bluuebunny/crossref_metadata_2025 huggingface dataset:
The SlHB8 acts as a negative regulator in tapetum development and pollen wall formation in Tomato
Authors: Wu Caiyu , Yang Yang , Su Deding , Yu Canye , Xian Zhiqiang , Pan Zanlin , Guan Hongling , Hu Guojian , Chen Da , Li Zhengguo , Chen Riyuan , Hao Yanwei
Published: August 2022

Pollen development is crucial for the fruit setting process of tomatoes, but the underlying regulatory mechanism remains to be elucidated. Here, we report the isolation of one HD-Zip III family transcription factor, SlHB8, whose expression levels decreased as pollen development progressed. SlHB8 knockout using CRISPR/Cas9 increased pollen activity, subsequently inducing fruit setting, whereas overexpression displayed opposite phenotypes. Overexpression lines under control of the 35 s and p2A11 promoters revealed that SlHB8 reduced pollen activity by affecting early pollen development. Transmission electron microscopy and TUNEL analyses showed that SlHB8 accelerated tapetum degradation, leading to collapsed and infertile pollen without an intine and an abnormal exine. RNA-seq analysis of tomato anthers at the tetrad stage showed that SlHB8 positively regulates SPL/NZZ expression and the tapetum programmed cell death conserved genetic pathway DYT1–TDF1–AMS–MYB80 as well as other genes related to tapetum and pollen wall development. In addition, DNA affinity purification sequencing, electrophoretic mobility shift assay, yeast one-hybrid assay and dual-luciferase assay revealed SlHB8 directly activated the expression of genes related to pollen wall development. The study findings demonstrate that SlHB8 is involved in tapetum development and degradation and plays an important role in anther development.
Associations of cigarette smoking, alcohol drinking and body mass index with survival after colorectal cancer diagnosis by anatomic subsite: a prospective patient cohort study in Japan
Authors: Minami Yuko , Kanemura Seiki , Kusaka Jun , Kinouchi Makoto , Suzuki Shinichi , Nishino Yoshikazu , Miura Koh
Published: August 2022

Background

Cigarette smoking, alcohol drinking and obesity are known to be risk factors for colorectal cancer. These factors may affect survival after diagnosis, but evidence has been inconsistent. We investigated subsite-specific associations between prediagnosis smoking, alcohol drinking and body mass index and survival in colorectal cancer.

Methods

Subjects were 1300 patients (colon 778; rectum 502; concurrent 20) with histologically confirmed colorectal cancer diagnosed during 1997–2013 at a single institution in Japan. Histories of smoking and alcohol drinking, height and prediagnosis weight were assessed using a self-administered questionnaire. Using Cox proportional hazards model, hazard ratios and 95% confidence intervals of mortality were estimated.

Results

During a median follow-up period of 6.7 years, 479 deaths were documented. Ever-smoking was associated with an increased risk of all-cause death among patients with colon cancer (hazard ratio: 1.47; 95% confidence interval: 1.07–2.02 compared with never-smoking). According to colon subsite, this increased risk was clear in patients with proximal colon cancer (hazard ratio: 2.09; 95% confidence interval: 1.28–3.40). There was no association between smoking and rectal cancer survival. Alcohol drinking was not associated with survival for either colon or rectal cancer. Among patients with rectal cancer, higher body mass index was associated with a lower risk of all-cause (Ptrend = 0.0006) and disease-specific death (Ptrend = 0.02). For colon cancer, lower body mass index tended to be associated with a higher risk of all-cause death (Ptrend = 0.05).

Conclusions

The results indicate that lifestyles identified as risk factors for colorectal cancer may impact differently on patient survival according to anatomic subsite.
General Treatment Format and Guiding Therapy Principles
Authors: Craske Michelle G. , Dour Halina J. , Treanor Michael , Meuret Alicia E.
Published: August 2022

This chapter explores the general format and guiding principles of the Positive Affect Treatment (PAT) program. As it was developed with theory, science, and clinical experience in mind, PAT follows the rationale, components, and structure of traditional evidence-based therapies. However, flexibility is vital as individuals with anhedonia are lacking the prerequisites for cognitive–behavioral therapy to be successful. Treatments are expected to be tailored to each client’s particular deficits to ensure that maximum benefits ensue. The chapter covers the treatment module designed to deliver psychoeducation on the nature of anhedonia, therapy expectations and structure, and the concepts of the mood cycle.
Building Positivity
Authors: Craske Michelle G. , Dour Halina J. , Treanor Michael , Meuret Alicia E.
Published: August 2022

This chapter discusses the importance of building positivity as part of the Positive Affect Treatment (PAT) program. It explains the skills of loving-kindness, gratitude, generosity, and appreciating joy, and therapists are encouraged to introduce them in that order. Suggestions for troubleshooting and case vignettes are provided. Evidence suggests that these practices will help clients feel more connected, will improve relationships, and will promote prosocial behavior. The skills will enhance positive emotions as they target liking and learning the reward system. Therapists are encouraged to review the science and history behind these concepts with clients. The goal is for clients to practice loving-kindness and appreciative joy while applying generosity and gratitude in their daily lives.
Actions Toward Feeling Better
Authors: Meuret Alicia E. , Dour Halina J. , Guinyard Amanda G. Loerinc , Craske Michelle G.
Published: August 2022

