bluuebunny/crossref_metadata_2025 huggingface dataset:
Repercussions of intermittent fasting on the intestinal microbiota community and body composition: a systematic review
Authors: Pinto Flaydson C S , Silva Amanda A M , Souza Sandra L
Published: November 2021

Context

Several therapies have been tested for combating weight gain and obesity-related metabolic diseases, and among these therapies, intermittent fasting (IF) has gained a great deal of interest.

Objective

The aim of this study was to provide the reader with a current survey of IF protocols and an understanding of the outcomes found to date in terms of the profile of the intestinal microbiota (IM) in obese organisms.

Data Sources

Data were obtained from 4 databases: PubMed, SCOPUS, LILACs, and Web of Science.

Data Extraction

Data from studies relating IF protocols to the microbiota and weight loss were extracted using a protocol in START program.

Data Analysis

Of the 82 original articles identified from the databases, 35 were eliminated due to duplication, and 32 were excluded due to not meeting the inclusion criteria. Two additional articles found in a new search were added, yielding a total of 17 studies to be included in this review. Among the protocols, alternate-day fasting (ADF) and time-restricted feeding (TRF) were the most common, and they were shown to have different mechanisms of metabolic signaling. TRF influences weight control and biochemical parameters by regulating the circadian system, and improving satiety control systems by acting on leptin secretion. On the other hand, ADF leads to a reduction of ±75% of all energy consumption regardless of dietary composition in addition to promoting hormonal adjustments that promote weight control. Furthermore, both protocols showed the ability to remodel the IM by changing the Firmicutes/Bacteroidetes ratio and increasing the abundance of strains such as Lactobacillus spp. and Akkermansia m. that have a protective effect on metabolism against the effects of weight gain.

Conclusion

In short, the ADF and TRF protocols have a positive effect on the remodeling of the IM and can possibly be used to control body adiposity, improve insulin sensitivity, and achieve other obesity-related metabolic changes.
Healthcare Utilization Patterns for Patients with a History of Substance Use Requiring OPAT
Authors: Ashraf Bilal , Hoff Emily , Brown L Steven , Smartt Jillian , Mathew Sheryl , Bird Cylaina , Collins Ryan , Johnson David , Marambage Kapila , Bhavan Kavita
Published: November 2021

Background

Uninsured people who use drugs (PWUD) require extended parenteral antibiotic therapy when diagnosed with complex infections such as osteomyelitis. They are ineligible to enroll in our self-administered outpatient antimicrobial therapy (S-OPAT) program and instead sent to a skilled nursing facility (SNF). We aim to retrospectively assess clinical outcomes of PWUD discharged from our safety net hospital to complete OPAT in a SNF.

Methods

Using our hospital electronic medical record, PWUD and discharged to SNF for extended antibiotic therapy were identified for the study period 1/1/17 -4/30/18. Demographics, drug use, discharge diagnosis, antibiotic therapy, discharge disposition from SNF (AMA, early non-AMA, completed), 30-day emergency department (ED) utilization, and 30-day readmission were collected for the study cohort. ED-utilization and 30-day readmission rates were analyzed by disposition group.

Results

While the majority of patients completed treatment (83), a sizeable number left AMA (26) or early non-AMA (20) Patients who left early, AMA or non-AMA, had increased rates of 30-day readmission or ED-utilization (p=0.01), increased rates of 30-day readmission alone (p=0.01), but not ED-utilization alone (p=0.43) compared to patients who completed treatment.

Conclusions

In our cohort, many PWUD discharged to SNF to receive parenteral antibiotics do not complete treatment. These patients are observed to have increased healthcare utilization compared to patients completing therapy.
Arclogites in the Subarc Lower Crust: Effects of Crystallization, Partial Melting, and Retained Melt on the Foundering Ability of Residual Roots
Authors: Bowman Emilie E , Ducea Mihai N , Triantafyllou Antoine
Published: November 2021

Thick-crusted (>45 km) Cordilleran arcs exhibit cyclic processes including periods of magmatic quiescence interspersed with pulses of high-flux magmatism. Most models assume that during high-flux events, fractional crystallization and partial melting within the deep crustal hot zone generate a dense (>3.4 g/cm3) arclogitic subarc root that can readily founder into the mantle. Yet these models do not consider that: (1) the retention of low-density melt within the subarc root, and (2) the protolith lithology of the restitic portion of the subarc root may greatly impact the density evolution of the root and its susceptibility to foundering. In this article, we first address the effect of retained melt on the foundering ability of the subarc root by calculating the density and time for foundering of melt-bearing arclogitic residue at 1.5, 2, and 2.5 GPa. We find that melt volumes >10–18% are required to stabilize the root within the lower crust; melt volumes below this threshold lower the viscosity of the residue so much so as to decrease the time for foundering by an order of magnitude. We then constrain through phase equilibria modeling the effect of partial melting of different lower crustal protoliths on the density of the restitic subarc root. To do this, we model the density and mineralogical evolution of restites in equilibrium with their derivative melts during open-system, isobaric partial melting of typical crustal assemblages from 600–1100°C at 1.5 (~50 km) and 2 GPa (~65 km). In our models, typical end-member assemblages in a lower crustal hot zone include basalt, metapelite, and metagraywacke. We find that melt-depleted restites derived from basaltic compositions are amphibole-bearing arclogites with densities conducive to foundering, which at 2 GPa can occur even in the presence of the coexisting hydrous felsic residual melt. Foundering of the amphibole ± melt-bearing root may refertilize the mantle wedge and induce melting of the surrounding asthenosphere as well as the arclogitic mass. However, if temperatures in a 50-km deep subarc hot zone are not sufficient to drive melt depletion of basaltic restites, these dense (3.1–3.3 g/cm3) residues are gravitationally stable, increasing the density of the lower crust and lowering the elevation of the arc. In comparison, partial melting of metasedimentary country rock produces alkali feldspar-rich residues that never achieve densities conducive to foundering. Thus, if high-flux events are driven by the influx of melt-fertile lithosphere beneath the arc as envisioned by the Cordilleran cycle model, then partial melting of the metasedimentary portion will generate low-density residues that remain in the lower crust and contribute to the thickness, geochemistry, and seismic structure of the bulk arc.
The evolutionarily conserved kinase SnRK1 orchestrates resource mobilization during Arabidopsis seedling establishment
Authors: Henninger Markus , Pedrotti Lorenzo , Krischke Markus , Draken Jan , Wildenhain Theresa , Fekete Agnes , Rolland Filip , Müller Martin J , Fröschel Christian , Weiste Christoph , Dröge-Laser Wolfgang
Published: November 2021

