bluuebunny/crossref_metadata_2025 huggingface dataset:
Screening South American Potato Landraces and Potato Wild Relatives for Novel Sources of Late Blight Resistance
Authors: Perez Willmer , Alarcon Lesly , Rojas Tania , Correa Yanina , Juarez Henry , Andrade-Piedra Jorge L. , Anglin Noelle L. , Ellis David
Published: January 2022

Late blight (LB) caused by the oomycete Phytophthora infestans is one of the most important biotic constraints for potato production worldwide. This study assessed 508 accessions (79 wild potato species and 429 landraces from a cultivated core collection) held at the International Potato Center genebank for resistance to LB. One P. infestans isolate belonging to the EC-1 lineage, which is currently the predominant type of P. infestans in Peru, Ecuador, and Colombia, was used in whole plant assays under greenhouse conditions. Novel sources of resistance to LB were found in accessions of Solanum albornozii, S. andreanum, S. lesteri, S. longiconicum, S. morelliforme, S. stenophyllidium, S. mochiquense, S. cajamarquense, and S. huancabambense. All of these species are endemic to South America and thus could provide novel sources of resistance for potato breeding programs. We found that the level of resistance to LB in wild species and potato landraces cannot be predicted from altitude and bioclimatic variables of the locations where the accessions were collected. The high percentage (73%) of potato landraces susceptible to LB in our study suggests the importance of implementing disease control measures, including planting susceptible genotypes in less humid areas and seasons or switching to genotypes identified as resistant. In addition, this study points out a high risk of genetic erosion in potato biodiversity at high altitudes of the Andes due to susceptibility to LB in the native landraces, which has been exacerbated by climatic change that favors the development of LB in those regions.

[Formula: see text] Copyright © 2022 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Bacterial Vaginosis and Prospective Ultrasound Measures of Uterine Fibroid Incidence and Growth
Authors: Moore Kristen R. , Harmon Quaker E. , Zhao Shanshan , Taylor Brandie D. , Baird Donna D.
Published: January 2022

Background:

Uterine fibroids often cause intolerable symptoms leading to invasive treatments, most commonly hysterectomy. Reproductive tract infections are hypothesized to influence uterine fibroid development, but few studies exist, especially for the highly prevalent condition bacterial vaginosis (BV). Both fibroids and BV have documented racial–ethnic disparities, with higher burden in Blacks.

Methods:

With prospective data from a community-based study (four standardized ultrasound examinations over 5 years) in young Black women, we examined baseline BV associations with fibroid incidence and growth. We computed adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for incidence comparing BV and no BV (Nugent score ≥7 vs. <7) using Cox proportional hazards models among 1027 women fibroid-free at baseline. Fibroid growth associations were based on linear mixed models estimating volume change between ultrasounds indexed to 18 months. We then expressed BV association as estimated percent difference in growth per 18 months, comparing exposed and unexposed.

Results:

There were n = 247 incident fibroids and 1181 growth measures; average fibroid growth per 18 months was a 78% (95% CI: 69 to 87) increase in volume. BV prevalence was 51% and not associated with fibroid incidence (aHR: 1.0, 95% CI: 0.80 to 1.4) or growth (estimated % difference in growth, −3% (95% CI: −12 to 6).

Conclusions:

In this first study (to our knowledge) of ultrasound-monitored fibroid development and Nugent-assessed BV, we found no evidence to support the hypothesis that BV increased risk of fibroid incidence or growth or BV’s role in the high burden of fibroids in Black women.
Dose-Related Reference Range as a Tool in Therapeutic Drug Monitoring
Authors: Haen Ekkehard
Published: January 2022

Background:

Therapeutic drug monitoring (TDM) aims to individualize drug therapy. This systematic review provides a state-of-the-art overview of the benefits of adding the dose-related reference range (DRR) as a second reference range to the set of tools used by TDM for measurement and evaluation. It discusses alternative pharmacokinetic approaches for individualization of drug therapy.

Methods:

Literature was searched in PubMed. Textbooks provided Bateman transformations for calculating expected drug concentrations at various times after drug application in “normal patients,” that is, the population of phase II clinical trials. The review compiles conditions and prerequisites for these transformations to be valid.

Results:

Relating a measured drug concentration to the orienting therapeutic reference range provides pharmacodynamic information for improving the benefit-to-risk ratio of desired drug effects versus adverse drug effects. The discriminating DRR considers a patient's individual pharmacokinetic situation. DRR is statistically based on the pharmacokinetic parameters total clearance, time to reach maximal concentrations, and elimination half-life. Relating the measured drug concentration to a range rather than a particular value, DRR determines if individual patients do or do not belong to the population of “normal patients.” Once a patient is identified to be outside the population of “normal patients,” the clinical–pharmacological TDM report elaborates the cause. It consists of the measured value, the TDM 9-field-board, the elimination pathways table, and a medication recommendation taking into account clinical information. The internet-based platform KONBEST supports editing of the clinical–pharmacological TDM report. It is personally signed and send to the therapist.