This chapter discusses the significance of positive activities in the Positive Affect Treatment (PAT) program. It explains how behaviors such as isolation, avoidance, and withdrawing could contribute to maintaining low positive mood. Research has found that doing more activities overall usually leads to feeling better and engaging in more rewarding activities. Additionally, behavior is a part of the mood cycle; thus, changing one’s behavior is the most direct way of changing one’s emotions and physical feelings. Detailed recounting with imagery could also help boost pleasurable or rewarding activities. The chapter also discusses the importance and process of monitoring daily activities and mood. It gives examples and case studies for guidance through monitoring mood.
Overview
Authors: McNaught Elizabeth , Treasure Janet , Pollard Nick
Published: August 2022

Eating disorders are complex and multifactorial. There is no simple path which leads into or out of these disorders. However, we do know that a general pattern of development in these conditions has been recognized. This chapter covers some of these patterns, discusses the epidemiology of the diseases, both together and by anorexia nervosa, bulimia nervosa, and binge eating disorder separately. Classification is covered, as are risk factors. General principles of treatment are outlined. Eating disorders in the context of diabetes are singled out. The chapter goes on to provide a brief overview of cultural influence on eating disorders, and eating disorders that appear in older age.
Avoidant/restrictive food intake disorder (ARFID)
Authors: McNaught Elizabeth , Treasure Janet , Pollard Nick
Published: August 2022

Avoidant/restrictive food intake disorder (ARFID) describes a complex eating disorder characterised by a restriction of food intake secondary to an adverse reaction to features such as smell, texture, taste, or previous experiences. This chapter covers the epidemiology of the disease, and biological, psychological, and socio-cultural risk factors for developing ARFID. Presentation and clinical features are listed, and taking a history is explained, alongside potential differential diagnoses. Examination and investigations are discussed, and the diagnostic criteria are outlined. Psychological and potential pharmacological interventions are presented, with the importance of the multidisciplinary team. Complications to ARFID, comorbidities, and prognosis are all included.
Mental health literacy in low- and middle-income countries
Authors: Raghavan Raghu , Brown Brian , Svirydzenka Nadia
Published: August 2022

Mental health literacy is defined as the ability of an individual to recognize specific disorders or different types of psychological distress but is equally relevant to communities. It is learning about not only the risk factors and causes of various psychiatric disorders, but also self-help, knowledge of professional services, and how to seek help and remain well. Low- and middle-income countries (LMICs) face specific challenges such as financial challenges, poverty, and inadequate services. This chapter explores mental health literacy, focusing on LMICs with special reference to South Asian countries (India, Pakistan, Bangladesh, and Sri Lanka). In order to improve populations’ mental health, it is crucial to improve people’s understanding of mental illnesses, ensuring that all sections of society and communities in LMICs are involved if mental health literacy is to improve. This chapter also addresses key issues related to key factors associated with mental health literacy in LMICs.
Oculoplastics
Authors: Ting Michelle , Than Jonathan
Published: August 2022

This chapter explores oculoplastics. It first details eyelid and nasolacrimal system anatomy and physiology. It then discusses lash abnormalities, covering trichiasis, distichiasis, madarosis, eyelash ptosis, hypertrichosis, and poliosis. Next, it considers entropion, covering congenital entropion, involutional entropion, and cicatricial entropion. Following this, ectropion is discussed, including congenital ectropion, paralytic ectropion, involutional ectropion, cicatricial ectropion, and mechanical ectropion. Ptosis is covered in two sections, and benign lid lesions, malignant lid lesions, epiphora, acquired nasolacrimal system abnormalities, and congenital nasolacrimal system abnormalities are also discussed. In addition, practical skills in oculoplastics are outlined, such as ptosis examination, syringing and probing, removing sutures, surgical repair of lid trauma, lateral tarsorrhaphy, and emergency lateral canthotomy/cantholysis.
Medical retina
Authors: Sim Peng Yong , Sundaram Venki
Published: August 2022

This chapter begins with a discussion of fundus fluorescein angiography and the causes of abnormal fluorescein angiography. It then discusses indocyanine green angiography, including the main indications for this technique. It goes on to cover fundus autofluorescence imaging and electrophysiology. It also includes clinical knowledge areas of diabetic retinopathy, hypertensive retinopathy, retinal vein occlusion, retinal artery occlusions, age-related macular degeneration, central serous chorioretinopathy, retinal vascular anomalies, inherited retinal disorders, macular dystrophies, and choroidal dystrophies. It also discusses a number of important clinical trial studies and contains a section on the use of intravitreal injections of agents against vascular endothelial growth factor (known as VEGF).
Uveitis and medical ophthalmology
Authors: Wagner Siegfried Karl , Hughes Edward
Published: August 2022

This chapter focuses on uveitis and medical ophthalmology. It details uveal anatomy, before discussing anterior uveitis, intermediate uveitis, and posterior uveitis. Next, it discusses specific non-infectious posterior uveitides before moving on to infectious uveitis (viral, parasitic, fungal, and bacterial) and HIV-related disease. It continues by examining systemic associations with uveitis, including sarcoidosis, Behçet’s disease, multiple sclerosis, and the seronegative arthritides ankylosing spondylitis, reactive arthritis, psoriatic arthritis, and inflammatory bowel disease. In addition, it discusses scleritis and episcleritis, ocular inflammatory disorders (systemic treatment, biological agents and periocular treatments, intraocular treatments), rheumatological disease, vasculitis, cardiovascular disease and the eye, and endocrine, respiratory, and skin diseases in ophthalmology.
Paediatric ophthalmology and strabismus
Authors: Nixon Nisha , Saward Victoria , Barker Lucy
Published: August 2022

