bluuebunny/crossref_metadata_2025 huggingface dataset:
The Unity of Perceptual Content
Authors: Reiland Indrek
Published: November 2023

Representationalists hold that perceptual experience is a conscious representational state with content, something which is accurate or inaccurate in certain conditions. The most common version of Representationalism takes perceptual content to be singular in the object-place and otherwise consisting of attribution of properties (Singularism/Attributionism). Schellenberg has recently developed a version on which perceptual content is singular even in the property-place in containing a de re mode of presentation of a property-instance (Particularism). In this paper, I show that Particularism faces a version of the problem of the Unity of Perceptual Content. Namely, its supporters haven’t told us how objects can be bound together with property-instances into a content such that it represents them and has accuracy-conditions. Furthermore, I argue that Particularists face an in-principle obstacle in solving it. In contrast, Attributionists can solve the problem and that establishes their view as the only game in town.
The Talented Tenth Meets the Twenty-First Century: Young, Gifted and Diverse in the Post-Affirmative Action Era
Authors: Davis Patricia G
Published: November 2023

In the wake of the Supreme Court's dismantling of affirmative action policies in higher education in its SFFA v. Harvard ruling, this review essay offers a detailed explication of the relevant themes Camille Z. Charles, Rory Kramer, Douglas Massey, and Kimberly C. Torres analyze in “Young, Gifted, and Diverse: Origins of the New Black Elite.” Taking DuBois's conceptualization of the “Talented Tenth” as their starting point, the authors present a combination of quantitative and qualitative research to examine the experiences and aspirations of Black students who matriculated to elite colleges over a decades-long period. This analysis expands Charles et al.'s intersecting themes of social mobility, colorism, and model minority discourses, situating them within a broader discursive field that includes the relevant historical and contemporary sociopolitical contexts as reflected in the Court's majority and dissenting opinions.
Heterogeneity of Tasks and Outcome Measures in Dual Tasking Studies in Children With Cerebral Palsy: A Scoping Review
Authors: Rubsam Meaghan , Girolami Gay L , Bhatt Tanvi
Published: November 2023

Objective

The aims of this scoping review are to examine the available literature regarding dual tasking in children with cerebral palsy (CP) and to identify and categorize both the motor and cognitive tasks and outcome measures used primarily through the International Classification of Functioning, Disability, and Health model.

Methods

Five electronic databases were searched. Studies were included if they: (1) were published in English; (2) included at least 1 group of children or adolescents with a diagnosis of CP; (3) assessed dual tasking as part of the study; (4) reported the method for performing the dual task; and (5) reported the outcome measures utilized.

Results

Twenty-three studies with 439 children with CP were included. All studies utilized motor activities as the primary task, including walking, balance, and a functional transition. Motor secondary tasks occurred in 10 studies, cognitive secondary tasks in 12 studies, and 1 study used both. Forty-one outcome measures over 23 studies assessed the body structure and function domain, 7 measures over 6 studies assessed activity limitations, and 2 outcomes over 2 studies assessed participation.

Conclusion

The 23 included studies demonstrated heterogeneity in the age and function of participants, secondary tasks, and outcome measures. Future studies on dual tasking in children with CP should consider the difficulty of the primary motor or cognitive task and compare secondary tasks to establish this contribution to motor performance. Studies should incorporate activity and participation measures to assess meaningful functional outcomes.

Impact

Children with CP experience challenges when exposed to dual task situations. This scoping review highlights the importance of considering multiple factors when designing dual tasking studies involving children with CP to facilitate results translation, improved participation, and enhanced function. Similarly, studies should utilize activity and participation outcomes to assess quality of life.
Effect of ursodeoxycholic acid on preventing SARS-CoV-2 infection in patients with liver transplantation: a multicenter retrospective cohort study
Authors: Hu L , Zhang H , Huang C , Shen T , Feng Z , Mu F , Xu L , Lin Y , Yue C , Guo K , Tian M , Shi J , Zhang C , Wen P , Cao S , Wang Y , Zhang J , Shi X , Wang Z , He Y , Zhang X , Liu X , Lv Y , Liu Z , Guo W , Wang B
Published: November 2023

Background

Immunosuppressed recipients of liver transplantation (LT) are more likely to develop coronavirus disease 2019 (COVID-19) and may have an increased risk of developing worse outcomes.

