bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of clinical outcomes in older individuals who received pharmaceutical care and posthospital discharge follow‐up
Authors: de Oliveira Alan Maicon , Rodrigues João Paulo Vilela , Campos Marília Silveira de Almeida , Varallo Fabiana Rossi , Pereira Leonardo Régis Leira
Published: May 2024

Background

Previous evidence underscores the need to assess potential clinical outcomes resulting from pharmaceutical care interventions and to monitor patient's progress to evaluate their clinical evolution, which is crucial for bolstering the relevance of implementing pharmaceutical care in healthcare services.

Aims

To conduct an in‐depth analysis of pharmaceutical care practices in a geriatric ward and monitor the clinical outcomes of older people served.

Methods

This interventionist study was conducted in the geriatrics ward of a Brazilian university hospital. The research intervention occurred between January and May 2022, with a follow‐up conducted for up to 90 days after patients' hospital discharge. Older patients in the geriatrics ward received pharmaceutical care, including medication reconciliation, medication review, and pharmacotherapeutic follow‐up, aimed at identifying and resolving drug‐related problems (DRPs). The clinical relevance of DRPs and pharmaceutical recommendations was evaluated. Additionally, analyses were conducted on mortality and rehospitalization outcomes in older patients at 30, 60, and 90 days following initial hospital discharge.

Results

Of the patients evaluated, a significant 88.3% exhibited at least one DRP (with an average of 2.6 ± 1.9 DRPs per patient), with the majority classified as need/indication problems (38.9%). The acceptance rate of pharmaceutical recommendations was 80.9%, with the majority categorized as very significant relevance (60.4%). DRPs were predominantly of serious clinical relevance (50.9%). In patients whose clinical indicators could be monitored, 95.5% showed some clinical response (in vital signs, laboratory tests and/or clinical status evolution) potentially related to resolved DRPs. Association analysis revealed that a higher number of medications in use before hospitalization correlated with a greater identification of DRPs during hospitalization (p = 0.03). At hospital discharge, 23.6% of patients were no longer using polypharmacy. In total, 16 patients (26.7%) died during the study period. Among patients who did not die during hospitalization (n = 54), 20 patients (37%) experienced rehospitalizations within 90 days following discharge.

Conclusion

This study facilitated the consolidation of pharmaceutical care implementation in a geriatric ward. We conducted identification, evaluation, and proposed evidence‐based solutions, as well as monitored cases for outcome analysis. It is anticipated that this methodology will inspire future research and the implementation of pharmaceutical care‐related services.
Urban flood drifters (UFD): Identification, classification and characterisation
Authors: Bayón Arnau , Valero Daniel , Franca Mário J.
Published: May 2024

Extreme floods threaten lives, assets and ecosystems, with the largest impacts occurring in urbanised areas. However, flood mitigation schemes generally neglect the fact that urban floods carry a considerable amount of solid load. In this study, we define urban flood drifters (UFDs) as loose objects present in the urban landscape that can become mobile under certain flow conditions, thereafter blocking drainage infrastructure and endangering both downstream and upstream communities. Based on 270 post‐flood photographic records from 63 major inundations of the past quarter‐century across 46 countries, we provide a comprehensive analysis of UFDs and their flood‐hazard implications. We show that a variety of vehicles, furniture and a heterogeneous mixture of drifters are present in post‐flooding scenarios. Plastic, construction debris and wood (natural or anthropogenic) dominate the statistics of transported drifters in urban floods (with frequencies of roughly 50%–60% each), followed by cars (present in 31.5% of post‐flood images). Other heavy vehicles are readily observed in post‐flood imagery and furniture such as bins, garden sheds or water tanks also appear occasionally, therefore suggesting that they can play a relevant role in extreme floods.
Reply to: Comment on: Adaptive care planning: A paradigm shift
Authors: Moody Sandra Y. , Bell Christina L. , Lindenberger Elizabeth C. , Reid M. Carrington
Published: May 2024

This letter comments on the letter by Tan et al.
Well‐to‐wheels analysis of greenhouse gas emissions for passenger vehicles in Middle East and North Africa
Authors: Ankathi Sharath , Gan Yu , Lu Zifeng , Littlefield James A. , Jing Liang , Ramadan Farah O. , Monfort Jean‐Christophe , Badahdah Alhassan , El‐Houjeiri Hassan , Wang Michael
Published: May 2024

Battery electric vehicles (BEVs) are widely considered a pathway to achieve low carbon mobility. BEVs emit zero emissions from the tailpipe, but their life cycle carbon reduction compared to gasoline vehicles varies based on primary energy sources, electricity generation, and use efficiency. The Middle East and North Africa (MENA) region is an area rich in fossil fuels, meriting a detailed comparison between the emissions from BEV and other powertrains. We developed a MENA‐specific life cycle model that estimates well‐to‐wheel (WTW) greenhouse gas (GHG) emissions from passenger transport with internal combustion engine vehicles (ICEVs), hybrid electric vehicles (HEVs), plug‐in hybrid electric vehicles, and BEVs. MENA's average WTW GHG emissions for all supply chain steps including combustion emissions from vehicle operation are 767 g/kWh and 84 g CO2eq/MJ for electricity and gasoline, respectively, but are highly variable due to heterogeneity in upstream supply chains. The use of hybrid gasoline ICEVs provides the largest emission reduction opportunity for existing vehicle fleets in 9 of the 16 MENA countries. For these nine countries, replacing gasoline ICEVs with HEVs could, on average, reduce country‐level life cycle GHG emissions by 47%. There is a similar emission reduction opportunity for 14 of the 16 MENA countries when normalizing vehicle efficiencies irrespective of the powertrain shares and other trends in existing vehicle fleets. Future scenario analysis shows that BEVs would have the lowest WTW GHG emissions among all powertrains in most MENA countries only if significantly reduced electricity transmission losses and cleaner grid mix are realized, although a high cost of infrastructure developments is expected.
Perceived stress, positive psychological capital and health literacy in patients with multiple chronic conditions: A structural equation modelling
Authors: Zou Jiaxu , Liu Ying
Published: May 2024

Aim

To investigate the structural relationships among perceived stress (PS), positive psychological capital (PsyCap) and health literacy (HL) in patients with multiple chronic conditions (MCC) and construct a model to explore the relationships of PS and PsyCap on HL.

