bluuebunny/crossref_metadata_2025 huggingface dataset:
Organizational and Resident Characteristics of Nursing Homes Associated With Partial and Complete Implementation of the Preferences for Everyday Living Inventory
Authors: Madrigal Caroline , Moore Reese , Kunkel Miranda C , Bowblis John R , Straker Jane , Van Haitsma Kimberly , Abbott Katherine M
Published: February 2023

Background and Objectives

Person-centered care practices are essential to providing high-quality care for nursing home (NH) residents. A key component of implementing person-centered care is the assessment and fulfillment of residents’ preferences. However, few NHs consistently assess and implement residents’ preferences into care. From 2015 to 2019, the Ohio Department of Medicaid added the Preference for Everyday Living Inventory (PELI), a scientifically validated tool to assess residents’ preferences, as a quality indicator to improve the person centeredness of Ohio’s NHs. In this study, we sought to identify the associations between resident and organizational characteristics and PELI implementation in Ohio NHs.

Research Design and Methods

We constructed an NH-level database that merged data from the Ohio Biennial Survey of Long-Term Care Facilities, Ohio Medicaid Cost Reports, the Certification and Survey Provider Enhanced Reports data, the WWAMI Rural Health Research Center, and the Minimum Data Set. Freestanding NHs were included if they were owned by a for-profit or not-for-profit organization, and had data collected in 1 of 2 years (n = 1,320; year 2015, n = 814; year 2017, n = 506). Descriptive statistics and multiple logistic regression were used to understand the relationships between resident demographics, NH organizational characteristics, and partial versus complete PELI implementation.

Results

Most NHs (71.2%) reported complete implementation of the PELI over 2 years with implementation increasing over time. There was a relationship between complete PELI implementation and for-profit status, higher number of beds, higher Medicare funding, higher certified nursing assistants and activity staff hours, and urban location.

Discussion and Implications

This work has important implications for the implementation of person-centered care interventions in NHs and our understanding of what NH characteristics are related to successful implementation. The next steps should include a continued, detailed assessment of PELI implementation and an exploration of the potential impact of PELI implementation on residents, staff, and organizational outcomes.
Biopsy-detected myocardial fibrosis predicts adverse cardiac events after pulmonary valve replacement in patients with repaired tetralogy of Fallot
Authors: Yuan Jianhui , Su Zhanhao , Wang Guanxi , Yang Keming , Zhang Benqing , Ma Kai , Zhang Sen , Yang Yang , Feng Zicong , Mao Fengqun , He Qiyu , Dou Zheng , Li Shoujun
Published: February 2023

OBJECTIVES

Risk factors associated with adverse cardiac events (cardiac AEs) after pulmonary valve replacement (PVR) in patients with repaired tetralogy of Fallot are incompletely understood. In this study, we aimed to determine the relationship between histological myocardial fibrosis and cardiac AEs after PVR in patients with rTOF.

METHODS

We consecutively collected clinical, cardiac magnetic resonance, echocardiography and electrocardiogram data of 51 patients with rTOF who underwent surgical PVR. The right ventricular outflow tract tissue was collected during the PVR and the degree of histological myocardial fibrosis was determined by a tailor-made automated image analysis method of picrosirius red staining.

RESULTS

The median follow-up time was 4.9 years, and 14 patients had cardiac AEs (a composite of heart failure admission and arrhythmia) during follow-up. The total analysis area of myocardial samples was 5782.18 mm2, and the median percentage of myocardial fibrosis was 20.6% (interquartile range 16.7–27.0%), which were significantly elevated in patients with cardiac AEs compared with patients without cardiac AEs (24.1% vs 19.7%, P = 0.007). Right ventricular ejection fraction and left ventricular end-systolic volume index were significantly associated with myocardial fibrosis in multivariable stepwise linear regression analysis (R2 = 0.238). Cox proportional hazards regression identified degree of myocardial fibrosis [hazard ratio 1.127; 95% confidence interval (CI) 1.047–1.213; P = 0.001] and age at PVR (hazard ratio 1.062; 95% CI 1.010–1.116; P = 0.019) were associated with increased risk of cardiac AEs. The incidence of adverse cardiac events was significantly increased when myocardial fibrosis >20.1% and age at PVR >18.2 years.

CONCLUSIONS

Histological myocardial fibrosis was associated with biventricular systolic functions in rTOF. Higher myocardial fibrosis and older age at PVR are independent risk factors for the adverse cardiac events after PVR in patients with rTOF.
Research recruitment through the patient portal: perspectives of community focus groups in Seattle and Atlanta
Authors: Porter Kathryn M , Kraft Stephanie A , Speight Candace D , Duenas Devan M , Niyibizi Nyiramugisha K , Mitchell Andrea , O’Connor M Rebecca , Gregor Charles , Liljenquist Kendra , Shah Seema K , Wilfond Benjamin S , Dickert Neal W
Published: February 2023

Objective

Research recruitment through patient portals (ie, patient-facing, web-based clinical interfaces) has the potential to be effective, efficient, and inclusive, but best practices remain undefined. We sought to better understand how patients view this recruitment approach.

