bluuebunny/crossref_metadata_2025 huggingface dataset:
Myelin modulates the process of isoflurane anesthesia through the regulation of neural activity
Authors: Wang Xu , Yi Rulan , Liang Xiaoling , Zhang Ning , Zhong Fuwang , Lu Yali , Chen Wenjia , Yu Tian , Zhang Linyong , Wang Haiying , Zhou Liang
Published: August 2024

Aims

The mechanism underlying the reversible unconsciousness induced by general anesthetics (GA) remains unclear. Recent studies revealed the critical roles of myelin and oligodendrocytes (OLs) in higher functions of the brain. However, it is unknown whether myelin actively participates in the regulation of GA. The aim of this study is to investigate the roles and possible mechanisms of myelin in the regulation of consciousness alterations induced by isoflurane anesthesia.

Methods

First, demyelination models for the entire brain and specific neural nuclei were established to investigate the potential role of myelination in the regulation of GA, as well as its possible regional specificity. c‐Fos staining was then performed on the demyelinated nuclei to verify the impact of myelin loss on neuronal activity. Finally, the activity of neurons during isoflurane anesthesia in demyelinated mice was recorded by optical fiber photometric calcium signal. The related behavioral indicators and EEG were recorded and analyzed.

Results

A prolonged emergence time was observed from isoflurane anesthesia in demyelinated mice, which suggested the involvement of myelin in regulating GA. The demyelination in distinct nuclei by LPC further clarified the region‐specific roles of isoflurane anesthesia regulation by myelin. The effect of demyelination on isoflurane anesthesia in the certain nucleus was consistent with that in neurons towards isoflurane anesthesia. Finally, we found that the mechanism of myelin in the modulation of isoflurane anesthesia is possibly through the regulation of neuronal activity.

Conclusions

In brief, myelin in the distinct neural nucleus plays an essential role in regulating the process of isoflurane anesthesia. The possible mechanism of myelin in the regulation of isoflurane anesthesia is neuronal activity modification by myelin integrity during GA. Our findings enhanced the comprehension of myelin function, and offered a fresh perspective for investigating the neural mechanisms of GA.
Generalizability of electroencephalographic interpretation using artificial intelligence: An external validation study
Authors: Mansilla Daniel , Tveit Jesper , Aurlien Harald , Avigdor Tamir , Ros‐Castello Victoria , Ho Alyssa , Abdallah Chifaou , Gotman Jean , Beniczky Sándor , Frauscher Birgit
Published: August 2024

Objective

The automated interpretation of clinical electroencephalograms (EEGs) using artificial intelligence (AI) holds the potential to bridge the treatment gap in resource‐limited settings and reduce the workload at specialized centers. However, to facilitate broad clinical implementation, it is essential to establish generalizability across diverse patient populations and equipment. We assessed whether SCORE‐AI demonstrates diagnostic accuracy comparable to that of experts when applied to a geographically different patient population, recorded with distinct EEG equipment and technical settings.

Methods

We assessed the diagnostic accuracy of a “fixed‐and‐frozen” AI model, using an independent dataset and external gold standard, and benchmarked it against three experts blinded to all other data. The dataset comprised 50% normal and 50% abnormal routine EEGs, equally distributed among the four major classes of EEG abnormalities (focal epileptiform, generalized epileptiform, focal nonepileptiform, and diffuse nonepileptiform). To assess diagnostic accuracy, we computed sensitivity, specificity, and accuracy of the AI model and the experts against the external gold standard.

Results

We analyzed EEGs from 104 patients (64 females, median age = 38.6 [range = 16–91] years). SCORE‐AI performed equally well compared to the experts, with an overall accuracy of 92% (95% confidence interval [CI] = 90%–94%) versus 94% (95% CI = 92%–96%). There was no significant difference between SCORE‐AI and the experts for any metric or category. SCORE‐AI performed well independently of the vigilance state (false classification during awake: 5/41 [12.2%], false classification during sleep: 2/11 [18.2%]; p = .63) and normal variants (false classification in presence of normal variants: 4/14 [28.6%], false classification in absence of normal variants: 3/38 [7.9%]; p = .07).

Significance

SCORE‐AI achieved diagnostic performance equal to human experts in an EEG dataset independent of the development dataset, in a geographically distinct patient population, recorded with different equipment and technical settings than the development dataset.
Adjunctive cenobamate in people with focal onset seizures: Insights from the Italian Expanded Access Program
Authors: Roberti Roberta , Assenza Giovanni , Bisulli Francesca , Boero Giovanni , Canafoglia Laura , Chiesa Valentina , Di Bonaventura Carlo , Di Gennaro Giancarlo , Elia Maurizio , Ferlazzo Edoardo , Giordano Alfonso , La Neve Angela , Liguori Claudio , Meletti Stefano , Operto Francesca Felicia , Pietrafusa Nicola , Puligheddu Monica , Pulitano Patrizia , Rosati Eleonora , Sammarra Ilaria , Tartara Elena , Vatti Giampaolo , Villani Flavio ,   CNB EAP Italy Study Group, Russo Emilio , Lattanzi Simona
Published: August 2024

Objective

This study was undertaken to assess the effectiveness/tolerability of adjunctive cenobamate, variations in the load of concomitant antiseizure medications (ASMs) and predictors of clinical response in people with focal epilepsy.