Background

HL is critical in the rehabilitation and management of patients with MCC. Extensive understanding of the relationships between research variables can help nursing staff to implement effective programmes that improve the level of HL of patients. However, currently there is no research that has evaluated the structural relationships among these variables using a single model.

Methods

This study adhered to the STROBE guidelines for reporting cross‐sectional studies. The Health Literacy Scale for Chronic Patients, Chinese Perceived Stress Scale (CPSS) and Positive Psychological Capital Questionnaire were used to assess HL, PS and PsyCap, respectively. Questionnaires were distributed to 317 patients with MCC attending a tertiary general care hospital in China from February to May 2023, using convenience sampling approach. Structural equation modelling was used to validate the proposed model.

Results

The findings showed that PS has a negative relationship with HL and PsyCap. PS was indirectly associated with HL through PsyCap. The results indicated that PsyCap was positively associated with HL. The PS and PsyCap explained 64% of the variance in HL.

Conclusions

The findings showed that the proposed model had high validity and structural relationships between chosen variables were observed for MCC patients.

Relevance to Clinical Practice

These results may help nursing staff develop strategies to improve the HL of patients with MCC, which should focus on reducing PS and enhancing PsyCap to improve HL. Nursing staff can provide targeted psychological counselling and health guidance for patients to alleviate negative emotions and further promote their HL.

Patient or Public Contribution

Participate in research and fill out questionnaires.
Addressing the White problem critically: A latent profile analysis of racial attitudes
Authors: Parigoris Ryan , Hochman Alissa , Hayes‐Skelton Sarah , Suyemoto Karen L.
Published: May 2024

Advancing racial justice requires changes in White people's critical consciousness, including understanding the historical, material, and cultural conditions that have given rise to and maintain racism and White supremacy on individual, interpersonal, and systemic levels. To effect such changes, we need to better understand White people's current racial attitudes and their relation to anti‐racist action. Consistent with the QuantCrit framework, this study explored White Americans’ (N = 531; mean age = 34.4; 60.8% female) racial attitudes using Latent Profile Analysis with indicators selected from measures categorized within four themes: empathic connection in cross‐racial relationships, affective awareness of white privilege, blatant colorblind racial attitudes, and structural awareness. LPA resulted in four profiles based on patterns in participant responses to indicator items: Uncritical, Ambivalent, Incongruous, and Critical racial attitudes. Analyses of demographic differences between profile members indicated that participants with higher levels of critical racial consciousness were more likely to be women, trans, or non‐heterosexual, and have more friendships with People of Color. Members of profiles with higher levels of critical reflection also had significantly higher scores on racial justice action outcomes.
Colorblindness and race dismissiveness: Discursive racism and the limits of multicultural competence
Authors: Liu Wen , Buckley Tamara R. , Foldy Erica Gabrielle
Published: May 2024

This qualitative study integrates critical race theory to examine the practice of multicultural competence and the mechanism of discursive racism in the context of child welfare workers. We troubled the dominant paradigm of multicultural competence taken up by practitioners, and deployed discourse analysis on racial dialogue in a real‐life setting to highlight how the multicultural competence approach risks becoming a form of colorblind racism that diminish the importance of structure racial power which we call race dismissiveness. In our findings we identified four distinct patterns of race dismissiveness that the practitioners adopted to deflect racial dialogue: race identity fetishism, racial peripheralization, racial erasure, and racial externalization. We argue that the separation between semantic expressions of multicultural beliefs and enacted racial practices needs to be conceptualized as a part of the discursive enactment of colorblind racism that functions to keep structural racism intact through everyday practice.
The transition process for paediatric rheumatology clinic patients at a single tertiary paediatric rheumatology centre in Australia
Authors: Huynh Aimee , Buckle Joanne , Cox Angela , Czerniecki Leanne , Gowdie Peter , Renton William , Allen Roger , Tiller Georgina
Published: May 2024

Aim

This study aimed to examine the transition process of paediatric rheumatology patients from the Monash Children's Hospital (MCH) in Melbourne in order to identify areas that could be improved.

Methods

Retrospective review of clinical data from the rheumatology database of paediatric rheumatology patients eligible for transition between January 2015 and September 2020.

Results

One hundred and sixty‐five patients were included; 57 patients were transitioned. Of patients transitioned to an adult service, 38 (88%) were on medication and 14 (33%) had active disease. All patients transitioned to the general practitioner (GP) had inactive disease off medication. Juvenile idiopathic arthritis (JIA) (non‐systemic) was the most common diagnosis in patients transitioned. The mean age at which transition was first discussed was 18.0 years; the first referral was made at a mean of 18.3 years. The mean age at the first adult appointment was 18.5 years. Thirty‐nine (91%) patients had a referral completed and 8 (19%) had a transfer letter. Thirteen (93%) patients transferred to the GP had a transfer letter. Transfer documents to an adult public rheumatology service rated 4.3 for quality, compared to 5.5 to the GP. Transfer of care was confirmed in 40 (93%) patients transitioned to an adult service; however, correspondence was available for only 3 (7%).