This chapter focuses on paediatric ophthalmology and strabismus. It details the embryology, anatomy, and actions of the extraocular muscles, along with clinical skills that include patient assessment and assessment of visual acuity, binocular vision, and stereopsis, assessment of binocular single vision, and retinal correspondence and suppression. It then discusses amblyopia, the measurement and assessment of ocular deviation, the assessment of ocular movements, Hess charts, and the field of binocular single vision. In addition, it discusses concomitant strabismus (the heterophorias, esotropia, and exotropia), incomitant strabismus, the principles of strabismus surgery, general paediatric development, retinopathy of prematurity, retinoblastoma, congenital cataract, paediatric glaucoma, uveitis in children, phacomatoses, and metabolic and storage diseases.
Neuro-ophthalmology
Authors: Minakaran Neda , Plant Gordon T.
Published: August 2022

The focus of this chapter is on neuro-ophthalmology. The chapter begins by outlining the anatomy of the visual pathway, pupil reflex anatomy, cranial nerve anatomy, and the central control of ocular motility. It goes on to discuss neuro-ophthalmology history taking and examination, and neuroimaging. It continues with a discussion of chiasmal and retrochiasmal visual pathway disorders, optic nerve disorders, papilloedema and idiopathic intracranial hypertension, and congenial optic nerve disorders. In addition, it discusses cranial nerve palsies, nystagmus, supranuclear eye movement disorders, pupil abnormalities, headache, and non-organic visual loss. The chapter concludes with a discussion of neuromuscular junction disorders and ocular myopathies.
Description of Hospitalizations due to the Severe Acute Respiratory Syndrome Coronavirus 2 Omicron Variant Based on Vaccination Status
Authors: Moffa Matthew A , Shively Nathan R , Carr Dustin R , Bremmer Derek N , Buchanan Carley , Trienski Tamara L , Jacobs Max W , Saini Vikram , Walsh Thomas L
Published: August 2022

Background

Limited descriptive data exist regarding the clinical characteristics of hospitalizations due to the severe acute respiratory syndrome coronavirus 2 Omicron variant based on vaccination status.

Methods

This was a retrospective cohort study of all patients hospitalized with a diagnosis of coronavirus disease 2019 (COVID-19) between 15 January 2022 and 15 February 2022 across 9 hospitals in a large health network. Data were extracted by manual records review.

Results

A total of 351 of 452 (77.7%) unvaccinated, 209 of 331 (63.1%) fully vaccinated, and 107 of 163 (65.6%) boosted patients hospitalized with a COVID-19 diagnosis were determined to be admitted specifically due to COVID-19 (P < .001). Most (85%) boosted patients admitted due to COVID-19 were at least 65 years old and/or had severe immunosuppression, compared to 72.2% of fully vaccinated and 60.7% of unvaccinated patients (P < .001). Significantly more unvaccinated patients (34.2%) required >6 L/minute of supplemental oxygen compared to fully vaccinated (24.4%) and boosted (25.2%) patients (P = .027). The age-adjusted vaccine effectiveness (VE) against hospitalization due to COVID-19 was estimated to be 81.1% and 94.1% for full vaccination and boosted status, respectively, whereas VE against mortality related to COVID-19 was estimated to be 84.7% and 94.8%, respectively.

Conclusions

During the Omicron BA.1 sublineage wave, unvaccinated patients hospitalized with a COVID-19 diagnosis were more likely than vaccinated patients to be admitted specifically due to COVID-19. Despite being younger with fewer comorbidities, unvaccinated patients required higher levels of care. Vaccination with a booster provides the greatest protection against hospitalization and death from COVID-19.
Dying at Home Due to Coronavirus Disease 2019
Authors: Edwards Jessie K , Wohl David Alain
Published: August 2022

Background

Coronavirus disease 2019 (COVID-19) is a leading cause of US deaths and when severe requires admission to a hospital; however, 9% of US COVID-19 deaths before 2022 occurred at home.

Methods

Death certificate data were used to examine the cumulative probability of dying at home from COVID-19 and from any cause in North Carolina, including by race and ethnicity.

Results

Between March 1, 2020 and December 31, 2021, 22 646 COVID-19 deaths were recorded in North Carolina; of these, 1771 (7.8%) occurred at home. Cumulative risk of dying at home with COVID-19 increased from 3.3/100 000 on December 31, 2020 to 13.0/100 000 on December 31, 2021. After standardizing each racial/ethnic group, cumulative at-home COVID-19 mortality among Hispanic people compared to White people was 9.9/100 000 versus 2.3/100 000, respectively, at year-end 2020 (difference, 7.6/100 000; 95% confidence interval [CI], 5.6–9.6) and 19.0/100 000 versus 11.4/100 000 at year-end 2021 (difference, 7.6; 95% CI, 4.9–10.4). At-home mortality among Black people was also elevated compared to White people (difference, 5.6/100 000; 95% CI, 3.7–7.4) at year-end 2021. Rates of dying at home from any cause increased overall but were greatest among Hispanic people.