Methods

This was a retrospective study at 21 centers participating in the Italian Expanded Access Program. Effectiveness outcomes included retention and responder rates (≥50% and 100% reduction in baseline seizure frequency). Tolerability/safety outcomes included the rate of treatment discontinuation due to adverse events (AEs) and their incidence. Total drug load was quantified as the number of concomitant ASMs and total defined daily dose (DDD). Concomitant ASMs were also classified according to their mechanism of action and pharmacokinetic interactions to perform explorative subgroup analyses.

Results

A total of 236 subjects with a median age of 38 (Q1–Q3 = 27–49) years were included. At 12 months, cenobamate retention rate was 78.8% and responders were 57.5%. The seizure freedom rates during the preceding 3 months were 9.8%, 12.2%, 16.3%, and 14.0% at 3, 6, 9, and 12 months. A higher percentage of responders was observed among subjects treated with clobazam, although the difference was not statistically significant. A total of 223 AEs were recorded in 133 of 236 participants, leading to cenobamate discontinuation in 8.5% cases. At 12 months, a reduction of one or two concomitant ASMs occurred in 42.6% and 4.3% of the subjects. The median total DDD of all concomitant ASMs decreased from 3.34 (Q1–Q3 = 2.50–4.47) at baseline to 2.50 (Q1–Q3 = 1.67–3.50) at 12 months (p < .001, median percentage reduction = 22.2%). The highest rates of cotreatment withdrawal and reductions in the DDD were observed for sodium channel blockers and γ‐aminobutyric acidergic modulators (above all for those linked to pharmacokinetic interactions), and perampanel.

Significance

Adjunctive cenobamate was associated with a reduction in seizure frequency and in the burden of concomitant ASMs in adults with difficult‐to‐treat focal epilepsy. The type of ASM associated did not influence effectiveness except for a favorable trend with clobazam.
Identification of a new retigabine derivative with improved photostability for selective activation of neuronal Kv7 channels and antiseizure activity
Authors: Wang Hongbin , Qiao Zhen , Luan Kun , Xiang Wei , Chang Xiuying , Zhang Yanru , Wei Ningning , Wang KeWei
Published: August 2024

Objective

Pharmacological activation of neuronal Kv7 channels by the antiepileptic drug retigabine (RTG; ezogabine) has been proven effective in treating partial epilepsy. However, RTG was withdrawn from the market due to the toxicity caused by its phenazinium dimer metabolites, leading to peripheral skin discoloration and retinal abnormalities. To address the undesirable metabolic properties of RTG and prevent the formation of phenazinium dimers, we made chemical modifications to RTG, resulting in a new RTG derivative, 1025c, N,N′‐{4‐[(4‐fluorobenzyl) (prop‐2‐yn‐1‐yl)amino]‐1,2‐phenylene}bis(3,3‐dimethylbutanamide).

Methods

Whole‐cell recordings were used to evaluate Kv7 channel openers. Site‐directed mutagenesis and molecular docking were adopted to investigate the molecular mechanism underlying 1025c and Kv7.2 interactions. Mouse seizure models of maximal electroshock (MES), subcutaneous pentylenetetrazol (scPTZ), and PTZ‐induced kindling were utilized to test compound antiepileptic activity.

Results

The novel compound 1025c selectively activates whole‐cell Kv7.2/7.3 currents in a concentration‐dependent manner, with half‐maximal effective concentration of .91 ± .17 μmol·L−1. The 1025c compound also causes a leftward shift in Kv7.2/7.3 current activation toward a more hyperpolarized membrane potential, with a shift of the half voltage of maximal activation (ΔV1/2) of −18.6 ± 3.0 mV. Intraperitoneal administration of 1025c demonstrates dose‐dependent antiseizure activities in assays of MES, scPTZ, and PTZ‐induced kindling models. Moreover, through site‐directed mutagenesis combined with molecular docking, a key residue Trp236 has been identified as critical for 1025c‐mediated activation of Kv7.2 channels. Photostability experiments further reveal that 1025c is more photostable than RTG and is unable to dimerize.

Significance

Our findings demonstrate that 1025c exhibits potent and selective activation of neuronal Kv7 channels without being metabolized to phenazinium dimers, suggesting its developmental potential as an antiseizure agent for therapy.
Ants (Hymenoptera: Formicidae) intercepted at South Korean points of entry
Authors: Suh Soo‐Jung , Tasen Wattanachai
Published: August 2024

Sixty‐two species of ants (Hymenoptera: Formicidae) were intercepted at South Korean points of entry on plants for planting imported from tropical and subtropical Asia from 1996 to 2023. Information on the number of interceptions, host plants, consignment origin and their years of interception is provided. Data on intercepted ant species were analysed to determine potential invasive species of ants that could cause damage not only to agricultural, forestry, and natural ecosystems but also to industry and that could endanger human health.
Correlation between kinematic parameters, ataxia and ground‐to‐lip distance in detomidine sedated horses
Authors: Izquierdo‐Moreno Jorge , de Paz Marta Illán , Manso‐Díaz Gabriel , Villalba‐Orero María , López‐Sanromán Javier
Published: August 2024

Background

An accurate evaluation of the degree of sedation is mandatory to adjust the dosage of sedative drugs.

Objectives

To determine the correlation between head height above the ground and ataxia degree in horses sedated with detomidine and the correlation existing between accelerometric variables and both parameters.