Conclusion

Although the transition process at MCH was adequate, it could be improved through earlier discussion of the process and improved referrals and documentation. A readiness‐to‐transfer checklist and a young adult clinic have the potential to improve the process of transition to adult rheumatology care.
Paediatric obesity diagnosis and intervention practices in Australian hospitals – Australia‐wide survey
Authors: Ocariza Linnette M , Leong Gary M , Gandham Sowmya , Poulton Alison , Liu Anthony , Bhurawala Habib
Published: May 2024

Aim

Previous studies suggest a lack of a unified approach in identifying and addressing children with obesity while being inpatients in individual Australian hospitals. Our study aimed to describe current clinical practice across Australia and identify discrepancies that can aid in developing a more unified response to children identified with obesity as hospital inpatients.

Methods

A cross‐sectional exploratory online survey was distributed to major paediatric in‐patient departments in Australia, with a response rate of 68%. Questions focused on education, identification, interventions and attitudes towards a national protocol.

Results

Twenty percent of respondents indicated that staff in their department regularly record body mass index, 66% address weight issues and only 8% consistently refer to appropriate outpatient services. Although 88% of respondents believe that a national protocol for addressing paediatric obesity would be beneficial, respondents emphasised concerns regarding their local resources.

Conclusion

Our study can inform the development of a guideline for a unified response to opportunistically identify children with overweight and obesity as inpatients.
Unveiling the molecular mechanisms of pigmentation control in Queen Loach, Botia dario (Hamilton, 1822): Insights from sesame seed and marigold‐induced antityrosinase effects
Authors: Tripathy Partha Sarathi , Dash Soumya Shephalika , Devi Ningthoujam Chaoba , Mandal Sagar Chandra , Pandey Pramod Kumar , Parhi Janmejay , Behera Bijay Kumar , Khatei Ananya
Published: May 2024

Fish pigmentation study can reveal understandings in dermatological research based on functional genomics. Cultured ornamental fish becomes dull coloured and antityrosinase activity through sesame seed may enhance skin colour, which has not been studied. Botia dario is an indigenous fish, having ornamental and aesthetic value and can be studied as a model for fish pigmentation genetics. In this study, fish specimens were fed with 15% marigold petal meal along with 5, 10 and 15% w/w sesame seed in diet. Pigmentation genes, that is, tyr, tyrp1a, asip1, gnaq, kitlga, mc1r, mitf, pax7a, rab38, slc7a11, sox9a, sox10, csf1r, bcdo2 and gsta2 in skin and immunogens, that is, il20, nramp, tlr9 and trail in kidney were studied. Gene expression in tissues revealed enhanced pigmentation and immunity as well as the role of tyr, tyrp1a and asip1 in pigmentation. Immunogenes and blood parameters confirmed the best pigmentation diet. Colorimetric analysis also showed the enhancement of pigmentation. Insights from sesame seed and marigold‐induced antityrosinase effects will be applied in aquaculture to develop natural, dietary formulations that will enhance pigmentation in ornamental fish, leading to improved skin colour and market value.
Sleep health among US Navy afloat versus ashore personnel in the Millennium Cohort Study
Authors: Jacobson Isabel G. , Harbertson Judith , Sharifian Neika , Rull Rudolph P. , Steele Christopher T. , Russell Dale W.
Published: May 2024

Despite emerging public concern regarding the sleep health of military personnel over the past two decades, there remains a dearth of research examining sleep health among naval personnel assigned to sea duty. This study examined sleep metrics (e.g. fatigue, short sleep duration) and mental (e.g. posttraumatic stress disorder, depression) and physical health (e.g. type 2 diabetes, bodily pain) outcomes among naval personnel with recent sea duty (i.e. afloat) compared with naval personnel with recent shore duty (i.e. ashore). Prevalence ratios and mean differences for all outcomes were estimated and adjusted for demographic and military variables, and subsequently stratified by obesity. Sleep metrics were similar between afloat and ashore sailors except for short sleep duration, while sailors with recent shore duty had poorer physical health compared with those with recent sea duty. Stratified analyses suggested naval personnel with obesity had a higher proportion of nearly all adverse sleep‐related health outcomes than those without obesity. Among participants without obesity, afloat personnel were more likely to report very short sleep (≤ 5 hours) and fewer hours of average nightly sleep, but were less likely to report physical health outcomes compared with ashore personnel. These findings suggest potential differences in sleep metrics and sleep‐related health outcomes between afloat and ashore naval personnel. Additional research examining sleep outcomes using more objective measures is required to further investigate these findings, which may inform strategies to foster consolidated sleep despite environmental and occupational challenges in order to maintain high‐performing naval personnel.
Verbal Symbols Support Concrete but Enable Abstract Concept Formation: Evidence From Brain‐Constrained Deep Neural Networks
Authors: Dobler Fynn R. , Henningsen‐Schomers Malte R. , Pulvermüller Friedemann
Published: May 2024