Conclusions

By the end of 2021, the risk of dying at home from COVID-19 increased, especially for persons of color. The risk of dying at-home from any cause also increased for all but more so for Hispanic persons. These findings suggest perennial barriers to care prevent those with progressive COVID-19 from accessing medical attention and the need for initiatives that extend healthcare access for those disproportionately impacted by COVID-19 to prevent avoidable death.
A Quantitative Model of Dynamic Moral Hazard
Authors: Ai Hengjie , Kiku Dana , Li Rui
Published: August 2022

We develop an equilibrium model with moral hazard, which arises because some productivity shocks are privately observed by firm managers only. We characterize the optimal contract and its implications for firm size, growth, and managerial pay-performance sensitivity and exploit them to quantify the severity of the moral hazard problem. Our estimation suggests that unobservable shocks are relatively modest and account for about 10$\%$ of the total variation of firm output. Nonetheless, moral-hazard-induced incentive pay is quantitatively significant and accounts for 50$\%$ of managerial compensation. Eliminating moral hazard would result in about a 1$\%$ increase in aggregate output.
Optimizing the Internal Cell Structure of the Radon Monitor Based on Electrostatic Collection Method
Authors: Fan Zhongkai , Xie Lin , Lin Fen , Hu Tao , Mo Yixiang , Yuan Hongzhi , Tan Yanliang
Published: August 2022

As Rn-222 decays, an alpha particle is emitted and the residual polonium nucleus recoils in the opposite direction. At the end of the recoil path, 88% of the polonium atoms have a positive charge and 12% are neutral. The electric potential distribution in the 60 ml hemispherical internal cell of the radon monitor based on electrostatic collection is studied for reducing the combined probability of the positively charged Po-218 and the OH− produced by the ionization of water vapour in the air. The COMSOL software is used to simulate the electric potential distribution in the internal cell of the radon monitor based on the electrostatic collection method at 27°C, a pressure of 0.1 Mpa. For improving the collection efficiency of Po-218 ions, the average collection time along vertical and oblique lines is calculated when the upper surface of the internal cell is plastic, uncharged metal and charged metal, respectively. Assuming that the gas in the internal cell is uniformly distributed, the results show that if the upper surface of the hemispherical internal cell is plastic or uncharged metal, the electric potential formed in the internal cell is more uniform, and it is beneficial to reduce the total collection time of the positively charged Po-218 ions, thereby improving collection efficiency. The simulation results can be used as an effective reference for optimizing the design of the internal cell structure of the radon monitor based on electrostatic collection method.
Influence factors and calculation model of the adhesion strength of clayey soil for EPB shield tunnelling
Authors: Wang Shuying , Liu Pengfei , Zhong Jiazheng , Ni Zhunlin , Qu Tongming
Published: August 2022

When earth pressure balance (EPB) shield tunnels are constructed through clayey ground, the soil adheres to the cutter, cutterhead and chamber bulkhead due to the high adhesion strength between the steel and the clay, thus clogging the shield. To investigate the influence of different factors on the adhesion strength, this study used montmorillonite, kaolin and mixtures of the two as test soils. The adhesion strength between the steel and clay is determined with a customized rotary shear apparatus. The results show that when the consistency index of the soil specimen is less than 1, the adhesion strength between the steel and clay increases with the consistency index. As the consistency index decreases, the effect of the normal pressure on the adhesion strength gradually weakened. As the contact angle of the shear plate increases, thus reducing the hydrophilicity, the adhesion strength decreases. When the soil specimens with different plasticity index values have the same consistency index value, the adhesion strengths are similar. The adhesion strength increases gradually with increasing surface roughness. Based on grey incidence analysis, the order of the factors affecting the adhesion strength is as follows: normal pressure > consistency index > contact angle > plasticity index ≈ surface roughness. The normal pressure, consistency index and contact angle all have important effects on the adhesion strength between steel and clay. However, because there are no large differences in the contact angle among the metal materials, the approximate adhesion strength can be calculated by considering the effects of only the normal pressure and consistency index. The measures that are effective for preventing EPB shield clogging are increasing the soil softness and decreasing the hydrophilicity of the cutterhead by applying new materials for the cutters and cutterhead.
Analysis of the potential role of fission yeastPP2Ain spindle assembly checkpoint inactivation
Authors: Deng Da‐Jie , Wang Xi , Yue Kai‐Ye , Wang Yamei , Jin Quan‐Wen
Published: August 2022

As a surveillance mechanism, the activated spindle assembly checkpoint (SAC) potently inhibits the E3 ubiquitin ligase APC/C (anaphase‐promoting complex/cyclosome) to ensure accurate chromosome segregation. Although the protein phosphatase 2A (PP2A) has been proposed to be both, directly and indirectly, involved in spindle assembly checkpoint inactivation in mammalian cells, whether it is similarly operating in the fission yeastSchizosaccharomycer pombehas never been demonstrated. Here, we investigated whether fission yeast PP2A is involved in SAC silencing by following the rate of cyclin B (Cdc13) destruction at SPBs during the recovery phase innda3‐KM311cells released from the inhibition of APC/C by the activated spindle checkpoint. The timing of the SAC inactivation is only slightly delayed when two B56 regulatory subunits (Par1 and Par2) of fission yeast PP2A are absent. Overproduction of individual PP2A subunits either globally in thenda3‐KM311arrest‐and‐release system or locally in the synthetic spindle checkpoint activation system only slightly suppresses the SAC silencing defects in PP1 deletion (dis2Δ) cells. Our study thus demonstrates that the fission yeast PP2A is not a key regulator actively involved in SAC inactivation.
Retinoic acid regulates pyruvate dehydrogenase kinase 4 (Pdk4) to modulate fuel utilization in the adult heart: Insights from wild‐type and β‐carotene 9′,10′ oxygenase knockout mice
Authors: Holloway Chelsee , Zhong Guo , Kim Youn‐Kyung , Ye Hong , Sampath Harini , Hammerling Ulrich , Isoherranen Nina , Quadro Loredana
Published: August 2022