Study design

Retrospective study.

Methods

Twelve horses were given 0.01 mg/kg of detomidine hydrochloride iv. Measured accelerometric parameters, with one accelerometer positioned between both sacral tuberosities, included speed, stride frequency and length, regularity, dorsoventral, longitudinal, mediolateral and total accelerometric activities, relative force index and dorsoventral, longitudinal and mediolateral parts of the accelerometric activities. Head height above the ground (cm) and subjective ataxia degree were also measured. Baseline values (−15 min) and values measured 5 and 15 min after the injection and then every 15 min for a period of 2 h were obtained.

Results

There was a negative and strong correlation between head height above the ground and ataxia degree (Pearson r = −0.78, p < 0.001), particularly during the first 45 min. A significant correlation was found between head height above the ground and almost all accelerometric parameters. This correlation was very strong with stride frequency, regularity and dorsoventral and total accelerometric activities in both cases, but for ataxia, also with total accelerometric activity.

Main limitations

Experimental conditions may not represent real clinical situations.

Conclusions

Stride frequency and regularity are the most reliable parameters to determine degree of sedation and are related to the sedation produced. Ataxia should not be considered a separate property of sedation and does not need to be assessed separately to the depth of sedation.
The integration of diel vertical migration and hydrodynamic process influences the transport of swimming crab zoea (Portunus trituberculatus)
Authors: Jiang Huidong , Ye Zhenjiang , Zhang Yixiao , Zhang Wenchao , Tian Yongjun , Li Jianchao , Liu Yang , Yu Haiqing , Zhang Xingui
Published: August 2024

Vertical migration and dispersal processes during the marine crab larval stage markedly affect transport, habitat selection, population connectivity, and resource replenishment success rates. However, not much is known of the reproductive ecology of swimming crabs in the nearshore waters of the northwest Pacific shelf. Here, we investigated the diel vertical migration (DVM) characteristics and transport patterns of the swimming crab zoea (Portunus trituberculatus) in this area. A Lagrangian particle‐tracking algorithm coupled with a hydrodynamic model, incorporating a DVM pattern of zoeae based on observations from a field survey of the diurnal distribution of swimming crab zoea, was used to simulate the transport of zoeae, and the impact of zoeal transport on population connectivity was explored. The results revealed that particles were predominantly transported in a nearshore direction from the particle release point, with short dispersal distances during the zoeal stages. In nearshore waters on the continental shelf, the swimming crab zoeae are exposed to shoreward‐moving currents with the aid of prolonged daytime locations in the lower water column, whereas larvae migrate upward to the middle and upper layers of the water column at night rather than the most superficial layer, potentially avoiding surface offshore‐moving currents that may be responsible for the retention and shoreward transport of larvae. Most zoeae are transported to shallow waters, and the contribution of transport to population connectivity during the zoeal stages is relatively limited. The findings here have considerable implications for understanding the mechanisms governing the early recruitment dynamics of this species, as well as for fisheries management and conservation of marine biodiversity.
Megakaryocyte maturation involves activation of the adaptive unfolded protein response
Authors: Faiz Mifra , Kalev‐Zylinska Maggie L. , Dunstan‐Harrison Caitlin , Singleton Dean C. , Hay Michael P. , Ledgerwood Elizabeth C.
Published: August 2024

Endoplasmic reticulum stress triggers the unfolded protein response (UPR) to promote cell survival or apoptosis. Transient endoplasmic reticulum stress activation has been reported to trigger megakaryocyte production, and UPR activation has been reported as a feature of megakaryocytic cancers. However, the role of UPR signaling in megakaryocyte biology is not fully understood. We studied the involvement of UPR in human megakaryocytic differentiation using PMA (phorbol 12‐myristate 13‐acetate)‐induced maturation of megakaryoblastic cell lines and thrombopoietin‐induced differentiation of human peripheral blood‐derived progenitors. Our results demonstrate that an adaptive UPR is a feature of megakaryocytic differentiation and that this response is not associated with ER stress‐induced apoptosis. Differentiation did not alter the response to the canonical endoplasmic reticulum stressors DTT or thapsigargin. However, thapsigargin, but not DTT, inhibited differentiation, consistent with the involvement of Ca2+ signaling in megakaryocyte differentiation.
Cost‐Effectiveness of Population‐Based Helicobacter pylori Screening With Eradication for Optimal Age of Implementation
Authors: Kowada Akiko
Published: August 2024

Background

Helicobacter pylori screening with eradication reduces gastric cancer (GC) development. However, it was unknown at what age the H. pylori screening should be implemented to achieve the greatest benefits at the least cost. This study aimed to determine the optimal age of H. pylori screening for primary GC prevention.

Materials and Methods

A state transition model for a hypothetical cohort of 15‐year‐olds from a healthcare payer perspective on a lifetime horizon was developed. Nine ages for H. pylori testing were considered: 15, 18, 20, 30, 40, 50, 60, 70, and 80 years. H. pylori screening was compared with no screening and annual, biennial, and triennial endoscopies starting at age 50. The main outcomes were costs, quality‐adjusted life‐years (QALYs), life expectancy life‐years (LYs), incremental cost‐effectiveness ratios, GC cases, stage I GC cases, and GC‐related deaths. One‐way, two‐way, and probabilistic sensitivity analyses were performed to assess the uncertainty of the parameters.