Concrete symbols (e.g., sun, run) can be learned in the context of objects and actions, thereby grounding their meaning in the world. However, it is controversial whether a comparable avenue to semantic learning exists for abstract symbols (e.g., democracy). When we simulated the putative brain mechanisms of conceptual/semantic grounding using brain‐constrained deep neural networks, the learning of instances of concrete concepts outside of language contexts led to robust neural circuits generating substantial and prolonged activations. In contrast, the learning of instances of abstract concepts yielded much reduced and only short‐lived activity. Crucially, when conceptual instances were learned in the context of wordforms, circuit activations became robust and long‐lasting for both concrete and abstract meanings. These results indicate that, although the neural correlates of concrete conceptual representations can be built from grounding experiences alone, abstract concept formation at the neurobiological level is enabled by and requires the correlated presence of linguistic forms.
Igneous intrusion origin for the petrofabric of Erg Chech 002
Authors: Beros C. , Tait K. T. , Di Cecco V. E. , Moser D. E.
Published: May 2024

Achondrites provide an opportunity to examine the igneous processes of differentiated bodies in our solar system. The recent discovery of several silica‐rich achondrites suggests that andesitic crusts were more common among planetesimals than previously thought, though the processes behind their emplacement are not well understood. Here, electron backscatter diffraction (EBSD) is used to investigate the igneous emplacement conditions of Erg Chech 002 (EC 002), a recently discovered ungrouped achondrite representing andesitic magmatism ~2 Myr after the formation of calcium–aluminum‐rich inclusions (CAIs). EBSD analyses of crystallographic preferred orientations (CPOs) for augite and plagioclase feldspar phenocrysts indicate that EC 002 exhibits a weak foliation CPO. Augite misorientation inverse pole figures (mIPF) indicate preferential slip along the (100)[001] system with a distinct shift toward the {0kl}[u0w] system in plastically deformed grains. Our findings support the hypothesis that EC 002 was likely emplaced in the lower regions of a magmatic intrusion. Augite slip signatures suggest that EC 002 crystallization and emplacement were restricted to high temperatures (>800°C) and experienced at least two strain regimes. The distinct shift from a dominant (100)[001] slip system, which corresponds to high temperatures (800–1050°C), to a [0kl][u0w] slip system indicates an increased strain rate due to shock deformation (1–5 GPa) attributed to ejection by hypervelocity impact.
From policy to practice: Measuring success in widening participation
Authors: Simpson Ashley Victoria , Hope David
Published: May 2024

.@A_V_Simpson & Hope discuss the relevance of intersectionality in widening participation indicators while considering the importance of measuring policy success in a granular way.
Prevalence of co‐existent COVID‐19‐associated pulmonary aspergillosis (CAPA) and its impact on early mortality in patients with COVID‐19‐associated pulmonary mucormycosis (CAPM)
Authors: Muthu Valliappan , Agarwal Ritesh , Rudramurthy Shivaprakash Mandya , Thangaraju Deepak , Shevkani Manoj Radhakishan , Patel Atul K. , Shastri Prakash Srinivas , Tayade Ashwini , Bhandari Sudhir , Gella Vishwanath , Savio Jayanthi , Madan Surabhi , Hallur Vinaykumar , Maturu Venkata Nagarjuna , Srinivasan Arjun , Sethuraman Nandini , Sibia Raminder Pal Singh , Pujari Sanjay , Mehta Ravindra , Singhal Tanu , Saxena Puneet , Gupta Varsha , Nagvekar Vasant , Prayag Parikshit , Patel Dharmesh , Xess Immaculata , Savaj Pratik , Sehgal Inderpaul Singh , Panda Naresh , Rajagopal Gayathri Devi , Parwani Riya Sandeep , Patel Kamlesh , Deshmukh Anuradha , Vyas Aruna , Gandra Raghava Rao , Sistla Srinivas Kishore , Padaki Priyadarshini A. , Ramar Dharshni , Panigrahi Manoj Kumar , Sarkar Saurav , Rachagulla Bharani , Vallandaramam Pattabhiraman , Premachandran Krishna Prabha , Pawar Sunil , Gugale Piyush , Hosamani Pradeep , Dutt Sunil Narayan , Nair Satish , Kalpakkam Hariprasad , Badhwar Sanjiv , Kompella Kiran Kumar , Singla Nidhi , Navlakhe Milind , Prayag Amrita , Singh Gagandeep , Dhakecha Poorvesh , Chakrabarti Arunaloke
Published: May 2024

Background

Data on mixed mould infection with COVID‐19‐associated pulmonary aspergillosis (CAPA) and COVID‐19‐associated pulmonary mucormycosis (CAPM) are sparse.

Objectives

To ascertain the prevalence of co‐existent CAPA in CAPM (mixed mould infection) and whether mixed mould infection is associated with early mortality (≤7 days of diagnosis).

Methods

We retrospectively analysed the data collected from 25 centres across India on COVID‐19‐associated mucormycosis. We included only CAPM and excluded subjects with disseminated or rhino‐orbital mucormycosis. We defined co‐existent CAPA if a respiratory specimen showed septate hyphae on smear, histopathology or culture grew Aspergillus spp. We also compare the demography, predisposing factors, severity of COVID‐19, and management of CAPM patients with and without CAPA. Using a case–control design, we assess whether mixed mould infection (primary exposure) were associated with early mortality in CAPM.

Results

We included 105 patients with CAPM. The prevalence of mixed mould infection was 20% (21/105). Patients with mixed mould infection experienced early mortality (9/21 [42.9%] vs. 15/84 [17.9%]; p = 0.02) and poorer survival at 6 weeks (7/21 [33.3] vs. 46/77 [59.7%]; p = 0.03) than CAPM alone. On imaging, consolidation was more commonly encountered with mixed mould infections than CAPM. Co‐existent CAPA (odds ratio [95% confidence interval], 19.1 [2.62–139.1]) was independently associated with early mortality in CAPM after adjusting for hypoxemia during COVID‐19 and other factors.

