bluuebunny/crossref_metadata_2025 huggingface dataset:
A Small but Significantly Greater Incidence of Inflammatory Heart Disease Identified After Vaccination for Severe Acute Respiratory Syndrome Coronavirus 2
Authors: Knowlton Kirk U , Knight Stacey , Muhlestein Joseph B , Le Viet T , Horne Benjamin D , May Heidi T , Stenehjem Edward A , Anderson Jeffrey L
Published: December 2021

Background

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines are being administered on an unprecedented scale. Assessing the risks of side effects is needed to aid clinicians in early detection and treatment. This study examined the risk of inflammatory heart disease, including pericarditis and myocarditis, after SARS-CoV-2 vaccination.

Methods

Intermountain Healthcare patients with inflammatory heart disease from December 15, 2020 to June 15, 2021, and with or without preceding SARS-CoV-2 vaccinations, were studied. Relative rates of inflammatory heart disease were examined for vaccinated patients compared to unvaccinated patients.

Results

Of 67 patients identified with inflammatory heart disease, 21 (31.3%) had a SARS-Cov-2 vaccination within the previous 60 days. Overall, 914 611 Intermountain Healthcare patients received a SARS-CoV-2 vaccine, resulting in an inflammatory heart disease rate of 2.30 per 100 000 vaccinated patients. The relative risk of inflammatory heart disease for the vaccinated patients compared to the unvaccinated patients was 2.05 times higher rate within the 30-day window (P = .01) and had a trend toward increase in the 60-day window (relative rate = 1.63; P = .07). All vaccinated patients with inflammatory heart disease were treated successfully with 1 death related to a pre-existing condition.

Conclusions

Although rare, the rate of inflammatory heart disease was greater in a SARS-CoV-2-vaccinated population than the unvaccinated population. This risk is eclipsed by the risk of contracting coronavirus disease 2019 and its associated, commonly severe outcomes. Nevertheless, clinicians and patients should be informed of this risk to facilitate earlier recognition and treatment.
Postural Maintenance Is Associated With Walking Ability in People Receiving Acute Rehabilitation After a Stroke
Authors: Wang Ching-Yi , Chen Yueh-Chi , Wang Chun-Hou
Published: December 2021

Objectives

The Postural Assessment Scale for Stroke Patients (PASS) assesses the ability of people post stroke to maintain or change a given posture from lying to standing, and the items on which people with different walking status perform differently may suggest potential interventions. The purpose of this study was to (1) examine the association of PASS scores at admission for acute rehabilitation with walking status at admission and 3 months post stroke (3 M), and (2) identify PASS items that discriminate walking status.

Methods

In this prospective observational study, 93 people post stroke were assessed with the PASS and a 2.44-m gait speed test at admission, with walking status assessed by telephone interview at 3 M. Those who could walk over a 2.44-m distance without the assistance of a walking aid or another person were considered to be independent in walking; others were considered to be dependent. Those who were dependent at admission were divided into the “regained independence” and “remained dependent” groups based on their status at 3 M. The association of the PASS at admission with 3 levels of walking status (independent at admission, regained independence, and remained dependent) was examined using the Kruskal-Wallis test. For those dependent at admission, the association of PASS score at admission with walking status at 3 M was examined using logistic regression and receiver operating curve analysis.

Results

PASS scores at admission differed significantly across the 3 walking status groups and were significantly associated with walking status at 3 M (odds ratio = 0.864; 95% CI = 0.798–0.935) over and above length of stay. People post stroke who were dependent at admission and had PASS scores ≥22 were more likely to regain independence at 3 M. Nine PASS items differed among the 3 groups.

Conclusions

PASS score is significantly associated with walking status at admission and at 3 M. The identified 9 items suggest possible interventions for acute rehabilitation.

Impact

This study identified 9 PASS items that could guide clinicians in selecting interventions for acute rehabilitation.
GAMMA SPECTROMETRY AND NEUTRON ACTIVATION ANALYSIS OF TOOT OILFIELD WELLS OF DATTA FORMATION, UPPER INDUS BASIN, DISTRICT ATTOCK, PUNJAB, PAKISTAN
Authors: Shah Zawwar Hussain , Siddique Naila , Wazir Zafar , Batool Nafeesa , Nusrat Muhammad , Somaily Hamoud H
Published: December 2021

Present study was aimed to investigate trace elemental composition and possible elemental correlation with depth of some Pakistani wells. Exploratory oil wells of Toot oilfield from Potwar region of upper Indus basin were selected for this purpose. Samples of well cuttings and soil sections were collected with the assistance of Oil and Gas Development Company Limited. Elemental analyses were performed using instrumental neutron activation analysis. This study is the first of its kind to report detailed elemental profile of Toot oilfield, Attock, Punjab, Pakistan, via instrumental neutron activation analysis (INAA). Source formation of Toot oilfield is characterized by Jurassic Datta formation. Around 19–26 elements were identified by INAA. Major, minor and trace elemental concentrations varied with depths along the sampling lines. Data analysis was performed by the application of principal component analysis (PCA). PCA was useful in differentiating between surface and depth samples. Elemental volumes of different wells were established through bi-plots. In extension, naturally occurring radioactive materials and technologically enhanced naturally occurring radioactive materials were also determined for the wells of Toot oilfield. Annual dose rates and activity levels were calculated in oil well formations. Measurements of annual dose rates fall within safe limits, indicating anodyne atmosphere. Contamination indices, such as enrichment factor with respect to Al, geo accumulation index (Igeo), pollution index and integrated pollution index, were also determined. Cr and Zn were found to cross the safe limits, which may be due to the local industrial and anthropogenic activities.
‘A Healthy Sex Life’: Love, Marriage and Sexual Knowledge in Franco’s Spain (1960–1975)
Authors: García-Fernández Mónica
Published: December 2021