Results

All H. pylori screenings at ages 15–80 were more cost‐effective than all endoscopies and no screening. H. pylori screening at age 15 yielded the greatest cost‐saving and benefits. The cost‐effectiveness was sensitive to the adherence rate of H. pylori screening at age 15. Cost‐effectiveness acceptability curves showed that H. pylori screening at age 15 was 99.6% cost‐effective at a willingness‐to‐pay threshold of US$50,000 per QALY gained. Compared with no screening and biennial endoscopy in 15.6 million 15‐year‐olds from 2022 to 2037, respectively, H. pylori screening at age 15 saves US$9.70 million and US$2.39 billion, increases 1.26 million QALYs with 1312 LYs and 651 LYs, prevents 436 GC cases with 254 stage I GC cases and 305 stage I GC cases, and avoids 176 GC‐related deaths and 72 GC‐related deaths.

Conclusions

The optimal age for population‐based H. pylori screening at ages 15–80 is the youngest, 15 years old. Shifting population‐based H. pylori screening to younger people will reduce GC morbidity and mortality worldwide, along with a detailed investigation of the feasibility and long‐term consequences of H. pylori eradication at a young age.
A New Process Model for Relationship‐Centred Shared Decision‐Making in Physical Medicine and Rehabilitation Settings
Authors: Papadimitriou Christina , Clayman Marla L. , Mallinson Trudy , Weaver Jennifer A. , Guernon Ann , Meehan Albert J. , Kot Trisha , Ford Paige , Ideishi Roger , Prather Christina , van der Wees Philip
Published: August 2024

Introduction

We present a relationship‐centred shared‐decision‐making (RCSDM) process model to explicate factors that shape decision‐making processes during physical medicine and rehabilitation (PMR) encounters among patients, their care partners and practitioners. Existing shared decision‐making (SDM) models fall short in addressing the everyday decisions routinely made regarding persons with chronic disabilities who require high levels of support, their care partners and rehabilitation practitioners. In PMR, these everyday decisions are small scale, immediate and in service to a larger therapeutic goal. They can be thought of as micro‐decisions and involve multiple practitioners, care partners and patients. How micro‐decisions are made in this context is contingent on multiple roles and relationships among these relevant parties. Our model centres on micro‐decisions among patients, their care partners and practitioners based on our disorders of consciousness (DoC) research.

Methods

To develop our model, we examined peer‐reviewed literature in SDM in PMR, chronic disability and person‐centeredness; formed collaborations and co‐created our constructs with rehabilitation practitioners and with care partners who have lived experience of caring for persons with DoC; analysed emerging empirical data and vetted early versions with expert scientific and clinical audiences. Our model builds from the core tenets of relational autonomy, and scholarship and activism of disability advocates.

Findings

Our model conceptualizes four non‐hierarchical levels of analysis to understand the process of micro‐decision‐making in chronic disability and medical rehabilitation: social forces (historical and sociological); roles and relationships (multiple and intersecting); relational dimensions (interactional and contextual) and micro‐decision moments (initiation, response and closure).

Discussion

Relationships among patients, their care partners and practitioners are the intersubjective milieu within which decisions are made. Our conceptual model explicates the process of micro‐decision‐making in PMR.

Patient or Public Contribution

Care partners (or caregivers) and rehabilitation practitioners are active members of our team. We work together to develop research projects, collect, analyse and disseminate data. The conceptual model we present in this manuscript was co‐created—input from care partners and practitioners on previously collected data became the impetus to develop the RCSDM process model and share co‐authorship in this manuscript.
Mitigation of ultraviolet‐induced erythema and inflammation by para‐hydroxycinnamic acid in human skin
Authors: Janson William P. , Breyfogle Laurie E. , Bierman John C. , Chew Zhi Yan , Ehrman Matthew C. , Oblong John E.
Published: August 2024

Objective

To evaluate whether p‐hydroxycinnamic acid (pHCA) alone and in combination with niacinamide (Nam) can mitigate UV‐induced erythema, barrier disruption, and inflammation.

Methods

Three independent placebo‐controlled double‐blinded studies were conducted on female panellists who were pretreated on sites on their backs for 2 weeks with skin care formulations which contained 0.3% or 1% pHCA with 5% Nam, 1% pHCA alone, 1.8% octinoxate, or control formula. Treated sites were then exposed to 1.5 minimal erythemal dose (MED) solar simulated radiation (SSR) and had chromameter and expert grading measures for erythema, barrier integrity via TEWL, and the skin surface IL‐1RA/IL‐1α inflammatory biomarkers isolated from D‐Squame tapes.

Results

Across the three independent studies, pHCA alone or in combination with Nam showed a significant mitigation of UV‐induced erythema, barrier disruption, and levels of the surface inflammatory biomarkers IL‐1RA/IL‐1α. The cinnamate analogue Octinoxate did not replicate the effects of pHCA.