Materials and Methods

We conducted 6 focus groups in Atlanta, GA and Seattle, WA with members of patient advisory committees and the general public. Discussions addressed acceptability of patient portal recruitment and communication preferences. Focus groups were audio-recorded, transcribed, and analyzed using deductive and inductive codes. Iterative team discussions identified major themes.

Results

Of 49 total participants, 20 were patient advisory committee members. Participants’ mean age was 49 (range 18–74); 59% identified as non-Hispanic White and 31% as Black/African American. Participants were supportive of patient portal recruitment and confident that messages were private and legitimate. Participants identified transparency and patient control over whether and how to participate as essential features. Concerns included the frequency of research messages and the ability to distinguish between research and clinical messages. Participants also discussed how patient portal recruitment might affect diversity and inclusion.

Discussion

Focus group participants generally found patient portal recruitment acceptable and perceived it as secure and trustworthy. Transparency, control, and attention to inclusiveness were identified as key considerations for developing best practices.

Conclusion

For institutions implementing patient portal recruitment programs, continued engagement with patient populations can help facilitate translation of these findings into best practices and ensure that implemented strategies accomplish intended goals.
Problem-oriented documentation: design and widespread adoption of a novel toolkit in a commercial electronic health record
Authors: Altman Richard L , Lin Chen-Tan , Earnest Mark
Published: February 2023

Background

Problem-oriented documentation is an accepted method of note construction which facilitates clinical thought processes. However, problem-oriented documentation is challenging to put into practice using commercially available electronic health record (EHR) systems.

Objective

Our goal was to create, iterate, and distribute a problem-oriented documentation toolkit within a commercial EHR that maximally supported clinicians’ thinking, was intuitive to use, and produced clear documentation.

Materials and Methods

We used an iterative design process that stressed visual simplicity, data integration, a predictable interface, data reuse, and clinician efficiency. Creation of the problem-oriented documentation toolkit required the use of EHR-provided tools and custom programming.

Results

We developed a problem-oriented documentation interface with a 3-column view showing (1) a list of visit diagnoses, (2) the current overview and assessment and plan for a selected diagnosis, and (3) a list of medications, labs, data, and orders relevant to that diagnosis. We also created a series of macros to bring information collected through the interface into clinicians’ notes. This toolkit was put into a live environment in February 2019. Over the first 9 months, the custom problem-oriented documentation toolkit was used in a total of 8385 discrete visits by 28 clinicians in 13 ambulatory departments. After 9 months, the go-live education and EHR optimization teams in our health system began promoting the toolkit to new and existing users of our EHR resulting in a significantly increased uptake by outpatient clinicians. In April 2022 alone, the toolkit was used in more than 92 000 ambulatory visits by 894 users in 271 departments across our health system.

Conclusions

As a health-system client of a commercial EHR, we developed and deployed a revised problem-oriented documentation toolkit that is used by clinicians more than 92 000 times a month. Key success elements include an emphasis on usability and an effective training effort.
Common Finger Injuries: Treatment Guidelines for Emergency and Primary Care Providers
Authors: Hunt Tyler J , Powlan Franklin J , Renfro Kayleigh N , Polmear Michael , Macias Reuben A , Dunn John C , Wells Matthew E
Published: February 2023

Introduction

Finger and hand injuries are among the most common musculoskeletal conditions presenting to emergency departments and primary care providers. Many rural and community hospitals may not have immediate access to an orthopedic surgeon on-site. Furthermore, military treatment facilities, both within the continental United States and in austere deployment environments, face similar challenges. Therefore, knowing how to treat basic finger and hand injuries is paramount for patient care.

Materials and Methods

The Armed Forces Health Surveillance Branch operates the Defense Medical Surveillance System, a database that serves as the central repository of medical surveillance data for the armed forces. The Defense Medical Surveillance System was queried for ICD-10 codes associated with finger injuries from 2015 to 2019 among active duty service members across the major branches of the military.

Results

The most commonly reported finger injuries were open wounds to fingers without damage to nails, metacarpal fractures, phalanx fractures, and finger subluxation/dislocation. Emergency departments were the most commonly reported treatment facility type accounting for 35% of initial finger injuries, followed by 32.2% at orthopedic surgery clinics, 22.2% at family medicine clinics, and 10.8% at urgent care centers.

Conclusions

Finger injuries are common in the military setting and presenting directly to an orthopedic surgeon does not appear the norm. Fingertip injuries, fractures within the hand, and finger dislocations can often be managed without the need for a subspecialist. By following simple guidelines with attention to “red flags,” primary care providers can manage most of these injuries with short-term follow-up with orthopedics.
EAGLE-like simulation models do not solve the entropy core problem in groups and clusters of galaxies
Authors: Altamura Edoardo , Kay Scott T , Bower Richard G , Schaller Matthieu , Bahé Yannick M , Schaye Joop , Borrow Josh , Towler Imogen
Published: February 2023