Conclusions:

The DRR embedded into a clinical–pharmacological TDM report allows adjusting a patient's medication to the patient's individual needs (individualization of drug therapy).
A Patient With Sepsis-Induced Multiorgan Failure and Increasing Serum Methadone Concentration: A Case Study
Authors: Dale Gro Helen , Holmaas Gunhild , Berg Jon A. , Riedel Bettina , Schjøtt Jan , Bjånes Tormod K.
Published: January 2022

The authors describe a patient with substance use disorder admitted to the hospital with septic shock and multiorgan failure, in whom the serum concentration of methadone kept increasing despite discontinuation of the drug. Therapeutic drug monitoring was performed to monitor the methadone serum concentration during treatment of the underlying diseases.
Genetics of sudden cardiac death
Authors: Ben-Haim Yael , Behr Elijah R.
Published: January 2022

Purpose of review

Numerous cardiac diseases may cause sudden cardiac death (SCD), and a genetic basis for SCD has been established in the inherited cardiac conditions (ICCs). Previously, ICCs were thought to have a Mendelian inheritance pattern, wherein a rare pathogenic/likely pathogenic variant in a known diseasecausing gene conferred risk. This inheritance model, however, could not explain a large proportion of cases.

Recent findings

Advancements in genomic technology have facilitated application of genome-wide association studies (GWAS), allowing appreciation of the full spectrum of genetic variation in large populations. It has become clear that common variants may contribute to disease phenotype in ICCs as well, albeit with a smaller effect size and the need for additional factors. This has caused a shift in the understanding of inheritance patterns in ICCs, now thought to have a more complex, polygenic nature.

Implementing this knowledge into genetic testing of SCD decedents will improve its diagnostic yield by identifying a subset of patients who do not carry a variant in one of the acknowledged disease-causing genes. It will also assist our understanding of modification of phenotype and potentially outcomes.
Radiation Dose to Veterinarians and Veterinary Technicians During Radioiodine Treatment of Felis Catus
Authors: Dieffenthaller Meghan M. , Johnson Thomas E.
Published: January 2022

The uptake of radioiodine in veterinarians or veterinary staff when 131I is administered via injection to domesticated cats (Felis catus) with hyperthyroidism has not been well studied. Veterinarians and staff undergo specific training for the handling of radioiodine injection of cats to minimize and prevent an inhalation intake. An in-vivo bioassay is performed post cat injection to determine if 131I was inhaled or absorbed. The frequency of in-vivo bioassays requires dedicated time of the veterinarians and those who must perform the bioassay. Bioassay data from veterinarians and staff at the Colorado State University Veterinary Teaching Hospital administering 131I from the past 20 years were analyzed (n = 168) to ascertain if there is a correlation between the amount of time elapsed between the 131I administration, the bioassay, and the net counts resulting from the bioassay. The amount of 131I administration and the bioassay net counts were also analyzed to determine if there was a correlation. No correlations were found, and out of 168 131I administrations over 20 years, only 3 bioassays resulted in measurable doses of 131I with a committed dose equivalent (CDE) of 0.19 mSv, 0.77 mSv, and 1.6 mSv. The current precautions taken to prevent the inhalation intake of 131I appear sufficient to consider changing the requirements for veterinary bioassay after routine administration of 131I to cats.
VISUAL PROGNOSTIC VALUE OF NEUTROPHIL-TO-LYMPHOCYTE RATIO AND PLATELET-TO-LYMPHOCYTE RATIO IN BEHÇET UVEITIS
Authors: Lee Eun Kyoung , Lee Sang-Yoon , Kim Bo Hee , Park Un Chul , Yu Hyeong Gon
Published: January 2022

Purpose:

To investigate the significance of systemic indicators, including neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), as long-term visual prognostic factors in patients with Behçet uveitis.

Methods:

This study comprised 114 eyes from 114 patients diagnosed with Behçet uveitis. Ophthalmologic evaluations and biochemical measurements including NLR and PLR values were consecutively obtained at each visit. Patients were divided into good and poor visual outcome groups, based on the visual acuity of 0.5 logarithm of the minimum angle of resolution in the worse-seeing eyes at the last visit. Factors associated with poor visual outcomes were analyzed, and optimal cutoff values of NLR and PLR were also evaluated.

Results:

Sixty-six eyes (57.9%) were included in the good visual outcome group. Multivariate regression analysis showed that younger age of onset (odds ratio = 0.939; P = 0.010), longer disease duration (odds ratio = 1.164; P < 0.001), higher maximum NLR (odds ratio = 1.215; P = 0.033), and higher initial PLR (odds ratio = 1.014; P = 0.039) were significantly associated with poor visual outcomes. The optimal cutoff value for patients with poor visual outcome was 5.608 for NLR and 128.078 for PLR.

Conclusion:

A higher maximum NLR and higher initial PLR, as well as a younger age of onset and longer disease duration, were significantly associated with poor visual outcomes. Systemic inflammatory factors might be important indicators of visual prognosis in Behçet uveitis.
Mind Your Heart
Authors: Salmoirago-Blotcher Elena , Walaska Kristen , Trivedi Dyuti , Dunsiger Shira , Breault Christopher , Levine Daniel , Wu Jia-Rong , Cohen Ronald
Published: January 2022

Background

Mindfulness training (MT) may promote medication adherence in outpatients with heart failure.

Objective

The aims of this study were to determine the feasibility and acceptability of MT (primary outcomes) and explore effects on medication adherence, functional capacity, cognitive function, depression, and mindfulness skills (secondary outcomes).

Methods

In this pre/post-design study, participants received a 30-minute phone-delivered MT session weekly for 8 weeks.

