bluuebunny/crossref_metadata_2025 huggingface dataset:
Acquired bedaquiline resistance during the treatment of drug-resistant tuberculosis: a systematic review
Authors: Mallick Jahan Saeed , Nair Parvati , Abbew Elizabeth Tabitha , Van Deun Armand , Decroo Tom
Published: March 2022

Background

Drug-resistant tuberculosis (DR-TB) is considered to be a public health threat and is difficult to cure, requiring a lengthy treatment with potent, potentially toxic drugs. The novel antimicrobial agent bedaquiline has shown promising results for patients with DR-TB, improving the rate of culture conversion and reducing TB-related mortality. However, increasing numbers of cases with acquired bedaquiline resistance (ABR) have been reported in recent years.

Methods

This systematic review aimed to assess the frequency of ABR and characteristics of patients acquiring it. Studies showing data on sequential bedaquiline drug-susceptibility testing in patients treated with a bedaquiline-containing regimen were included. The databases CENTRAL, PubMed and Embase were manually searched, and 866 unique records identified, eventually leading to the inclusion of 13 studies. Phenotypic ABR was assessed based on predefined MIC thresholds and genotypic ABR based on the emergence of resistance-associated variants.

Results

The median (IQR) frequency of phenotypic ABR was 2.2% (1.1%–4.6%) and 4.4% (1.8%–5.8%) for genotypic ABR. Among the studies reporting individual data of patients with ABR, the median number of likely effective drugs in a treatment regimen was five, in accordance with WHO recommendations. In regard to the utilization of important companion drugs with high and early bactericidal activity, linezolid was included in the regimen of most ABR patients, whereas the usage of other group A (fluoroquinolones) and former group B drugs (second-line injectable drugs) was rare.

Conclusions

Our findings suggest a relevant frequency of ABR, urging for a better protection against it. Therefore, treatment regimens should include drugs with high resistance-preventing capacity through high and early bactericidal activity.
Intraoperative Methadone Use in Pediatric Burn Patients
Authors: Carlson Amanda , Pham David , Price Cayenne , Reisch Joan , Iskander Ingy , Ambardekar Aditee
Published: March 2022

Burn injury in children can cause severe and chronic physical and mental sequelae. Opioids are a mainstay in burn pain management but increasing utilization in this country has led to concern for their continued use and potential for dependence. Methadone is a long-acting analgesic that targets the N-methyl-D-aspartate (NMDA) receptor in addition to the mu opioid receptor and has benefit in adult burn patients. However, its use in the pediatric burn population has been less robustly studied. This is a retrospective cohort study at a single Level 1 Burn Center whose primary aim is to compare opioid utilization 36 hours postoperatively between pediatric burn patients who received intraoperative, intravenous methadone and those who did not. Secondary aim was to describe differences in methadone-related complications between the cohorts. There was decreased opioid utilization measured by median morphine equivalents per kilogram (ME/kg) postoperatively in the methadone cohort compared to the control cohort (0.54 vs 0.77 mg/kg, P = .18). No adverse events were noted upon chart review. The data suggest that methadone use is beneficial in pediatric burn patients, but further prospective studies are warranted on a larger population.
Review of the Limnadiidae (Crustacea: Branchiopoda: Spinicaudata) of southern Africa
Authors: Rogers D Christopher , Meyer-Milne Elizabeth
Published: March 2022

The limnadiid clam shrimps of southern Africa are revised and the history and difficulties surrounding the taxonomy of the species in this region are discussed. Three new species are described: two of EulimnadiaPackard, 1874 and one of GondwanalimnadiaRogers, Rabet & Weeks, 2016. The two new Eulimnadia species are distinguished from congeners by their unique egg ornamentation: dense, fine, long striae in E. striatan. sp., broadly angular to subcylindrical with numerous rows of narrow, rectangular polygons in E. subcylindriforman. sp. The taxonomy and identity of Gondwanalimnadia is discussed in detail and validated as a new species as Gondwanalimnadia costatan. sp. This species is readily separated from the southern African Eulimnadia by the characters of the genus and the egg, which is spherical with large, broad costae.
A Rhetorical Reading of Self–Other Polarities in Counsel Arguments made before the Trials of Major Criminals at Nuremberg and Tokyo
Authors: Nell Albert
Published: March 2022

An argumentative narrative apart from positive rules appeared in early international criminal law (ICL). This article argues that a complex narrative pertaining to Self–Other polarities can be identified from the arguments presented by the counsel, whether prosecution or defence, in their respective case’s opening and closing arguments before the major war criminals’ trials at the Nuremberg International Military Tribunal, on the one hand, and at the International Military Tribunal for the Far East, on the other. This article proposes a fourfold taxonomy to explain said Self–Other narratives. It is further argued that these narratives could be explained through a classical rhetorical frame as aimed at enhancing the persuasion (by appealing, in particular, to logos, ethos and pathos) of the respective sides’ arguments. The article finally reflects on possible reasons why counsel appearing before these early ICL tribunals took recourse to these narratives to persuade. The constitution of the respective intended target audiences to be persuaded are considered in the process as well.
Ultrahigh-throughput screening of industrial enzyme-producing strains by droplet-based microfluidic system
Authors: Yuan Huiling , Tu Ran , Tong Xinwei , Lin Yuping , Zhang Yuanyuan , Wang Qinhong
Published: March 2022