Conclusion

The study results show that pHCA alone or in combination with Nam can mitigate UV‐induced damage to skin. These include mitigation of UV‐induced erythema as measured by instrument and expert grade visualization. Additionally, pHCA with Nam protected damage to the barrier and reduced the induction of the SASP‐related surface inflammatory biomarker IL‐1RA/IL‐1α. The inability of Octinoxate to have any protective effect and the detection of low levels of pHCA on skin surface after 24 h of application supports that these effects are based on a biological response to pHCA. These findings add to the body of evidence that pHCA alone or in combination with Nam can enhance the skin's biological response to UV‐induced damage. This supports pHCA can potentially impact aging and senescence, thereby maintain skin's functionality and appearance.
Measuring the effectiveness of L&D: Time to move on from Kirkpatrick and Phillips?
Authors: Kirwan Cyril
Published: August 2024

Given the pressure to demonstrate meaningful return from investment in Learning and Development (L&D) interventions, there is an increasing need to reliably evaluate such interventions, both from the point of view of their overall effectiveness (summative approach) and their continuing improvement (formative approach). A literature review, the focus of this conceptual paper, highlights the strengths and weaknesses of various approaches to L&D evaluation. Currently, the most popular methodologies in management practice are the summative‐focused frameworks of Donald Kirkpatrick and Jack Phillips. In this paper, their limitations in terms of being able to answer important questions for evaluation are discussed, particularly their failure to take into account a range of factors that influence learning transfer and, thus, learning effectiveness, as well as a lack of guidance on how such interventions could be made better. Arguments for a greater emphasis on formative evaluation are made, and a model for doing so is put forward. Limitations and further research are discussed.
Assessing workplace well‐being in healthcare: The violence‐prevention climate and its relationship with workplace happiness
Authors: Yesildag Ahmet Y. , Turan Kurtaran Ayten , Sevim Ferit
Published: August 2024

Aim

To identify the relationship between the violence‐prevention climate and workplace happiness in hospitals. The secondary objective is to adapt a valid and reliable scale to a different culture in healthcare settings.

Background

Healthcare settings are not immune to the harmful effects of violence, which can exacerbate existing challenges such as staff shortages. In the midst of these challenges, organizational efforts to ensure the safety of health workers are critical. These efforts can contribute positively to workers' happiness or well‐being.

Method

Using a cross‐sectional design with 400 healthcare professionals from five hospitals in Trabzon, Turkey, data collection involved the Violence‐Prevention Climate Scale and Workplace Happiness Scale. Confirmatory factor analysis was conducted to test the Turkish validity and reliability of the scale, and the consistency coefficient was calculated.

Results

The findings revealed that, on average, employees exhibited high levels of violence‐prevention climate ( = 4.22) and moderate levels of workplace happiness ( = 3.70). Subsequently, correlation analysis unveiled a statistically significant association between the dimensions of violence‐prevention climate and workplace happiness (p < 0.05, r = 0.392). It was observed that those who experienced violence and did not feel safe in the workplace had lower levels of happiness.

Discussion

The instances of healthcare workers being exposed to violence identified in the study largely align with previous theories related to both individual and organizational effects.

Conclusion

Violence‐prevention climate affects the safety and workplace happiness of workers.

Implications for nursing and/or health policy

Employees expect their managers to seriously consider all reports of violence. In this context, creating a violence‐prevention climate would be a good start. According to WHO 2030 targets, in an environment where there is a significant shortage of healthcare personnel, especially nurses, ensuring that existing employees work in a safer and happier environment will make a positive contribution to healthcare systems.
Effect of the nurse‐led Hospital Elder Life Program on delirium reduction among delirious patients with COVID‐19: A randomized clinical trial
Authors: Ni Yun‐Xia , Hu Zi‐Yi , Wang Rui‐Li , Huang Yan , Jiang Yang‐Yang , Wang Hai‐Yan , Ruan Shun‐Li , Zhou Dong , Chen Qian , Jiang Yan
Published: August 2024

Background

Infectious diseases, such as COVID‐19, are high‐risk factors for delirium. However, the implementation of nonpharmacological interventions faces major challenges during an infectious disease pandemic.

Aims

To evaluate the effect of the nurse‐led Hospital Elder Life Program (NL‐HELP) on delirium reduction among delirious patients with COVID‐19.

Design

A single‐blind randomized clinical trial.

Methods

This study recruited 122 delirious patients with COVID‐19 from internal medicine wards at West China Hospital in China between January 30 and March 31, 2023. Participants were randomized to the NL‐HELP group (n = 62) or the usual care group (n = 60). Patients in the intervention group received the NL‐HELP protocol three times daily for 7 days. Patients in the control group received usual care. The primary outcome was the absence/presence of delirium during the intervention period measured by the 3‐min Diagnostic Confusion Assessment Method.

Results

Fewer patients remained delirious in the NL‐HELP group than in the control group. There were significantly more delirium‐free days in the NL‐HELP group than in the usual care group. There were no statistically significant differences between the two groups in terms of delirium severity, length of hospital stay, delirium at 30 days after discharge, 30‐day readmission, 30‐day mortality, physical function or quality of life.

Conclusions

This study demonstrated that NL‐HELP could reduce the presence of delirium in delirious patients. No effect was observed in terms of shortening the length of hospital stay, reducing 30‐day mortality, or improving quality of life.

Impact

NL‐HELP may be effective in reducing the presence of delirium in delirious patients. Further research is needed to determine whether the NL‐HELP can improve patient outcomes (e.g. mortality and quality of life) in a larger study.

Patient or Public Contribution

Caregivers of delirious patients were invited to provide intervention strategies to prevent or abate delirium, including environmental management, orientation communications and identification of alert signs.