Results

We enrolled 33 outpatients (32% women; 69.7 White; mean age, 60.3 years). Retention was 100%, and session attendance was 91%. Overall, participants (97%) rated MT as enjoyable. Objectively assessed (P < .05) adherence decreased post intervention, whereas improvements were noted in functional capacity (P = .05), mindfulness (P < .05), and cognitive function (reaching significance for Flanker scores).

Conclusions

Phone-delivered MT was feasible and acceptable. Whereas no improvements were noted in medication adherence and depression, cognitive function, functional capacity, and mindfulness levels increased post intervention, suggesting MT may have beneficial effects in outpatients with heart failure.
Development of Quality Measures for Pediatric Agitation Management in the Emergency Department
Authors: Hoffmann Jennifer A. , Johnson Julie K. , Pergjika Alba , Alpern Elizabeth R. , Corboy Jacqueline B.
Published: January 2022

Objective:

Pediatric mental health emergency department (ED) visits that involve restraints for agitation are increasing. Quality measures are used to assess and improve healthcare quality. Our objective was to develop quality measures for pediatric ED agitation management informed by multidisciplinary perspectives.

Methods:

A multidisciplinary panel developed quality measures for pediatric ED agitation management through the modified Delphi method. Panelists ranked measures in importance and feasibility on a 9-point scale during 2 survey rounds, with a teleconference discussion between surveys. Consensus was defined by >75% of panelists ranking a quality measure highly (≥7) in importance and a median feasibility score of ≥4.

Results:

Panelists included 36 physicians, nurses, social workers, security, child life specialists, hospital data analysts, and parents. The panel reached consensus on 20 quality measures. Measures with the highest percentage of scores with importance ≥7 were related to adverse medication events, patients restrained, staff/patient injuries, reescalation plans, presence of an algorithm to standardize care, formal staff training on deescalation techniques, time to medication administration, and room safety.

Conclusions:

Twenty quality measures that incorporate multidisciplinary perspectives were developed for pediatric ED agitation management. Once operationalized and field tested, these measures may be used to assess and improve healthcare quality for pediatric agitation.
An Integrated Point-of-Care Ultrasound Curriculum: An Evidence-Based Approach
Authors: Breunig Michael , Huckabee Michael , Rieck Katie M.
Published: January 2022

Point-of-care ultrasound (POCUS) has been demonstrated to improve students' medical knowledge and clinical exam skills and advances patient care through numerous diagnostic and therapeutic applications. Despite the growing use of ultrasound in medical education and clinical practice, few physician assistant (PA) programs have successfully integrated POCUS education into their curricula. This manuscript describes an evidence-based approach for integrating POCUS education throughout a 2-year PA curriculum, with the goal of serving as a useful guidepost for other PA programs as they strive to incorporate this valuable skill into their curricula.
A Clinical Year PACKRAT Score That Identifies Risk of Physician Assistant National Certifying Examination Failure: A 10-Year Analysis
Authors: Stream Charles
Published: January 2022

Purpose

A 10-year analysis to identify a Physician Assistant Clinical Knowledge Rating and Assessment Tool (PACKRAT) score that identifies students at risk of poor performance on the Physician Assistant National Certifying Examination (PANCE) was performed.

Methods

A total of 712 student PACKRAT scores were analyzed to identify a score that would indicate those students at risk of failing the PANCE.

Results

Students with scores of 145 or lower were identified as a risk after the completion of clinical rotations. Remediation to strengthen knowledge deficits was implemented for those with scores of 145 or lower.

Conclusion

After 9 years of remediating those students identified as at-risk according to their PACKRAT score, the program's average PANCE pass rate increased from 92.1% to 96.7% with pass rates of 100% over the last 2 years.
Urgent Care: A Valuable New Setting for Training Physician Assistant Students
Authors: Addington Tiffany , Johnson Jennifer , Montalbano Amanda
Published: January 2022

Purpose

The purpose of this study was to assess physician assistant (PA) students' perceptions of using a pediatric urgent care clinic for their pediatric acute care experience.

Methods

PA students were surveyed on completion of their pediatric urgent care rotations (June 2017 to March 2020). Positive perception was ≥4 on a 5-point scale or ≥80% on agreement for dichotomous variables. Qualitative question responses were open coded for positive themes and opportunities for improvement.

Results

Of the 32 students, 29 (90.6%) completed evaluations. Students reported an overall positive perception: patient care, 4.66 (standard deviation [SD] 0.61); system-based practice, 4.76 (SD 0.44); professionalism, 4.90 (SD 0.31); medical knowledge, 4.90 (SD 0.31); and practice-based learning and improvement, 4.66 (SD 0.61). However, interpersonal and communication skills were rated positively on only 65.5% of the evaluations.

Conclusions

An academic pediatric urgent care clinic was regarded positively by PA students as a novel setting to complete a pediatric acute care rotation, but students required more opportunities to work collaboratively.
Long-acting amylin analogues for the management of obesity
Authors: Mathiesen David S. , Bagger Jonatan I. , Knop Filip K.
Published: January 2022

Purpose of review

To summarize recent developments of long-acting amylin analogues for the treatment of obesity and to outline their mode of action.