Regulation of the pyruvate dehydrogenase (PDH) complex by the pyruvate dehydrogenase kinase PDK4 enables the heart to respond to fluctuations in energy demands and substrate availability. Retinoic acid, the transcriptionally active form of vitamin A, is known to be involved in the regulation of cardiac function and growth during embryogenesis as well as under pathological conditions. Whether retinoic acid also maintains cardiac health under physiological conditions is unknown. However, vitamin A status and intake of its carotenoid precursor β‐carotene have been linked to the prevention of heart diseases. Here, we provide in vitro and in vivo evidence that retinoic acid regulates cardiac Pdk4 expression and thus PDH activity. Furthermore, we show that mice lacking β‐carotene 9′,10′‐oxygenase (BCO2), the only enzyme of the adult heart that cleaves β‐carotene to generate retinoids (vitamin A and its derivatives), displayed cardiac retinoic acid insufficiency and impaired metabolic flexibility linked to a compromised PDK4/PDH pathway. These findings provide novel insights into the functions of retinoic acid in regulating energy metabolism in adult tissues, especially the heart.
Dapagliflozin for patients with heart failure and reduced ejection fraction
Authors: Ferry Abigail
Published: August 2022

The CDC estimates that national costs related to heart failure exceed $30 billion annually. Clinicians and researchers continue to aggressively pursue measures aimed at reducing morbidity and mortality among the 6.5 million adults affected by the disease. Dapagliflozin recently emerged as a promising FDA-approved therapy for patients with systolic heart failure, more commonly referred to as heart failure with reduced ejection fraction.
Direct-acting oral anticoagulants in patients with atrial fibrillation and valvular heart disease
Authors: Canales Natalie , Cao Tina , Fakourfar Neeloufar , Snee Mara , Tsu Laura
Published: August 2022

Direct-acting oral anticoagulants (DOACs) are an effective alternative to warfarin for patients with atrial fibrillation (AF) who require thromboembolic risk reduction. This article discusses the newly acceptable use of DOACs in patients with valvular AF, including native valvular heart disease and patients with bioprosthetic valves.
Seven facts you need to know about continuous glucose monitors
Authors: Solano Laura
Published: August 2022

This article reviews seven facets of continuous glucose monitors (CGMs): how they work, advantages for patients and clinicians, device limitations, effect on outcomes in patients with diabetes, who should be prescribed these devices, their cost, and their accuracy. Four major CGMs marketed today are compared: Abbott's FreeStyle Libre, Medtronic's Guardian, Dexcom's G6, and Senseonic's Eversense.
Diversity in Nursing Is Not Enough
Authors: Muirhead Lisa , Richard-Eaglin Angela , Webb Michelle
Published: August 2022

An introspective look.
Diabetes Self-Management in the Acute Care Unit
Authors: Molyneux Jacob
Published: August 2022

Despite practical and policy barriers, new technologies support the case for greater flexibility.
New Indication for Dupilumab
Authors: Aschenbrenner Diane S.
Published: August 2022

Dupilumab (Dupixent) has been approved to treat eosinophilic esophagitis in adults and children ages 12 years and older who weigh at least 40 kilograms. This is the first drug approved to treat this disease.
Drug Receives New Indication for Juvenile Myelomonocytic Leukemia
Authors: Aschenbrenner Diane S.
Published: August 2022

Azacitidine (Vidaza) is now approved to treat juvenile myelomonocytic leukemia, a rare form of blood cancer mostly affecting children under four years of age.
Increasing Access to Diabetes Education in Rural Alabama Through Telehealth
Authors: Ladner Kathleen A. , Berry Shaina R. , Hardy Jessica
Published: August 2022

The high prevalence of diabetes in Alabama and the limited diabetes education available to patients in that state suggest that new interventions are needed. To that end, the authors developed a project to assess whether the use of telehealth technology to deliver diabetes self-management education and support (DSMES) in a small group setting is an effective and acceptable way to increase access to such education by underserved individuals. Certified diabetes educators, RNs, and telehealth services at three rural county health departments in Alabama implemented a DSMES program. Data were collected from participant registration forms, pre- and postintervention surveys, and telehealth surveys to assess participants' baseline and postintervention diabetes knowledge, self-care, and sense of self-efficacy. Blood pressure, glycated hemoglobin (HbA1c) levels, and weight were also measured before and after the intervention. Forty-two people attended the DSMES program and participated in its evaluation. The findings demonstrated that for this sample, telehealth was an effective and acceptable way to conduct DSMES. The substantial improvements in health status, coupled with the fact that most participants had never participated in a DSMES program before, highlight the untapped potential of such programs to increase access to diabetes education in underserved areas.
Gender Equality in the Health Care Workforce
Authors: McSpedon Corinne
Published: August 2022