The onset of plant life is characterized by a major phase transition. During early heterotrophic seedling establishment, seed storage reserves fuel metabolic demands, allowing the plant to switch to autotrophic metabolism. Although metabolic pathways leading to storage compound mobilization are well-described, the regulatory circuits remain largely unresolved. Using an inducible knockdown approach of the evolutionarily conserved energy master regulator Snf1-RELATED-PROTEIN-KINASE1 (SnRK1), phenotypic studies reveal its crucial function in Arabidopsis thaliana seedling establishment. Importantly, glucose feeding largely restores growth defects of the kinase mutant, supporting its major impact in resource mobilization. Detailed metabolite studies reveal sucrose as a primary resource early in seedling establishment, in a SnRK1-independent manner. Later, SnRK1 orchestrates catabolism of triacylglycerols and amino acids. Concurrent transcriptomic studies highlight SnRK1 functions in controlling metabolic hubs fuelling gluconeogenesis, as exemplified by cytosolic PYRUVATE ORTHOPHOSPHATE DIKINASE (cyPPDK). Here, SnRK1 establishes its function via phosphorylation of the transcription factor BASIC LEUCINE ZIPPER63 (bZIP63), which directly targets and activates the cyPPDK promoter. Taken together, our results disclose developmental and catabolic functions of SnRK1 in seed storage mobilization and describe a prototypic gene regulatory mechanism. As seedling establishment is important for plant vigor and crop yield, our findings are of agronomical importance.
Implementing a stand-alone investigative unit to clear non-fatal shooting cases
Authors: Phillips Scott W , Kim Dae-Young , Drake Greg M , Altheimer Irshad
Published: November 2021

This research contributes to the small but growing body of scholarship examining non-fatal shooting cases. This study is particularly important considering the recent increase in the number of shooting incidents in the USA, and the fact that there are often many more non-fatal shooting cases than fatal outcomes. The Buffalo Police Department developed a specific investigative unit focusing exclusively on non-fatal shootings with the expectation that this would allow one group of detectives to focus on all homicides, while the other group focused exclusively on non-fatal shootings. Data from the Buffalo Police Department included both fatal and non-fatal shooting incidents, and an interrupted time series analysis was used to determine if there was an increase in the number of cases cleared by arrest. Results indicated that the implementation of the specific investigative unit did not influence clearances for non-fatal shootings. Furthermore, contrary to expectations, the numbers of clearances for homicides in the post-intervention period were significantly lower than those in the pre-intervention period. Two conclusions are offered. First, the non-fatal shooting unit was not structured in a way that mimicked a homicide unit, thus lacking the resources to clear non-fatal shooting cases. Secondly, separating investigative units created a ‘silo effect’ where the units may not have communicated enough on similar incidents.
Public Debt, Consumption Growth, and the Slope of the Term Structure
Authors: Nguyen Thien T
Published: November 2021

The debt-to-GDP ratio negatively predicts cumulative nominal consumption growth up to a 10-year horizon, resulting from the ratio’s ability to forecast lower inflation and real growth. Moreover, the debt-to-GDP ratio is positively associated with yield spreads. I rationalize these facts in a model in which positive shocks to government debt cause lower inflation and growth, making bonds attractive assets. Furthermore, because longer-term bonds are less exposed to current debt shock than are shorter-term bonds, they are better hedges, resulting in high yield spreads in high-debt states. The model highlights the importance of fiscal risk in understanding the Treasury bond market.

Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online.
CCR2- and CCR5-mediated macrophage infiltration contributes to glomerular endocapillary hypercellularity in antibody-induced lupus nephritis
Authors: Zoshima Takeshi , Baba Tomohisa , Tanabe Yamato , Ishida Yuko , Nakatani Kimihiko , Nagata Michio , Mukaida Naofumi , Kawano Mitsuhiro
Published: November 2021

Objectives

LN comprises various glomerular lesions, including endocapillary hypercellularity with macrophage infiltration. In this study, we aimed to clarify the involvement of macrophage-tropic chemokine receptors in the pathogenesis of these glomerular lesions.