Aim

To assess the effect of ursodeoxycholic acid (UDCA) on preventing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in LT recipients.

Design

Adult patients (aged ≥ 18 years) who underwent LT between 1 January 2015 and 31 December 2022 were included and categorized into two groups according to their use of UDCA.

Methods

The prevalence and severity of COVID-19 among transplantation patients between the UDCA and non-UDCA groups were estimated and compared.

Results

Among the 897 LT patients who met the inclusion criteria, infection rate of SARS-CoV-2 was 78.4%, and the rate of severe illness was 5.1% from January 2022 to January 2023 in China. In the multivariate analysis, only UDCA treatment (P = 0.006) was found to be a protective factor against SARS-CoV-2 infection. After propensity score matching, the SARS-CoV-2 infection rate in the UDCA group was lower than that in the non-UDCA group (74.1% vs. 84.6%, P = 0.002). This rate was further reduced to 62.1% (P = 0.002) when the oral administration dose was >15 mg/kg/day. There was no difference in the rates of severe COVID-19 illness, ICU admission, or ventilation rate or length of hospital stay with or without UDCA treatment (all P > 0.05).

Conclusions

The use of UDCA in LT patients significantly reduced the SARS-CoV-2 infection rate and showed a dose-dependent protective effect.
“Safe Legal Pathways” or New Colonial Frontiers? A Critical Analysis of European Intervention in the Sahel and the Creation of Anomalous Legal Zones
Authors: Zagor Matthew
Published: November 2023

This article critiques the increasingly popular concept of the “safe legal pathway” in refugee politics, policy and law, using European engagement and intervention in the Sahel as its primary case study. It draws upon neo-colonial studies, necropolitics, border studies and the legal literature on sovereignty and extraterritoriality to explore the function, structure, and import of the “safe legal pathway”, and its compatibility with contemporary understandings of international legal history and argumentation. Divided into four sections, the article focuses on the drivers behind Europe’s migration-development-security objectives in the Sahelout of which the pathways discourse emerges, the EU’s concomitant insistence on criminalising the illusive “people smuggling business model”, and the role which the traditional tropes of sovereignty, territory, and civilisation play in determining policy parameters. Noting the multidirectional nature and multifunctional purposes of pathways, and focusing on the policing of migrant communities both within and outside Europe, this article provides a comprehensive and critical overview of the nature, structure, function, and regulation of the pathway, its susceptibility to being leveraged for the commodification, extraction, discipline and transformation of non-European bodies and narratives, and its place in the creation of differentiated, suspended, and anomalous legal zones for the transfer and manipulation of global norms.
Assaying Effector Cell-to-Cell Mobility in Plant Tissues Identifies Hypermobility and Indirect Manipulation of Plasmodesmata
Authors: Ohtsu Mina , Jennings Joanna , Johnston Matthew , Breakspear Andrew , Liu Xiaokun , Stark Kara , Morris Richard J. , de Keijzer Jeroen , Faulkner Christine
Published: November 2023

In plants, plasmodesmata establish cytoplasmic continuity between cells to allow for communication and resource exchange across the cell wall. While plant pathogens use plasmodesmata as a pathway for both molecular and physical invasion, the benefits of molecular invasion (cell-to-cell movement of pathogen effectors) are poorly understood. To establish a methodology for identification and characterization of the cell-to-cell mobility of effectors, we performed a quantitative live imaging-based screen of candidate effectors of the fungal pathogen Colletotrichum higginsianum. We predicted C. higginsianum effectors by their expression profiles, the presence of a secretion signal, and their predicted and in planta localization when fused to green fluorescent protein. We assayed for cell-to-cell mobility of nucleocytosolic effectors and identified 14 that are cell-to-cell mobile. We identified that three of these effectors are “hypermobile,” showing cell-to-cell mobility greater than expected for a protein of that size. To explore the mechanism of hypermobility, we chose two hypermobile effectors and measured their impact on plasmodesmata function and found that even though they show no direct association with plasmodesmata, each increases the transport capacity of plasmodesmata. Thus, our methods for quantitative analysis of cell-to-cell mobility of candidate microbe-derived effectors, or any suite of host proteins, can identify cell-to-cell hypermobility and offer greater understanding of how proteins affect plasmodesmal function and intercellular connectivity.