Trial Registration

This study was prospectively registered at the Chinese Clinical Trial Registry (https://www.chictr.org.cn/) Identifier: ChiCTR2300067874.
Electroporation saves the day again: Pulsed‐field ablation for phrenic nerve‐sparing in right atrial tachycardia
Authors: Lozano‐Granero Cristina , Franco Eduardo , Matía‐Francés Roberto , Amores‐Luque Miguel , Hernández‐Madrid Antonio , Sánchez‐Pérez Inmaculada , Zamorano José Luis , Moreno Javier
Published: August 2024

Introduction

Pulsed‐field ablation (PFA) is a novel nonthermal energy that shows unique features that can be of use beyond pulmonary vein ablation, like tissue selectivity or proximity rather than contact dependency.

Methods and Results

We report three cases of right focal atrial tachycardias arising from the superior cavoatrial junction and the crista terminalis, in close relationship with the phrenic nerve, effectively ablated using a commercially available PFA catheter designed for pulmonary vein isolation without collateral damage.

Conclusion

PFA can be useful for treating right atrial tachycardias involving sites near the phrenic nerve, avoiding the need for complex nerve‐sparing strategies.
Nurses' perspectives and experiences on medical errors: A qualitative study
Authors: Yılmaz Ayşegül , Sönmez Betül
Published: August 2024

Introduction

Medical errors are among the most important factors that threaten patient safety. Therefore, nurses' perspectives and experiences about medical errors are important for this manner.

Aims

The aim of this study was to determine in depth the perspectives and experiences of nurses related to how they define medical error, as well as its causes, management and reporting.

Design

This descriptive, exploratory study involved a qualitative design.

Methods

A total of 15 clinical nurses from eleven provinces were reached by snowball sampling method. In the study, nurses' perspectives on medical errors were obtained through semistructured in‐depth online interviews conducted based on phenomenological methods. Descriptive analysis was used in the analysis of the data obtained from the interviews. The research was conducted following the COnsolidated criteria for REporting Qualitative checklist.

Results

The resulting 26 codes were categorized under seven themes: “Definition of medical error”, “Experience of medical errors”, “Frequency of medical errors”, “Causes of medical errors”, “Reporting of medical errors”, “Medical error approach” and “Prevention of medical errors”.

Conclusions

The results show that it is still necessary to increase the awareness of nurses about medical errors and the importance of error reporting. In addition, it reveals the need for leadership to eliminate the negative approach to medical errors and shows that nurse managers should be empowered accordingly.

Implications for Nursing Practice and Policy

It is the first step of quality and safe care to reveal nurses' perspectives on medical errors, their thoughts about medical errors and their experiences about errors in their institutions. In this study, nurses' knowledge, opinions and experiences regarding medical errors were revealed in this qualitative study. Therefore, this study offers important clues to nursing services, hospital managers and policy makers for clinical and institutional arrangements.
Patients' experiences of dietary changes during a structured dietary intervention for irritable bowel syndrome
Authors: Weznaver Cecilia , Nybacka Sanna , Simren Magnus , Törnblom Hans , Jakobsson Sofie , Störsrud Stine
Published: August 2024

Background

Diet plays an important role in management of gastrointestinal (GI) symptoms in patients with irritable bowel syndrome (IBS). Restrictive diets have gained popularity as treatment for IBS, but no studies have examined the patients' experiences of implementing such diets. Thus, the present study aimed to explore the experience of patients with IBS undergoing a structured dietary intervention.

Methods

Using inductive content analysis, semi‐structured interviews were conducted in 19 patients with IBS, who were recruited from a randomised controlled trial evaluating two different restrictive diets for 4 weeks: a diet low in total carbohydrates; and a diet low in fermentable oligo‐, di‐ and monosaccharides and polyols (i.e., FODMAP) combined with traditional IBS dietary advice.

Results

Three main themes developed from the qualitative analysis and together they describe the dietary intervention as supportive, as well as the dietary changes as challenging and contributing to reflection. Patients found the dietary support effective in both initiating and adhering to their dietary changes. Despite the support, the implementation of the diet was perceived as challenging when it interfered with other important aspects of their lives. However, going through the dietary change process, the patients began to reflect on their eating behaviours, which enabled individual dietary adjustments. The adjustments that patients maintained were not only a result of alleviation of GI symptoms, but also based on personal preferences.

Conclusions

Patients with IBS undergoing restrictive diets appear to benefit from structured support. However, considering the individual patient's life situation and personal preferences, individualised dietary options should be encouraged to achieve long‐term dietary changes.
Optimal Monetary and Transfer Policy in a Liquidity Trap
Authors: CORBELLINI STEFANO MARIA
Published: August 2024

Optimal monetary and fiscal policy are jointly analyzed in a heterogeneous two‐agent New Keynesian environment, where fiscal policy is modeled as lump‐sum transfers. Transfer policy does not substitute for forward guidance—as it entails consumption dispersion costs—nor affect its optimal duration. The stay at the zero lower bound is indeed influenced through two offsetting channels: ashorteningchannel works through an initial increase in transfers that mitigates the recession (reducing the need for forward guidance), while alengtheningchannel works through a later transfer cut that curbs the expansion (making forward guidance desirable for a longer horizon).
Evaluation of microhardness, degree of conversion, and abrasion resistance of nanoglass and multiwalled carbon nanotubes reinforced three‐dimensionally printed denture base resins
Authors: Mohamed Pansai Ashraf , Ibrahim Yomna Mohamed , Hanno Kenda Ibrahim Hisham , Abdul‐Monem Mohamed Mahmoud
Published: August 2024

Purpose

To assess the effect of nanoglass (NG) particles and multiwalled carbon nanotubes’ (MWCNTs) addition on Vickers hardness (VH), degree of conversion (DC), and abrasion resistance of 3D‐printed denture base resin.