Methods

MRL/lpr mouse-derived monoclonal IgG3 antibody-producing hybridomas, 2B11.3 and B1, were injected intraperitoneally into BALB/c mice [wild type (WT)] to induce endocapillary hypercellularity and wire-loop lesions, respectively. The expression of chemokine and chemokine receptors was analysed by quantitative real-time PCR and IF. The roles of chemokine receptors in these lesions were evaluated using chemokine receptor-deficient mice or a selective CCR5 antagonist, maraviroc.

Results

2B11.3 caused glomerular endocapillary hypercellularity with a significant number of glomerular CD68-positive macrophages. Further, enhanced expression of CCL2, CCL3, CCR2, CCR5 and CX3CR1 was observed in the renal cortex, compared with B1 injection, which induced wire-loop lesions. In 2B11.3-induced glomerular lesions, CD68 -positive glomerular macrophages expressed CCL2, CCL3, CCR2, CCR5 and CX3CR1, while glomerular endothelial cells expressed CCL2, CCL3, CX3CL1 and CCR2. When 2B11.3 was injected, CCR2–/– and CCR5–/–, but not CX3CR1–/–, mice exhibited reduced endocapillary hypercellularity, attenuated glomerular macrophage infiltration and improved serum blood urea nitrogen levels. Only CCR2–/– mice developed wire-loop lesions. B1 injection caused wire-loop lesions in these chemokine receptor-deficient mice to a similar extent as WT. Maraviroc treatment reduced 2B11.3-induced endocapillary hypercellularity and improved serum blood urea nitrogen levels.

Conclusion

CCR2 and CCR5 regulate glomerular macrophage infiltration and contribute to the development of glomerular endocapillary hypercellularity in LN. CCR5 inhibition can be a specific therapy for endocapillary hypercellularity without inducing wire-loop lesions.
Disparity in peripheral and renal B-cell depletion with rituximab in systemic lupus erythematosus: an opportunity for obinutuzumab?
Authors: Reddy Venkat R , Pepper Ruth J , Shah Kavina , Cambridge Geraldine , Henderson Scott R , Klein Christian , Kell Loren , Taylor Samuel J , Isenberg David A , Cragg Mark S , Leandro Maria J
Published: November 2021

Objectives

To investigate key factors that may contribute to the variability of rituximab-mediated peripheral and renal B cell depletion (BCD) in SLE.

Methods

We analysed: (i) CD19+ B cell counts in patients with SLE before and 1, 2, 3 and 6 months after treatment with rituximab, comparing them with RA patients; (ii) the presence of B cells in renal biopsies after rituximab therapy; (iii) whether the duration of BCD correlated with patient demographics and B cell expression of CD20 and FcγRIIb; and (iv) the effect of B cell activation factor (BAFF) on the efficiency of rituximab and obinutuzumab at inducing BCD in whole blood assays, in vitro.

Results

In SLE (n = 71), the duration of BCD was shorter compared with RA (n = 27). B cells were detectable in renal biopsy samples (n = 6) after treatment with rituximab in all patients with poor response while peripheral blood B cells remained low or undetectable in the same patients. There were no significant relationships between peripheral BCD and patient age, disease duration, serum C3 levels or the level of expression of B cell surface proteins CD20 and FcγRIIb. Obinutuzumab was more efficient than rituximab at inducing BCD in whole blood assays, regardless of excess BAFF.

Conclusions

BCD in SLE is less efficient than in RA. Renal B cell presence following rituximab treatment was associated with poor outcomes. No significant relationships between any measured B cell related, clinical or laboratory parameters and the efficiency of BCD by rituximab was found. Obinutuzumab was superior to rituximab at inducing BCD.
Brain activation during cognitive reappraisal depending on regulation goals and stimulus valence
Authors: Sokołowski Andrzej , Morawetz Carmen , Folkierska-Żukowska Monika , Łukasz Dragan Wojciech
Published: November 2021

Neural bases of cognitive reappraisal may depend on the direction of regulation (up- or downregulation) and stimulus valence (positive or negative). This study aimed to examine this using a cognitive reappraisal task and conjunction analysis on a relatively large sample of 83 individuals. We identified regions in which activations were common for all these types of emotion regulation. We also investigated differences in brain activation between the ‘decrease’ and ‘increase’ emotional response conditions, and between the regulation of negative and positive emotions. The common activation across conditions involved mainly the prefrontal and temporal regions. Decreasing emotions was associated with stronger involvement of the dorsolateral prefrontal cortex, while increasing with activation of the amygdala and hippocampus. Regulation of negative emotions involved stronger activation of the lateral occipital cortex, while regulation of positive emotions involved stronger activation of the anterior cingulate cortex extending to the medial prefrontal cortex. This study adds to previous findings, not only by doing a conjunction analysis on both emotional valences and regulation goals, but also doing this in a bigger sample size. Results suggest that reappraisal is not a uniform process and may have different neural bases depending on regulation goals and stimulus valence.
Diverging Trends in Single-Mother Poverty across Germany, Sweden, and the United Kingdom: Toward a Comprehensive Explanatory Framework
Authors: Zagel Hannah , Hübgen Sabine , Nieuwenhuis Rense
Published: November 2021