Recent findings

Amylin is a pancreatic hormone acting to control energy homeostasis and body weight. Activity at the calcitonin and amylin receptors in the area postrema seems to – at least partly – be responsible for these effects of amylin. Both preclinical and early-stage clinical studies investigating long-acting amylin receptor analogues demonstrate beneficial effects on body weight in obesity. Cagrilintide, a novel amylin analogue suitable for once-weekly administration, is in phase II clinical development and has shown promising body weight reducing effects alone and in combination with the glucagon-like peptide 1 receptor agonist semaglutide.

Long-acting amylin analogues have emerged as a possible pharmacotherapy against obesity, but more studies are needed to support the utility and long-term effects of this strategy in relevant populations.
“Individualized Care” From the Viewpoint of Turkish Patients and Oncology Nurses
Authors: Altinisik Muge , Arikan Fatma
Published: January 2022

Background

Cancer is a chronic disease that leads to major life changes for individuals because it affects physical, psychological, social, and spiritual aspects. It is important that nursing care is able to respond to different individual needs regarding the challenges experienced by cancer patients.

Objective

The aim of this study was to evaluate the concept of individualized care as perceived by oncology patients and nurses working in oncology clinics.

Methods

This descriptive, cross-sectional study was conducted at a medical oncology clinic in Turkey. Participants were oncology nurses (n = 23) and cancer patients (n = 180) discharged after treatment. The data were collected using the Patient-Nurse Identification Form, Individualized Care Scale (ICS-A, ICS-B), and Individualized Care Scale-Nurse.

Results

Nurses’ perceptions of individualized care were more positive than those of patients. Patients’ age, marital status, education level, income level, and disease characteristics did not have an effect on their awareness of interventions supporting their individuality or on their perceptions of individualized care. More years of employment in the nursing profession and in oncology had a positive effect on individualization of patient care.

Conclusion

Perceptual differences between patients and nurses exist; individualized care plans may be needed to minimize the differences.

Implications for Practice

These study outcomes can guide individualized care for cancer patients.
Nurse Practitioner Transition to Practice
Authors: Hande Karen , Jackson Heather , McClure Natasha
Published: January 2022

Fellowships prepare new graduate nurse practitioners (NPs) to become skilled providers with advanced knowledge and clinical competency to practice nursing in a specialized area. The literature lacks guidance about comprehensive approaches for the development, implementation, evaluation, and accreditation of NP fellowships. The purpose of this article was to describe recommendations and useful strategies for professional development nurse educators to deliver optimal learning and training for NPs transitioning into practice.
The Multisite Nursing Professional Development Leader Competency Determination Study
Authors: Harper Mary G. , Maloney Patsy
Published: January 2022

In recognition of the emerging role of the multisite nursing professional development (NPD) leader, the Association for Nursing Professional Development commissioned a study to obtain consensus around the competencies needed by individuals in this position. Electronic Delphi surveys with NPD practitioners who have responsibility for multiple sites identified competencies related to executive nursing, business acumen, organizational alignment, communication and relationship building, and NPD practice.
A Pandemic’s Impact
Authors: Grimm Khristina L. , Barker Sarah
Published: January 2022

The purpose of this comparative study was to identify the difference in self-efficacy in nursing practice of newly licensed nurses who transitioned to acute care during the pandemic to those who transitioned prior to the pandemic. Analysis revealed no significant difference in the overall self-efficacy scores of the groups. However, a significant difference was identified in questions related to self-efficacy with death and finding nursing exciting. Findings of this study provide insight for providing orientation for nurses regarding their readiness to practice.
Opportunities for Poetic Analysis in Qualitative Nursing Research
Authors: Tarbi Elise C. , Morgan Brianna
Published: January 2022

Background

The voices of people living with serious, life-limiting illnesses are often underrepresented in research. Furthermore, a biomedical bias toward treatment and stigma associated with illness prevents healthcare providers from engaging with topics critical for people living with serious illness, such as existential communication and inner strength. Poetry is an established method of analysis and dissemination in qualitative research but is underutilized by nursing researchers.

Objectives

The purpose of this article is to demonstrate the inherent opportunities in using poetry in nursing research to highlight the voices and issues of people whose experiences are outside the assumed norms of the biomedical paradigm.

Methods

We apply methods of poetic analysis to qualitative data sets that highlight the voice of people living with serious illness—in naturally occurring palliative care conversations and dyadic interviews of people with dementia and their care partners. Methods of poetic analysis include poetic transcription and voice poems.

Results

Methods of poetic analysis allowed us to engage with the data reflexively to intensify and evoke the deeper meaning of narratives. Poetic analysis served to center the participant’s voices by using their own words to demonstrate themes. Poems are a uniquely accessible method of disseminating complex findings, as poems relay layered cognitive and emotional meaning resonant of universal human experiences in a concise and relatable format.

Discussion

Especially in circumstances where participant’s voices are underrepresented, poetic analysis enables nurse researchers to challenge normative assumptions and reimagine a difference-centered society. Our findings offer opportunities to incorporate poetry into clinical and research nursing training to better meet the needs of the populations we serve.
Relationship of Psychological Characteristics to Daily Life Ischemia: An Analysis From the National Heart, Lung, and Blood Institute Psychophysiological Investigations in Myocardial Ischemia
Authors: Dasa Osama , Mahmoud Ahmed N. , Kaufmann Peter G. , Ketterer Mark , Light Kathleen C. , Raczynski James , Sheps David S. , Stone Peter H. , Handberg Eileen , Pepine Carl J.
Published: January 2022

Objective

Cardiac ischemia during daily life is associated with an increased risk of adverse outcomes. Mental stress is known to provoke cardiac ischemia and is related to psychological variables. In this multicenter cohort study, we assessed whether psychological characteristics were associated with ischemia in daily life.