This article aims to explore changes in the marital sex advice that was available in Spain during the last decade of the Franco Regime (1939–75). It pays particular attention to the representation of female sexuality, which was shaped by fluctuating ideas on the relationship between sexual pleasure, love and contraception. The study looks at a variety of sources and ponders the relationships between different types of discourses: male- and female-defined; religious and medical; popular and intellectual; expert and lay. These include marriage manuals, intellectual essays and women’s magazines. These sources suggest that paying attention to the means by which sexual knowledge is conveyed, to the context in which it is disseminated, and to the subtle changes in the agents with the authority to communicate it gives us insight into how sexual knowledge is distributed, received and redefined.
Hypocretin in locus coeruleus and dorsal raphe nucleus mediates inescapable footshock stimulation (IFS)-induced REM sleep alteration
Authors: Lo Yun , Yi Pei-Lu , Hsiao Yi-Tse , Chang Fang-Chia
Published: December 2021

Hypocretin (hcrt) is a stress-reacting neuropeptide mediating arousal and energy homeostasis. An inescapable footshock stimulation (IFS) could initiate the hcrt release from the lateral hypothalamus (LHA) and suppresses rapid eye movement (REM) sleep in rodents. However, the effects of the IFS-induced hcrts on REM-off nuclei, the locus coeruleus (LC) and dorsal raphe nucleus (DRN), remained unclear. We hypothesized that the hcrt projections from the LHA to LC or DRN mediate IFS-induced sleep disruption. Our results demonstrated that the IFS increased hcrt expression and the neuronal activities in the LHA, hypothalamus, brainstem, thalamus, and amygdala. Suppressions of REM sleep and slow wave activity during non-REM (NREM) sleep caused by the high expression of hcrts were blocked when a nonspecific and dual hcrt receptor antagonist was administered into the LC or DRN. Furthermore, the IFS also caused an elevated innate anxiety, but was limitedly influenced by the hcrt antagonist. This result suggests that the increased hcrt concentrations in the LC and DRN mediate stress-induced sleep disruptions and might partially involve IFS-induced anxiety.
A National Survey of Collaboration Between Nurse Faculty Members and Staff Nurses in the Clinical Learning Environment
Authors: Hooven Katie
Published: December 2021

AIM

The purpose of this study was to measure collaboration in the clinical learning environment.

BACKGROUND

Clinical learning, which is essential for nursing education, allows students to integrate what they have learned in the classroom in a complex social context with an interactive network of forces. Stakeholders are nursing students, nursing faculty, and staff nurses who must collaborate in providing an effective learning environment for students.

METHOD

Quantitative data were collected via the Collaboration in the Clinical Learning Environment tool, an author-developed 24-item Likert scale designed to measure the amount of collaboration between staff nurses and nursing faculty members in the clinical learning environment.

RESULTS

Three groups (n = 882) were surveyed: staff nurses, nurse faculty, and nurses who worked concurrently in academia and practice.

CONCLUSION

This study adds to the literature on collaboration between nursing faculty members and staff nurses. It also highlights areas for improvement for both parties.
Hearing Assessment and Rehabilitation for People Living With Dementia
Authors: Dawes Piers , Littlejohn Jenna , Bott Anthea , Brennan Siobhan , Burrow Simon , Hopper Tammy , Scanlan Emma
Published: December 2021

Hearing impairment commonly co-occurs with dementia. Audiologists, therefore, need to be prepared to address the specific needs of people living with dementia (PwD). PwD have needs in terms of dementia-friendly clinical settings, assessments, and rehabilitation strategies tailored to support individual requirements that depend on social context, personality, background, and health-related factors, as well as audiometric HL and experience with hearing assistance. Audiologists typically receive limited specialist training in assisting PwD and professional guidance for audiologists is scarce. The aim of this review was to outline best practice recommendations for the assessment and rehabilitation of hearing impairment for PwD with reference to the current evidence base. These recommendations, written by audiology, psychology, speech-language, and dementia nursing professionals, also highlight areas of research need. The review is aimed at hearing care professionals and includes practical recommendations for adapting audiological procedures and processes for the needs of PwD.
Bilinguals Show Proportionally Greater Benefit From Visual Speech Cues and Sentence Context in Their Second Compared to Their First Language
Authors: Chauvin Alexandre , Phillips Natalie A.
Published: December 2021

Objectives:

Speech perception in noise is challenging, but evidence suggests that it may be facilitated by visual speech cues (e.g., lip movements) and supportive sentence context in native speakers. Comparatively few studies have investigated speech perception in noise in bilinguals, and little is known about the impact of visual speech cues and supportive sentence context in a first language compared to a second language within the same individual. The current study addresses this gap by directly investigating the extent to which bilinguals benefit from visual speech cues and supportive sentence context under similarly noisy conditions in their first and second language.