To explain single-mother poverty, existing research has either emphasized individualistic, or contextual explanations. Building on the prevalences and penalties framework (Brady et al. 2017), we advance the literature on single-mother poverty in three aspects: First, we extend the framework to incorporate heterogeneity among single mothers across countries and over time. Second, we apply this extended framework to Germany, the United Kingdom and Sweden, whose trends in single-mother poverty (1990–2014) challenge ideal-typical examples of welfare state regimes. Third, using decomposition analyses, we demonstrate variation across countries in the relative importance of prevalences and penalties to explain time trends in single-mother poverty. Our findings support critiques of static welfare regime typologies, which are unable to account for policy change and poverty trends of single mothers. We conclude that we need to understand the combinations of changes in single mothers’ social compositions and social policy contexts, if we want to explain time trends in single-mother poverty.
Binge Ethanol Exposure in Mice Represses Expression of Genes Involved in Osteoblast Function and Induces Expression of Genes Involved in Osteoclast Differentiation Independently of Endogenous Catalase
Authors: Denys Alexandra , Pedersen Kim B , Watt James , Norman Allison R , Osborn Michelle L , Chen Jin-Ran , Maimone Cole , Littleton Shana , Vasiliou Vasilis , Ronis Martin J J
Published: November 2021

Excessive ethanol consumption is a risk factor for osteopenia. Since a previous study showed that transgenic female mice with overexpression of catalase are partially protected from ethanol-mediated trabecular bone loss, we investigated the role of endogenous catalase in skeletal ethanol toxicity comparing catalase knockout to wild-type mice. We hypothesized that catalase depletion would exacerbate ethanol effects. The mice were tested in a newly designed binge ethanol model, in which 12-week-old mice were exposed to 4 consecutive days of gavage with ethanol at 3, 3, 4, and 4.5 g ethanol/kg body weight. Binge ethanol decreased the concentration of serum osteocalcin, a marker of bone formation. The catalase genotype did not affect the osteocalcin levels. RNA sequencing of femoral shaft RNA from males was conducted. Ethanol exposure led to significant downregulation of genes expressed in cells of the osteoblastic lineage with a role in osteoblastic function and collagen synthesis, including the genes encoding major structural bone proteins. Binge ethanol further induced a smaller set of genes with a role in osteoclastic differentiation. Catalase depletion affected genes with expression in erythroblasts and erythrocytes. There was no clear interaction between binge ethanol and the catalase genotype. In an independent experiment, we confirmed that the binge ethanol effects on gene expression were reproducible and occurred throughout the skeleton in males. In conclusion, the binge ethanol exposure, independently of endogenous catalase, reduces expression of genes involved in osteoblastic function and induces expression of genes involved in osteoclast differentiation throughout the skeleton in males.
Host Plant Adaptation Drives Changes inDiaphorina citriProteome Regulation, Proteoform Expression, and Transmission of ‘CandidatusLiberibacter asiaticus’, the Citrus Greening Pathogen
Authors: Ramsey John S. , Ammar El-Desouky , Mahoney Jaclyn E. , Rivera Keith , Johnson Richard , Igwe David O. , Thannhauser Theodore W. , MacCoss Michael J. , Hall David G. , Heck Michelle
Published: November 2021

The Asian citrus psyllid (Diaphorina citri) is a pest of citrus and the primary insect vector of the bacterial pathogen, ‘Candidatus Liberibacter asiaticus’ (CLas), which is associated with citrus greening disease. The citrus relative Murraya paniculata (orange jasmine) is a host plant of D. citri but is more resistant to CLas compared with all tested Citrus genotypes. The effect of host switching of D. citri between Citrus medica (citron) and M. paniculata plants on the acquisition and transmission of CLas was investigated. The psyllid CLas titer and the proportion of CLas-infected psyllids decreased in the generations after transfer from CLas-infected citron to healthy M. paniculata plants. Furthermore, after several generations of feeding on M. paniculata, pathogen acquisition (20 to 40% reduction) and transmission rates (15 to 20% reduction) in psyllids transferred to CLas-infected citron were reduced compared with psyllids continually maintained on infected citron. Top-down (difference gel electrophoresis) and bottom-up (shotgun MS/MS) proteomics methods were used to identify changes in D. citri protein expression resulting from host plant switching between Citrus macrophylla and M. paniculata. Changes in expression of insect metabolism, immunity, and cytoskeleton proteins were associated with host plant switching. Both transient and sustained feeding on M. paniculata induced distinct patterns of protein expression in D. citri compared with psyllids reared on C. macrophylla. The results point to complex interactions that affect vector competence and may lead to strategies to control the spread of citrus greening disease.
Cutting Through the Noise: Noise-Induced Cochlear Synaptopathy and Individual Differences in Speech Understanding Among Listeners With Normal Audiograms
Authors: DiNino Mishaela , Holt Lori L. , Shinn-Cunningham Barbara G.
Published: November 2021

