecules into pig zygotes and highlights the relevance of commercial fluorescence-coupled dextrans as useful tools for exploring permeability dynamics in electroporated zygotes.
Achieving tractable and reliable agriculture supply chain operations through Industry 4.0 tools to support Lean Six Sigma application
Authors: Yeni Fatma Betül , Gürsoy Yılmaz Beren , Kayhan Behice Meltem , Özçelik Gökhan , Yılmaz Ömer Faruk
Published: August 2024

Purpose

This study aims to address challenges related to long lead time within a hazelnut company, primarily attributed to product quality issues. The purpose is to propose an integrated lean-based methodology incorporating a continuous improvement cycle, drawing on Lean Six Sigma (LSS) and Industry 4.0 applications.

Design/methodology/approach

The research adopts a systematic approach, commencing with a current state analysis using VSM and fishbone analysis to identify underlying problems causing long lead time. A Pareto analysis categorizes these problems, distinguishing between supplier-related issues and deficiencies in lean applications. Lean tools are initially implemented, followed by a future state VSM. Supplier-related issues are then addressed, employing root cause analyses and Industry 4.0-based countermeasures, including a proposed supplier selection model.

Findings

The study reveals that, despite initial lean implementations, lead times remain high. Addressing supplier-related issues, particularly through the proposed supplier selection model, significantly reduces the number of suppliers and contributes to lead time reduction. Industry 4.0-based countermeasures ensure traceability and strengthen supplier relationships.

Originality/value

This research introduces a comprehensive LSS methodology, practically demonstrating the application of various tools and providing managerial insights for practitioners and policymakers. The study contributes theoretically by addressing challenges comprehensively, practically by showcasing tool applications and managerially by offering guidance for system performance enhancement.
Risk factor of disability as new certification of long‐term care needs in older Japanese adults with diabetes mellitus: A longitudinal study
Authors: Toyoshima Kenji , Tamura Yoshiaki , Murao Yuji , Kodera Remi , Oba Kazuhito , Ishikawa Joji , Chiba Yuko , Araki Atsushi
Published: August 2024

Aim

This observational longitudinal study aimed to explore the risk factors for disabilities in older Japanese individuals with diabetes at a frailty clinic, an outpatient clinic specializing in comprehensive geriatric assessments for older patients.

Methods

The outcome was the onset of disability as a new certification of long‐term care needs in outpatients aged ≥65 years. Multivariable Cox regression analyses examined the independent associations between the onset of disability and the variables that reached significance in the bivariate analysis, after adjusting for age and sex, years of education, and certification of need for support.

Results

A total of 182 participants (mean age 77.8 years, 59.9% female) were included in the study. During a mean follow‐up period of 1070 days, 28 patients (15.4%) developed disabilities. Multivariable analysis showed that poor glycemic control (higher levels of glycosylated albumin and HbA1c), frailty as measured by the Clinical Frailty Scale (CFS), cognitive decline as assessed by the revised Hasegawa Dementia Scale (especially “5 object recall” and verbal fluency as assessed by the number of “vegetable names”), poor adherence to medications, and reduced muscle mass were significantly associated with the development of disability. Multivariable Cox regression analyses revealed independent and significant associations between the development of disability and HbA1c ≥7.5%, CFS ≥4, and generating vegetable names≤9.

Conclusion

In identifying older patients with diabetes who are at risk of developing disabilities, it may be useful to evaluate glycemic control, CFS, cognition, and medication adherence. Verbal fluency tests using vegetable names may serve as simple tools for assessing the risk of disability. Geriatr Gerontol Int 2024; ••: ••–••.
Oil‐to‐electricity retrofitting and deployment of rubber‐tyred gantry cranes considering low‐carbon policies
Authors: Ding Yi , Pan Deng , Chen Kaimin , Yang Yang
Published: August 2024

To address the high‐carbon emissions from port equipment, one of the most effective measures is to replace diesel‐powered rubber‐tyred gantry cranes (RTGs) with electric‐powered alternatives. However, the oil‐to‐electricity retrofitting for diesel‐driven RTGs may negatively impact port operation efficiency. Moreover, port enterprises typically do not initiate the retrofitting without the low‐carbon policies. Therefore, this study focuses on the retrofitting of RTGs in combination with their deployment under the carbon emissions trading (CET) and government subsidy policies. An integer programming model is developed to help port enterprises determine the multistage planning of RTGs' retrofitting and deployment. Based on the block‐diagonal structure of the proposed model, a column generation method employing Dantzig–Wolfe decomposition is developed. The optimal integer solution of the model is then further refined using a branch‐and‐price approach. The Shanghai Yangshan Deep Water Port is used for numerical experiments. Numerical results demonstrate that the implementation of CET and government subsidy policies can reduce approximately 17,630 tons of carbon emissions and $8,751,861 operating costs in container terminal yard. Meanwhile, increasing government subsidies and carbon trading prices, and reducing free carbon emission quotas can encourage port enterprises to reduce more emissions.
How germane are moral and economic policies to ideology? Evidence from Latin American legislators
Authors: Chavarría‐Mora Elías , Chen Chuang , González‐Rostani Valentina , Morgenstern Scott
Published: August 2024

How do legislators, many of whom hold policy positions that are not consistently conservative or progressive, position themselves on the left–right ideological scale? Analyzing data from the Parliamentary Elites in Latin America (PELA) survey, this paper leverages combinations of moral and economic policy positions to determine the weight—germaneness—of each policy on that scale. Using bi‐ and multivariate models on a database of about 5000 legislators, we confirm the importance of economics but also find that moral issues can be germane to the left–right placement of many of the region's legislators. The relative germaneness of the policies is inconsistent for legislators of the left and right. The left is more heterogeneous because moral policies are less germane to their identification. However, many centrists hold conservative economic and moral views, blurring the tie between policy and ideological positions. We confirm that contextual factors can sharpen the issue‐to‐ideology relationship.
Decoding plant‐induced transcriptomic variability and consistency in two related polyphagous mites differing in host ranges
Authors: Chen Lei , Guo Li‐Xue , Yu Xin‐Yue , Huo Shi‐Mei , Hoffmann Ary A. , Zhou Jia‐Yi , Sun Jing‐Tao , Hong Xiao‐Yue
Published: August 2024

The diet breadth of generalist herbivores when compared to specialists tends to be associated with greater transcriptional plasticity. Here, we consider whether it may also contribute to variation in host range among two generalists with different levels of polyphagy. We examined two related polyphagous spider mites with different host ranges, Tetranychus urticae (1200 plants) and Tetranychus truncatus (90 plants). Data from multiple populations of both species domesticated on common beans and transferred to new plant hosts (cotton, cucumber, eggplant) were used to investigate transcriptional plasticity relative to population‐based variation in gene expression. Compared to T. truncatus, T. urticae exhibited much higher transcriptional plasticity. Populations of this species also showed much more variable expression regulation in response to a plant host, particularly for genes related to detoxification, transport, and transcriptional factors. In response to the different plant hosts, both polyphagous species showed enriched processes of drug/xenobiotics metabolism, with T. urticae orchestrating a relatively broader array of biological pathways. Through co‐expression network analysis, we identified gene modules associated with host plant response, revealing shared hub genes primarily involved in detoxification metabolism when both mites fed on the same plants. After silencing a shared hub CYP gene related to eggplant exposure, the performance of both species on the original bean host improved, but the fecundity of T. truncatus decreased when feeding on eggplant. The extensive transcriptomic variation shown by T. urticae might serve as a potential compensatory mechanism for a deficiency of hub genes in this species. This research points to nuanced differences in transcriptomic variability between generalist herbivores.