Droplet-based microfluidics has emerged as a powerful tool for single-cell screening with ultrahigh throughput, but its widespread application remains limited by the accessibility of a droplet microfluidic high-throughput screening (HTS) platform, especially to common laboratories having no background in microfluidics. Here, we first developed a microfluidic HTS platform based on fluorescence-activated droplet sorting technology. This platform allowed (i) encapsulation of single cells in monodisperse water-in-oil droplets; (ii) cell growth and protein production in droplets; and (iii) sorting of droplets based on their fluorescence intensities. To validate the platform, a model selection experiment of a binary mixture of Bacillus strains was performed, and a 45.6-fold enrichment was achieved at a sorting rate of 300 droplets per second. Furthermore, we used the platform for the selection of higher α-amylase-producing Bacillus licheniformis strains from a mutant library generated by atmospheric and room temperature plasma mutagenesis, and clones displaying over 50% improvement in α-amylase productivity were isolated. This droplet screening system could be applied to the engineering of other industrially valuable strains.
Arbitrage Pricing Theory for Idiosyncratic Variance Factors
Authors: Renault Eric , Van Der Heijden Thijs , Werker Bas J M
Published: March 2022

We develop an arbitrage pricing theory framework extension to study the pricing of squared returns/volatilities. We analyze the interplay between factors at the return level and those in idiosyncratic variances. We confirm the presence of a common idiosyncratic variance factor, but do not find evidence that this represents a missing risk factor at the (linear) return level. Thereby, we consistently identify idiosyncratic returns. The price of the idiosyncratic variance factor identified by squared returns is small relative to the price of market variance risk. The quadratic pricing kernels induced by our model are in line with standard economic intuition.
Calcitriol Pretreatment Attenuates Glutamate Neurotoxicity by Regulating NMDAR and CYP46A1 Gene Expression in Rats Subjected to Transient Middle Cerebral Artery Occlusion
Authors: Khassafi Negar , Zahraei Zohreh , Vahidinia Zeinab , Karimian Mohammad , Azami Tameh Abolfazl
Published: March 2022

Although the neuroprotective effects of calcitriol have been demonstrated in a variety of neurological diseases, such as stroke, the precise molecular mechanism has yet to be determined. This study aimed to investigate the possible role of calcitriol as a neuroprotective agent via CYP46A1 and glutamate receptors in a middle cerebral artery occlusion (MCAO) animal model. The MCAO technique was performed on adult male Wistar rats to induce focal cerebral ischemia for 1 hour followed by 23 hours of reperfusion. Calcitriol was given for 7 days prior to stroke induction. Sensorimotor functional tests were done 24 hours after ischemia/reperfusion, and infarct volume was estimated by tetrazolium chloride staining of brain sections. Gene expression of NR2A, NR2B, NR3B, and CYP46A1 was evaluated by RT-PCR followed by western blotting for NR3B protein. Our data revealed that calcitriol pretreatment reduced lesion volume and improved ischemic neurobehavioral parameters. Calcitriol therapy altered the expression of glutamate receptor and CYP46A1 genes. A possible molecular mechanism of calcitriol to reduce the severity and complications of ischemia may be through alterations of glutamate receptor and CYP46A1 gene expression.
Search in Response to Negative Performance Feedback: Problem-Definition and Solution-Generation
Authors: van der Voet Joris
Published: March 2022

Behavioral theory states that decision-makers engage in search in response to a performance shortfall. However, public administration research has remained remarkably inattentive of decision-makers’ attention. This study conceptually disentangles problem-defining and solution-generation as two distinct search objectives, in order to test theoretical expectations concerning individual decision-makers’ search in response to negative performance. Using a survey experiment among 1,562 political and managerial public sector decision-makers across 263 local government organizations that links factual performance feedback about budgetary performance and citizen satisfaction to a behavioral measure of both search objectives, the study finds increased solution-generation search in response to negative budgetary performance feedback, but not in response to low citizen satisfaction. Search of politicians and managers is found to be highly similar. These findings contribute to a behavioral understanding of how performance information influences search by politicians and managers, and reveal novel research avenues about information-processing that are of particular relevance to public administration research and theory.
Spectroscopic properties and driving factors of dissolved organic matter in the Yellow River Delta
Authors: Cui Yuan , Luo Fang-Li , Zhang Ming-Xiang , Yu Fei-Hai
Published: March 2022