[Formula: see text] Copyright © 2024 The Author(s). This is an open access article distributed under the CC BY 4.0 International license .
Potential for Cultural Management of Lettuce Drop (Sclerotinia sclerotiorum) in High Tunnels Through Modification of Soil Moisture, Planting Date, and Cultivar
Authors: Rudolph Rachel E. , Dixon Edward , Munir Misbakhul , Leonberger Kimberly , Pettigrew Kathryn , Polo Martín , Smith Henry S. , Bajek Victoria , Irwin Lauren , Gauthier Nicole A.
Published: November 2023

Lettuce is a high-value crop commonly grown in high tunnels. However, lettuce drop, caused by Sclerotinia sclerotiorum, can greatly impact lettuce production and profitability. Crop loss from S. sclerotiorum can be especially severe in high tunnels because of intensive cropping and limited options for non-host rotations. A study was conducted in a Kentucky high tunnel infested with S. sclerotiorum to determine if soil moisture, planting date, and host resistance can successfully manage lettuce drop. The experiment was arranged in a split-split plot design with soil moisture (high: 60 to 100%, low: 40 to 80% plant available water), planting date (early, mid, and late spring), and lettuce cultivar (Galactic, Harmony, Pirat, and Vulcan) being the main plot, subplot, and sub-subplot factors, respectively. In year one, lettuce drop incidence was significantly lower in the low soil moisture and early planting date, and significantly higher in Pirat lettuce. Marketable lettuce weight was significantly higher in the late planting and Vulcan treatments. In year two, lettuce drop incidence was significantly lower in the late planting and Galactic compared with all other treatments. There was no significant difference in lettuce drop incidence between the high and low soil moisture in year two. Harmony and Vulcan had significantly higher marketable weight compared with all cultivars. Planting date and lettuce cultivar had the strongest effect on lettuce drop incidence. Although mid-spring is considered the ideal time to plant lettuce in Kentucky, growers managing lettuce drop should consider planting earlier or later and selecting resistant cultivars appropriate for their markets.
Recognizing postural orthostatic tachycardia syndrome in primary care
Authors: Hulsey Brittney
Published: November 2023

Postural orthostatic tachycardia syndrome (POTS) is a complex autonomic disorder characterized by abnormal tachycardia on standing. This disorder predominantly affects young women, with a peak incidence between ages 20 and 30 years. POTS often is associated with a variety of symptoms, including dizziness, palpitations, fatigue, generalized weakness, anxiety, and exercise intolerance, which can significantly impair patient quality of life. Primary care providers (PCPs) often are the first healthcare professionals to whom patients present. This article provides an overview of POTS, including diagnostic criteria and the importance of a thorough clinical evaluation to rule out other causes of symptoms. PCPs play a critical role in the comprehensive approach to care, involving patient education, lifestyle modifications, and treatment to improve outcomes and enhance patient quality of life.
Risk Factors, Trends, and Outcomes Associated With Postpartum Sepsis Readmissions
Authors: Liu Lilly Y. , Wen Timothy , Reddy Uma M. , Mourad Mirella , Goffman Dena , Nathan Lisa , Sheen Jean-Ju , D'Alton Mary E. , Friedman Alexander M.
Published: November 2023

OBJECTIVE:

To evaluate the prevalence, timing, clinical risk factors, and adverse outcomes associated with postpartum readmissions for maternal sepsis.

METHODS:

We conducted a retrospective cohort study of delivery hospitalizations and 60-day postpartum readmissions for females aged 15–54 years with and without sepsis using the 2016–2020 Nationwide Readmissions Database. Temporal trends in sepsis diagnoses during delivery hospitalizations and 60-day postpartum readmissions were analyzed with the National Cancer Institute's Joinpoint Regression Program to estimate the average annual percent change with 95% CIs. Logistic regression models were fit to determine whether delivery hospitalization characteristics were associated with postpartum sepsis readmissions, and unadjusted and adjusted odds ratios with 95% CIs were reported. Adverse outcomes associated with sepsis during delivery hospitalization and readmission were described, including death, severe morbidity, a critical care composite, and renal failure.