Conclusion

Coinfection of CAPA and CAPM was not uncommon in our CAPM patients and portends a worse prognosis. Prospective studies from different countries are required to know the impact of mixed mould infection.
Innate and adaptive immune responses in subjects with CPA secondary to post‐pulmonary tuberculosis lung abnormalities
Authors: Chirumamilla Naresh Kumar , Arora Kanika , Kaur Mandeep , Agarwal Ritesh , Muthu Valliappan , Rawat Amit , Dhooria Sahajal , Prasad Kuruswamy Thurai , Aggarwal Ashutosh Nath , Rudramurthy Shivaprakash M. , Chakrabarti Arunaloke , Choudhary Hansraj , Pal Arnab , Sehgal Inderpaul Singh
Published: May 2024

Background

Post‐tuberculosis lung abnormality (PTLA) is the most common risk factor for chronic pulmonary aspergillosis (CPA), and 14%–25% of the subjects with PTLA develop CPA. The pathogenesis and the host immune response in subjects with PTLA who develop CPA need to be better understood.

Methods

We prospectively compared the innate and adaptive immune responses mounted by patients of PTLA with or without CPA (controls). We studied the neutrophil oxidative burst (by dihydrorhodamine 123 test), classic (serum C3 and C4 levels) and alternative (mannose‐binding lectin [MBL] protein levels) complement pathway, serum immunoglobulins (IgG, IgM and IgA), B and T lymphocytes and their subsets in subjects with PTLA with or without CPA.

Results

We included 111 subjects (58 CPA and 53 controls) in the current study. The mean ± SD age of the study population was 42.6 ± 15.7 years. The cases and controls were matched for age, gender distribution and body weight. Subjects with CPA had impaired neutrophil oxidative burst, lower memory T lymphocytes and impaired Th‐1 immune response (lower Th‐1 lymphocytes) than controls. We found no significant difference between the two groups in the serum complement levels, MBL levels, B‐cell subsets and other T lymphocyte subsets.

Conclusion

Subjects with CPA secondary to PTLA have impaired neutrophil oxidative burst and a lower Th‐1 response than controls.
Predictive value of fluid balance before extubation on its outcome in mechanically ventilated adults in the intensive care unit
Authors: Wang Zhenzhen , Li Wenrui , Shui Chunmei , Xie Qiuyu , Han Xinyi , Zhang Caiyun , Tu Lili , Zhang Zhigang
Published: May 2024

Background

Although there are many reasons for extubation failure, maintaining negative or lower positive fluid balances 24 hours before extubation may be a key measure for successful extubation.

Aim

To assess the predictive value of fluid balance before extubation and its outcome in mechanically ventilated cases in the intensive care unit (ICU).

Study Design

This retrospective cohort study involved collecting clinical data from patients undergoing mechanical ventilation in Lanzhou general adult ICU from January 2022 to December 2022. Based on extubation outcomes, the patients were divided into a successful extubation group and a failed extubation group. Their fluid balance levels 24 h before extubation were compared with analyse the predictive value of fluid balance on extubation outcomes in patients undergoing mechanical ventilation.

Results

In this study, clinical data from 545 patients admitted to a general adult ICU were collected. According to the inclusion and exclusion criteria, 265 (48.6%) patients were included, of which 197 (74.3%) were successfully extubated; extubation was unsuccessful in 68 (25.7%) patients. The total intake and fluid balance levels in patients in the failed extubation group 24 h before extubation were significantly higher than those in the successful extubation group, with a median of 2679.00 (2410.44–3193.50) mL versus 2435.40 (1805.04–2957.00) mL, 831.50 (26.25–1407.94) mL versus 346.00 (−163.00–941.50) mL. Receiver operating characteristic (ROC) curve analysis showed that the optimal cut‐off value for predicting extubation outcomes was 497.5 mL (sensitivity 64.7%, specificity 59.4%) for fluid balance 24 h before extubation. The area under the ROC curve was 0.627 (95% confidence interval [CI] 0.547–0.707). Based on the logistic regression model, cumulative fluid balance >497.5 mL 24 h before extubation could predict its outcomes in mechanically ventilated patients in the ICU (OR = 5.591, 95% CI [2.402–13.015], p < .05).

Conclusions

The fluid balance level 24 h before extubation was correlated with the outcome of extubation in mechanically ventilated patients in the ICU. The risk of extubation failure was higher when the fluid balance level was >497.5 mL.

Relevance to Clinical Practice

Tracheal intubation is a crucial life support technique for many critically ill patients, and determining the appropriate time for extubation remains a challenge for clinicians. Although there are many reasons for extubation failure, acute pulmonary oedema caused by continuous positive fluid balance and volume overload is one of the main reasons for extubation failure. Therefore, it is very important to study the relationship between fluid balance and extubation outcome to improve the prognosis of patients with invasive mechanical ventilation in ICU.
Discriminating “impaired” from “disordered” contractile response on FLIP panometry by utilizing pressure measurement
Authors: Chambo Leya , Pandolfino John E. , Halder Sourav , Kahrilas Peter J. , Konda Vani , Carlson Dustin A.
Published: May 2024

Background

Functional lumen imaging probe (FLIP) panometry evaluates esophageal motility, including the contractile response to distension, that is, secondary peristalsis. Impaired/disordered contractile response (IDCR) is an abnormal, but nonspecific contractile response that can represent either hypomotility or spastic motor disorders on high‐resolution manometry (HRM). We hypothesized that FLIP pressure could be incorporated to clarify IDCR and aimed to determine its utility in a cohort of symptomatic esophageal motility patients.