River deltas are hot spots of biogeochemical cycling. Understanding sources and driving factors of dissolved organic matter (DOM) in river deltas is important for evaluating the role of river deltas in regulating global carbon flux. In this study, spectroscopic properties of soil DOM were analyzed in both freshwater and tidal areas of the Yellow River Delta. Five fluorescent components of soil DOM (two humic-like DOM, two protein-like DOM and one possible contaminant) were identified by parallel factor analysis and further confirmed by comparison with an online database. Concentration, spectroscopic properties and sources of soil DOM and its components differed between freshwater and tidal areas. DOM concentration was much higher in freshwater areas than in tidal areas. In freshwater areas, soil DOM was mainly derived from phytoplankton and microorganisms, while it was mainly derived from microorganisms and human activities in tidal areas. These differences in DOM between both areas were strongly driven by environmental factors, especially soil carbon (C), nitrogen (N) and its stoichiometric ratio C/N. These explained 80.7% and 69.6% of variations in DOM and chromophoric DOM (CDOM), respectively. In addition, phytoplankton also contributed to soil DOM, CDOM and fluorescent components C1–C4 as identified by significant positive correlations between them. These results imply that both the concentration and composition of soil DOM are strongly driven by soil properties and phytoplankton density in the Yellow River Delta.
Understanding health costs in the Jordanian public health sector: analysis of the cost-to-charge ratio
Authors: Hammad Eman A , Mousa Rimal , Massad Eman , Alabbadi Ibrahim
Published: March 2022

Objectives

To investigate the cost to charge ratios (CCRs) and understand the costs of procedures, laboratory tests and imaging in the public health sector in Jordan..

Methods

CCRs were estimated using published public data and data obtained from the financial departments of the three main public health programs in Jordan including the Ministry of Health, Military Royal Medical Services , and university affiliated hospitals. CCR was estimated by dividing the total cost by total charges (CCR = Total Hospital [or Cost Centre] Cost/Total Hospital [or Cost Centre] Charges) for the fiscal year 2016–2017. The charges master lists of procedures, diagnostics, and lab services were analyzed. Costs of most performed procedures, diagnostics and lab services were estimated using CCR approach. The cost of service equaled the billing charge (unit price) multiplied by the overall CCR of a provider.

Key findings

CCRs for the Ministry of Health ranged between 1.09 and 2.3 and expenditures approximately overweight charges two times. CCRs ranged between 0.31–0.89 for the Military Royal Medical Services and ranged between 0.34–0.79 for university-affiliated hospitals. Costs for 187 of the most performed procedures, diagnostics and lab tests were estimated.

Conclusions

CCR methodology is considered uncomplex in practice and useful to approximate costs from charges. The cost to charge of MoH was too high reflecting the highly subsidized health services offered by MoH facilities. Sustaining health service delivery and quality might be unwarranted. Master charge lists are old dated and not calibrated annually. There is no evidence based records on how these been estimated. Investing in cost data collection and analysis is demanded to enhance healthcare management.
Omental calcified fibrous tumor with symptoms after COVID-19 infection
Authors: Topcu Feyza Sönmez , İpek Turgut , Kapan Metin , Yılmaz Serpil , Ensaroğlu Fatih
Published: March 2022

Calcified fibrous tumor (CFT) is a rare benign tumor of mesenchymal origin. Between 1988 and 2019, a total of 272 CFT cases were reported. CFTs can be seen in all anatomical regions with soft tissue. Histologically, mononuclear inflammatory infiltrates and the presence of psammomatous calcification in dense hyalinized collagen are characteristic features of the tumor. Currently, if the tumor is located in only one focus, surgical removal is recommended. Although CFT is a benign tumor, it may cause complications. Diagnosis is often difficult due to the confusion of tumor findings with many diseases. We present a patient with CFT, whose omental lesions were detected on abdominal computed tomography, and the diagnosis was confirmed by histopathological examination.
Phytomelatonin as a signaling molecule for protein quality control via chaperone, autophagy, and ubiquitin–proteasome systems in plants
Authors: Lee Hyoung Yool , Hwang Ok Jin , Back Kyoungwhan
Published: March 2022

Physiological effects mediated by melatonin are attributable to its potent antioxidant activity as well as its role as a signaling molecule in inducing a vast array of melatonin-mediated genes. Here, we propose melatonin as a signaling molecule essential for protein quality control (PQC) in plants. PQC occurs by the coordinated activities of three systems: the chaperone network, autophagy, and the ubiquitin–proteasome system. With regard to the melatonin-mediated chaperone pathway, melatonin increases thermotolerance by induction of heat shock proteins and confers endoplasmic reticulum stress tolerance by increasing endoplasmic reticulum chaperone proteins. In chloroplasts, melatonin-induced chaperones, including Clps and CpHSP70s, play key roles in the PQC of chloroplast-localized proteins, such as Lhcb1, Lhcb4, and RBCL, during growth. Melatonin regulates PQC by autophagy processes, in which melatonin induces many autophagy (ATG) genes and autophagosome formation under stress conditions. Finally, melatonin-mediated plant stress tolerance is associated with up-regulation of stress-induced transcription factors, which are regulated by the ubiquitin–proteasome system. In this review, we propose that melatonin plays a pivotal role in PQC and consequently functions as a pleiotropic molecule under non-stress and adverse conditions in plants.
Towards a linked open data resource for direct speech acts in Greek and Latin epic
Authors: Forstall Christopher W , Finkmann Simone , Verhelst Berenice
Published: March 2022