RESULTS:

Overall, 15,268,190 delivery hospitalizations and 256,216 associated 60-day readmissions were included after population weighting, of which 16,399 (1.1/1,000 delivery hospitalizations) had an associated diagnosis of sepsis at delivery, and 20,130 (1.3/1,000 delivery hospitalizations) had an associated diagnosis of sepsis with postpartum readmission. A sepsis diagnosis was present in 7.9% of all postpartum readmissions. Characteristics associated with postpartum sepsis readmission included younger age at delivery, Medicaid insurance, lowest median ZIP code income quartile, and chronic medical conditions such as obesity, pregestational diabetes, and chronic hypertension. Postpartum sepsis readmissions were associated with infection during the delivery hospitalization, including intra-amniotic infection or endometritis, wound infection, and delivery sepsis. Sepsis diagnoses were associated with 24.4% of maternal deaths at delivery and 38.4% postpartum, 2.2% cases of nontransfusion severe morbidity excluding sepsis at delivery and 13.6% postpartum, 15.6% of critical care composite diagnoses at delivery and 30.1% postpartum, and 11.1% of acute renal failure diagnoses at delivery and 36.4% postpartum.

CONCLUSION:

Sepsis accounts for a significant proportion of postpartum readmissions and is a major contributor to adverse outcomes during delivery hospitalizations and postpartum readmissions.
Incidence of Abnormal Findings During Pelvic Examinations in Women Aged 21–35 Years
Authors: Norby Nicole , Sabu Priya , Locklear Tonja , Shygin Anna , Lara-Torre Eduardo , Johnson Isaiah M.
Published: November 2023

To describe the incidence of abnormal gynecologic examination findings in asymptomatic compared with symptomatic patients during preventive visits, we conducted a retrospective study of 1,121 visits for patients between the ages of 21 and 35 years from January 2017 to March 2017. Only 1.2% (95% CI, 0.5%,1.9%) of asymptomatic patients had abnormal findings on pelvic examination, compared with 32.4% (95% CI, 27.0%, 37.8%) of those with symptoms (P≤.001). In symptomatic patients, the most common symptoms were vaginal discharge (25.1%), pelvic pain (16.4%), and vaginal bleeding (15.7%). In asymptomatic patients, the most common findings were bacterial vaginosis and Candida infection. Asymptomatic patients presenting for a routine preventive visit have low rates of abnormalities detected on examination, and routine pelvic examinations should be re-considered.
The Genie Is Out of the Bottle
Authors: Morales-Ramirez Pedro , Mishek Henry , Dasgupta Arhita
Published: November 2023

ChatGPT is a cutting-edge artificial intelligence technology that was released for public use in November 2022. Its rapid adoption has raised questions about capabilities, limitations, and risks. This article presents an overview of ChatGPT, and it highlights the current state of this technology for the medical field. The article seeks to provide a balanced perspective on what the model can and cannot do in three specific domains: clinical practice, research, and medical education. It also provides suggestions on how to optimize the use of this tool.
Risk Factors for Reintubation After Anterior Cervical Spine Surgery
Authors: Tanaka Atsushi , Onishi Eijiro , Hashimura Takumi , Ota Satoshi , Takeuchi Hisataka , Tsukamoto Yoshihiro , Yamashita Shinnosuke , Mitsuzawa Sadaki , Yasuda Tadashi
Published: November 2023

Study Design:

Single-center retrospective study.

Objectives:

The aim was to compare the postoperative outcomes of anterior cervical spine surgery (ACSS) in patients with and without cervical spine trauma.

Summary of Background:

Few papers have addressed airway obstruction after anterior ACSS for patients with cervical spine trauma. This study aimed to compare airway obstruction after ACSS between patients with cervical degenerative disorders and cervical spine injuries and identify the risk factors for unplanned postoperative reintubation.