Nursing and global health experts discuss the implications of gender inequity.
Mediterranean Diet Superior to Low-Fat Diet for CVD Prevention
Authors: Rosenberg Karen
Published: August 2022

According to this study:

Results of a large, long-term secondary prevention study showed that the Mediterranean diet is superior to a low-fat diet in preventing major cardiovascular events.
Efforts Needed to Improve Real-World Effectiveness of HIV Prophylaxis
Authors: Rosenberg Karen
Published: August 2022

According to this study:

Suboptimal consumption and frequent discontinuation of preexposure prophylaxis (PrEP) in men who are at high risk for HIV make PrEP less effective in real-world conditions than in clinical trials.

Better monitoring of compliance is needed to make PrEP more effective, especially among young and socioeconomically deprived recipients.
Differential Susceptibility
Authors: Kelly Michelle M. , Sullivan Mary C.
Published: August 2022

Differential susceptibility theory posits that some individuals, with specific characteristics, are more, or less susceptible than others, to both adverse and beneficial environmental influences. It offers a perspective for understanding the directional trajectories across the life course affected by daily context and individual characteristics, in order to identify influential components. The aim of this article is to describe differential susceptibility theory, critically evaluate research findings in which the theory is tested, and consider implications of differential susceptibility theory as a theoretical framework for nursing science. Preterm birth trajectories and outcomes research are used as a lens for this examination.
Nursing, Social Justice, and Health Inequities
Authors: Velasco Roque Anthony F. , Reed Sean M.
Published: August 2022

Walter's theory of emancipatory nursing praxis (ENP) was created to explore nurses' social justice–related transformational learning process. We analyzed the theory within the context of stigma-related health inequities faced by transgender and gender-diverse (TGD) people. The theory of ENP provides a theoretical framework to incorporate social justice in nursing practice, research, education, and policy. We also determined the theory bridges the gap in understanding the role of nurses in advancing social justice through embodied actions and social activism. The theory of ENP underscores the moral, ethical, and professional obligations for nurses to abolish health inequities for TGD people.
Opioid and Sedative NarxCare Scores Greater Than 300 Are Associated with Adverse Outcomes After Non-Emergent Spine Surgery
Authors: Emara Ahmed K. , Sultan Assem , Grits Daniel , Savage Jason , Piuzzi Nicolas S. , Pelle Dominic W.
Published: August 2022

Study Design.

Prospectively Captured Cohort.

Objective.

To explore associations between the preoperative opioid-specific NarxCare Scores NCS(NCS-opioids) as well as sedative-specific NCS(NCS-sedatives) as measures of patients’ prescription drug use and (1)90-day postoperative readmission; (2)E.D. visits; (3)reoperation; (4)prolonged (>2 d) hospital length of stay(LOS); and (5)non-home discharge. In addition, we sought to evaluate the previously suggested 300+ threshold as a cutoff for moderate/high-risk designation.

Background.

The association between preoperative opioids and sedative use and healthcare utilization after non-emergent spine surgery is not well quantified. The NarxCare score (NCS) is a weighted scalar measure of opioids and sedatives that accounts for the number of prescribing providers, dispensing pharmacies, milligram equivalence doses, and overlapping prescription days.

Methods.

A total of 4,680 non-emergent spine surgery cases were included. Preoperative NCS-Opioids/Sedatives were captured. Bivariate and multivariable regression models were constructed to analyze associations between NCS-opioids/sedatives ranges and outcomes while accounting for baseline differences. Spline regression and propensity score matching (PSM) analyses were also implemented.

Results.

For NCS-opioid, multivariable regression demonstrated higher odds of prolonged LOS starting in the 400-499 NCS-opioids category (odds ratio(OR)1.44; 95% confidence interval(CI)[1.05-1.97];P=0.026) going into the 500+ category(OR:1.94; 95%CI[1.29-2.93];P=0.002). The 500+ categories exhibited higher odds of 90-day readmission (OR:1.77; 95%CI[1.01-3.09];P=0.045). PSM comparison demonstrated that patients within the 300+ category had higher incidence of prolonged LOS[n=455(44%) vs. n=537(52%); P<0.001], 90-day readmission [n=118(11%) vs. n=155(15%);P=0.019] and 90-day reoperation[n=51(4.9%) vs. n=74(7.2%); P=0.042]. For NCS-sedative; there was higher odds of prolonged LOS(OR:1.73; 95%CI[1.14- 2.63];P=0.010) and non-home discharge(OR:2.09; 95%CI:[1.22-3.63];P=0.008) within the 400-499 NCS-sedatives category. PSM comparison demonstrated significantly higher rates of prolonged LOS within the 300+ NCS-sedative cohort (vs. scores<300), [n=277(44%) vs. 319(50%);P=0.021].

Conclusion.