The Digital Initiative for Classics: Epic Speeches (DICES) research group reports here on preliminary work to integrate research on Greek and Latin epic speeches into the larger ecosystem of linked open data (LOD) for classical scholarship. The ability to collate speech data from different researchers and to leverage external repositories of texts and characters opens up new possibilities for interrogation of the epic corpus. We briefly survey the current state of scholarship on epic speeches and of the digital infrastructure on which we propose to build. We outline a model for harmonizing speech data across studies and aligning it with existing LOD standards. Finally, we discuss some early proof-of-concept results and the larger implications of this approach for the field. The long-term aim of the DICES project is to build a database of metadata on direct speech in Greek and Latin epic, not only covering canonical texts such as Homer and Virgil, but also including the less-studied texts of the late antique period, which will benefit greatly both from the increased accessibility and also from the diachronic perspective afforded by a corpus-based approach. The envisioned database also has the potential to include diachronic data from additional genres and languages at a later stage.
Handling Tovey’s Bach
Authors: Phillips Reuben
Published: March 2022

Adopting an approach inspired by the field of book history, this article examines a heavily annotated copy of the Bach-Gesellschaft edition that belonged to Donald Francis Tovey. Tovey’s annotations mix scholarly acumen with witticism and wonderment, variously providing thoughts on performance practice, complaints about idiotic editors, personal memories of past performances, and penetrating critical commentary. I consider the affordances of this edition as a material object, reflecting on the new ways of being around Bach’s music that it enabled. The later sections of the article suggest that Tovey’s wider engagement with Bach’s music might be viewed as a kind of resistance to the Gesellschaft edition’s presentation of Bach’s compositions as a series of ontologically stable musical works. As well as contributing new insights into Tovey’s achievements, I demonstrate the value of a richer understanding of what might constitute ‘score-based’ engagement with music in the late nineteenth and early twentieth century.
Low-efficiency long gamma-ray bursts: a case study with AT2020blt
Authors: Sarin N , Hamburg R , Burns E , Ashton G , Lasky P D , Lamb G P
Published: March 2022

The Zwicky Transient Facility recently announced the detection of an optical transient AT2020blt at redshift z = 2.9, consistent with the afterglow of an on-axis gamma-ray burst. However, no prompt emission was observed. We analyse AT2020blt with detailed models, showing the data are best explained as the afterglow of an on-axis long gamma-ray burst, ruling out other hypotheses such as a cocoon and a low-Lorentz factor jet. We search Fermi data for prompt emission, setting deeper upper limits on the prompt emission than in the original detection paper. Together with KONUS-Wind observations, we show that the gamma-ray efficiency of AT2020blt is $\lesssim 0.3\!-\!4.5{{\ \rm per\, cent}}$. We speculate that AT2020blt and AT2021any belong to the low-efficiency tail of long gamma-ray burst distributions that are beginning to be readily observed due to the capabilities of new observatories like the Zwicky Transient Facility.
A deterministic code for transcription factor-DNA recognition through computation of binding interfaces
Authors: Trerotola Marco , Antolini Laura , Beni Laura , Guerra Emanuela , Spadaccini Mariano , Verzulli Damiano , Moschella Antonino , Alberti Saverio
Published: March 2022

The recognition code between transcription factor (TF) amino acids and DNA bases remains poorly understood. Here, the determinants of TF amino acid-DNA base binding selectivity were identified through the analysis of crystals of TF-DNA complexes. Selective, high-frequency interactions were identified for the vast majority of amino acid side chains (‘structural code’). DNA binding specificities were then independently assessed by meta-analysis of random-mutagenesis studies of Zn finger-target DNA sequences. Selective, high-frequency interactions were identified for the majority of mutagenized residues (‘mutagenesis code’). The structural code and the mutagenesis code were shown to match to a striking level of accuracy (P = 3.1 × 10−33), suggesting the identification of fundamental rules of TF binding to DNA bases. Additional insight was gained by showing a geometry-dictated choice among DNA-binding TF residues with overlapping specificity. These findings indicate the existence of a DNA recognition mode whereby the physical-chemical characteristics of the interacting residues play a deterministic role. The discovery of this DNA recognition code advances our knowledge on fundamental features of regulation of gene expression and is expected to pave the way for integration with higher-order complexity approaches.
Physics-informed deep-learning parameterization of ocean vertical mixing improves climate simulations
Authors: Zhu Yuchao , Zhang Rong-Hua , Moum James N , Wang Fan , Li Xiaofeng , Li Delei
Published: March 2022

Uncertainties in ocean-mixing parameterizations are primary sources for ocean and climate modeling biases. Due to lack of process understanding, traditional physics-driven parameterizations perform unsatisfactorily in the tropics. Recent advances in the deep-learning method and the new availability of long-term turbulence measurements provide an opportunity to explore data-driven approaches to parameterizing oceanic vertical-mixing processes. Here, we describe a novel parameterization based on an artificial neural network trained using a decadal-long time record of hydrographic and turbulence observations in the tropical Pacific. This data-driven parameterization achieves higher accuracy than current parameterizations, demonstrating good generalization ability under physical constraints. When integrated into an ocean model, our parameterization facilitates improved simulations in both ocean-only and coupled modeling. As a novel application of machine learning to the geophysical fluid, these results show the feasibility of using limited observations and well-understood physical constraints to construct a physics-informed deep-learning parameterization for improved climate simulations.
Legislative Overreach, Adaptation and Administrative Re-regulation in Environmental Law
Authors: Pedersen Ole W
Published: March 2022