Recent high-resolution cosmological hydrodynamic simulations run with a variety of codes systematically predict large amounts of entropy in the intra-cluster medium at low redshift, leading to flat entropy profiles and a suppressed cool-core population. This prediction is at odds with X-ray observations of groups and clusters. We use a new implementation of the EAGLE galaxy formation model to investigate the sensitivity of the central entropy and the shape of the profiles to changes in the sub-grid model applied to a suite of zoom-in cosmological simulations of a group of mass M500 = 8.8 × 1012 M⊙ and a cluster of mass 2.9 × 1014 M⊙. Using our reference model, calibrated to match the stellar mass function of field galaxies, we confirm that our simulated groups and clusters contain hot gas with too high entropy in their cores. Additional simulations run without artificial conduction, metal cooling or active galactic nuclei (AGN) feedback produce lower entropy levels but still fail to reproduce observed profiles. Conversely, the two objects run without supernova feedback show a significant entropy increase which can be attributed to excessive cooling and star formation. Varying the AGN heating temperature does not greatly affect the profile shape, but only the overall normalization. Finally, we compared runs with four AGN heating schemes and obtained similar profiles, with the exception of bipolar AGN heating, which produces a higher and more uniform entropy distribution. Our study leaves open the question of whether the entropy core problem in simulations, and particularly the lack of power-law cool-core profiles, arise from incorrect physical assumptions, missing physical processes, or insufficient numerical resolution.
A catalogue of unusually long thermonuclear bursts on neutron stars
Authors: Alizai K , Chenevez J , Cumming A , Degenaar N , Falanga M , Galloway D K , in ’t Zand J J M , Jaisawal G K , Keek L , Kuulkers E , Lampe N , Schatz H , Serino M
Published: February 2023

Rare, energetic (long) thermonuclear (Type I) X-ray bursts are classified either as intermediate-duration or ‘supern’ bursts, based on their duration. Intermediate-duration bursts lasting a few to tens of minutes are thought to arise from the thermonuclear runaway of a relatively thick (≈1010 g cm−2) helium layer, while superbursts lasting hours are attributed to the detonation of an underlying carbon layer. We present a catalogue of 84 long thermonuclear bursts from 40 low-mass X-ray binaries, and defined from a new set of criteria distinguishing them from the more frequent short bursts. The three criteria are: (1) a total energy release longer than 1040 erg, (2) a photospheric radius expansion phase longer than 10 s, and (3) a burst time-scale longer than 70 s. This work is based on a comprehensive systematic analysis of 70 bursts found with INTEGRAL, RXTE, Swift, BeppoSAX, MAXI, and NICER, as well as 14 long bursts from the literature that were detected with earlier generations of X-ray instruments. For each burst, we measure its peak flux and fluence, which eventually allows us to confirm the distinction between intermediate-duration bursts and superbursts. Additionally, we list 18 bursts that only partially meet the above inclusion criteria, possibly bridging the gap between normal and intermediate-duration bursts. With this catalogue, we significantly increase the number of long-duration bursts included in the MINBAR and thereby provide a substantial sample of these rare X-ray bursts for further study.
A feasibility, safety, and efficacy evaluation of supervised aerobic and resistance exercise for patients with glioblastoma undertaking adjuvant chemoradiotherapy
Authors: Nowak Anna K , Newton Robert U , Cruickshank Travis , Cormie Prue , Halkett Georgia K B , Tsoi Daphne , Galvão Daniel A
Published: February 2023

Background

While therapeutically effective, chemoradiotherapy treatment for high-grade glioma (glioblastoma) is often accompanied by side effects. Exercise has been demonstrated to alleviate the adverse effects of such treatments in other cancers. We aimed to evaluate the feasibility and preliminary efficacy of supervised exercise incorporating autoregulation.

Methods

Thirty glioblastoma patients were recruited, five declined exercise and 25 were provided with a multimodal exercise intervention for the duration of their chemoradiotherapy treatment. Patient recruitment, retention, adherence to training sessions and safety were evaluated throughout the study. Physical function, body composition, fatigue, sleep quality, and quality of life were evaluated before and after the exercise intervention.

Results

Eight of the 25 participants commencing exercise withdrew prior to completion of the study (32%). Seventeen patients (68%) demonstrated low to high adherence (33%–100%) and exercise dosage compliance (24%–83%). There were no reported adverse events. Significant improvements were observed for all trained exercises and lower limb muscle strength and function with no significant changes observed for any other physical function, body composition, fatigue, sleep, or quality of life outcomes.

Conclusions

Only half of glioblastoma patients recruited were willing or able to commence, complete or meet minimum dose compliance for the exercise intervention during chemoradiotherapy indicating the intervention evaluated may not be feasible for part of this patient cohort. For those who were able to complete the exercise program, supervised, autoregulated, multimodal exercise was safe and significantly improved strength and function and may have prevented deterioration in body composition and quality of life.
Bacterial Form II Rubisco can support wild-type growth and productivity in Solanum tuberosum cv. Desiree (potato) under elevated CO2
Authors: Manning Tahnee , Birch Rosemary , Stevenson Trevor , Nugent Gregory , Whitney Spencer
Published: February 2023