Materials and Methods

3D‐printed denture base resin was reinforced using silanized NG and MWCNTs to obtain four groups: Control, 0.25 wt% NG reinforced resin, 0.25 wt% MWCNTs reinforced resin, and a combination group of 0.25 wt% of both fillers. All specimens (N= 176) were tested before and after thermal aging (600 cycles) for VH (n= 22), DC, and abrasion resistance (n= 22). Abrasion resistance specimens were subjected to 60,000 brushing strokes, and then assessed for surface roughness (Ra) and weight loss. Specimens were then scanned with a benchtop scanner before and after abrasion to produce a color map of topographical changes from superimposed images. Data were analyzed using ANOVA tests followed by Tukey post hoc test. Kruskal‐Wallis test was used to compare percent change among groups, followed by Dunn post hoc test (α= 0.05).

Results

The interaction between nanofiller content and thermal cycling displayed a significant effect on VH and DC. The 0.25% NG expressed the highest VH before aging but revealed the highest percent decrease after aging. Nanofiller content, thermal aging, and brushing displayed a significant interaction impact on the Ra values.

Conclusions

The addition of nanofillers resulted in an overall improvement in resin microhardness and abrasion resistance. The 0.25% MWCNTs group revealed the lowest Ra with the least percent change in VH and DC, while the combination one displayed the least change in weight.
Coping with ethnic‐racial discrimination: Protective‐reactive effects of shift‐and‐persist coping on internalizing symptoms among Black American adolescents
Authors: Santo Cassidy Dal , Desmarais Ariane , Christophe N. Keita
Published: August 2024

Ethnic‐racial discrimination has pervasive negative effects on Black youth's mental health; therefore, it is crucial to identify factors that provide resilience against discrimination. Two promising factors to help youth cope are ethnic‐racial identity (how one feels about their ethnicity/race) and shift‐and‐persist coping (reappraising and accepting an uncontrollable stressor while remaining optimistic about the future). While there is existing scholarship on ethnic‐racial identity among Black youth, this work has not yet assessed the impacts of shift‐and‐persist in this population. Using a sample of 155 Black youth (ages 13–17), the current study examined the interplay between discrimination, ethnic‐racial identity, shift‐and‐persist coping, and internalizing symptoms. Symptoms of depression and anxiety were positively associated with discrimination and negatively associated with shift‐and‐persist. Significant interactions between discrimination and shift‐and‐persist predicting both depressive and anxiety symptoms revealed significant negative associations between shift‐and‐persist and internalizing symptoms at low and average, but not high discrimination levels. Effects are, thus, protective‐reactive; the protective effects of shift‐and‐persist are not significant for youth facing high levels of discrimination. Ethnic‐racial identity, surprisingly, was not significantly associated with either depressive or anxiety symptoms, nor did it interact with shift‐and‐persist as it has in studies of Latinx youth. By understanding the protective benefits of shift‐and‐persist and ethnic‐racial identity in Black youth, during a pivotal period for mental health, we can provide this growing population with tools to lessen the maladaptive outcomes associated with discrimination.
A critical perspective on institutional violence against hospitalized children: Testimonies by health professionals and family members
Authors: Santos Ana Carla Petersen de Oliveira , de Camargo Climene Laura , Vargas Mara Ambrosina de Oliveira , de Araujo Cristina Nunes Vitor , Whitaker Maria Carolina Ortiz , Zilli Francielly , Martins Ridalva Dias , Gomes Nadirlene Pereira
Published: August 2024

The purpose of this study is to understand institutional violence (IV) in the relationships between health professionals, hospitalized children, and family members. This is a qualitative study developed at the pediatric inpatient unit of a university hospital in the city of Salvador, Bahia, Brazil. The research participants consisted of 39 health professionals who specialized in pediatrics and 10 family members of hospitalized children. Semi‐structured interviews were the method used for data collection. Using discourse analysis as a basis and taking a Foucauldian perspective, the researchers observed that the expressions of IV could be traced to abusive power relations within the system. We found four discursive forms within the data set: communication problems as IV, violence through inattention and neglect, violence as an action and consequent materialization on the body, and psychological violence as a submission mechanism. Based on these findings, we argue that professionals, managers, the scientific community, and users might be able to better guarantee the safety of children by recognizing IV and effectively intervening in it.
On the importance of vapor pressure deficit for the determination of the photosynthetic temperature optimum in tropical trees
Authors: Gauthey Alice , Gardner Anna
Published: August 2024

This article is a Commentary on Slot et al. (2024), 244: 1238–1249.
Abscisic acid increase correlates with the soil water threshold of transpiration decline during drought
Authors: Manandhar Anju , Pichaco Javier , McAdam Scott A. M.
Published: August 2024