Design:

Thirty young adult English–French/French–English bilinguals were recruited from the undergraduate psychology program at Concordia University and from the Montreal community. They completed a speech perception in noise task during which they were presented with video-recorded sentences and instructed to repeat the last word of each sentence out loud. Sentences were presented in three different modalities: visual-only, auditory-only, and audiovisual. Additionally, sentences had one of two levels of context: moderate (e.g., “In the woods, the hiker saw a bear.”) and low (e.g., “I had not thought about that bear.”). Each participant completed this task in both their first and second language; crucially, the level of background noise was calibrated individually for each participant and was the same throughout the first language and second language (L2) portions of the experimental task.

Results:

Overall, speech perception in noise was more accurate in bilinguals’ first language compared to the second. However, participants benefited from visual speech cues and supportive sentence context to a proportionally greater extent in their second language compared to their first. At the individual level, performance during the speech perception in noise task was related to aspects of bilinguals’ experience in their second language (i.e., age of acquisition, relative balance between the first and the second language).

Conclusions:

Bilinguals benefit from visual speech cues and sentence context in their second language during speech in noise and do so to a greater extent than in their first language given the same level of background noise. Together, this indicates that L2 speech perception can be conceptualized within an inverse effectiveness hypothesis framework with a complex interplay of sensory factors (i.e., the quality of the auditory speech signal and visual speech cues) and linguistic factors (i.e., presence or absence of supportive context and L2 experience of the listener).
Outpatient Bryant’s Overhead Traction Does Not Affect the Rate of Open Reduction or Avascular Necrosis in Developmental Dislocation of the Hip
Authors: Elerson Emily E. , Martin Benjamin D. , Muchow Ryan D. , Pierce William A. , Jo Chan-Hee , Hinds Sean A. , Birch John G.
Published: December 2021

Background:

The efficacy of preliminary traction to increase the likelihood of closed reduction and/or decrease the incidence of avascular necrosis in the management of developmental dysplasia of the hip (DDH) is controversial. We sought to document compliance with and effectiveness of Bryant’s outpatient traction in patients with idiopathic DDH.

Methods:

Patients presenting between 6 and 24 months of age with idiopathic irreducible DDH were prospectively enrolled in the study. Prereduction outpatient traction was prescribed at participating surgeons’ preference and parents’ expressed willingness to comply with a traction protocol of at least 14 hours/day for 4 weeks. Traction hours were documented using a validated monitor; parents also reported average daily usage. Rate of successful closed reduction and evidence of capital epiphyseal growth disturbance 1 year’ and 2 years’ postreduction were documented.

Results:

Ninety-six patients with 115 affected hips were enrolled. Reliable recorded traction hours were obtained in 31 patients with 36 affected hips. Defining compliance as 14 hours/day average use, 14 of 31 patients (45.2%) were compliant, 2 (6.5%) admitted noncompliance, while 15 (48.2%) claimed to be compliant, but were not. Overall, 68/115 hips (59.0%) were closed reduced. Age at treatment was the only demographic characteristic associated with an increased incidence of closed reduction (11.7 vs. 14.6 mo, P<0.01). Successful closed reduction was achieved in 10/16 hips (62.5%) of compliant patients, 12/20 (60.0%) of noncompliant patients, and 43/72 (59.7%) of no-traction patients. Irregular ossific nucleus development was noted 1-year postindex reduction in 5/16 (31.3%) of complaint-patient hips and 25/92 (27.2%) of noncomplaint and no-traction hips. Distorted proximal femoral epiphysis was noted at 2 years postreduction in 2/15 hips (13.3%) of compliant patients and 15/52 hips (28.8%) in noncompliant and no-traction patients. None of these differences was statistically significant.

Conclusions:

Parent-reported use of outpatient traction is unreliable. Four weeks of outpatient overhead Bryant’s traction did not affect the rate of closed reduction or avascular necrosis in late-presenting DDH in this cohort.

Level of Evidence:

Level II—prospective cohort.
The Mysterious Role of Epidural Fat Tissue in Spine Surgery
Authors: Alonge Emmanuel O. , Guo Chaofeng , Wang Yuxiang , Zhang Hongqi
Published: December 2021

Background:

Though both neurosurgeons and orthopedic spinal surgeons are keenly aware of the clinical importance of epidural fat (EF), surgical practice varies amongst individual surgeons and across both fields. Thus, an in-depth understanding of the anatomical structure and composition of EF is vital, as it will play a significant role in the therapeutic management and the surgical choice of treatment.

Objective:

We aim to extensively review the anatomical and biological properties of EF and further outline the surgical importance of EF management.

Study Methodology:

(i) MEDLINE search 1966–July 2019. Keywords: Review of the Literature. Authorship, Meta-analysis, Descriptive/Narrative overview; (ii) CINAHL search from 1982 to May 2019. Keywords: Review of the Literature spinal epidural fat; Authorship; Meta-analysis; Descriptive/Narrative overview; (iii) Hand searches of the references of retrieved literature; (iv) Personal and college libraries were searched for texts on research methods and literature reviews; and (v) 200 articles were downloaded, 50 were excluded because of similarity of topics and also because of new update on the same topics. (vi) Discussions with experts in the field of reviews of the literature.