Spine surgery continues to advance towards patient-specific care. Higher NCS-Opioids/Sedatives values may predict up to a two-fold increase in postoperative healthcare utilization. High values should prompt an interdisciplinary approach to mitigate deleterious prescription drug use.
Deriving a Novel Score Predicting Progression in Early-Onset Scoliosis: A Multicenter Initiative
Authors: AlNouri Mason , Wada Kanichiro , Kumagai Gentaro , Asari Toru , Nitobe Yohshiro , Morishima Toshibumi , Uesato Ryoko , Aoki Megumi , Ishibashi Yasuyuki
Published: August 2022

Study Design.

Retrospective multicenter.

Objective.

Develop a novel progression risk stratification scoring system for early-onset scoliosis.

Summary of Background Data.

There is a lack of investigations into variables affecting risk of curve progression in early-onset scoliosis, which prevents stratification. A novel risk score system is needed to help in progression risk estimation.

Methods.

A retrospective analysis was done at three centers, from 1995 to 2020. Scoliosis cases prior to age 10 years, were included. Medical identifier, date of birth, sex, primary diagnosis, curve type, date/modality of treatment, date of follow-up appointments, and Cobb angles, were collected. Five ranks were selected for stratification. Categories with the same ranks were discarded. Point scores started at 0, for lowest risk, and ended at 4, for highest risk. Iterations of variable combinations were conducted and clinical relevance was determined by evaluating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) based on score ranges for low and high risk of progression.

Results.

A total of 476(230 males,246 females) early-onset scoliosis patients were collected. Average age at diagnosis was 4.8years(SD±2.8 y). Average follow-up duration was 9.3years (SD±6.9 y, range: 5 mo to 38 y). Appointments totaled 2911, giving 2182 observations for the analysis. Patient observations numbered: 800(36.7%) ending in progression, 1265(58.0%) for non-progression, 117(5.4%) for inadequate follow-up, and 368(16.9%) for rapid progression. The risk scoring system contained 4 categories: etiology, age, curve magnitude, and curve type. Categorized point combinations totaled 755, giving 1975 iterations. Sensitivity, specificity, PPV, and NPV were calculated to be 85.8%, 96.5%, 89.7%, and 95.1%, respectively.

Conclusion.

A novel progression risk score for early-onset scoliosis was derived. The system can reliably differentiate between low and high-risk cases in clinical settings. Further validation in other regions may be important for verifying clinical relevance.

Level of Evidence.

3
In-Hospital Depressed Level of Consciousness and Long-Term Functional Outcomes in ICU Survivors*
Authors: Mart Matthew F. , Thompson Jennifer L. , Ely E. Wesley , Pandharipande Pratik P. , Patel Mayur B. , Wilson Jo Ellen , Williams Roberson Shawniqua , Birdrow Caroline I. , Raman Rameela , Brummel Nathan E.
Published: August 2022

OBJECTIVES:

Among critically ill patients, acutely depressed level of consciousness is associated with mortality, but its relationship to long-term outcomes such as disability and physical function is unknown. We investigated the relationship of level of consciousness during hospitalization with long-term disability and physical function in ICU survivors.

DESIGN:

Multi-center observational cohort study.

SETTING:

Medical or surgical ICUs at five U.S. centers.

PATIENTS:

Adult survivors of respiratory failure or shock.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Depressed level of consciousness during hospitalization was defined using the Richmond Agitation Sedation Scale (RASS) score (including all negative scores) by calculating the area under the curve using linear interpolation. Sedative-associated level of consciousness was similarly defined for all hospital days that sedation was received. We measured disability in basic activities of daily living (BADLs), instrumental activities of daily living (IADLs), discharge destination, and self-reported physical function. In separate models, we evaluated associations between these measures of level of consciousness and outcomes using multivariable regression, adjusted for age, sex, race, body mass index, education level, comorbidities, baseline frailty, baseline IADLs and BADLs, hospital type (civilian vs veteran), modified mean daily Sequential Organ Failure Assessment score, duration of severe sepsis, duration of mechanical ventilation, and hospital length of stay. Of the 1,040 patients enrolled in the ICU, 781 survived to hospital discharge. We assessed outcomes in 624 patients at 3 months and 527 patients at 12 months. After adjusting for covariates, there was no association between depressed level of consciousness (total or sedation-associated) with BADLs or IADLs at either 3- or 12-month follow-up. There was also no association with self-reported physical function at 3 or 12 months or with discharge destination.

CONCLUSIONS:

Depressed level of consciousness, as defined by the RASS, was not associated with disability or self-reported physical function. Future studies should investigate additional modifiable in-hospital risk factors for disability and poor physical function following critical illness.
Prioritizing Clinical Teaching Excellence: A Hidden Curriculum Problem
Authors: Fantaye Arone Wondwossen , Gnyra Catherine , Lochnan Heather , Wiesenfeld Lorne , Hendry Paul , Whiting Sharon , Kitto Simon
Published: August 2022