Materials and Methods:

Seventy-seven patients who underwent ACSS were enrolled in this retrospective study. There were 52 men and 25 women, with a mean age of 60.3±15.5 years old. The causes of surgery were as follows: 24 cervical spine fractures or dislocations, 12 spinal cord injuries without bony fracture, 19 disc herniations, and 22 myelopathies. The patients’ characteristics, operative data, and risk factors for unplanned reintubation within 5 days postoperatively were analyzed using medical records.

Results:

Postoperative reintubation was performed in 3 patients (3.9%), all of whom suffered trauma. We further examined risk factors for reintubation in patients in the trauma group. There was no significant difference between the reintubation (R) and nonreintubation (non-R) groups in age, sex, body mass index, amount of blood loss and operation time, preoperative paralysis severity, and the number of fused segments. Patients in group R had significantly higher rates of severe anterior element injury (100% vs. 27.3%, P=0.0011). Airway obstruction due to laryngopharyngeal edema and swelling was confirmed by laryngoscopy and computed tomography images.

Conclusions:

Unplanned reintubation after ACSS occurred at a higher rate in trauma patients than in patients with degenerative disorders. Our results suggested that the severe damage to the anterior element of the cervical spine was associated with postoperative reintubation.

Evidence level:

Level IV.
Randomised clinical trial: efficacy and safety of H. pylori eradication treatment with and without Saccharomyces boulardii supplementation
Authors: Sjomina Olga , Poļaka Inese , Suhorukova Jekaterina , Vangravs Reinis , Paršutins Sergejs , Knaze Viktoria , Park Jin Young , Herrero Rolando , Murillo Raul , Leja Mārcis
Published: November 2023

Background

Standard triple therapy is commonly prescribed Helicobacter pylori eradication regimen in Europe. However, the world is witnessing declines in eradication success. It is crucial to find better treatment options.

Aims

To evaluate efficacy, compliance and side effects of H. pylori eradication treatment by adding Saccharomyces boulardii.

Methods

We conducted a randomized clinical trial within the GISTAR cohort, consisting of healthy individuals aged 40–64 years. Participants were administered clarithromycin-containing triple therapy (clarithromycin 500 mg, amoxicillin 1000 mg, esomeprazole 40 mg) twice daily. Randomization was applied based on two factors: 1)addition of Saccharomyces boulardii CNCM I-745 500 mg BID or not; 2)treatment duration of 10 or 14 days. Treatment completion and adverse events were assessed via telephone interview 21–28 days after medication delivery. The efficacy was evaluated using a 13C-urea breath test (UBT) six months after treatment.

Results

Altogether 404 participants were enrolled; data on adverse events were available from 391. Overall, 286 participants received follow-up UBT. Intention-to-treat analysis revealed higher eradication rates for 10-day probiotic treatment (70.8% vs. 54.6%, P = 0.022), but not for 14-day. Probiotic subgroups combined showed non-significantly higher efficacy in per-protocol analysis (90.6% vs. 85.0%, P = 0.183). S. boulardii reduced the frequency of adverse events (P = 0.033) in 14-day regimen, particularly treatment-associated diarrhea (P = 0.032). However, after the adjustment to control Type I error, results lost their significance.

Conclusion

Addition of S. boulardii to 14-day clarithromycin-containing triple regimen non-significantly lowers the likelihood of diarrhea and does not increase the eradication rate.
Duration of Dual Antiplatelet Treatment After Percutaneous Coronary Intervention in Patients With Diabetes: A Systematic Review and Meta-analysis
Authors: Apostolos Anastasios , Travlos Christofer , Tsioulos Georgios , Chlorogiannis Dimitrios-David , Karanasos Antonios , Papafaklis Michail , Alexopoulos Dimitrios , Toutouzas Konstantinos , Davlouros Periklis , Tsigkas Grigorios
Published: November 2023

Aim of our systematic review and meta-analysis is to compare shortened (≤3 months) dual antiplatelet therapy (DAPT) with longer DAPT in diabetic patients undergoing percutaneous coronary interventions.

We systematically screened 3 major databases (MEDLINE, Cochrane Central Register of Controlled Trials, and Scopus) searching for randomized-controlled trials or subanalyses of them, which compared shortened DAPT (S-DAPT) with longer DAPT regimens of DAPT. Primary end point of systematic review and meta-analysis is the net adverse clinical events (NACE), and secondary are major adverse cardiac events (MACE), mortality, bleedings, myocardial infarction, and stent thrombosis. Subgroup analyses included studies using only ticagrelor-based regimens and 3-month duration of DAPT.