Discussion:

Though excessive or reductive amounts of EF usually exacerbates neurological symptoms and lead to various pathologic conditions such as spinal epidural lipomatosis, but there is no basic science, experimental, or clinical research that proves the role of EF in the aforementioned pathologic situations.

Conclusion:

Anatomical illustration, biological function and properties of EF knowledge may lead to changes in the stages of the surgical approach to avoid postoperative complications. However, the role of EF is exclusively bound to a scientific hypothesis as one cannot be sure if an excessive or reductive amount in EF is entirely responsible for the pathologic findings, or just only an incidental finding.
Just-in-Time Continuing Education: Perceived and Unperceived, Pull and Push Taxonomy
Authors: Yilmaz Yusuf , Papanagnou Dimitrios , Fornari Alice , Chan Teresa M.
Published: December 2021

We live in a world where “just-in-time” (JiT) methodologies are increasingly used. Continuing professional development (CPD), including faculty development, has the opportunity to leverage online technologies in a JiT format to further support learner engagement and program sustainability. In this article, the authors propose a model that can serve as a taxonomy for defining and implementing JiT continuing education (JiTCE). The anatomy of JiTCE describes four mechanisms to address CPD needs and delivery procedures: perceived and unperceived, as well as pull and push (PUPP) taxonomy. JiTCE PUPP taxonomy defines four components for designing and developing a program with JiT: on-demand learning, subscription-based learning, performance feedback–driven learning, and data-driven learning. These methods, as backbones, use various online technologies, which offer fundamental support for JiTCE. Delivery systems and technologies are provided as specific examples for JiTCE throughout the article. JiTCE introduces a novel taxonomy to meet continuing education needs and provides an organized approach to design and deploy programming in a sustainable way. Online technologies are evolving everyday and are an indispensable part of both clinical practice and medical education. Pull–push and perceived–unperceived axes can help guide new opportunities for instructional designers and curriculum developers to leverage best practices to align with CPD offerings, which include cutting-edge technologies.
Professional Development Coaching for Health Professions Graduate Faculty: A Pilot Implementation
Authors: Pearce Michelle J.
Published: December 2021

Introduction:

Organizations have offered executive coaching to their senior leaders for several decades and report improvement in performance, leadership, self-efficacy, and goal attainment. Despite this success, little research exists on coaching programs for faculty who may also benefit from this resource. We sought to develop, implement, and evaluate a professional development coaching program for diverse graduate faculty at a health professions university.

Methods:

We implemented a professional development coaching program to provide one-on-one support for interested faculty. Faculty were offered four 1-hour or eight half-hour sessions each academic semester by eight trained volunteer coaches unaffiliated with the university. We had 67 faculty members participate across the academic year. They were asked to complete a brief impact survey at the end of each semester.

Results:

The coaches provided 378 sessions, totaling 281 hours of coaching. Survey results revealed that coaching was effective in helping faculty achieve their professional goals and empowered them for future professional success. Faculty were highly satisfied with the program.

Discussion:

There is early evidence that professional development coaching can help faculty reach their professional goals and add value to an institution. The program may be a helpful model for developing and implementing coaching programs on other campuses.
In Vivo Reflectance Confocal Microscopy of Adnexal Tumors: Evaluation of Trichoepithelioma, Sebaceoma, and Fibrofolliculoma
Authors: Rosales-Duran Sharon , Ricaurte-Jiménez Marcela , Ferreira Paula S. , Sangueza Martin , Lourenço Silvia V. , Nico Marcello M. S.
Published: December 2021

Cutaneous adnexal tumors are benign and malignant neoplasms that undergo morphological differentiation into cutaneous adnexa, comprising pilosebaceous, eccrine, or apocrine units. Reflectance confocal microscopy is a noninvasive diagnostic method that enables in vivo visualization of tissues at a similar resolution as conventional histopathology. The use of this method in skin imaging over the past several years has improved dermatological diagnoses, potentiating its wide application, especially for benign and malignant skin tumors. We describe the use of reflectance confocal microscopy in cases of trichoepithelioma, sebaceoma, and fibrofolliculoma and correlate the resulting clinical, histopathological, and confocal microscopy images.
Primary Cutaneous Anaplastic Large Cell Lymphoma With 6p25.3 Rearrangement and Epidermotropism
Authors: Dutra Eduardo , Maia Tiago , Cabeçadas José
Published: December 2021

Primary cutaneous anaplastic large cell lymphoma may harbor a 6p25.3 rearrangement, which has been associated with an epidermotropic small cell component. We report the case of a patient with said lymphoma harboring that rearrangement. It presented as a forehead nodule, histologically composed of an intermediate-to-large cell dermal component alongside a small-to-intermediate cell epidermotropic component. After multiple cutaneous and regional lymph node relapses, disease progression has been documented to a distant lymph node, despite local radiotherapy of the cutaneous lesions, chemotherapy, and anti-CD30 therapy, albeit with an indolent course over 6 years. Cases of pcALCL with nonregional lymph node involvement are unusual. Nevertheless, in this case, progression to a distant lymph node was not associated with an aggressive transformation of the disease.
Follicular Melanocytes in Frontal Fibrosing Alopecia: An Immunohistochemical Study With Trichoscopic Correlation
Authors: Salas-Callo Corina Isabel , Carvalho Quintella Danielle , Saceda-Corralo David , Pirmez Rodrigo
Published: December 2021

Background:

Frontal fibrosing alopecia (FFA) is a scarring alopecia that affects the frontotemporal hairline. Clinically, it may develop with cutaneous hypopigmentation of the affected areas, which has been associated with a reduction in the epidermal melanocyte count. In trichoscopy, peripilar white halos can be observed, which have been associated with fibrosis in other scarring alopecias.