This article interrogates the use of regulatory position statements (RPSs) by the Environment Agency. Through an RPS, the Environment Agency undertakes to take no enforcement action against an operator in circumstances that ordinarily constitutes a breach of the law. The article argues that RPSs serve several important functions, chief among which is to respond to regulatory overreach, which arises when legislators enact comprehensive statutory instruments to deal with complex and technical matters such as environmental protection. Beyond responding to regulatory overreach, the RPSs also serve to provide regulators with a regulatory tool that allows flexible and swift changes to the regulatory regime when faced with unforeseen challenges. Although their informal enactment suggests otherwise, the RPSs have significant ‘law-like’ implications, giving rise to a regulatory hybrid instrument, which is neither law or policy nor a rule or a discretionary power. Moreover, even if RPSs serve to disapply important statutory controls, they impose a range of additional and vague regulatory conditions and requirements. RPSs therefore contribute to a regulatory system which fluctuates between regulation, deregulation and re-regulation.
Empirical Research and Recommendations for Moral Action: A Plea for the Transparent Reporting of Bridge Principles in Public Health Research
Authors: Kuehlmeyer Katja , Mertz Marcel , Haltaufderheide Joschka , Kremling Alexander , Schleidgen Sebastian , Inthorn Julia
Published: March 2022

Academic publications of empirical public health research often entail recommendations for moral action that address practitioners and policy makers. These recommendations are regularly based on implicit moral judgments with the underlying reasons not explicitly stated. In this paper, we elaborate on the moral relevance of such judgments and the need to explain them in order to account for academic argumentation. We argue for an explicit reporting of bridge principles to increase the transparency of the reporting of public health research. The reporting of bridge principles can inform readers, support them in understanding the relationship between empirical and normative claims in a specific paper, and may pave new ways for the rigorous reporting of empirical research that has moral implications. Furthermore, it can be used to classify studies to systematically address the justification for their argumentation.
Phytoplankton and particle size spectra indicate intense mixotrophic dinoflagellates grazing from summer to winter
Authors: García-Oliva Ovidio , Hantzsche Florian M , Boersma Maarten , Wirtz Kai W
Published: March 2022

Mixotrophic dinoflagellates (MTD) are a diverse group of organisms often responsible for the formation of harmful algal blooms. However, the development of dinoflagellate blooms and their effects on the plankton community are still not well explored. Here we relate the species succession of MTD with parallel changes of phytoplankton size spectra during periods of MTD dominance. We used FlowCAM analysis to acquire size spectra in the range 2–200 μm every one or two weeks from July to December 2007 at Helgoland Roads (Southern North Sea). Most size spectra of dinoflagellates were bimodal, whereas for other groups, e.g. diatoms and autotrophic flagellates, the spectra were unimodal, which indicates different resource use strategies of autotrophs and mixotrophs. The biomass lost in the size spectrum correlates with the potential grazing pressure of MTD. Based on size-based analysis of trophic linkages, we suggest that mixotrophy, including detritivory, drives species succession and facilitates the formation of bimodal size spectra. Bimodality in particular indicates niche differentiation through grazing of large MTD on smaller MTD. Phagotrophy of larger MTD may exceed one of the smaller MTD since larger prey was more abundant than smaller prey. Under strong light limitation, a usually overlooked refuge strategy may derive from detritivory. The critical role of trophic links of MTD as a central component of the plankton community may guide future observational and theoretical research.
Tensor force effect on pairing correlations for the Gamow–Teller transition in 42Ca, 46Ti, and 18O
Authors: Ha Eunja , Cheoun Myung-Ki , Sagawa H
Published: March 2022

We investigate the tensor force (TF) effect on the Gamow–Teller (GT) transition strength distributions in 42Ca, 46Ti, and 18O, which are known to have strong low-energy GT states, the so-called low-energy super GT (LeSGT) transition, peculiar to nuclei retaining a neutron number N = Z + 2. The TF is explicitly taken into account in the pairing channels of the residual interaction on top of the mean field described by a deformed Woods–Saxon potential. The pairing matrix elements (PMEs) comprising isoscalar and isovector parts, which consistently describe both the ground and the GT excited states, are calculated by a Brückner G-matrix based on the charge-dependent Bonn potential. By switching the TF on and off in the PMEs, we deduce meaningful correlations between the TF and the GT strength distributions. It is found that an attractive TF affects not only the ground state but also plays a crucial role in shifting the main GT peak to the low excitation-energy region leading to the LeSGT.
The Experiences and Needs of Families of Comatose Patients After Cardiac Arrest and Severe Neurotrauma: The Perspectives of National Key Stakeholders During a National Institutes of Health–Funded Workshop
Authors: Muehlschlegel Susanne , Perman Sarah M. , Elmer Jonathan , Haggins Adrianne , Teixeira Bailey Natalie D. , Huang Jennifer , Jansky Liz , Kirchner Jessica , Kasperek-Wynn Renee , Lipman Paula Darby , Yeatts Sharon D. , Fetters Michael D. , Dickert Neal W. , Silbergleit Robert
Published: March 2022

OBJECTIVES:

Severe acute brain injury (SABI) from cardiac arrest and traumatic brain injury happens suddenly and unexpectedly, carrying high potential for lifelong disability with substantial prognostic uncertainty. Comprehensive assessments of family experiences and support needs after SABI are lacking. Our objective is to elicit “on-the-ground” perspectives about the experiences and needs of families of patients with SABI.