Methods

This study examined patients with clinically stable coronary artery disease (CAD) with documented cardiac ischemia during treadmill exercise (n = 196, mean [standard deviation] age = 62.64 [8.31] years; 13% women). Daily life ischemia (DLI) was assessed by 48-hour ambulatory electrocardiophic monitoring. Psychological characteristics were assessed using validated instruments to identify characteristics associated with ischemia occurring in daily life stress.

Results

High scores on anger and hostility were common in this sample of patients with CAD, and DLI was documented in 83 (42%) patients. However, the presence of DLI was associated with lower anger scores (odds ratio [OR] = 2.03; 95% confidence interval [CI] = 1.12–3.69), reduced anger expressiveness (OR = 2.04; 95% CI = 1.10–3.75), and increased ratio of anger control to total anger (OR = 2.33; 95% CI = 1.27–4.17). Increased risk of DLI was also associated with lower hostile attribution (OR = 2.22; 95% CI = 1.21–4.09), hostile affect (OR = 1.92; 95% CI = 1.03–3.58), and aggressive responding (OR = 2.26; 95% CI = 1.25–4.08). We observed weak inverse correlations between DLI episode frequency and anger expressiveness, total anger, and hostility scores. DLI was not associated with depression or anxiety measures. The combination of the constructs low anger expressiveness and low hostile attribution was independently associated with DLI (OR = = 2.59; 95% CI = 1.42–4.72).

Conclusions

In clinically stable patients with CAD, the tendency to suppress angry and hostile feelings, particularly openly aggressive behavior, was associated with DLI. These findings warrant a study in larger cohorts, and intervention studies are needed to ascertain whether management strategies that modify these psychological characteristics improve outcomes.
Sleep, Positive Affect, and Circulating Interleukin-6 in Women With Temporomandibular Joint Disorder
Authors: Hunt Carly A. , Mun Chung Jung , Owens Michael A. , Lerman Sheera F. , Kunatharaju Shriya , Tennen Howard A. , Buenaver Luis F. , Campbell Claudia M. , Haythornthwaite Jennifer A. , Smith Michael T. , Finan Patrick H.
Published: January 2022

Objective

Systemic inflammation is commonly observed in idiopathic chronic pain conditions, including temporomandibular joint disorder (TMD). Trait positive affect (PA) is associated with lower inflammation in healthy controls, but those effects may be threatened by poor sleep. The associations between PA with proinflammatory cytokine activity and potential moderation by sleep in chronic pain are not known. We thus investigated the association between PA and circulating interleukin-6 (IL-6) and moderation of that association by sleep in a sample of women with TMD and sleep difficulties.

Methods

Participants (n = 110) completed the insomnia severity index and provided blood samples at five intervals throughout an evoked pain testing session. They then completed a 14-day diary assessing sleep and affect, along with wrist actigraphy.

Results

There was not a significant main effect of PA on resting or pain-evoked IL-6 (b = 0.04, p = .33). Diary total sleep time (b = −0.002, p = .008), sleep efficiency (b = −0.01, p = .005), sleep onset latency (b = 0.006, p = .010), and wake after sleep onset (b = 0.003, p = .033) interacted with PA to predict IL-6, such that PA inversely predicted IL-6 at higher levels of total sleep time and sleep efficiency and at lower levels of sleep onset latency and wake after sleep onset. Surprisingly, when sleep was poor, PA predicted greater IL-6.

Conclusions

The potential salutary effects of PA on resting IL-6 erode when sleep is poor, underscoring the importance of considering sleep in conceptual and intervention models of TMD.
Stress Measurement in Primary Care: Conceptual Issues, Barriers, Resources, and Recommendations for Study
Authors: Wulsin Lawson R. , Sagui-Henson Sara J. , Roos Lydia G. , Wang Diana , Jenkins Brooke , Cohen Beth E. , Shah Amit J. , Slavich George M.
Published: January 2022

Objective

Exposure to stressors in daily life and dysregulated stress responses are associated with increased risk for a variety of chronic mental and physical health problems, including anxiety disorders, depression, asthma, heart disease, certain cancers, and autoimmune and neurodegenerative disorders. Despite this fact, stress exposure and responses are rarely assessed in the primary care setting and infrequently targeted for disease prevention or treatment.

Method

In this narrative review, we describe the primary reasons for this striking disjoint between the centrality of stress for promoting disease and how rarely it is assessed by summarizing the main conceptual, measurement, practical, and reimbursement issues that have made stress difficult to routinely measure in primary care. The following issues will be reviewed: a) assessment of stress in primary care, b) biobehavioral pathways linking stress and illness, c) the value of stress measurements for improving outcomes in primary care, d) barriers to measuring and managing stress, and e) key research questions relevant to stress assessment and intervention in primary care.

Results

On the basis of our synthesis, we suggest several approaches that can be pursued to advance this work, including feasibility and acceptability studies, cost-benefit studies, and clinical improvement studies.