There have been many initiatives to improve the conditions of clinical teachers to enable them to achieve clinical teaching excellence in Academic Medical Centres (AMC). However, the success of such efforts has been limited due to unsupportive institutional cultures and the low value assigned to clinical teaching in comparison to clinical service and research. This forum article characterizes the low value and support for clinical teaching excellence as an expression of a hidden curriculum that is central to the cultural and structural etiology of the inequities clinical teachers experience in their pursuit of clinical teaching excellence. These elements include inequity in relation to time for participation in faculty development and recognition for clinical teaching excellence that exist within AMCs. To further compound these issues, AMCs often engage in the deployment of poor criteria and communication strategies concerning local standards of teaching excellence. Such inequities and poor governance can threaten the clinical teaching workforce's engagement, satisfaction and retention, and ultimately, can create negative downstream effects on the quality of patient care. While there are no clear normative solutions, we suggest that the examination of local policy documents, generation of stakeholder buy-in, and a culturally sensitive, localized needs assessment and integrated knowledge translation approach can develop a deeper understanding of the localized nature of this problem. The findings from local interrogations of structural, cultural and process problems can help to inform more tailored efforts to reform and improve the epistemic value of clinical teaching excellence. In conclusion, we outline a local needs assessment plan and research study that may serve as a conceptually generalizable foundation that could be applied to multiple institutional contexts.
Facial Onset Sensory and Motor Neuronopathy-Like Syndrome: A Case Report
Authors: Bruss David M. , Venkataraman Prashanth , Mozaffar Tahseen
Published: August 2022

Objectives:

Facial onset sensory and motor neuronopathy syndrome (FOSMN) is a rare motor neuron disorder characterized by facial sensory and motor aberrations that progress to the upper limbs. We present a case of FOSMN-like syndrome that has characteristics of FOSMN but is confined to the craniofacial region.

Methods:

Retrospective chart review and review of the literature.

Results:

A 70-year-old woman presented with a 1-month history of progressive bilateral facial sensory loss and weakness affecting the trigeminal and hypoglossal nerves. Within 12 months, she developed debilitating weakness affecting her lower and midface bilaterally. After an extensive workup, a diagnosis of FOSMN-like syndrome was made, as symptoms failed to progress to the upper extremities.

Conclusions:

This case demonstrates a unique presentation of FOSMN that we classify as FOSMN-like syndrome. Clinicians must maintain a high index of suspicion when a patient presents with clinical features characteristic of FOSMN syndrome without progression of symptoms distal to the craniofacial region because it may represent a FOSMN-like syndrome.
Validation of Acute Pancreatitis Among Adults in an Integrated Healthcare System
Authors: Floyd James S. , Bann Maralyssa A. , Felcher Andrew H. , Sapp Daniel , Nguyen Michael D. , Ajao Adebola , Ball Robert , Carrell David S. , Nelson Jennifer C. , Hazlehurst Brian
Published: August 2022

Background:

Acute pancreatitis is a serious gastrointestinal disease that is an important target for drug safety surveillance. Little is known about the accuracy of ICD-10 codes for acute pancreatitis in the United States, or their performance in specific clinical settings. We conducted a validation study to assess the accuracy of acute pancreatitis ICD-10 diagnosis codes in inpatient, emergency department (ED), and outpatient settings.

Methods:

We reviewed electronic medical records for encounters with acute pancreatitis diagnosis codes in an integrated healthcare system from October 2015 to December 2019. Trained abstractors and physician adjudicators determined whether events met criteria for acute pancreatitis.

Results:

Out of 1,844 eligible events, we randomly sampled 300 for review. Across all clinical settings, 182 events met validation criteria for an overall positive predictive value (PPV) of 61% (95% confidence intervals [CI] = 55, 66). The PPV was 87% (95% CI = 79, 92%) for inpatient codes, but only 45% for ED (95% CI = 35, 54%) and outpatient (95% CI = 34, 55%) codes. ED and outpatient encounters accounted for 43% of validated events. Acute pancreatitis codes from any encounter type with lipase >3 times the upper limit of normal had a PPV of 92% (95% CI = 86, 95%) and identified 85% of validated events (95% CI = 79, 89%), while codes with lipase <3 times the upper limit of normal had a PPV of only 22% (95% CI = 16, 30%).

Conclusions:

These results suggest that ICD-10 codes accurately identified acute pancreatitis in the inpatient setting, but not in the ED and outpatient settings. Laboratory data substantially improved algorithm performance.
DISTORTION RESOLUTION AFTER VITRECTOMY FOR MACULA-INVOLVING RETINAL DETACHMENT REPAIR
Authors: Casswell Edward J. , Yorston David , Lee Edward , Charteris David G.
Published: August 2022

Purpose:

To investigate changes in subjective and objective distortion in the first 6 months after macula-involving retinal detachment repair.

Methods:

Post hoc analysis of the PostRD trial: a prospective, multicentered randomized controlled trial. Two hundred and sixty-two patients with macula-involving retinal detachments undergoing repair with vitrectomy and gas tamponade were asked to complete a distortion questionnaire and objective distortion assessment (D chart) 2 and 6 months postoperatively. Visual acuity, retinal displacement (measured with fundus autofluorescence imaging), and quality of life were also recorded.

Results:

Two months postoperatively 75.5% of patients reported subjective distortion, and this fell to 61.1% at 6 months. Over that period, distortion persisted in 56.5% of patients, resolved in 19.2%, and developed in 5.6%. Approximately one in four had resolution of their distortion by 6 months. The median overall and weighted D chart distortion scores fell between 2 and 6 months but 29% of patients had a worsening of D chart distortion score. D chart distortion scores were more closely correlated with amplitude of postoperative retinal displacement and quality-of-life scores in comparison with subjective distortion.

Conclusion:

Subjective distortion and objective distortion are common after macula-involving retinal detachment, but can improve over time. Objective measures of distortion were more closely correlated with quality of life and retinal displacement in comparison with subjective distortion.