DESIGN:

Two-phase qualitative study of families and multidisciplinary U.S. healthcare professionals (mHCPs) with expertise in SABI: Phase 1 included semistructured interviews to generate formative findings; phase 2 entailed facilitated discussions to confirm and expand initial findings.

SETTING:

Phase 1: academic medical center; phase 2: virtual workshop.

SUBJECTS:

Phase 1 included seven family members and 12 mHCPs. Phase 2 included nationally recruited stakeholders (17 family members and 12 mHCPs).

INTERVENTION:

None.

MEASUREMENTS AND RESULTS:

We explored: 1) what are families’ needs in the first 48 hours? 2) How are these needs addressed? and 3) How can hospitals better meet these needs? Qualitative analysis included inductive and deductive approaches guided by a conceptual ecological model. Four major needs were identified: 1) challenges in coping with uncertainty in early prognostication, 2) inattention to physical needs of family, 3) deficits in compassionate and consistent communication, and 4) need for engagement with families as stakeholders in improving future practices. Participants’ recommendations included: 1) ways to communicate more clearly and consistently, 2) better assistance with navigating resources and access to places for families to care for themselves, and 3) opportunities for families to remain connected with their loved ones, social support networks, and the clinical team.

CONCLUSIONS:

Stakeholders identified novel insights regarding families’ experiences during the hospitalization of comatose SABI patients and factors that can contribute to improved decision-making and physical/emotional outcomes. Interventions to address these unmet needs are promising targets to improve outcomes.
Incidence of Adverse Events Associated With the In-Hospital Transport of Critically Ill Patients
Authors: Nonami Suguru , Kawakami Daisuke , Ito Jiro , Ouchi Kenjiro , Miyoshi Yusuke , Tatebe Masao , Tsuchida Takahiro , Seo Ryutaro , Mima Hiroyuki
Published: March 2022

IMPORTANCE:

Despite various reports on the incidence of adverse events related to the in-hospital transport of critically ill patients, there is little verification of the correlation between the occurrence of adverse events and the use of checklists. The risk factors for the occurrence of adverse events during transport based on the use of checklists have not been well studied. Understanding them can contribute to making patient transport safer.

OBJECTIVES:

We aimed to investigate the frequency of adverse events and risk factors related to the in-hospital transport of critically ill patients in a hospital that uses a checklist for transporting patients.

DESIGN, SETTING, AND PARTICIPANTS:

This single-center, prospective, observational study was conducted between February 1, 2020, and July 31, 2020, at Kobe City Medical Center General Hospital, Japan. Patients greater than or equal to 18 years old who were admitted to the ICU and were transported for examination or procedures were included.

MAIN OUTCOMES AND MEASURES:

The transport member recorded patient information and any adverse events that occurred and filled out an information collection form. We then applied multivariate analysis to identify risk factors.

RESULTS:

A total of 117 transports for 117 patients were evaluated in this study. Twenty-two adverse events occurred in 20 transports (17.1%). There were nine transports (7.7%) in which the patients required treatment, all of which were related to patient instability. Multivariate logistic regression analysis showed that the use of sedative drugs was related to adverse events (odds ratio, 2.9; 95% CI, 1.0–8.5; p = 0.04). We were not able to show a relationship of either the severity of the illness or body mass index with the occurrence of adverse events.

CONCLUSIONS AND RELEVANCE:

This study revealed that the frequency of adverse events related to the in-hospital transportation of critically ill patients based on the use of a checklist was 17.1% and that the use of sedatives was associated with adverse events.
The role of imaging in immunoglobulin G4-related disease of the upper urinary tract
Authors: Taktak Samih , El-Taji Omar , Venugopal Suresh
Published: March 2022

Background:

Immunoglobulin G4-related disease remains a modern, relatively unknown field in the urological world. An increasing number of cases require urological input, often with invasive diagnostics and aggressive medical treatment first-line. Given this, we sought to evaluate modern radiological options of disease affecting the upper urinary tract, to provide clarity and reduce diagnostic burden and delay in this poorly understood yet potentially debilitating disease process.

We conducted a systematic literature search including PubMed and Medline, focusing on immunoglobulin G4-related disease affecting the upper urinary tract, before reviewing articles assessing different radiological modalities in diagnosis. Consistent computed tomography findings have been demonstrated in the literature and contributed to recent breakthroughs in classification criteria, however invasive biopsy remains a mainstay in work-up, given the difficulties in comparing against malignancy. Early work in positron-emission tomography and magnetic resonance imaging has shown promise in radiologically distinguishing from other differentials, especially diffusion-weighted imaging showing high sensitivity levels, but not yet enough to formulate protocols and cause histological investigation to be redundant.