Objective:

To evaluate the trichoscopic, histopathological and immunohistochemical characteristics of the peripilar white halos in FFA patients.

Materials and methods:

We conducted a descriptive cross-sectional study that included 12 patients with FFA presenting peripilar white halos. Two 2-mm punch trichoscopy-guided biopsies were performed in all patients, one fragment for vertical section and another for horizontal section. The vertical sections were stained with Fontana-Mason and Melan-A.

Results:

On trichoscopic examination, peripilar white halos ≤ 1 mm in size were observed on the affected scalp. In vertical sections, a reduction in basal melanin pigmentation and a decrease in the melanocyte count in the upper segment of the hair follicle were observed with Fontana-Masson staining and Melan-A immunostaining, respectively.

Limitations:

The small sample size and absence of a control group.

Conclusion:

This study shows follicular melanocyte involvement in FFA, and this finding may be associated with the peripilar white halos observed in trichoscopy.
Local Tumor Infiltration and Locoregional Recurrence in Desmoplastic Cutaneous Squamous Cell Carcinoma
Authors: Kofler Katrin , Breuninger Helmut , Eigentler Thomas , Kofler Lukas , Schaefer Viola , Blumenstock Gunnar , Häfner Hans-Martin , Schnabl Saskia Maria
Published: December 2021

BACKGROUND

Perusal of the literature of cutaneous squamous cell carcinoma (SCC) reveals that the role of the desmoplastic subtype is indistinct. Data on local infiltration and recurrence are inconsistent dependent on surgical technique, histological method, and investigated collective.

OBJECTIVE

The aim of the study was to analyze local infiltration and locoregional recurrence of the desmoplastic subtype under a uniform procedure.

METHODS AND MATERIALS

Between 2005 and 2015, 320 SCCs were analyzed and histological sections of all tumors were examined. Data collection included locoregional recurrence, metastasis rate, and tumor-specific death. The median follow-up was 36.5 months.

RESULTS

The desmoplastic subtype required significant more re-excisions (70.0% vs 23.9%, p < .001), more interventions until tumor-free margins were achieved (maximal 6 vs 2; p < .001), showed more widespread tumor infiltration with larger excisional margins (median 9 mm, 2–51 mm vs median 4 mm, 1–10 mm; p < .001), and a 5-fold higher local recurrence rate (26.7% vs 5.0%, p < .001). The metastasis rate (16.6% vs 2.3%, p < .001) was increased.

CONCLUSION

The desmoplastic subtype is characterized by a widespread local infiltration associated with perineural infiltration. It seems to be a marker for decreased histological detectability with a high rate of locoregional recurrence and metastasis.
Reproductive Technology Considerations in Uterus Transplant
Authors: Walter Jessica R. , O’Neill Kathleen E.
Published: December 2021

Uterus transplantation (UTx) provides a new pathway to parenthood for patients with absolute uterine factor infertility. The application of reproductive technologies, such as in vitro fertilization, embryo cryopreservation, and frozen embryo transfers, for this unique population, is particularly nuanced and continually evolving. There are important pretransplant and posttransplant reproductive considerations for physicians and patients anticipating UTx. As with any rapidly evolving medical innovation, efforts to consolidate experiences and knowledge by centers offering UTx is paramount.
Compensatory Considerations for Radiological Emergency Response and Public Protective Actions during the COVID-19 Pandemic
Authors: Leek Angela E. , Semancik Jeffrey D.
Published: December 2021

Epidemiological evidence and models have demonstrated that the current COVID-19 pandemic introduces a significant public risk to implementing large-scale community evacuations in response to disasters. While guidance documented in the US Environmental Protection Agency Protective Action Guidance (PAG) Manual is widely accepted as the standard basis for public and emergency worker protective actions for a radiological emergency, it is based primarily on assessing the risks associated with the radiological factors alone. However, as demonstrated in response to the nuclear incident in Fukushima, these events seldom occur in isolation from other risk-inducing events. Today, the COVID-19 pandemic represents a significant public health risk that must also be considered alongside the radiation risks in determining appropriate public and emergency worker protection action decisions. In particular, the significant public health risks associated with community transmission and mortality of COVID-19 challenge our most familiar and rehearsed radiological response strategies. The 1992 and 2017 US Environmental Protection Agency PAG manuals allow for considerations in protective action decision making. Much of the radiation emergency response community has been conditioned through decades of structured training and exercises to focus public protection considerations on specific guidelines referenced numerically in tables within the manual. Discussion regarding adjustment of specific PAG values is provided in the footnotes and bases portions of the PAG manual but is often not included in jurisdictional plans or routinely considered in exercises. However, when properly applied, the protective action guidance provides the necessary flexibility for decision-makers to account for additional public health risks or impediments, and jurisdictions can use this guidance to build a more effective response strategy. The authors have applied the full guidance and flexibility provided in the 2017 US Environmental Protection Agency PAG Manual to develop more specific guidance for their respective jurisdictions’ radiation emergency response plans and will outline a process for consideration of protective action decisions to maximize the protection of public health and safety.
SEED: An Operational Numerical Tool for Dosimetric Reconstruction in Case of External Radiological Overexposure
Authors: Entine F. , Garnier G. , Dondey M. , Rizzi Y. , Gobert A. , Bassinet C. , Papin S. , Pennacino I. , Cazoulat A. , Amabile J.C. , Huet C.
Published: December 2021