A total of 8 studies and 12,665 patients were included in our analysis. Our meta-analysis met its primary end point because S-DAPT was associated significantly with a reduced risk ratio (RR) by 17% [RR: 0.83, 95% confidence intervals (CI), 0.72–0.96]. Nonsignificant difference among the rest end points was detected between the 2 groups. Subgroup analyses showed that ticagrelor-based regimens were associated with a significant reduction of mortality (RR: 0.67, 95% CI, 0.48–0.93) and 3-month DAPT reduced furtherly NACE by 27% (RR: 0.73, 95% CI, 0.60–0.89).

In conclusion, our systematic review and meta-analysis showed that (i) S-DAPT was significantly associated with a lower incidence of NACE, (ii) ticagrelor-based S-DAPT was associated with decreased mortality rates, and (iii) the benefit of 3-month duration of DAPT achieved an even greater NACE reduction. Thus, S-DAPT could be considered as a safe and feasible option in diabetic patients.
Ambulatory Status before Diabetic Foot Ulcer Development as a Predictor of Amputation and 1-Year Outcomes: A Retrospective Analysis
Authors: Clegg Devin J. , Tasman Jordan G. , Whiteaker Erica N. , Mazonas Thomas W. , Salomon Brett J. , Dupuy Samuel D. , Goldman Mitchell H. , Roberson Patricia N.E.
Published: November 2023

Background:

Up to 25% of people with diabetes develop a diabetic foot ulcer (DFU) during their lifetime, which precedes approximately 85% of nontraumatic lower limb amputations. Diabetic limb salvage has been at the forefront of recent research, as major amputation is associated with 5-year mortality rates of 52%–80%. We sought to determine if ambulatory status before DFU diagnosis is predictive of amputations and outcomes within 1 year, as no studies have directly examined this relationship.

Methods:

A retrospective review of patients diagnosed with DFUs from January 2011 to December 2021 was performed. Patients aged 18 years or more with type II diabetes were included. Ambulatory status was defined as the primary form of mobility reported by the patient before development of DFU, and was categorized as independent ambulation, ambulatory with assisting device (AWAD), or nonambulatory (NA). Statistical analyses included χ2, multinomial, and multivariable logistic regressions.

Results:

After review, 506 patients were included. NA (OR = 5.10; P = 0.002) and AWAD status (OR = 2.77; P = 0.01) before DFU development were predictive of major (below or above-knee) amputation during hospitalization, emergency department visits within 30-days (NA: OR = 4.19; P = 0.01, AWAD: OR = 3.09; P = 0.02), and mortality within one-year (NA: OR = 4.19; P = 0.01, AWAD: OR = 3.09; P = 0.02). AWAD status was also associated with increased risk of hospital readmission (OR = 2.89; P < 0.001) within 30-days and any amputation (OR = 1.73; P = 0.01) within 1 year.

Conclusions:

In patients with DFUs, NA and AWAD status were predictive of major amputation during hospitalization and are associated with poorer 1-year outcomes, including mortality. Ambulatory status assessment may be used to inform DFU treatment approaches.
Descemet Membrane Endothelial Keratoplasty in Corneal Endothelial Decompensation After a Forceps-Induced Corneal Birth Injury: Case Series and Technique
Authors: Igarashi Ami , Hayashi Takahiko , Shimizu Toshiki , Takeda Masato , Ishida Atsuyuki , Yuda Kenji , Yuda Kentaro , Wajima Haguku , Kobayashi Akira , Yamagami Satoru
Published: November 2023

Purpose:

The aim of this study was to describe the efficacy of Descemet membrane endothelial keratoplasty (DMEK) in patients with corneal endothelial decompensation secondary to a forceps-induced corneal birth injury.