Key messages:

Our article has highlighted repeated findings in the literature of computed tomography appearances of IgG4-RD in the upper urinary tract, however invasive work-up remains a mainstay given the overlap with malignancy. Prospective, comparative studies into magnetic resonance imaging and positron-emission tomography are now required, given their early results, to improve consistency in reporting and reduce patient burden when investigating this benign, yet debilitating disease process.
The Occupational Medicine Pipeline
Authors: Zheng Shoshana , Rivera Margarin Aisha , Connaughton Peter , Spanjaard Herman , Crispen Reese , Ording Julie , Cloeren Marianne
Published: March 2022

Objective:

To learn how occupational and environmental medicine (OEM) expertise is developed and maintained around the world and to inform strategies for further international development of OEM.

Methods:

An anonymous survey was conducted of leaders of the 48 member societies (from 43 countries) of the International Occupational Medicine Society Collaborative (IOMSC) to evaluate OEM training, certification, maintenance, and recertification requirements.

Results:

OEM physician leaders representing 46 of the 48 IOMSC member societies (95.8%) completed the survey between December 2019 and February 2020. Academic post-graduate and on-the-job training were the most frequent methods for developing OEM expertise, with little use of online coursework and minimal OEM content in medical school in most countries. Occupational medicine board certification usually required graduate specialty training and passing a certification examination, while occupational medicine recertification requirements were uncommon.

Conclusion:

The IOMSC is positioned to support the international development of OEM expertise by sharing information on competencies, best practices in medical education curriculum content and examples of OEM specialty certification pathways from different countries.
Occupational and Environmental Hazards of Correctional Settings
Authors: Montoya-Barthelemy Andre , Gibson Brent R. , Lee Charles D. , Bade Aashia M. , Butler James W. , Smith Eric , Skipworth Diane , Gutekunst Julie , Segula Marjorie Naila , Wicken Cassie , Friedman Eric , Darbari Isha , Menegas Samantha , Thatai Shreya , Wheeler Lauren
Published: March 2022

Objective:

Maintaining healthful, safe, and productive work environments for workers in correctional settings is a matter of deep consequence to the workers themselves, the institutions they serve, the incarcerated individuals with whom they share space, and inevitably, to our wider community. We hypothesized that an examination of the academic literature would reveal opportunities for an improved approach to research in these settings.

Methods:

We performed a scoping literature review using search terms related to the occupational and environmental health of workers in correctional environments, limited to studies performed in the United States.

Results:

A total of 942 studies underwent title and abstract screening, 342 underwent full-text review, and 147 underwent data extraction by a single reviewer. The results revealed a body of literature that tends strongly toward analyses of stress and burnout of correctional staff, largely based on self-reported data from cross-sectional surveys. Those studies related to physical health were predominantly represented by topics of infectious disease. There were few or no studies examining exposures or outcomes related to diagnosable mental health conditions, musculoskeletal injury, environmental hazards, medical or mental health staff, immigration detention settings, or regarding incarcerated workers. There were very few studies that were experimental, longitudinal, or based on objective data.

Discussion:

The National Institute for Occupational Safety and Health (NIOSH) has promulgated a research strategy for correctional officers that should guide future research for all workers in correctional settings, but realization of these goals will rely upon multidisciplinary collaboration, specific grants to engage researchers, and an improved understanding of the barriers inherent to correctional research, all while maintaining rigorous protection for incarcerated persons as an especially vulnerable population.
The perception of smile attractiveness to altered vertical position of maxillary anteriors by various groups
Authors: Babeer Walaa A. , Bakhsh Zuhair T. , Natto Zuhair S.
Published: March 2022

There is a gap in research about the differences in smile attractiveness. The problem the study addresses is how the vertical canine and incisor position affect smile attractiveness. The aim of this study was to assess the perception of the smile attractiveness between Saudi laypersons, orthodontists, non-orthodontist, and various dental students levels, and to determine how the canine and incisor vertical positions affect the attractiveness of smile. The study is a cross-sectional survey and was conducted at King Abdulaziz University, Jeddah, Saudi Arabia. Six groups of subjects participated in the study: Orthodontic residents (n = 31), prosthodontic, restorative, periodontics specialties residents specialties residents (n = 30), interns (n = 31), fifth year students (n = 41), 6th year students (n = 39), and laypeople (n = 39). Participants were asked to rate the attractiveness of a smile of a female subject photographed using a Minolta DiMage 7i digital camera. The image had been manipulated to produce 2 sets of images; 1 to modify the incisors and 1 to change the canines. The subjects were asked to choose the most and least attractive picture. For the best incisor positions, only the laypeople and prosthodontics liked the original picture, the rest liked +0.5 mm which accentuate the smile curve and make it follow the lower lip line. For the worst incisor position, all groups did not prefer the minus 1.5 reversed smile. For the best canine vertical position, all groups preferred the original position where canine was at the level of the incisal plane. For the worst canine position, they all disliked the minus 1.5 reversed smile. Results confirmed past findings that orthodontists are in general more critical about smile attractiveness than laypersons, but just like other dental specialists. The findings can be used in the esthetic dentistry field, but further research on the study population based on other dental design parameters remain necessary.
Successful treatment of pancreatic schwannoma by enucleation
Authors: Xu Shao-Yan , Zhou Bo , Wei Shu-Mei , Zhao Ya-Nan , Yan Sheng
Published: March 2022

Rationale:

Pancreatic schwannomas are extremely rare and are difficult to diagnose preoperatively. Over the past 50 years, only 96 cases of pancreatic schwannoma have been reported in English literature. Herein, we report a case of pancreatic schwannoma treated with enucleation.