Conclusions

Although stress is recognized as a key contributor to chronic disease risk and mortality, additional research is needed to determine how and when instruments for assessing life stress might be useful in the primary care setting, and how stress-related data could be integrated into disease prevention and treatment strategies to reduce chronic disease burden and improve human health and well-being.
Governance for Patient Safety: A Framework of Strategy Domains for Risk Management
Authors: Buja Alessandra , Damiani Gianfranco , Manfredi Mariagiovanna , Zampieri Chiara , Dentuti Elena , Grotto Giulia , Sabatelli Giuseppe
Published: January 2022

Background

Adverse events in healthcare are primarily due to system failures rather than individuals. Risk reduction strategies should therefore focus on strengthening systems, bringing about improvements in governance, and targeting individual practices or products. The purpose of this study was to conduct a scoping review to develop a global framework of management strategies for sustaining a safety-oriented culture in healthcare organizations, focusing on patient safety and the adoption of good safety-related practices.

Methods

We conducted a search on safety-related strategies in 2 steps. The first involved a search in the PubMed database to identify effective, broadly framed, cross-sector domains relevant to clinical risk management strategies in healthcare systems. In the second step, we then examined the strategies adopted by running a scoping review for each domain.

Results

Our search identified 8 strategy domains relevant to patient safety: transformational leadership, patient engagement, human resources management quality, innovation technology, skills certification, education in patient safety, teamwork, and effective communication.

Conclusions

This scoping review explores management strategies key to healthcare systems’ efforts to create safety-oriented organizations. Improvement efforts should focus particularly on the domains identified: combined together, they would nurture an overall safety-oriented culture and have an impact on preventable adverse events.
Postdischarge Adverse Events Among Neonates Admitted to the Neonatal Intensive Care Unit
Authors: Tsilimingras Dennis , Natarajan Girija , Bajaj Monika , Agarwal Prashant , Lua Jorge , Deriemacker Amanda , Zuair Areeg , Misra Dawn , Janisse James , Zhang Liying , Schnipper Jeffrey
Published: January 2022

Objectives

We aimed to determine the rate of postdischarge adverse events (AEs), classify the types of postdischarge AEs, and identify risk factors for postdischarge AEs among neonates admitted to the neonatal intensive care unit (NICU).

Study Design

This was a prospective cohort study of neonates admitted to the NICU from February 2017 through June 2019. We enrolled 170 neonates from a level 4 NICU who were being discharged home and whose parents can speak English and could be contacted after discharge. The main outcome of the study was postdischarge AEs based on structured telephone interviews, health record review, and adjudication by 2 blinded, trained physicians using a previously established methodology.

Results

Fourteen percent of 170 neonates admitted to the NICU experienced postdischarge AEs, with 48% being either preventable or ameliorable. Adverse drug events and procedural complications comprised most of the AEs (48%), but most of the preventable and ameliorable AEs were due to management, therapeutic, or diagnostic errors. Seventy-nine percent of neonates who suffered an AE experienced either a readmission to the hospital or an emergency department visit. Neonates admitted to a level 4 NICU from another NICU (level 1, 2, or 3) (adjusted odds ratio, 3.62; 95% confidence interval, 1.27–12.60; P = 0.01) and those 28 to 36 weeks (adjusted odds ratio, 11.38; 95% confidence interval, 1.67–127.98; P = 0.01) had a significantly higher risk of AEs at discharge.

Conclusions

Neonates discharged from a level 4 NICU were at high risk for experiencing postdischarge AEs. The identification of AE types and risk factors can be used to guide efforts to develop interventions to improve neonatal patient safety during the postdischarge period.
Prevalence of Inflammatory Back Pain in a Low-Income Population
Authors: de Oliveira Jobson Lopes , Maciel da Silva Guilherme Ferreira , Nogueira Igor Albuquerque , Azevedo Artur Queirós , Baraliakos Xenofon , Rocha Francisco Airton Castro
Published: January 2022

Background

Inflammatory back pain (IBP) is a major criterion in identifying axial spondyloarthritis. Whether socioeconomic issues impact prevalence of IBP assessed using standardized questionnaires has not been assessed. We determined IBP prevalence and performance of IBP questionnaires in a low-income, low-literacy population.

Methods

Individuals were interviewed in Fortaleza, Brazil, for the prevalence of IBP using Calin's, Berlin, and ASAS IBP questionnaires; monthly family income (US dollars), literacy (>/≤8 school years [SYs]), and smoking habit (present/absent) were registered.

Results

Two hundred nineteen individuals were included (mean age, 38.2 ± 12.9 years), 110 (50.2%) men, 58 (26.4%) White, and 38 (17.3%) smokers. Overall, 152 (69.4%) declared <US $720 (mean local income) earnings, and 64 (29.2%) had ≤8 SYs. Chronic back pain was declared by 134 (61%) with 32 (14.6%), 25 (11.9%), and 63 (28.3%) fulfilling ASAS, Berlin, and Calin's IBP criteria, respectively. Chronic back pain or IBP prevalence was similar regardless of ethnicity, smoking habit, income, or literacy with IBP prevalence higher among women (p = 0.006).