Following a conversation in a crowded restaurant or at a lively party poses immense perceptual challenges for some individuals with normal hearing thresholds. A number of studies have investigated whether noise-induced cochlear synaptopathy (CS; damage to the synapses between cochlear hair cells and the auditory nerve following noise exposure that does not permanently elevate hearing thresholds) contributes to this difficulty. A few studies have observed correlations between proxies of noise-induced CS and speech perception in difficult listening conditions, but many have found no evidence of a relationship. To understand these mixed results, we reviewed previous studies that have examined noise-induced CS and performance on speech perception tasks in adverse listening conditions in adults with normal or near-normal hearing thresholds. Our review suggests that superficially similar speech perception paradigms used in previous investigations actually placed very different demands on sensory, perceptual, and cognitive processing. Speech perception tests that use low signal-to-noise ratios and maximize the importance of fine sensory details— specifically by using test stimuli for which lexical, syntactic, and semantic cues do not contribute to performance—are more likely to show a relationship to estimated CS levels. Thus, the current controversy as to whether or not noise-induced CS contributes to individual differences in speech perception under challenging listening conditions may be due in part to the fact that many of the speech perception tasks used in past studies are relatively insensitive to CS-induced deficits.
Auditory Brainstem Response Detection Using Machine Learning: A Comparison With Statistical Detection Methods
Authors: McKearney Richard M. , Bell Steven L. , Chesnaye Michael A. , Simpson David M.
Published: November 2021

Objectives:

The primary objective of this study was to train and test machine learning algorithms to be able to detect accurately whether EEG data contains an auditory brainstem response (ABR) or not and recommend suitable machine learning methods. In addition, the performance of the best machine learning algorithm was compared with that of prominent statistical detection methods.

Design:

Four machine learning algorithms were trained and evaluated using nested k-fold cross-validation: a random forest, a convolutional long short-term memory network, a stacked ensemble, and a multilayer perceptron. The best method was evaluated on a separate test set and compared with conventional detection methods: Fsp, Fmp, q-sample uniform scores test, and Hotelling’s T2 test. The models were trained and tested on simulated data that were generated based on recorded ABRs collected from 12 normal-hearing participants and no-stimulus EEG data from 15 participants. Simulation allowed the ground truth of the data (“response present” or “response absent”) to be known.

Results:

The sensitivity of the best machine learning algorithm, a stacked ensemble, was significantly greater than that of the conventional detection methods evaluated. The stacked ensemble, evaluated using a bootstrap approach, consistently achieved a high and stable level of specificity across ensemble sizes.

Conclusions:

The stacked ensemble model presented was more effective than conventional statistical ABR detection methods and the alternative machine learning approaches tested. The stacked ensemble detection method may have potential both in automated ABR screening devices as well as in evoked potential software, assisting clinicians in making decisions regarding a patient’s ABR threshold. Further assessment of the model’s generalizability using a large cohort of subject recorded data, including participants of different ages and hearing status, is a recommended next step.
Patient reported outcomes in systemic vasculitis
Authors: Crawshaw Helena , Wells Matthew , Austin Keziah , Janagan Shalini , Robson Joanna C.
Published: November 2021

Purpose of review

This review paper evaluates the use of patient reported outcome (PROs) in systemic vasculitis and the increasing incorporation of these measures in the evaluation of clinical outcomes and healthcare provision.

Recent findings

Generic PROs such as the SF-12, SF-36, EQ-5D have been used to evaluate health-related quality of life (HRQOL) across the spectrum of vasculitis; including giant cell arteritis, antineutrophil cytoplasmic antibody (ANCA)-related vasculitis and immunoglobulin A vasculitis (IgA) vasculitis. More recently disease-specific PROs have been developed including the associated vasculitis (AAV)-PRO and GCA-PRO, whilst further work is ongoing including a Steroid-PRO.

Generic and disease-specific PROs are complimentary in nature, but the advent of disease-specific PROs allows evaluation of the impact of specific symptoms and intervention on patient HRQOL. Following the COVID-19 pandemic, the advent of increasing virtual work has brought the potential for electronic-PRO measures to the forefront and is a current area of interest.
A Comparison of Two Cross-Sectional Studies on Successful Model of Introducing Nursing Information System in a Regional Teaching Hospital in Taiwan
Authors: Yang Meei-Horng , Liu Chieh-Yu , Wang Tsae-Jyy , Lee Yea-Hui , Ko Shu-Hua , Chao Shan-Ching , Lin Hung-Ru
Published: November 2021

Nursing information system introduction is an important measure for hospital nursing departments to promote the clinical practice of nursing with both efficiency and quality. A comparison of two cross-sectional study designs was adopted, and the information systems success model, as proposed by DeLone and McLean (2003), was used to explore the effectiveness of the six dimensions of system quality, information quality, service quality, use, user satisfaction, and net benefits at 6 and 12 months after the introduction launch of the nursing information system in hospitals. Multiple regression analysis was used across the two cross-sectional studies. The research results found that the nursing information system conformed to the information systems success model, and half a year to 1 year after the introduction of the nursing information system, use affected the nursing information system net benefits via the mediator variable of user satisfaction; however, the effect of full mediation changed to partial mediation effect with time. The research results can be used as a reference for hospitals and nursing administrators for the newly developed nursing information system.
Patients' Technology Readiness and eHealth Literacy
Authors: Lee Wan Ling , Lim Zi Jing , Tang Li Yoong , Yahya Nor Aziyan , Varathan Kasturi Dewi , Ludin Salizar Mohamed
Published: November 2021