Patient concerns:

A 66-year-old woman visited a local hospital due to ventosities. Ultrasonography and computed tomography revealed a pancreatic mass. She visited our hospital for further diagnosis and treatment.

Diagnosis and interventions:

Magnetic resonance imaging revealed a tumor in the pancreatic body, and a solid pseudopapillary tumor was considered preoperatively. During the surgery, a pancreatic mass was found growing in the pancreatic body and tail. A successful tumor enucleation was performed. The mass was 7 × 6 × 3 cm in size with a thin capsule. Pathological examination revealed that the tumor was mainly composed of spindle-shaped cells with a palisading arrangement and no atypia. Both hypercellular and hypocellular areas were visible. Immunohistochemical staining showed that protein S-100 was strongly positive. The tumor was diagnosed as a benign schwannoma originating from the pancreatic body and tail.

Outcomes:

Postoperatively, the patient showed good recovery. During the 24-month follow-up period, the patient remained well and free of complications.

Lessons:

Pancreatic schwannomas are extremely rare and difficult to diagnose using imaging examinations. Enucleation is a safe and efficacious treatment for exophytic pancreatic schwannomas.
Cervical lymph node metastases in papillary thyroid cancer
Authors: Lu Guiling , Chen Liang
Published: March 2022

Preoperative screening of potential risk of lymph node metastasis is necessary for thyroidectomy plus lymph node dissection. The 2015 American thyroid association management guidelines do not recommend prophylactic cervical lymph node resection without clinical evidence of metastasis. Ultrasound is recommended imaging method and routine computed tomography is not recommended by the 2015 American thyroid association management guidelines for screening of lymph node metastasis. The objective of the study was to compare the diagnostic performance of ultrasound against that of computed tomography for screening cervical lymph node metastasis of patients with papillary thyroid cancer before thyroidectomy plus lymph node dissection.

Data regarding preoperative neck ultrasound, neck computed tomography, and physical examination of the head and neck and postoperative pathological results of a total of 185 patients (age > 18 years) with a diagnosis of papillary thyroid cancer who had suspicious lymph nodes on preoperative imaging and treated by thyroidectomy plus lymph node dissection for the therapeutic purpose were collected and analyzed.

Sensitivity (78.09% vs 75.28%, P < .0001) and accuracy (77.29% vs 75.13%, P = .0004) of neck computed tomography scanning to detect cervical lymph node metastasis were higher than those of neck ultrasound scanning. Sensitivity, accuracy, positive clinical utility, and negative clinical utility for neck ultrasound scanning plus neck computed tomography scanning to detect cervical lymph node metastasis were higher among all index tests (P < .05 for all) and were statistically the same as those of surgical pathology (P > .05 for all). The working areas for decision-making of thyroidectomy plus lymph node dissection of the physical examination, neck ultrasound, the neck computed tomography, and the neck ultrasound scanning plus the neck computed tomography scanning were 0 to 0.691 diagnostic confidence/lesion, 0 to 0.961 diagnostic confidence/lesion, 0 to 0.944 diagnostic confidence/lesion, and 0 to 0.981 diagnostic confidence/lesion, respectively.

Besides the neck ultrasound, the neck computed tomography scanning can be used as a complementary imaging method to detect cervical lymph node metastasis of patients with papillary thyroid cancer before thyroidectomy plus lymph node dissection.

Level of evidence: III.

Technical efficacy stage: 2.
Neurofilament light chain in cerebrospinal fluid or blood as a biomarker for mild cognitive impairment
Authors: Zhang Jing , Cheng Hongjiang , Liu Wei , Li Huimin , Song Yi , Jia Longbin
Published: March 2022

Background:

To allow early diagnosis and monitoring of disease progression, there is a need for biomarkers in mild cognitive impairment (MCI). Neurofilament light chain (NfL) is emerging protein biomarkers in neurodegenerative diseases and is of possible use in MCI. We aimed to assess the utility of NfL in blood and cerebrospinal fluid (CSF) as a biomarker in patients with MCI.

Methods:

A systematic search with comparison of NfL level between individuals with MCI and healthy controls were retrieved from PubMed, Embase, and Web of Science. The standard mean difference and 95% confidence interval were calculated using the random-effect model to analyze the differentiation of NfL between patients and controls.

Results:

A total of 7 studies were included. NfL was higher in 676 MCI than 504 healthy controls. Subgroup analysis according to sample type indicated that differentiation of NfL in CSF between patients with MCI and controls showed significant results but in blood. Moreover, the NfL increasing still existed when the NfL expression level was detected by enzyme-linked immunosorbent assay but single molecule array assay. However, no difference of NfL in MCI between Caucasian and Asian was found.

Conclusions:

NfL expression level in CSF was increased in MCI individuals, which indicated that NfL in CSF could be a potential biomarker of MCI.