The last decade has seen significant advances in the development of approaches for improving both the light harvesting and carbon fixation pathways of photosynthesis by nuclear transformation, many involving multigene synthetic biology approaches. As efforts to replicate these accomplishments from tobacco into crops gather momentum, similar diversification is needed in the range of transgenic options available, including capabilities to modify crop photosynthesis by chloroplast transformation. To address this need, here we describe the first transplastomic modification of photosynthesis in a crop by replacing the native Rubisco in potato with the faster, but lower CO2-affinity and poorer CO2/O2 specificity Rubisco from the bacterium Rhodospirillum rubrum. High level production of R. rubrum Rubisco in the potRr genotype (8 to 10 µmol catalytic sites m2) allowed it to attain wild-type levels of productivity, including tuber yield, in air containing 0.5% (v/v) CO2. Under controlled environment growth at 25°C and 350 µmol photons m2 PAR, the productivity and leaf biochemistry of wild-type potato at 0.06%, 0.5%, or 1.5% (v/v) CO2 and potRr at 0.5% or 1.5% (v/v) CO2 were largely indistinguishable. These findings suggest that increasing the scope for enhancing productivity gains in potato by improving photosynthate production will necessitate improvement to its sink-potential, consistent with current evidence productivity gains by eCO2 fertilization for this crop hit a ceiling around 560 to 600 ppm CO2.
Deep learning-based urban morphology for city-scale environmental modeling
Authors: Patel Pratiman , Kalyanam Rajesh , He Liu , Aliaga Daniel , Niyogi Dev
Published: February 2023

Herein, we introduce a novel methodology to generate urban morphometric parameters that takes advantage of deep neural networks and inverse modeling. We take the example of Chicago, USA, where the Urban Canopy Parameters (UCPs) available from the National Urban Database and Access Portal Tool (NUDAPT) are used as input to the Weather Research and Forecasting (WRF) model. Next, the WRF simulations are carried out with Local Climate Zones (LCZs) as part of the World Urban Data Analysis and Portal Tools (WUDAPT) approach. Lastly, a third novel simulation, Digital Synthetic City (DSC), was undertaken where urban morphometry was generated using deep neural networks and inverse modeling, following which UCPs are re-calculated for the LCZs. The three experiments (NUDAPT, WUDAPT, and DSC) were compared against Mesowest observation stations. The results suggest that the introduction of LCZs improves the overall model simulation of urban air temperature. The DSC simulations yielded equal to or better results than the WUDAPT simulation. Furthermore, the change in the UCPs led to a notable difference in the simulated temperature gradients and wind speed within the urban region and the local convergence/divergence zones. These results provide the first successful implementation of the digital urban visualization dataset within an NWP system. This development now can lead the way for a more scalable and widespread ability to perform more accurate urban meteorological modeling and forecasting, especially in developing cities. Additionally, city planners will be able to generate synthetic cities and study their actual impact on the environment.
The Chinese Communist Party and regulatory transparency in China's food industry
Authors: Gao Qihua , Huang Yasheng , Sui Yuze , Zheng Yanchong
Published: February 2023

While it is widely accepted that the Chinese Communist Party (CCP) occupies a dominant position in the Chinese political system, few studies have demonstrated CCP's dominant position based on rigorous statistical analysis. Our paper presents the first such analysis using an innovative measure of regulatory transparency in the food industry across nearly 300 prefectures in China over 10 years. We show that actions by the CCP, while broadly scoped and not targeting the food industry, significantly improved regulatory transparency in the industry. In sharp contrast, food-industry-specific interventions by the State Council, which exercises direct regulatory supervision of the industry, had no impact on regulatory transparency. These results hold in various specifications and robustness checks. Our research contributes to research in China's political system by empirically and explicitly demonstrating the dominating power of the CCP.
The circadian control of tryptophan metabolism regulates the host response to pulmonary fungal infections
Authors: Stincardini Claudia , Pariano Marilena , D’Onofrio Fiorella , Renga Giorgia , Orecchini Elena , Orabona Ciriana , Nunzi Emilia , Gargaro Marco , Fallarino Francesca , Chun Sung Kook , Fortin Bridget M , Masri Selma , Brancorsini Stefano , Romani Luigina , Costantini Claudio , Bellet Marina Maria
Published: February 2023

The environmental light/dark cycle has left its mark on the body's physiological functions to condition not only our inner biology, but also the interaction with external cues. In this scenario, the circadian regulation of the immune response has emerged as a critical factor in defining the host–pathogen interaction and the identification of the underlying circuitry represents a prerequisite for the development of circadian-based therapeutic strategies. The possibility to track down the circadian regulation of the immune response to a metabolic pathway would represent a unique opportunity in this direction. Herein, we show that the metabolism of the essential amino acid tryptophan, involved in the regulation of fundamental processes in mammals, is regulated in a circadian manner in both murine and human cells and in mouse tissues. By resorting to a murine model of pulmonary infection with the opportunistic fungus Aspergillus fumigatus, we showed that the circadian oscillation in the lung of the tryptophan-degrading enzyme indoleamine 2,3-dioxygenase (IDO)1, generating the immunoregulatory kynurenine, resulted in diurnal changes in the immune response and the outcome of fungal infection. In addition, the circadian regulation of IDO1 drives such diurnal changes in a pre-clinical model of cystic fibrosis (CF), an autosomal recessive disease characterized by progressive lung function decline and recurrent infections, thus acquiring considerable clinical relevance. Our results demonstrate that the circadian rhythm at the intersection between metabolism and immune response underlies the diurnal changes in host–fungal interaction, thus paving the way for a circadian-based antimicrobial therapy.
Severe Acute Respiratory Infection—Preparedness: Protocol for a Multicenter Prospective Cohort Study of Viral Respiratory Infections
Authors: Postelnicu Radu , Srivastava Avantika , Bhatraju Pavan K. , Wurfelc Mark M. , Anesi George L. , Gonzalez Martin , Andrews Adair , Lutrick Karen , Kumar Vishakha K. , Uyeki Timothy M. , Cobb Perren J. , Segal Leopoldo N. , Brett-Major David , Liebler Janice M. , Kratochvil Christopher J. , Mukherjee Vikramjit , Broadhurst M. Jana , Lee Richard , Wyles David , Sevransky Jonathan E. , Evans Laura , Landsittel Douglas ,   the Society of Critical Care Medicine Discovery Network Investigators
Published: February 2023