The COVID-19 pandemic has rerouted the healthcare ecosystem by accelerating digital health, and rapid adoption of eHealth is partly influenced by eHealth literacy (eHL). This study aims to examine patients' eHL in relation to their “technology readiness”—an innate attitude that is underexplored in clinical research. A total of 276 adult inpatients with hypertension, diabetes mellitus, and coronary heart disease were surveyed cross-sectionally in 2019 using self-reported questionnaires: eHealth Literacy Scale and Technology Readiness Index (2.0). The study found moderate eHL (mean, 27.38) and moderate technology readiness (mean, 3.03) among patients. The hierarchical regression model shows that lower eHL scores were associated with patients of minor ethnicity (Malaysian Chinese), with an unemployed status, and having >1 cardiovascular risk (β = −0.136 to −0.215, R
2 = 0.283, Ps < .005). Technology readiness is a strong determinant of eHL (ΔR
2 = 0.295, P < .001) with its subdomains (optimism, innovativeness, and discomfort) significantly influencing eHL (|β| = 0.28-0.40, Ps < .001), except for the insecurity subdomain. Deployment of eHealth interventions that incorporate assessment of patients' eHL and technology readiness will enable targeted strategies, especially in resource-limited settings hit hard by the pandemic crisis.
Decreased Systemic Busulfan Exposure After Oral Dosing With Concomitant Levetiracetam Compared With Phenytoin
Authors: Artul Tareq , Henig Israel , Nassar Laila , Yehudai-Ofir Dana , Scherb Inna , Lurie Yael , Efrati Edna , Zuckerman Tsila , Kurnik Daniel
Published: November 2021

Background:

Busulfan (Bu) conditioning used in hematopoietic stem cell transplantation may induce seizures, and prophylactic antiepileptic treatment is recommended. Following updated guidelines, in August 2019, the adult hematopoietic stem cell transplantation department of the Rambam Health Care Campus (Haifa, Israel) switched the antiepileptic prophylaxis protocol from phenytoin to oral levetiracetam during oral Bu conditioning. The aim of this study was to compare the pharmacokinetic parameters of Bu after oral dosing between patients receiving phenytoin and those receiving levetiracetam prophylaxis.

Methods:

This study was a retrospective cohort study in adults undergoing myoablative conditioning with oral Bu between August 2018 and August 2020. Bu pharmacokinetic parameters (AUC0-6, C0, Cmax, and Tmax) were compared in patients treated with phenytoin comedication (during the year before the change in policy) and levetiracetam comedication (during the year after the change). Potential confounders were accounted for including age, azole comedication, and body weight.

Results:

There were no significant differences in demographic and clinical parameters or weight-corrected Bu dose between the phenytoin group (n = 28) and the levetiracetam group (n = 25). There was no difference in the rate of voriconazole comedication, but fluconazole was more common in the phenytoin group (P = 0.026). The median AUC0-6 was significantly lower in the levetiracetam group (949 μM*min; IQR = 806 to 1101 μM*min) than in the phenytoin group (1208 μM*min; IQR = 1087 to 1389 μM*min; P < 0.001). This is a clinically significant difference of 258 μM*min (21%). Azole use was not associated with Bu exposure.

Conclusions:

The findings suggest that, after treatment with oral Bu, oral levetiracetam comedication is associated with reduced systemic exposure compared with phenytoin comedication, possibly because of decreased bioavailability.
A 30-Year Radiation Safety Prospectus Describing Organizational Drivers, Program Activities, and Outcomes
Authors: Gutierrez J. M. , Emery R. J.
Published: November 2021

In 1992, the University of Texas Health Science Center at Houston (UTHealth) Radiation Safety Program began assembling data on a monthly basis that described various program drivers and associated activities. A summary of the data was assembled on an annual basis and shared with the professional health physics community at the 10-y and 20-y intervals. With the inclusion of 1991 data points, three decades (1991 to 2020) of data have now been collected and summarized into an updated program prospectus. The prospectus models a commercial enterprise prospectus provided to potential investors and displays various program indicator parameters. The consistent formatting of the data affords an easily digestible and succinct snapshot of program activities and trends. Various program stakeholder’s feedback regarding this data continues to be well received. Additionally, UTHealth provides increasing support for UT Physicians clinics throughout the greater Houston, Texas area. The prospectus allows succinct description of the drivers of the program, revealed interesting trends, and has identified training needs for both existing personnel and academic programs that support the radiation protection sciences.
Ten Years of Pediatric Ocular Chemical Burn Experience in a Tertiary Eye Care Center in Turkey
Authors: Korkmaz Ilayda , Palamar Melis , Egrilmez Sait , Yagci Ayse , Barut Selver Ozlem
Published: November 2021

Objectives:

To report 10 years of pediatric ocular chemical burn experience in a tertiary eye care center in Turkey.

Methods:

Thirty-three patients aged 18 years and younger who presented with ocular chemical burn between 2011 and 2021 were enrolled. Demographic data and clinical characteristics of patients were reviewed. Limbal stem cell deficiency (LSCD) stage was assessed according to LSCD working group's staging system. The initial and final best-corrected visual acuities were recorded.

Results:

The mean age was 10.4±5.5 (0.25–18) years with an F/M ratio of 12/21. Eleven (33.3%) of the patients were injured with acid and 5 (15.1%) with alkaline. The most common causative agent was nail polish remover (n=7, 21.2%), followed by cologne (n=5, 15.1%) and hand sanitizer (n=4, 12.1%). The severity of burn was ≥grade 4 in 20 patients (60.6%). Chemical injury resulted in LSCD in 18 patients (54.5%). Surgery was performed (LSCD ≥Stage 2 B) in 13 patients (39.3%); limbal stem cell transplantation (LSCT) (n=11), staged amniotic membrane transplantation, and symblepharon release (n=2). Penetrating keratoplasty after LSCT was performed in three of 11 patients. The mean follow-up time was 31.9±28.6 months (6–102.33) after the surgery.