In the event of a radiological accident involving external exposure of one or more victims and potential high doses, it is essential to know the dose distribution within the body in order to sort the victims according to the severity of the irradiation and then to take them to the most suitable medical facilities. However, there are currently few techniques that can be rapidly deployed on field and capable of characterizing an irradiation. Therefore, a numerical simulation tool has been designed. It can be implemented by a doctor/physicist pairing, projected within a limited time as close as possible to the irradiation accident and emergency response teams. Called SEED (Simulation of External Exposures & Dosimetry), this tool (dedicated to dose reconstruction in case of external exposure) allows a rapid modeling of the irradiation scene and a visual exchange with the victims and witnesses of the event. The user can navigate in three dimensions in the accident scene thanks to a graphical user interface including a “first person” camera. To validate the performance of the SEED tool, two dosimetric benchmarking exercises were performed. The first consisted in comparing the dose value provided by SEED to that given by a reference calculation code: MCNPX. The purpose of the second validation was to perform an experiment irradiating a physical dummy equipped with dosimeters and to reconstruct this irradiation using SEED. These two validation protocols have shown satisfactory results with mean difference less than 2% and 12% for the first and second exercises, respectively. They confirm that this new tool is able to provide useful information to medical teams in charge of dosimetric triage in case of a major external exposure event.
Why don't all nurse practitioners precept? A comparative study
Authors: DeClerk Leonie , Lefler Leanne , Nagel Corey , Mitchell Anita , Rojo Martha , Sparbel Kathleen
Published: December 2021

Background:

Preceptors are integral in nurse practitioner (NP) education. A shortage of willing preceptors limits graduations from NP programs. However, little is known about why NPs decide not to precept.

Purpose:

To identify the factors significantly associated with NPs' status as currently, previously, or never precepting, using the Integrated Behavioral Model as the conceptual framework.

Methodology:

This was a cross-sectional, comparative, descriptive study of NPs using survey methodology. Our survey was based on published surveys with items added and adapted to reflect our framework. Subscales included personal factors, primary determinants of intent to precept, and external factors. We mailed recruitment postcards, with an online survey link, to all NPs in Arkansas. Data were analyzed using bivariate and stepwise multinomial logistic regression for each subscale.

Results:

We obtained 261 responses. Participants who had previously and/or never precepted differed from current preceptors on multiple variables on bivariate analysis. Predictive personal factors included experience and hours worked per week. Predictive primary determinants included knowing NPs that precept, support for precepting, recognition of preceptors, and clinical expertise. Predictive external factors included space, liability, having a “gatekeeper,” NP program, importance of precepting, and number of requests.

Conclusions:

Different factors predict NPs who currently, previously, and have never precepted. However, frequency of requests predicted both nonprecepting groups. Various supports in the clinical setting and program factors predicted one or other nonprecepting group.

Implications:

Strategies should be developed to ensure all potential preceptors are recruited, increase support for precepting, and ensure educational programs meet preceptors' needs.
Characteristics and Outcomes of Candidemia in Patients with Durable Left Ventricular Assist Device Support
Authors: Broderick Kaitlyn L. , Peters Carli J. , Mazurek Jeremy A. , Wald Joyce , Zhang Robert S. , Atluri Pavan , Urgo Kim , Goldberg Lee , Blumberg Emily A. , Weikert Blair C. , Birati Edo Y.
Published: December 2021

There are limited data on the characteristics and clinical course of fungal infections in patients on durable left ventricular assist device (LVAD) support. We sought to further characterize the epidemiology and outcomes of LVAD patients with fungemia. We performed a retrospective review of patients receiving LVAD support from January 2012 through June 2020 at a large academic institution. Among 336 patients on LVAD support, five (1.4%) were diagnosed with fungemia during the study period. Three patients had diabetes with mean hemoglobin A1c 7.1% (R 6.6, 7.4). Fever and leukocytosis (mean white blood count 17.0 thousand/µL [R 12.5, 29.9]) were the most common symptoms. Fungemia was diagnosed early after LVAD implantation (mean 14.4 support days [R 2, 19]). All patients were infected with Candida species, and four isolates were susceptible to fluconazole. Central nervous system outcomes included an ischemic stroke, subarachnoid hemorrhage, and malignant hemorrhagic stroke. Two patients were successfully transplanted, and two patients on destination therapy remain on suppressive fluconazole. In conclusion, fungemia is a rare and severe complication in LVAD patients occurring early postimplant.
Nutritional therapy in critically ill patients with diabetes
Authors: Doola Ra’eesa , Preiser Jean-Charles
Published: December 2021

Purpose of review

There has been a significant increase in nutrition therapy related studies within the critical care cohort in recent years. Management of patients with both diabetes and stress hyperglycaemia through targeted nutrition interventions is no exception. The aim of this review is to outline current available diabetes specific nutrition formula, its impact on gastric emptying and subsequently glycaemic control as well as explore recent literature on the efficacy of utilizing nutrition support to optimize glycaemic control in critically ill patients.