Methods

173 adult patients that had IDCR on FLIP panometry and HRM with a conclusive Chicago Classification v4.0 (CCv4.0) diagnosis were included and analyzed as development (n = 118) and validation (n = 55) cohorts. FLIP pressure values were assessed for prediction of either hypomotility or spasm, defined on HRM/CCv4.0.

Key Results

HRM/CCv4.0 diagnoses were normal motility in 48 patients (28%), “hypomotility” (ineffective esophageal motility, absent contractility, or Type I or II achalasia) in 89 (51%), and “spasm” (Type III achalasia, distal esophageal spasm, or hypercontractile esophagus) in 36 (21%). The pressure at esophagogastric junction‐distensibility index (DI) (60 mL) was lower in hypomotility (median [interquartile range] 34 [28–42] mmHg) than in spasm (49 [40–62] mmHg; p < 0.001) and had an area under the receiver operating characteristic curve of 0.80 (95% CI 0.73–0.88) for hypomotility and 0.76 (0.69–0.83) for spasm. For “spasm” on HRM, a threshold FLIP pressure of >35 mmHg provided 90% sensitivity (47% specificity) while >55 mmHg provided 93% specificity (40% sensitivity).

Conclusion & Inferences

Pressure on FLIP panometry can help clarify the significance of IDCR, with low‐pressure IDCR associated with hypomotility and high‐pressure IDCR suggestive of spastic motor disorders.
MASLD can cause halitosis by small intestinal bacterial overgrowth
Authors: Qian Xiao Xian
Published: May 2024

Objectives

Patients with metabolic dysfunction‐associated steatotic liver disease (MASLD) exhibit varying degrees of halitosis. The author speculated that small intestinal bacterial overgrowth (SIBO) might lead to MASLD and subsequent extra‐oral halitosis and aimed to test this hypothesis.

Methods

This retrospective cross‐sectional study reviewed 885 extra‐oral halitosis patients. Halitosis and exhaled dimethyl sulfide (DMS) were measured by organoleptic score (OLS) (0–5) and OralChroma, respectively. SIBO and MASLD were diagnosed by hydrogen breath test and Fibroscan combined with cardiometabolic criteria.

Results

In this study, 133/885 (15.05%) of the halitosis patients otherwise healthy had MASLD, while 87/133 (65.41%) of the MASLD patients were SIBO‐positive. No significant differences were observed in physical parameters such as age, serum biochemical parameters such as lipids, or Fibroscan parameters between the SIBO‐positive and SIBO‐negative patients. However, the OLS was 4 (interquartile range: 3–4) and exhaled DMS level was 56 (43–75) parts per billion (ppb) in the SIBO‐positive patients, significantly greater than 2 (2–3) and 43 (25–51) ppb in the SIBO‐negative patients (both p < 0.001). Exhaled hydrogen levels positively correlated with the OLS and exhaled DMS levels (r = 0.774, r = 0.740, both p < 0.001).

Conclusion

MASLD can cause halitosis by SIBO.
Isolation and phenotypic characterization of cancer stem cells from metastatic oral cancer cells
Authors: Aquino Iara Gonçalves , Cuadra‐Zelaya Florence Juana Maria , Bizeli Ana Laura Valença , Palma Patricia Vianna Bonini , Mariano Fernanda Viviane , Salo Tuula , Coletta Ricardo Della , Bastos Débora Campanella , Graner Edgard
Published: May 2024

Objectives

To isolate cancer stem cells (CSC) from a metastatic oral squamous cell carcinoma (OSCC) cell line and investigate their in vitro and in vivo phenotypic characteristics.

Materials and Methods

Subpopulations with individual staining intensities for CD44 and CD326 were isolated from the OSCC cell line LN‐1A by FACS: CD44Low/CD326− (CSC‐M1), CD44Low/CD326High (CSC‐E), and CD44High/CD326− (CSC‐M2). Proliferation, clonogenic potential, adhesion, migration, epithelial‐mesenchymal transition markers, and sensitivity to cisplatin and TVB‐3166 were analyzed in vitro. Tumor formation and metastasis were assessed by subcutaneous and orthotopic inoculations into BALB/c mice.

Results

E‐cadherin levels were higher in CSC‐E cells while vimentin and Slug more produced by CSC‐M2 cells. CSC‐M1 and CSC‐M2 subpopulations showed higher proliferation, produced more colonies, and have stronger adhesion to the extracellular matrix. All cell lines established tumors; however, CSC‐E and CSC‐M2 formed larger masses and produced more metastases.

Conclusion

The CSC subpopulations here described show increased cancer capabilities in vitro, tumorigenic and metastatic potential in vivo, and may be exploited in the search for novel therapeutic targets for OSCC.
Calcineurin inhibitor‐related hyperkalemia is caused by hyporeninemic hypoaldosteronism and fludrocortisone is an effective treatment: Report of a case series and review of the literature
Authors: Unsal Yagmur , Baltu Demet , Gulhan Bora , Okur Fatma Visal , Ozaltın Fatih , Düzova Ali , Topaloğlu Rezan , Ozon Zeynep Alev , Gonç Elmas Nazlı
Published: May 2024

Introduction

Calcineurin inhibitors (CNIs) are widely used in transplantation. Although CNI‐related hyperkalemia is common (10%–60.6%), the underlying pathogenetic mechanism is not well‐elucidated and may lead to dose adjustment or treatment withdrawal.