Conclusions:

In pediatric population, accurate diagnosis and management of ocular chemical burns are challenging. Although the severity of burn and consequently LSCD rate seems to be high in children, comparative studies in a larger population are still needed.
Evaluation of Orthokeratology Lens Fitting Assisted by Sagittal Height Simulation Software
Authors: Yi Zhen , Jing Shen , Wenhua Wang , Qian Li , Ningli Wang
Published: November 2021

Objectives:

To evaluate a novel sagittal height fitting algorithm for estimation of alignment curve (AC) radius during Euclid orthokeratology lens trial.

Methods:

Chinese myopic children were recruited in this study and were randomly divided into two groups. The AC radius of one group was calculated by the novel fitting algorithm. The AC radius of the other group was decided by the optometrist using flat K readings and eccentricity values. The number of lens trials was recorded for each patient, and the consistencies of AC radius between the first trial lenses and the final ordered lenses were tested by Pearson correlations and Bland–Altman plots.

Results:

One hundred three adolescent patients (103 eyes) were enrolled, including 57 boys and 46 girls. The numbers of trials for the novel algorithm and traditional method were 1.2±0.4 times versus 1.4±0.5 times, respectively, and the difference between the two methods was significant (t=2.404, P=0.018). The difference of AC value between the first trial lens and the lens to be produced for the novel algorithm and traditional method 0.000±0.020 mm and 0.003±0.028 mm separately. There was no statistical difference between the two methods (t=0.748, P=0.456).

Conclusions:

The new sagittal height simulation software can accurately calculate the AC value of the orthokeratology lens suitable for the Chinese patients.
Perceived Risk of Heart Attack and Type 2 Diabetes in Hispanic Adults With Overweight and Obesity
Authors: Fukuoka Yoshimi , Oh Yoo Jung
Published: November 2021

Background

Individuals with a greater perceived risk of heart attack or type 2 diabetes tend to adopt recommended lifestyle changes to minimize their risks. Despite the rapidly growing Hispanic population in the United States, data regarding their perceived risks are lacking.

Objective

This study aimed to examine the perceived risk of suffering a heart attack and/or developing type 2 diabetes and to explore the factors associated with these risk perceptions in Hispanic adults with overweight/obesity.

Methods

We analyzed 69 Hispanic adults with overweight/obesity who participated in the screening/baseline visit for the Adelgaza study, a weight loss and diabetes prevention trial, using descriptive statistics and logistic regressions. Heart attack or type 2 diabetes risk perception was assessed using a single-item questionnaire.

Results

The mean (SD) values for age and body mass index (BMI) were 43.8 (11.2) years and 31.7 (4.5) kg/m2, respectively. Of all participants, 46.4% perceived a low risk for heart attack and 29.0% perceived a low risk for developing type 2 diabetes in their lifetime, whereas only 11.6% reported both risk perceptions. Older age, lower BMI, and longer walking duration (minutes) per day were significantly associated with a lower perceived risk of heart attack (P < .05). Having no family history of heart attack, lower BMI, and lower fat intake were significant predictors of a lower diabetes-risk perception (P < .05).

Conclusions

Hispanic adults with overweight/obesity seem to underestimate their risks of heart attack and type 2 diabetes.
The use of pharmacogenetic testing in psychiatry
Authors: Kumar Aparna , Kearney Anne
Published: November 2021

Psychiatric pharmacogenetic testing is commonly used by providers in primary care and mental health settings. The purpose of this article is to describe the extent to which psychiatric pharmacogenetic testing supports clinical practice. human leukocyte antigen (HLA)-A and HLA-B should be tested before initiating carbamazepine and oxcarbazepine due to risk of serious skin reactions. For psychotropic medications metabolized through the liver, limited evidence suggests testing for variation in metabolism through CYP2D6 and CYP2D19. For specific medication and genotype–phenotype variations, guidance through the Clinical Pharmacogenetics Implementation Consortium (CPIC) or the International Society of Psychiatric Genetics (ISPG) should be reviewed. Commercial tests interpret this information differently and should not be used for broad guidance. Clinicians should follow current guidelines from professional bodies such as CPIC or ISPG and test for HLA-A or HLA-B before initiating carbamazepine or oxcarbazepine. Evidence is limited for psychiatric pharmacogenetic testing. Clinicians should continue to follow best practice and clinical practice guidelines.
MRI Correlates of Ototoxicity in the Auditory Pathway in Children Treated for Medulloblastoma
Authors: Moon Peter , Theruvath Johanna , Chang Julia , Song Yohan , Shpanskaya Katie , Maleki Maryam , Cheng Alan G. , Ahmad Iram N. , Yeom Kristen W.
Published: November 2021

Objective:

To assess diffusion and perfusion changes of the auditory pathway in pediatric medulloblastoma patients exposed to ototoxic therapies.

Study Design:

Retrospective cohort study.

Setting:

A single academic tertiary children's hospital.