Recent findings

Studies explored within this review were similar in terms of outcomes measures, focusing primarily on insulin use and glycaemic control. Although there were promising results in terms of the impact of diabetes-specific nutrition formula on these outcome measures, there were no significant associations with clinical outcomes.

The use of diabetes-specific formulae in critically ill patients with pre-existing diabetes and stress hyperglycaemia can be considered a logical approach to minimize the risks associated with high doses of insulin. Additional research is required to address the effects of these formulae on the dysglycaemia, nursing workload, safety of glycaemic control and cost-effectiveness.
Safety of breast/chest-feeding by those infected by SARS-CoV-2
Authors: Powell Rebecca L.R.
Published: December 2021

Purpose of review

One important question from the outset of the pandemic has been whether a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected person's milk might be a vehicle for SARS-CoV-2 transmission. This review summarizes the most recent data on this topic.

Recent findings

A SARS-CoV-2 sIgA response in milk after infection is very common. To date, there has been no evidence that SARS-CoV-2 transmits via human milk. Though viral RNA has been identified in a minority of milk samples studied, infectious virus particles have not.

The highly dominant transmission route for SARS-CoV-2 is via inhalation of respiratory droplets containing virus particles. Other routes of transmission are possible, including fecal–oral, trans-placental, and to a much lesser extent, via a contaminated surface. SARS-CoV-2 cannot transmit via human milk. There is no evidence that infants should be separated from SARS-CoV-2-infected mothers who are well enough to establish or continue breastfeeding.
Renal allograft-related inflammation complicated by acute coronary syndromes
Authors: Pliquett Rainer U. , Tannapfel Andrea , Daneschnejad Sait S.
Published: December 2021

Introduction:

Persistent systemic inflammation is considered to be predictive for future cardiovascular events. Here, in a patient with pyelonephritis of his failed renal allograft, consecutive coronary angiograms proved that coronary artery disease progressed within 3 weeks, when infection was uncontrolled.

Patient concerns:

A 52-year-old male type 2 diabetic with a failed renal allograft suffering from hematuria, leukocyturia, and chest pain at rest was hospitalized.

Diagnoses:

An acute coronary syndrome in presence of pyelonephritis was diagnosed. Besides pyelonephritis, the histological examination of the kidney transplant revealed signs of chronic rejection and the presence of a renal cell carcinoma in situ.

Interventions:

A percutaneous coronary intervention was performed, and an elective surgery for allograft removal was scheduled. However, within 5 weeks after discharge, two more surges of infection coincided with episodes of unstable angina.

Outcomes:

Once the renal allograft has been removed, systemic inflammation was contained. The patient was not re-hospitalized for acute-coronary syndrome within the next 12 months.

Conclusion:

Surges of systemic inflammation due to infection were paralleled by instability of coronary plaques as documented by repeat coronary angiograms.
The efficacy of dexmedetomidine for the prevention of catheter-related bladder discomfort
Authors: Lu Jia , Yang Xiamin , Zhang Jie , Huang Yuelong
Published: December 2021

Background:

The effective therapy to reduce postoperative catheter-related bladder discomfort (CRBD) remained unknown.

Objective:

We attempted to manage the systematic review and a meta-analysis to clarify the efficacy of dexmedetomidine (DEX) in potential prevention on CRBD.

Methods:

We performed the meta-analysis on randomized clinical trials (RCTs), and searched the databases from Web of Sciences, Embase and referred Cochrane Library published from October 2016 to September 2020. Data extraction was carefully conducted by 2 authors, respectively. Meta-analysis that was applied synthetically concerns the incidence and severity of CRBD and the treatment effect of DEX on CRBD.

Results:

We acquired 5 RCTs with interventions of DEX on CRBD. Meta-analysis showed DEX has significantly reduced the incidence and severity of CRBD compared with control at 0 hour (risk ratios [RR] = 0.40, 95% CI = 0.53–0.29, P < .01), 1 hour (RR = 0.44, 95% CI = 0.34–0.57, P < .01), and 2 hours (RR = 0.43, 95% CI = 0.32–0.58, P < .01) and 6 hours (RR = 0.43, 95% CI = 0.29–0.63, P < .01). DEX was also associated with lower incidence of moderate to severe CRBD at 0, 1, and 6 hours after surgery. There were no significant differences in adverse events other than bradycardia, hypotension, and hypertension.

Conclusion:

The 5 RCTs showed great effectiveness in reducing the incidence and severity of the early and later postoperative CRBD. Meta-analysis showed that DEX interventions were useful in preventing the early and later postoperative CRBD without significant side effects.
Efficacy and safety of sacubitril-valsartan in patients with heart failure: a systematic review and meta-analysis of randomized clinical trials
Authors: Lin Jiezhong , Zhou Jianyi , Xie Guiting , Liu Jinguang
Published: December 2021

Background:

To investigate the efficacy and safety of sacubitril-valsartan in patients with heart failure, relevant randomized clinical trials (RCTs) were analyzed.