Objective

The aim of this study is to describe CNI‐related hyperkalemia due to hyporeninemic hypoaldosteronism in pediatric transplant recipients who were successfully treated with fludrocortisone.

Method

In a total of 55 hematopoietic stem cell (HSCT) and 35 kidney transplant recipients followed according to institutional immunosuppression protocols, recipients diagnosed with CNI‐related hyperkalemia were reviewed. Recipients who were receiving intravenous fluid, potassium, or were diagnosed with hemolysis, acute graft rejection, or had an eGFR < 30 mL/min/1.73m2, were excluded. A detailed analysis of clinical history as well as biochemical studies was carried out to reveal possible pathophysiology.

Results

Three pediatric transplant recipients (one HSCT, two kidney transplantation) with findings of hyperkalemia, hyponatremia, and a mild elevation in blood urea nitrogen while on CNIs were recruited. Urinary potassium excretion was diminished while sodium excretion was increased. Plasma aldosterone levels were low, and renin was not increased in response. Primary adrenal insufficiency was ruled out, and hyporeninemic hypoaldosteronism was diagnosed. CNI‐related hyperkalemia was detected earlier in case 1, who had HSCT (22 days), than in the second and third cases, who had kidney transplantation (24 and 30 months post‐transplantation, respectively). The discrepancy was hypothesized to be explained by higher overall CNI dose due to higher serum target CNI used in HSCT than kidney transplantation.

Electrolyte imbalance was reversed upon administration of physiologic dose fludrocortisone (0.05 mg, daily), while fludrocortisone was ceased after CNI withdrawal in case 1, which is additional evidence for the etiological association of CNIs and hyporeninemic hypoaldosteronism.

Conclusion

Our three cases strengthen the premise that CNI‐related hyperkalemia may be due to hyporeninemic hypoaldosteronism, and the timing and severity may be related to CNI dose. Fludrocortisone is a safe and effective treatment in CNI‐related hyperkalemia, providing maintenance of CNIs, which are one of the essential therapeutic agents for pediatric transplantation.
Outcomes from hematopoietic stem cell transplantation following treosulfan‐based conditioning: A clinical and pharmacokinetic analysis
Authors: Rosser Sebastian P. A. , Brewer Alice , Gabriel Melissa , Wong Melanie , Chung Jason , McLachlan Andrew J. , Nath Christa E. , Keogh Steven J. , Shaw Peter J.
Published: May 2024

Background

The aims of this study are to report our experience with treosulfan‐based conditioning regimens for patients with non‐malignant hematologic conditions, correlating clinical outcomes at different time points post‐transplant with treosulfan exposure (AUC).

Methods

This study was a single‐center observational study investigating overall survival (OS), disease‐free survival (DFS), and event‐free survival (EFS) end‐points post‐transplant. The consequences of treosulfan AUC with respect to toxicity, correction of underlying disease, and long‐term chimerism were also explored using pharmacokinetic analysis.

Results

Forty‐six patients received 49 transplants with treosulfan and fludarabine‐based conditioning between 2005 and 2023. Twenty‐four patients also received thiotepa. Donor chimerism was assessed on either whole blood or sorted cell lines at different time points post‐transplant. Thirty‐nine patients received treosulfan pharmacokinetic assessment to evaluate cumulative AUC, with five infants receiving real‐time assessment to facilitate daily dose adjustment. OS, DFS, and EFS were 87%, 81%, and 69%, respectively. Median follow‐up was 32.1 months (range 0.82–160 months) following transplant. Lower EFS was associated with patient age (<1 year; p = .057) and lower cumulative treosulfan dose (<42 g/m2; p = .003). Stable donor chimerism in B‐cell, NK‐cell, and granulocyte lineages at 1‐year post‐transplant were more prevalent in patients receiving thiotepa conditioning. Two infants required daily dose adjustment to treosulfan to avoid high AUC.

Conclusions

Excellent clinical outcomes and stable chimerism were observed in this patient series. The addition of thiotepa conferred no significant toxicity and trended toward sustained ongoing donor engraftment. Correlating treosulfan AUC with long‐term patient outcomes is required.
The response readiness tool: An instrument to measure knowledge, skills, and attitude after taking a stop the Bleed® course
Authors: Johnston Katheryn Courville , Deal Belinda , Estrada Samantha , Elizabeth Caulkins , Barnes Glenn , Swanberg Amanda
Published: May 2024

Stop the Bleed® is an emergency response course that offers a certificate of completion but no ending assessment. The purpose of this educational study was to develop and test the Response Readiness Tool (RRT) that measures learning of participants after taking Stop the Bleed®. The study used a pre‐/post‐test design to measure knowledge and attitudes, and a post‐test only for skills. Participants were recruited from existing Stop the Bleed® courses. Knowledge was measured with a 10‐item questionnaire, attitude was measured with five Likert‐style questions, and skills were measured by observing simulated tourniquet placement. Ninety‐five participants were recruited over two semesters. There was a significant difference in the knowledge and attitude scores indicating participants’ improvement in learning and attitude toward responding. Internal consistency reliability of scores showed moderate reliability with Cronbach's Alpha of 0.73 and McDonald's Omega of 0.75. A positive correlation was found between expected proficiency and pre‐test indicating the tool had construct validity. RRT provides Stop the Bleed® instructors with an instrument to measure knowledge, skills, and attitude of participants after taking Stop the Bleed®. Statistics show moderate reliability and validity; however, larger samples are needed for full psychometric testing. This publication presents the revised tool after the completion of this study.
Interleukin 17F Gene Polymorphism as a Potential Protective Factor in the Immunopathology of Ocular Toxoplasmosis
Authors: da Silva Danilo Donizete , Frederico Fábio Batista , Previato Mariana , Siqueira Rubens Camargo , Bonini‐Domingos Claudia Regina , de Souza Victor Hugo , Castiglioni Lilian , Brandão Cinara Cássia , de Mattos Luiz Carlos , Ayo Christiane Maria
Published: May 2024