By regulating carbon uptake and water loss by plants, stomata are not only responsible for productivity but also survival during drought. The timing of the onset of stomatal closure is crucial for preventing excessive water loss during drought, but is poorly explained by plant hydraulics alone and what triggers stomatal closure remains disputed. We investigated whether the hormone abscisic acid (ABA) was this trigger in a highly embolism‐resistant tree species Umbellularia californica. We tracked leaf ABA levels, determined the leaf water potential and gravimetric soil water content (gSWC) thresholds for stomatal closure and transpiration decline during a progressive drought. We found that U. californica plants have a peaking‐type ABA dynamic, where ABA levels rise early in drought and then decline under prolonged drought conditions. The early increase in ABA levels correlated with the closing of stomata and reduced transpiration. Furthermore, we found that transpiration declined before any large decreases in predawn plant water status and could best be explained by transient drops in midday water potentials triggering increased ABA levels. Our results indicate that ABA‐mediated stomatal regulation may be an integral mechanism for reducing transpiration during drought before major drops in bulk soil and plant water status.
Analysis of root‐environment interactions reveals mechanical advantages of growth‐driven penetration of roots
Authors: Koren Yoni , Perilli Alessia , Tchaicheeyan Oren , Lesman Ayelet , Meroz Yasmine
Published: August 2024

Plant roots are considered highly efficient soil explorers. As opposed to the push‐driven penetration strategy commonly used by many digging organisms, roots penetrate by growing, adding new cells at the tip, and elongating over a well‐defined growth zone. However, a comprehensive understanding of the mechanical aspects associated with root penetration is currently lacking. We perform penetration experiments following Arabidopsis thaliana roots growing into an agar gel environment, and a needle of similar dimensions pushed into the same agar. We measure and compare the environmental deformations in both cases by following the displacement of fluorescent beads embedded within the gel, combining confocal microscopy and Digital Volume Correlation (DVC) analysis. We find that deformations are generally smaller for growing roots. To better understand the mechanical differences between the two penetration strategies, we develop a computational model informed by experiments. Simulations show that, compared to push‐driven penetration, grow‐driven penetration reduces frictional forces and mechanical work, with lower propagation of displacements in the surrounding medium. These findings shed light on the complex interaction of plant roots with their environment, providing a quantitative understanding based on a comparative approach.
Variations in ectomycorrhizal exploration types parallel seedling fine root traits of two temperate tree species under extreme drought and contrasting solar radiation treatments
Authors: Xie Lulu , Yang Yanmeng , Ma Jingran , Lin Guigang , Deng Jiaojiao , Robson Thomas M. , Peng Huan , Zhou Li , Yu Dapao , Wang Qing‐Wei
Published: August 2024

Summary statement

High solar radiation exacerbated the negative effects of extreme drought on plant growth and fine root traits. Ectomycorrhizae did not compensate for fine roots under drought stress. Fine roots biomass determined the role of ectomycorrhizal fungi, supporting the energy limitation hypothesis.
Bad faith as true contradiction: On the dialetheist interpretation of Sartre
Authors: McNulty Jacob
Published: August 2024

This essay defends a modified version of Nahum Browns “dialetheist” interpretation of bad faith. On this interpretation, bad faith, as a form of self‐deception, constitutes a dialetheia or true contradiction. While in agreement with the dialetheist interpretation, I argue that bad faith is just as much a flight from true contradiction and towards what I call “sham consistency.” I also put forward a multi‐step model of bad faith as cyclical, recursive and reflexive. And I respond to the objection that bad faith involves a truth value gap rather than a glut. I finally employ the dialetheist interpretation to explain Sartres contention that bad faith has its origins in the most primitive layer of human experience: the pre‐reflective cogito.
Leaf membrane leakage and xylem hydraulic failure define the point of no return in drought‐induced tree mortality in Cupressus sempervirens
Authors: Alon Asaf , Cohen Shabtai , Burlett Regis , Eselson Elena , Riov Joseph , Delzon Sylvain , David‐Schwartz Rakefet
Published: August 2024

Measurements of resistance to embolism suggest that Cupressus sempervirens has a stem xylem that resists embolism at very negative water potentials, with 50% embolism (P50) at water potentials of approximately −10 MPa. However, field observations in a semi‐arid region suggest tree mortality occurs before 10% embolism. To explore the interplay between embolism and plant mortality, we conducted a controlled drought experiment involving two types of CS seedlings: a local seed source (S‐type) and a drought‐resistant clone propagated from a semi‐arid forest (C‐type). We measured resistance to embolism, leaf relative water content (RWC), water potential, photosynthesis, electrolyte leakage (EL), plant water loss, leaf hydraulic conductivity, and leaf non‐structural carbohydrate (NSC) content during plant dehydration and before rewatering. All measured individuals were monitored for survival or mortality. While the S‐ and C‐types differed in P50, transpiration, and mortality rates, both displayed seedling mortality corresponding to threshold values of 52–55% leaf RWC, 55% and 18.5% percent loss of conductivity (PLC) in the xylem, which corresponds to 48% and 37% average EL values for S and C types, respectively. Although C‐type C. sempervirens NSC content increased in response to drought, no differences were observed in NSC content between live and dead seedlings of both types. Our findings do not fully explain tree mortality in the field but they do indicate that loss of membrane integrity occurs before or at xylem water potential, leading to hydraulic failure.