OBJECTIVES:

Respiratory virus infections cause significant morbidity and mortality ranging from mild uncomplicated acute respiratory illness to severe complications, such as acute respiratory distress syndrome, multiple organ failure, and death during epidemics and pandemics. We present a protocol to systematically study patients with severe acute respiratory infection (SARI), including severe acute respiratory syndrome coronavirus 2, due to respiratory viral pathogens to evaluate the natural history, prognostic biomarkers, and characteristics, including hospital stress, associated with clinical outcomes and severity.

DESIGN:

Prospective cohort study.

SETTING:

Multicenter cohort of patients admitted to an acute care ward or ICU from at least 15 hospitals representing diverse geographic regions across the United States.

PATIENTS:

Patients with SARI caused by infection with respiratory viruses that can cause outbreaks, epidemics, and pandemics.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Measurements include patient demographics, signs, symptoms, and medications; microbiology, imaging, and associated tests; mechanical ventilation, hospital procedures, and other interventions; and clinical outcomes and hospital stress, with specimens collected on days 0, 3, and 7–14 after enrollment and at discharge. The primary outcome measure is the number of consecutive days alive and free of mechanical ventilation (VFD) in the first 30 days after hospital admission. Important secondary outcomes include organ failure-free days before acute kidney injury, shock, hepatic failure, disseminated intravascular coagulation, 28-day mortality, adaptive immunity, as well as immunologic and microbiologic outcomes.

CONCLUSIONS:

SARI—Preparedness is a multicenter study under the collaboration of the Society of Critical Care Medicine Discovery, Resilience Intelligence Network, and National Emerging Special Pathogen Training and Education Center, which seeks to improve understanding of prognostic factors associated with worse outcomes and increased resource utilization. This can lead to interventions to mitigate the clinical impact of respiratory virus infections associated with SARI.
Chronic myeloid leukemia following low dose radioactive iodine (I131) for treatment of papillary thyroid cancer
Authors: Hailan Yousef Mohammed Ali , Yassin Mohamed A.
Published: February 2023

Introduction:

Therapy-related myeloid neoplasms result from exposure to specific agents such as ionizing radiation, chemotherapy, and immunosuppressive agents. Radioactive iodine plays an essential role in managing differentiated thyroid cancers such as papillary thyroid carcinoma to reduce the risk of recurrence.

Patient concerns:

We present the case of a 48-year-old Bangladeshi male with a history of papillary thyroid cancer after total thyroidectomy and radiofrequency ablation therapy with I131 (32.6 mCi) who presented with abdominal pain and was found to have chronic myeloid leukemia 3 years after treatment for papillary thyroid cancer.

Diagnosis:

Chronic myeloid leukemia secondary to low-dose radioactive iodine (I131).

Interventions:

The patient was started on dasatinib (140 mg/day).

Outcomes:

The patient is currently being prepared for bone marrow transplantation by donor search and HLA typing.

Conclusion:

This case emphasizes the importance of considering the leukemogenic effects of I131.
Characterizing unique supportive care needs among women living with metastatic breast cancer: A qualitative study
Authors: Moreno Patricia I. , Noriega Esquives Blanca , Thomas Jessica L. , Horner Fiona S. , Torzewski Joanna B. , Gradishar William , Victorson David , Penedo Frank J.
Published: February 2023

Background:

Women with metastatic breast cancer face unique challenges as they cope with life-limiting prognoses and arduous treatments. However, the vast majority of research has focused on optimizing quality of life in women with early-stage, nonmetastatic breast cancer and little is known about supportive care needs among women living with metastatic cancer. As part of a larger project that sought to inform the development of a psychosocial intervention, the aim of this study was to characterize supportive care needs among women with metastatic breast cancer and elucidate challenges unique to living with a life-limiting prognosis.

Methods:

Four, 2-hour focus groups with 22 women were audio-recorded, transcribed verbatim, and analyzed in Dedoose using a general inductive approach to code categories and extract themes.