Ocular toxoplasmosis (OT) is characterised by intraocular inflammation due to Toxoplasma gondii infection. Studies have found that interleukin 17 (IL‐17) plays a central role in the pathology of OT. However, nucleotide variability in IL17 and interleukin 17 receptor (IL17R) genes has not been characterised in OT. As cytokine gene polymorphisms may influence the expression of these molecules, the aim of this study was to verify whether IL17A (rs2275913), IL17F (rs763780), IL17RA (rs4819554) and IL17RC (rs708567) polymorphisms are associated with OT in a Brazilian population. This study enrolled 214 patients seropositive for T. gondii (110 with OT and 104 without) and 107 controls. Polymorphisms were identified by PCR‐restriction fragment length polymorphism analysis, validated by DNA sequencing with chi‐square and multivariate analyses being used to assess possible associations between polymorphisms and OT. Logistic regression under the dominant model revealed a protection factor against OT of the C mutant allele of the IL17F (rs763780) polymorphism. The T/C‐C/C genotypes were significantly more common in patients without OT compared to those with OT (p value = 0.0066) and controls (p value = 0.014). Findings from this study suggest that the IL17F polymorphism may have an influence in the immunopathology of OT in Brazilian individuals.
Metabolic changes in tomato plants caused by psychrotolerant Antarctic endophytic bacteria might be implicated in cold stress mitigation
Authors: Licciardello Giorgio , Doppler Maria , Sicher Carmela , Bueschl Christoph , Ruso David , Schuhmacher Rainer , Perazzolli Michele
Published: May 2024

Climate change is responsible for mild winters and warm springs that can induce premature plant development, increasing the risk of exposure to cold stress with a severe reduction in plant growth. Tomato plants are sensitive to cold stress and beneficial microorganisms can increase their tolerance. However, scarce information is available on mechanisms stimulated by bacterial endophytes in tomato plants against cold stress. This study aimed to clarify metabolic changes stimulated by psychrotolerant endophytic bacteria in tomato plants exposed to cold stress and annotate compounds possibly associated with cold stress mitigation. Tomato seeds were inoculated with two bacterial endophytes isolated from Antarctic Colobanthus quitensis plants (Ewingella sp. S1.OA.A_B6 and Pseudomonas sp. S2.OTC.A_B10) or with Paraburkholderia phytofirmans PsJN, while mock‐inoculated seeds were used as control. The metabolic composition of tomato plants was analyzed immediately after cold stress exposure (4°C for seven days) or after two and four days of recovery at 25°C. Under cold stress, the content of malondialdehyde, phenylalanine, ferulic acid, and p‐coumaric acid was lower in bacterium‐inoculated compared to mock‐inoculated plants, indicating a reduction of lipid peroxidation and the stimulation of phenolic compound metabolism. The content of two phenolic compounds, five putative phenylalanine‐derived dipeptides, and three further phenylalanine‐derived compounds was higher in bacterium‐inoculated compared to mock‐inoculated samples under cold stress. Thus, psychrotolerant endophytic bacteria can reprogram polyphenol metabolism and stimulate the accumulation of secondary metabolites, like 4‐hydroxybenzoic and salicylic acid, which are presumably involved in cold stress mitigation, and phenylalanine‐derived dipeptides possibly involved in plant stress responses.
Presidential attentiveness to international crises
Authors: Snyder Neil
Published: May 2024

Why, and under what conditions, do international crises make the president's national security agenda? I argue that international crises are opportunities for presidents to seek domestic political gains, but that presidents are likely to weigh anticipated political benefits against anticipated risk of political opposition. I analyze presidential National Security Council (NSC) meeting agendas from 1947 to 1993 to find that the War Powers Resolution (WPR) of 1973 reduced the likelihood of presidential crisis attentiveness, that low approval ratings are associated with increased crisis attentiveness, and that post‐WPR presidents under unified government are likely to be more crisis attentive. This article provides fresh analysis of the WPR by connecting presidential national security behavior with American domestic politics.
Metabolic Modernities: Digestion, Energy Transformations, and the Making and Unmaking of the World in Early Soviet Literature
Authors: Fratto Elena
Published: May 2024

Early Soviet society featured clear nutrition guidelines and a robust plan for streamlined logistics in food processing, distribution, and consumption, all of which was aimed at building a stronger state through a virtuous transformation of calories into labor power. Such rhetoric appeared even in children’s illustrated books, such as Vladimir Maiakovskii and Nikolai Kupreianov’s Story of Petia, Fat Boy, and of Sima, Who is Skinny (1926). This paper shows how in the 1920s authors such as Viktor Shklovskii and Iurii Olesha turned that rhetoric on its head and pushed back against the early Soviet obsession with planning and mastering nature and the human body by employing metaphors of food, digestion, and agriculture. In Shklovskii’s memoirs A Sentimental Journey (1923) and Knight’s Move (1923) and Olesha’s novel Envy (1927), the October Revolution itself emerges as a metabolic process on a vast scale: prerevolutionary aesthetic threads, motifs, and concepts are broken down and processed, reassembled, and repurposed into a seemingly new society and worldview, in which the individual original components are still recognizable.