Conclusions

This is the first report on IBP prevalence in a low-income, low-literacy population. Chronic back pain was highly prevalent with almost 15% having IBP using ASAS criteria. Inflammatory back pain prevalence looked similar using ASAS and Berlin criteria; values were higher using Calin's criteria. Literacy or income did not influence IBP prevalence in this population, which was higher among women. The higher prevalence of IBP using Calin's criteria in this population should be taken into account as it might impact studies aiming to determine prevalence of axial spondyloarthritis in clinical studies in this scenario.
Caudal Septal Deviation
Authors: Wiederkehr Iris , Kawabata Yuya , Tsumiyama Shinya , Hosokawa Yu , Iimura Jiro , Otori Nobuyoshi , Miyawaki Takeshi
Published: January 2022

Objective

Caudal septal deviation (CSD) correction during septorhinoplasty is challenging, and various surgical modifications and evaluations remain controversial. This study aimed to introduce an objective evaluation method based on computed tomography (CT) images to measure the effectiveness of septorhinoplasty for CSD treatment.

Methods

We retrospectively analyzed preoperative and postoperative CT images of patients who had undergone functional open septorhinoplasty by the plastic surgery and otorhinolaryngology teams between January and September 2019. Using OsiriX Lite (Pixmeo, Switzerland), CSD was calculated as the distance between the septum midline and palatal plane. Deformation was categorized as C-shaped unilateral or S-shaped bilateral deviations. The change in the distance between preoperative and postoperative images was considered because of surgical intervention.

Results

Twenty patients (mean age, 35 years; 13 males [65%], 7 females [35%]) were included. The median deviation was 3.01 mm (range, 0.45–7.34 mm) preoperatively and 1.6 mm (range, 0.5–2.86 mm) postoperatively, indicating a reduction of 1.26 mm (median, P < 0.05) due to surgical intervention. C- and S-shaped deviations were seen preoperatively in 9 (45%) and 11 (55%) patients and postoperatively in 6 (30%) and 14 (70%) patients, respectively. The mean ± SD time of analysis was 7 ± 2.1 minutes.

Conclusions

Caudal septal deviation showed significant changes from preoperative to postoperative CT images, based on the distance between the actual septum midline and the constructed straight septum. This allowed effective evaluation of surgical efficacy for septum straightening. Although additional studies are needed, this method allows clearer stratification of surgical outcomes.
Long-term Functional Outcomes Among Older Adults Undergoing Video-assisted Versus Open Surgery for Lung Cancer
Authors: Hallet Julie , Rousseau Mathieu , Gupta Vaibhav , Hirpara Dhruvin , Zhao Haoyu , Coburn Natalie , Darling Gail , Kidane Biniam ,   Members of the REcovery After Surgical Therapy for Older Adults Research – Cancer (RESTORE-Cancer) Group
Published: January 2022

Objective:

To examine the long-term healthcare dependency outcomes of older adults undergoing VATS compared to open lung cancer resection.

Summary of Background Data:

Although the benefits of VATS for lung cancer resection have been reported, there is a knowledge gap related to long-term functional outcomes central to decision-making for older adults.

Methods:

We conducted a population-based retrospective comparative cohort study of patients ≥70 years old undergoing lung cancer resection between 2010 and 2017 using linked administrative health databases. VATS was compared to open surgery for lung cancer resection. Outcomes were receipt of homecare and high time-at-home, defined as <14 institution-days within 1 year, in 5 years after surgery. We used time-to-event analyses. Homecare was analyzed as recurrent dichotomous outcome with Andersen-Gill multivariable models, and high time-at-home with Cox multivariable models.

Results:

Of 4974 patients, 2951 had VATS (59.3%). In the first three months postoperatively, homecare use ranged from 17.5% to 34.4% for VATS and 23.0% to 36.6% for open surgery. VATS was independently associated with lower need for postoperative homecare over 5 years (hazard ratio 0.82, 95% confidence interval 0.74-0.92). 1- and 5-year probability of high “time-at-home” were superior for VATS (74.4% vs 66.7% and 55.6% vs 45.4%, p < 0.001). VATS was independently associated with higher probability of high “time-at-home” (hazard ratio 0.81, 95% confidence interval 0.74-0.89) compared to open surgery.

Conclusions:

Compared to open surgery, VATS was associated with lower homecare needs and higher probability of high “time-at-home,” indicating reduced long-term functional dependence. Those important patient-centered endpoints reflect the overall long-term treatment burden on mortality and morbidity that can inform surgical decision-making.
Postoperative Opioid Prescribing and New Persistent Opioid Use
Authors: Howard Ryan , Brown Craig S. , Lai Yen-Ling , Gunaseelan Vidhya , Brummett Chad M. , Englesbe Michael , Waljee Jennifer , Bicket Mark C.
Published: January 2022

Objective:

Evaluate the association between postoperative opioid prescribing and new persistent opioid use.

Summary Background Data:

Opioid-nave patients who develop new persistent opioid use after surgery are at increased risk of opioid-related morbidity and mortality. However, the extent to which postoperative opioid prescribing is associated with persistent postoperative opioid use is unclear.

Methods:

Retrospective study of opioid-naïve adults undergoing surgery in Michigan from 1/1/2017 to 10/31/2019. Postoperative opioid prescriptions were identified using a statewide clinical registry and prescription fills were identified using Michigan's prescription drug monitoring program. The primary outcome was new persistent opioid use, defined as filling at least 1 opioid prescription between post-discharge days 4 to 90 and filling at least 1 opioid prescription between post-discharge days 91 to 180.