Methods:

This was a retrospective, noncomparative, interventional case series. Four eyes of 4 patients (1 female and 3 males; mean age, 64.0 ± 4.7 years) with corneal endothelial decompensation due to forceps-induced corneal birth injury were included. DMEK was performed in all cases, using a combined technique, including the use of intraoperative optical coherence tomography, vital staining of Descemet membrane of both host and donor, removal of scarred Descemet membrane with side-port forceps and vitreous cutter to smoothen the posterior corneal surface, epithelial peeling, and illumination for visualization. The examination included preoperative and postoperative ophthalmologic examinations: best-corrected visual acuity (converted to logarithm of the minimum angle of resolution [logMAR]), intraocular pressure, endothelial cell density (ECD), and central corneal thickness.

Results:

No postoperative complications were noted, and corneal transparency was maintained during follow-up (mean follow-up period, 32.0 ± 27.0 months; range, 3–71 months). The mean best-corrected visual acuity was 0.52 ± 0.35 logMAR preoperatively and 0.15 ± 0.09 logMAR at the last visit. The mean postoperative ECD was 1632 ± 631 cells/mm2 (mean ECD at baseline, 3167 cells/mm2). Central corneal thickness decreased from 640 ± 67 μm preoperatively to 576 ± 58 μm postoperatively.

Conclusions:

This study suggests that DMEK can be performed uneventfully in eyes with a forceps-induced corneal birth injury. The combination of surgical techniques may be an effective approach for DMEK.
The Association Among Clinical Profiles, Modifiers, and Prolonged Recovery in Adolescents With Sport-Related Concussion
Authors: Anderson Morgan , Reynolds Erin , Gilliland Taylor , Hammonds Kendall , Driver Simon
Published: November 2023

Objective:

The purposes were to (1) describe the prevalence of clinical profiles and modifiers, (2) examine the association between clinical profiles and prolonged recovery, and (3) examine the interaction between clinical profiles and modifiers and prolonged recovery in adolescents with sport-related concussion (SRC).

Design:

Retrospective, cross-sectional.

Setting:

Interdisciplinary specialty sports concussion clinic.

Patients:

Patients (n = 299) aged 12 to 19 years who were diagnosed with SRC within 30 days of injury.

Independent Variables:

Clinical profiles and modifiers were decided by the clinical judgment of the clinical neuropsychologist and sports medicine physician, using data from the Clinical Profile Screen and information gathered from the clinical interview, neurocognitive, and vestibular and ocular motor testing.

Main Outcome Measures:

Prolonged recovery was defined as ≥28 days from the date of injury to the date of clearance.

Results:

The most common clinical profiles were migraine (34.8%) and cognitive–fatigue (23.4%). There were no significant relationships between clinical profiles and prolonged recovery (Wald

= 5.89, df = 4, P = 0.21). The presence of a modifier did not significantly affect the relationship between clinical profiles and prolonged recovery (

= 6.5, df = 5, P = 0.26). The presence of any modifier yielded a 10-day increase in median recovery time within the cognitive/fatigue clinical profile (Wilcoxon rank-sum = 268.5, P = 0.01).

Conclusions:

Although patients with a clinical profile and modifier may not experience prolonged recovery, they may experience longer recovery time than patients with a clinical profile and no modifier.
Costs of Implementing Electronic Context Factor Assessments and Patient-reported Outcomes in Pain Clinic Settings
Authors: Elwy A. Rani , Taubenberger Simone , Dodds Nathan , DeSensi Rebecca , Gillman Andrea , Wasan Ajay , Greco Carol M.
Published: November 2023

Background:

The Healing Encounters and Attitudes Lists (HEALs) patient-reported measures, consisting of 6 separate context factor questionnaires, predict patients’ pain improvements. Our Patient-centered Outcomes Research Initiative-funded implementation project demonstrated success in using HEAL data during clinic consultations to enhance patient engagement, improve patient outcomes, and reduce opioid prescribing.

Objective:

We aimed to determine the resources needed for additional sites to implement HEAL to improve pain care treatment.

Research Design:

An observational study from March 1 to November 30, 2021, assessing implementation cost data from invoices, time and salary requirements for clinic personnel training, estimates of non–site-based costs, and one-time resource development costs.

Subjects:

Unique patients eligible to complete a HEAL survey (N=24,018) and 74 clinic personnel.