Results:

A total of 16 codes emerged from 201 participant comments regarding supportive care needs. Codes were collapsed into four supportive care need domains: (1) psychosocial, (2) physical and functional, (3) health system and information, and (4) sexuality and fertility needs. The most prevalent needs were breast cancer–related symptom burden (17.4%), lack of social support (14.9%), uncertainty (10.0%), stress management (9.0%), patient-centered care (7.5%), and sexual functioning (7.5%). More than half of needs (56.2%) were in the psychosocial domain, and more than two-thirds of needs (76.8%) were in the psychosocial and physical and functional domains. Supportive care needs unique to living with metastatic breast cancer included the cumulative effects of continuously undergoing cancer treatment on symptom burden, worry from scan-to-scan regarding response to cancer treatments, diagnosis-related stigma and social isolation, end-of-life concerns, and misconceptions regarding metastatic breast cancer.

Conclusions:

Findings suggest that women with metastatic breast cancer have unique supportive care needs compared with women with early-stage breast cancer that are specific to living with a life-limiting prognosis and are not typically captured in existing self-report measures of supportive care needs. The results also highlight the importance of addressing psychosocial concerns and breast cancer–related symptoms. Women with metastatic breast cancer may benefit from early access to evidence-based interventions and resources that specifically address their supportive care needs and optimize quality of life and well-being.
Improving Prescribing for Otitis Media in a Pediatric Emergency Unit: A Quality Improvement Initiative
Authors: Dube Amanda R. , Zhao Amy R. , Odozor Chioma U. , Jordan Katherine , Garuba Favour O. , Kennedy Angela , Niesen Angela , Kyrouac Rebecca C. , Stortz Danielle , Lodhi Hafsa , Newland Jason G. , Adeyanju Oloruntosin
Published: February 2023

Introduction:

Acute otitis media (AOM) is a commonly overtreated pediatric diagnosis. The American Academy of Pediatrics (AAP) recommends shorter antibiotic courses and wait-and-see prescriptions (WSPs) for healthy children with mild-to-moderate AOM. Still, clinicians do not consistently prescribe these in pediatric emergency units (EUs).

Methods:

We performed a quality improvement project to improve antibiotic prescribing in a tertiary pediatric EU over 16 months, focusing on shorter prescription durations and WSPs. We assessed AOM management via chart review, then implemented interventions, including clinician education, a guideline card, visual reminders, and updated emails. In addition, we contacted a percentage of families after their visit to assess their child’s outcome and parental satisfaction.

Results:

Our baseline data showed that only 39% of patients prescribed antibiotics were prescribed an appropriate duration based on age and estimated AOM severity, and only 3% were prescribed WSPs. Via 2 plan-do-study-act (PDSA) cycles, we increased the percentage of patients who received appropriate antibiotics to an average of 67%, sustained for >6 months. Follow-up phone calls suggested no difference in satisfaction or need for nonroutine follow-up care based on prescription length. We did not see a substantial increase in WSPs.

Conclusions:

AOM management in our children’s hospital’s EU was often inconsistent with AAP guidelines. Two PDSA cycles improved the rate of appropriate duration antibiotics, and follow-up phone calls suggested no difference in satisfaction or need for nonroutine follow-up care based on prescription length. The next steps involve developing an order set and implementing individualized feedback.
Phantom-Less Nonlinear Magnetic Resonance Imaging Calibration With Multiple Input Blood Flow Model
Authors: Saka Tomoki , Gotoh Toshiyuki , Kagei Seiichiro , Iwasawa Tae , Takimoto Rogerio Y. , Tsuzuki Marcos S. G.
Published: February 2023

Purpose:

Previous work used phantoms to calibrate the nonlinear relationship between the gadolinium contrast concentration and the intensity of the magnetic resonance imaging signal. This work proposes a new nonlinear calibration procedure without phantoms and considers the variation of contrast agent mass minimum combined with the multiple input blood flow system. This also proposes a new single-input method with meaningful variables that is not influenced by reperfusion or noise generated by aliasing. The reperfusion in the lung is usually neglected and is not considered by the indicator dilution method. However, in cases of lung cancer, reperfusion cannot be neglected. A new multiple input method is formulated, and the contribution of the pulmonary artery and bronchial artery to lung perfusion can be considered and evaluated separately.

Methods:

The calibration procedure applies the minimum variation of contrast agent mass in 3 different regions: (1) pulmonary artery, (2) left atrium, and (3) aorta. It was compared with four dimensional computerized tomography with iodine, which has a very high proportional relationship between contrast agent concentration and signal intensity.

Results:

Nonlinear calibration was performed without phantoms, and it is in the range of phantom calibration. It successfully separated the contributions of the pulmonary and bronchial arteries. The proposed multiple input method was verified in 6 subjects with lung cancer, and perfusion from the bronchial artery, rich in oxygen, was identified as very high in the cancer region.

Conclusions:

Nonlinear calibration of the contrast agent without phantoms is possible. Separate contributions of the pulmonary artery and aorta can be determined.
Direct Trauma Center Access by Helicopter Emergency Medical Services is Associated With Improved Survival After Severe Injury
Authors: Deeb Andrew-Paul , Teng Cindy Y. , Peitzman Andrew B. , Billiar Timothy R. , Sperry Jason L. , Lu Liling , Beiriger Jamison , Brown Joshua B.
Published: February 2023

Objective:

Evaluate the association of survival with helicopter transport directly to a trauma center compared with ground transport to a non-trauma center (NTC) and subsequent transfer.

Summary Background Data:

Helicopter transport improves survival after injury. One potential mechanism is direct transport to a trauma center when the patient would otherwise be transported to an NTC for subsequent transfer.