Results:

A total of 37,654 patients underwent surgery with a mean age of 52.2 (16.7) years and 20,923 (55.6%) female patients. A total of 31,920 (84.8%) patients were prescribed opioids at discharge. Six hundred twenty-two (1.7%) patients developed new persistent opioid use after surgery. Being prescribed an opioid at discharge was not associated with new persistent opioid use [adjusted odds ratio (aOR) 0.88 (95% confidence interval (CI) 0.71-1.09)]. However, among patients prescribed an opioid, patients prescribed the second largest [12 (interquartile range (IQR) 3) pills] and largest [20 (IQR 7) pills] quartiles of prescription size had higher odds of new persistent opioid use compared to patients prescribed the smallest quartile [7 (IQR 1) pills] of prescription size [aOR 1.39 (95% CI 1.04-1.86) andaOR 1.97 (95% CI 1.442.70), respectively].

Conclusions:

In a cohort of opioid-naïve patients undergoing common surgical procedures, the risk of new persistent opioid use increased with the size of the prescription. This suggests that while opioid prescriptions in and of themselves may not place patients at risk of long-term opioid use, excessive prescribing does. Consequently, these findings support ongoing efforts to mitigate excessive opioid prescribing after surgery to reduce opioid-related harms.
Into the wild—a field study on the evolutionary and ecological importance of thermal plasticity in ectotherms across temperate and tropical regions
Authors: Noer Natasja K. , Ørsted Michael , Schiffer Michele , Hoffmann Ary A. , Bahrndorff Simon , Kristensen Torsten N.
Published: January 2022

Understanding how environmental factors affect the thermal tolerance of species is crucial for predicting the impact of thermal stress on species abundance and distribution. To date, species' responses to thermal stress are typically assessed on laboratory-reared individuals and using coarse, low-resolution, climate data that may not reflect microhabitat dynamics at a relevant scale. Here, we examine the daily temporal variation in heat tolerance in a range of species in their natural environments across temperate and tropical Australia. Individuals were collected in their habitats throughout the day and tested for heat tolerance immediately thereafter, while local microclimates were recorded at the collection sites. We found high levels of plasticity in heat tolerance across all the tested species. Both short- and long-term variability of temperature and humidity affected plastic adjustments of heat tolerance within and across days, but with species differences. Our results reveal that plastic changes in heat tolerance occur rapidly at a daily scale and that environmental factors on a relatively short timescale are important drivers of the observed variation in thermal tolerance. Ignoring such fine-scale physiological processes in distribution models might obscure conclusions about species' range shifts with global climate change.

This article is part of the theme issue ‘Species’ ranges in the face of changing environments (part 1)’.
Gene surfing of underdominant alleles promotes formation of hybrid zones
Authors: Gilbert Kimberly J. , Moinet Antoine , Peischl Stephan
Published: January 2022

The distribution of genetic diversity over geographical space has long been investigated in population genetics and serves as a useful tool to understand evolution and history of populations. Within some species or across regions of contact between two species, there are instances where there is no apparent ecological determinant of sharp changes in allele frequencies or divergence. To further understand these patterns of spatial genetic structure and potential species divergence, we model the establishment of clines that occur due to the surfing of underdominant alleles during range expansions. We provide analytical approximations for the fixation probability of underdominant alleles at expansion fronts and demonstrate that gene surfing can lead to clines in one-dimensional range expansions. We extend these results to multiple loci via a mixture of analytical theory and individual-based simulations. We study the interaction between the strength of selection against heterozygotes, migration rates, and local recombination rates on the formation of stable hybrid zones. Clines created by surfing at different loci can attract each other and align after expansion, if they are sufficiently close in space and in terms of recombination distance. Our findings suggest that range expansions can set the stage for parapatric speciation due to the alignment of multiple selective clines, even in the absence of ecologically divergent selection.

This article is part of the theme issue ‘Species' ranges in the face of changing environments (part I)’.
On the macroecological significance of eco-evolutionary dynamics: the range shift–niche breadth hypothesis
Authors: Lancaster Lesley T.
Published: January 2022

Global correlations of range size and niche breadth, and their relationship to latitude, have long intrigued ecologists and biogeographers. Study of these patterns has given rise to a number of hypothesized ecological and evolutionary processes purported to shape biogeographic outcomes, including the climate variability hypothesis, oscillation hypothesis, ecological opportunity, competitive release and taxon cycles. Here, I introduce the alternative
range shift–niche breadth hypothesis
, which posits that broader niches and larger range sizes are jointly determined under eco-evolutionary processes unique to expanding ranges, which may or may not be adaptive, but which co-shape observed latitudinal gradients in niche breadth and range size during periods of widespread range expansion. I formulate this hypothesis in comparison against previous hypotheses, exploring how each relies on equilibrium versus non-equilibrium evolutionary processes, faces differing issues of definition and scale, and results in alternative predictions for comparative risk and resilience of global ecosystems. Such differences highlight that accurate understanding of process is critical when applying macroecological insight to biodiversity forecasting. Furthermore, past conceptual emphasis on a central role of local adaptation under equilibrium conditions may have obscured a ubiquitous role of non-equilibrium evolutionary processes for generating many important, regional and global macroecological patterns.

This article is part of the theme issue ‘Species’ ranges in the face of changing environments (part I)’.