Methods:

We used Cochrane Library, PubMed web of science, CNKI, VIP, Medline, ISI Web of Science, CBMdisc, and Wanfang database to conduct a systematic literature research. A fixed-effects model was used to evaluate the standardized mean differences (SMDs) with 95% confidence intervals. We conducted sensitivity analysis and analyzed publication bias to comprehensively estimate the efficacy and safety of sacubitril-valsartan in patients with heart failure.

Results:

Among 132 retrieved studies, 5 relevant RCTs were included in the meta-analysis. The result showed that left ventricular ejection fraction (LVEF) was improved after sacubitril-valsartan in patients with heart failure, with an SMD (95% CI of 1.1 [1.01, 1.19] and P < .00001 fixed-effects model). Combined outcome indicators showed that, combined outcome indicators showed that, compared with control group, the left ventricular volume index (LAVI) (WMD = −2.18, 95% CI [−3.63, −0.74], P = .003), the E/e’ (WMD = −1.01, 95% CI [−1.89, −0.12], P = .03), the cardiovascular death (RR = 0.89, 95% CI [0.83, 0.96], P = .003], and the rehospitalization rate of heart failure (RR = 0.83, 95% CI [0.78, 0.88], P < .01) decreased more significantly, but it had no effect on renal function (WMD = 0.74, 95% CI [0.54, 1.01], P = .06).

Conclusions:

The present meta-analysis suggested that sacubitril-valsartan may improve the cardiac function of heart failure. Given the limited number of included studies, additional large sample-size RCTs are required to determine the long-term effect of cardiac function of sacubitril-valsartan in patients with heart failure.
Study on the effect of pre-rehabilitation home-based on patients undergoing kidney transplantation with end-stage renal disease: A study protocol
Authors: Ma Xiaojie , Zhang Zaozhang , Yao Bonuan , Peng Mengsi , Jiang Hongtao , You Yong
Published: December 2021

Objective:

Evaluate the feasibility of ERAS-based home exercise pre-rehabilitation in patients awaiting kidney transplantation.

Methodology:

The proposed feasibility trial will be a single-arm, single-center study. A total of 47 ESRD patients awaiting kidney transplantation will be selected as subjects to undergo personalized family exercise pre-rehabilitation, including aerobic exercise, functional resistance exercise, and flexibility training. Briefly, a 6-minute walking test (6MWT), 4-meter gait speed, grip strength, and sit-to-stand test will be used as the main outcome indicators. The effect of family exercise pre-rehabilitation on the optimization of body function in ESRD patients undergoing kidney transplantation will be assessed. The days of hospitalization after kidney transplantation, postoperative complications, health survey (the Short Form Health Survey, SF-36), and the Hospital Anxiety and Depression Scale (HADS) will be used as secondary outcome indicators to evaluate the improvement of quality of life, psychological function, and postoperative rehabilitation of patients after kidney transplantation. These indexes will be collected before and after intervention (baseline and before kidney transplantation), before discharge (after kidney transplantation), and 1 month after discharge.

Conclusion:

This study will evaluate the effect of ERAS-based home exercise pre-rehabilitation on patients awaiting kidney transplantation, and possibly determine an application protocol for this population.

Trial registration:

Chinese Clinical Trial Registry, ChiCTR2000037846. Registered on September 2, 2020.
Comparative efficacy and safety of antivascular endothelial growth factors for central retinal vein occlusion
Authors: Liu Zhigao , Wang Shuya , Ma Aihua , Zhao Bojun
Published: December 2021

Background:

Central retinal vein occlusion (CRVO) is one of the most common retinal vascular diseases, which is closely related to systemic diseases like hypertension, diabetes and arteriosclerosis. Due of its blinding, it will seriously reduce the quality of life. Macular edema (ME) caused by CRVO is one of the serious complications of visual impairment. We found that the severity of ME in CRVO was positively associated with vascular endothelial growth factor (VEGF) in the anterior chamber. With the accelerated pace of modern life and the changed dietary structure, the incidence of this disease will continue to rise. Therefore, it is of great practical significance to seek effective treatment methods. Intraocular injection of anti-VEGF can effectively alleviate ME and improve visual acuity, showing excellent clinical application prospects. In recent years, there have been some new understandings and advances on the etiology and treatment methods of the present disease, such as the deepening into the molecular biology and gene level. Clinical studies on the efficacy of the disease have emerging. Therefore, a network meta-analysis (NMA) of anti-VEGF treatment for CRVO is particularly necessary to systematically compare its efficacy.

Methods:

The two reviewers will comprehensively retrieved electronic databases such as PubMed, The Cochrane Library, Wanfang database, Web of Science, Chinese Scientifific Journals Database, EMBASE, China National Knowledge Infrastructure, and China BioMedical Literature. A randomized controlled trial for CRVO against VEGF between January 2010 and June 2021 was included according to the relevant content of the study. In addition, 2 researchers will screen the literature to assess the risk bias for the included articles. We will evaluate the collected evidence and data using a Bayesian NMA method, and analyzed it with STATA and WinBUGS software.

Results:

Anti-VEGF is one of the effective methods for ME in CRVO patients, accordingly, this study will evaluate its efficacy and safety using a Bayesian NMA system.

Conclusion:

This study can provide an effective rationale for the clinical application of anti-VEGF for CRVO, contribute to the treatment of CRVO and patient condition rehabilitation in clinical work.

Ethics and dissemination:

Do not require.

INPLASY registration number:

INPLASY2021110073.