Methods:

Scene patients 16 years and above with positive physiological or anatomic triage criteria within PTOS 2000-2017 were included. Patients transported directly to level I/II trauma centers by helicopter were compared with patients initially transported to an NTC by ground with a subsequent helicopter transfer to a level I/II trauma center. Propensity score matching was used to evaluate the association between direct helicopter transport and survival. Individual triage criteria were evaluated to identify patients most likely to benefit from direct helicopter transport.

Results:

In all, 36,830 patients were included. Direct helicopter transport was associated with a nearly 2-fold increase in odds of survival compared with NTC ground transport and subsequent transfer by helicopter (aOR 2.78; 95% CI 2.24–3.44, P<0.01). Triage criteria identifying patients with a survival benefit from direct helicopter transport included GCS≤13 (1.71; 1.22–2.41, P<0.01), hypotension (2.56; 1.39–4.71, P<0.01), abnormal respiratory rate (2.30; 1.36–3.89, P<0.01), paralysis (8.01; 2.03–31.69, P<0.01), hemothorax/pneumothorax (2.34; 1.36–4.05, P<0.01), and multisystem trauma (2.29; 1.08–4.84, P=0.03).

Conclusions:

Direct trauma center access is a mechanism driving the survival benefit of helicopter transport. First responders should consider helicopter transport for patients meeting these criteria who would otherwise be transported to an NTC.
Bayesian network approach to develop generalisable predictive model for COVID-19 vaccine uptake
Authors: Awasthi Raghav , Nagori Aditya , Nasri Bouchra
Published: February 2023

The effectiveness of a vaccine depends on vaccine uptake, which is influenced by various factors, including vaccine hesitancy. Vaccine hesitancy is a complex socio-behavioral issue, influenced by misinformation, distrust in healthcare providers and government organizations, fear of side effects, and cultural or religious beliefs. To address this problem, AI models have been developed, but their global generalizability remains unclear. Therefore, this study aimed to identify global determinants of vaccine uptake and develop a generalizable machine learning model to predict individual-level vaccine uptake. The study used publicly available survey data from 23 countries and employed Bayesian networks and generalized mixed effects models to identify key determinants of vaccine uptake. The results showed that trust in the central government and vaccination restrictions for national and international travel were key determinants of vaccine uptake. A generalized mixed effects model achieved an AUC of 89% (SD=1%), precision of 90% (SD = 4%), and recall of 82% (SD=2%) on unseen testing data from new countries, demonstrating the model’s generalizability. The findings of this study can inform targeted interventions to improve vaccine uptake globally.
Blood pressure self-monitoring practice and associated factors among adult hypertensive patients on follow-up at South Wollo Zone Public Hospitals, Northeast Ethiopia
Authors: Geleta Esmael , Mengesha Zemen , Tegegne Belachew , Ademe Sewunet , Liknaw Tiliksew , Edmealem Afework
Published: February 2023

Background

Hypertension is a silent killer that causes serious health issues in all parts of the world.It is risk factor for cardiovascular disease, stroke, and kidney disease. Self-monitoring practice has been identified as an important component of hypertension management. Hence, this study aimed to assess blood pressure self-monitoring practice and associated factors among adult hypertensive patients on follow-up in South Wollo Zone public hospitals, Northeast Ethiopia.

Methods

Hospital based cross-sectional study was conducted from June 1 to June 30, 2022, among 336 adult hypertensive patients on follow-up at selected South Wollo Zone public hospitals.Data were collected by using self-administered pre-tested structured questionnaires; the collecteddata were entered into Epi-data version 4.6 and then exported to SPSS version 25 software for analysis. Descriptive statistics such as frequency and percentage were used to describe the study participants. Tables and texts were used for data presentation. Binary logistic regression was conductedto test the association between the independent and dependent variables. Adjusted Odds Ratio with 95% CI was estimated to identify the factors associated with BP self-monitoring and thelevel of significance wasdeclared at P-value <0.05.

Results

The proportion (95% CI) of Blood Pressure Self-Monitoring Practice among hypertensive patients in South Wollo Zone Public Hospitals was 8.93% [95%CI; 6.3, 12.5]. In the multivariable analysis, urban residence [AOR=3.97, 95%CI (1.11, 14.20)], comorbidity [AOR=4.80, 95%CI (1.23, 18.69)], regular healthcare professional visit [AOR=4.64, 95%CI (1.02, 21.14)], advice on the type of devices used for BP self-monitoring [AOR=5.26, 95%CI (1.49, 18.58)], and knowledge on hypertension self-care [AOR=13.13, 95%CI (4.21, 40.99)] were positively associated with BP self-monitoring practice.

Conclusion

In the study, the proportion of Blood Pressure Self-Monitoring Practice was low.Living in urban areas, comorbidity, regular healthcare professional visits, advice on the type of devices used for Blood Pressure self-monitoring, and knowledge of hypertension self-care were positively associated with Blood Pressure Self-Monitoring Practice.
Multimodal Fast–Slow Neural Network for learning engagement evaluation
Authors: Zhang Lizhao , Hung Jui-Long , Du Xu , Li Hao , Hu Zhuang
Published: February 2023

Purpose

Student engagement is a key factor that connects with student achievement and retention. This paper aims to identify individuals' engagement automatically in the classroom with multimodal data for supporting educational research.