Patients:

Twenty pediatric medulloblastoma patients (13 men; mean age 12.0 ± 4.8 yr) treated with platinum-based chemotherapy with or without radiation and 18 age-and-sex matched controls were included. Ototoxicity scores were determined using Chang Ototoxicity Grading Scale.

Interventions:

Three Tesla magnetic resonance was used for diffusion tensor and arterial spin labeling perfusion imaging.

Main Outcome Measures:

Quantitative diffusion tensor metrics were extracted from the Heschl's gyrus, auditory radiation, and inferior colliculus. Arterial spin labeling perfusion of the Heschl's gyrus was also examined.

Results:

Nine patients had clinically significant hearing loss, or Chang grades more than or equal to 2a; 11 patients had mild/no hearing loss, or Chang grades less than 2a. The clinically significant hearing loss group showed reduced mean diffusivity in the Heschl's gyrus (p = 0.018) and auditory radiation (p = 0.037), and decreased perfusion in the Heschl's gyrus (p = 0.001). Mild/no hearing loss group showed reduced mean diffusivity (p = 0.036) in Heschl's gyrus only, with a decrease in perfusion (p = 0.008). There were no differences between groups in the inferior colliculus. There was no difference in fractional anisotropy between patients exposed to ototoxic therapies and controls.

Conclusions:

Patients exposed to ototoxic therapies demonstrated microstructural and physiological alteration of the auditory pathway. The present study shows proof-of-concept use of diffusion tensor imaging to gauge ototoxicity along the auditory pathway. Future larger cohort studies are needed to assess significance of changes in diffusion tensor imaging longitudinally, and the relationship between these changes and hearing loss severity and longitudinal changes of the developing auditory white matter.
The Feasibility of Eustachian Tube Dilation With a Standard Endovascular Balloon: A Comparative Cadaver Study
Authors: Dahm Valerie , Chan Harley H. L. , Daly Michael J. , Lui Justin T. , Lin Vincent Y. , Irish Jonathan , Chen Joseph M. , Le Trung N.
Published: November 2021

Background:

Balloon dilation of the eustachian tube is a new therapeutic option for eustachian tube dysfunction. One of the limiting factors of wider adoption of this technique in many parts of the world is the high cost of the devices, in spite of regulatory approval of safety.

Objective:

Evaluate the performance and usability of standard less-expensive endovascular balloons for eustachian tube dilation in comparison to an approved device in a preclinical study.

Study Design:

Comparative cadaver feasibility study.

Setting:

University tertiary care facility.

Methods:

Ten eustachian tube dilations were performed with an approved eustachian tube dilation device. Ten other procedures were carried out with an endovascular balloon of similar dimensions. Cone beam computerized tomography was performed to evaluate the extent of dilation and possible damages. The lumen and mucosal lining were inspected endoscopically post-dilation. Volume measurements were compared before and after the procedure in both groups using contrast enhancement.

Results:

All 20 eustachian tube dilations were carried out successfully. No tissue damages could be identified on cone-beam computerized tomography or via endoscopic examination. There was a statistically significant difference of eustachian tube volumes between pre- and post-dilations, with no statistically significant difference between the devices.

Conclusion:

Eustachian tube dilation with a less costly endovascular balloon achieved similar results to an approved eustachian tube dilation device. No damages or any other safety concerns were identified in a cadaver study.
Comparative Effectiveness and Safety of Polyethylene Glycol Electrolyte Solution Versus Lactulose for Treatment of Hepatic Encephalopathy
Authors: Li Mengting , Zhang Zhijie , Chen Qiao , Zhou Xiaoling , Shui Diankui , Huang Jiean
Published: November 2021

Background:

Hepatic encephalopathy (HE) is a complex neuropsychiatric syndrome associated with liver failure and/or portal systemic shunting. Polyethylene glycol (PEG) electrolyte solution is a commonly used for catharsis of gut, which has been demonstrated to relieve HE in a number of randomized controlled trials. The aim of this paper was to evaluate the comparative efficacy and safety of PEG with lactulose for current HE treatment.

Methods:

PEG electrolyte solution versus lactulose of HE was deeply studied by conducting a systematic search in electronic databases and other sources until December 31, 2020. The PRISMA statement recommended the use of meta-analysis with 95% confidence interval (CI), relative risk (RR), and weighted mean deviation (WMD) as the estimated effect size. A sensitivity analysis was performed comprehensively to present the risk of bias and the source of heterogeneity.

Results:

A total of 434 patients were involved in 7 randomized studies. It is found that there was a significant advantage of PEG therapy in the increase of clinical efficacy (RR=1.46; 95% CI: 1.26-1.68; P=0.000; I
2=0.0%) and the decrease of hospital stay (WMD=−1.78; 95% CI: −2.72 to 0.85; P=0.000; I

2
=90.1%). There was no significant difference in the incidence of adverse events (RR=0.75; 95% CI: 0.48-1.19; P=0.222>0.05; I

2
=7.2%) and the level of serum ammonia (WMD=9.02; 95% CI: −14.39 to 32.43; P=0.45>0.05; I

2
=84.9%) after 24 hours between the 2 groups.

Conclusions:

The results prove that PEG has a beneficial effect on the treatment of HE. Compared with lactulose, PEG can lead to more rapid HE resolution during the first 24 hours and shorten the length of stay without increasing the rate of adverse effects.