Design/methodology/approach

The video and electroencephalogram data of 36 undergraduates were collected to represent observable and internal information. Since different modal data have different granularity, this study proposed the Fast–Slow Neural Network (FSNN) to detect engagement through both observable and internal information, with an asynchrony structure to preserve the sequence information of data with different granularity.

Findings

Experimental results show that the proposed algorithm can recognize engagement better than the traditional data fusion methods. The results are also analyzed to figure out the reasons for the better performance of the proposed FSNN.

Originality/value

This study combined multimodal data from observable and internal aspects to improve the accuracy of engagement detection in the classroom. The proposed FSNN used the asynchronous process to deal with the problem of remaining sequential information when facing multimodal data with different granularity.
Ratees' reactions to equal versus equitable performance outcomes: evidence from Pakistan and Japan
Authors: Naz Saiqa , Iqbal Muhammad Zahid , Ikramullah Malik , Raziq Muhammad Mustafa , Khalid Saddam
Published: February 2023

Purpose

Ratees' reactions to performance appraisal (PA) system suggest how effective the system is. However, there is less clarity about those different reactions that good versus poor performing ratees show vis-à-vis their performance appraisals. This paper seeks to examine the possible PA responses (PA fairness and PA satisfaction) of the ratees for the cases where they receive equitable versus equal performance-based rewards and punishments.

Design/methodology/approach

Two studies were designed. Study 1 was a scenario-based experiment in Pakistan (N = 100 students) and Study 2 was based on surveys in Japan (N = 123 employed students) and Pakistan (N = 111 full-time working professionals). Data were analyzed using one-way repeated measures (Study 1) and structural equation modeling (Study 2).

Findings

Overall, good performers considered PA fairer and more satisfying under equity than under equality. However, poor performers considered PA fairer under equity than under equality.

Originality/value

The study has value for PA theorists and managers, as it offers: (a) an understanding on the differential effect of equity versus equality, on employees' perceptions of fairness and satisfaction in a PA setting; (b) clarity about the likely disparity between good and poor performers' reactions toward perceived fairness and satisfaction; and, (c) ratee reactions from both organizational and social perspectives contributing to the philosophical debate questioning whether both distributive fairness and retributive fairness should operate under similar or different normative principles.
Loss of DNA repair mechanisms in cardiac myocytes induce dilated cardiomyopathy
Authors: Henpita Chathurika , Vyas Rajesh , Healy Chastity L. , Kieu Tra L. , Gurkar Aditi U. , Yousefzadeh Matthew J. , Cui Yuxiang , Lu Aiping , Angelini Luise A. , O'Kelly Ryan D. , McGowan Sara J. , Chandrasekhar Sanjay , Vanderpool Rebecca R. , Hennessy‐Wack Danielle , Ross Mark A. , Bachman Timothy N. , McTiernan Charles , Pillai Smitha P. S. , Ladiges Warren , Lavasani Mitra , Huard Johnny , Beer‐Stolz Donna , St. Croix Claudette M. , Watkins Simon C. , Robbins Paul D. , Mora Ana L. , Kelley Eric E. , Wang Yinsheng , O'Connell Timothy D. , Niedernhofer Laura J.
Published: February 2023

Cardiomyopathy is a progressive disease of the myocardium leading to impaired contractility. Genotoxic cancer therapies are known to be potent drivers of cardiomyopathy, whereas causes of spontaneous disease remain unclear. To test the hypothesis that endogenous genotoxic stress contributes to cardiomyopathy, we deleted the DNA repair gene Ercc1 specifically in striated muscle using a floxed allele of Ercc1 and mice expressing Cre under control of the muscle‐specific creatinine kinase (Ckmm) promoter or depleted systemically (Ercc1−/D mice). Ckmm‐Cre+/−;Ercc1−/fl mice expired suddenly of heart disease by 7 months of age. As young adults, the hearts of Ckmm‐Cre+/−;Ercc1−/fl mice were structurally and functionally normal, but by 6‐months‐of‐age, there was significant ventricular dilation, wall thinning, interstitial fibrosis, and systolic dysfunction indicative of dilated cardiomyopathy. Cardiac tissue from the tissue‐specific or systemic model showed increased apoptosis and cardiac myocytes from Ckmm‐Cre+/‐;Ercc1−/fl mice were hypersensitive to genotoxins, resulting in apoptosis. p53 levels and target gene expression, including several antioxidants, were increased in cardiac tissue from Ckmm‐Cre+/−;Ercc1−/fl and Ercc1−/D mice. Despite this, cardiac tissue from older mutant mice showed evidence of increased oxidative stress. Genetic or pharmacologic inhibition of p53 attenuated apoptosis and improved disease markers. Similarly, overexpression of mitochondrial‐targeted catalase improved disease markers. Together, these data support the conclusion that DNA damage produced endogenously can drive cardiac disease and does so mechanistically via chronic activation of p53 and increased oxidative stress, driving cardiac myocyte apoptosis, dilated cardiomyopathy, and sudden death.