Measures:

The Stages of Implementation Completion guided documentation of preimplementation, implementation, and sustainment activities of HEAL pain clinic operations. These informed the calculations of the costs of implementation.

Results:

The total time for HEAL implementation is 7 months: preimplementation and implementation phases (4 mo) and sustainment (3 mo). One hour of HEAL implementation involving a future clinical site consisting of 2 attending physicians, 1 midlevel provider, 1 nurse manager, 1 nurse, 1 radiology technician, 2 medical assistants, and 1 front desk staff will cost $572. A 10-minute time increment for all clinic staff is $95. Total implementation costs based on hourly rates over 7 months, including non–site-based costs of consultations, materials, and technology development costs, is $28,287.

Conclusions:

Documenting our implementation costs clarifies the resources needed for additional new sites to implement HEAL to measure pain care quality and to engage patients and clinic personnel.
The Costs of Implementing a Conversation Aid for Uterine Fibroids in Multiple Health Care Settings
Authors: Acquilano Stephanie C. , Forcino Rachel C. , Schubbe Danielle , Engel Jaclyn , Tomaino Marisa , Johnson Lisa C. , Durand Marie-Anne , Elwyn Glyn
Published: November 2023

Background:

Health care organizations considering adopting a conversation aid (CA), a type of patient decision aid innovation, need information about the costs of implementation.

Objectives:

The aims of this study were to: (1) calculate the costs of introducing a CA in a study of supported implementation in 5 gynecologic settings that manage individuals diagnosed with uterine fibroids and (2) estimate the potential costs of future clinical implementation efforts in hypothetical settings.

Research Design:

We used time-driven activity-based costing to estimate the costs of CA implementation at multiple steps: integration with an electronic health record, preimplementation, implementation, and sustainability. We then estimated costs for 2 disparate hypothetical implementation scenarios.

Subjects and Data Collection:

We conducted semistructured interviews with participants and examined internal documentation.

Results:

We interviewed 41 individuals, analyzed 51 documents and 100 emails. Overall total implementation costs over ∼36 months of activities varied significantly across the 5 settings, ranging from $14,157 to $69,134. Factors influencing costs included size/complexity of the setting, urban/rural location, practice culture, and capacity to automate patient identification. Initial investments were substantial, comprising mostly personnel time. Settings that embedded CA use into standard workflows and automated identification of appropriate patients had the lowest initial investment and sustainability costs. Our estimates of the costs of sustaining implementation were much lower than initial investments and mostly attributable to CA subscription fees.

Conclusion:

Initiation and implementation of the interventions require significant personnel effort. Ongoing costs to maintain use are much lower and are a small fraction of overall organizational operating costs.
Optimal Definition of Pancreaticoduodenectomy in the International Classification of Diseases, 10th Revision, Procedure Coding System
Authors: Utter Garth H. , Rajasekar Ganesh , Nuño Miriam , Bold Richard J.
Published: November 2023

Background:

The implementation of the International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS) has created difficulty in identifying certain procedures, including pancreaticoduodenectomy. We sought to evaluate which combinations of ICD-10-PCS codes best identify pancreaticoduodenectomy.

Study Design:

We used 2017–2018 Medicare data to identify acute care hospitalization claims of beneficiaries with both ICD-10-PCS and Current Procedural Terminology (CPT) codes available. We developed 12 candidate ICD-10-PCS definitions of pancreaticoduodenectomy and evaluated their test characteristics in identifying hospitalizations involving CPT codes 48150, 48152, 48153, 48154, or 48155 as the criterion standard. We selected one candidate definition with the best balance of test characteristics, then performed decision tree analysis and evaluated the conditional marginal sensitivity and positive predictive value of each individual code to understand which were most informative.

Results:

Among 964,613 hospitalization claims from 4648 hospitals, 385 claims from 217 hospitals involved a CPT code for pancreaticoduodenectomy. The ICD-10-PCS definition with the best balance had a sensitivity of 92.2% (95% CI: 89.2%–94.4%), specificity of 99.9977% (95% CI: 99.9961%–99.9984%), positive predictive value of 93.7% (95% CI: 90.3%–95.9%), and negative predictive value of 99.9969% (95% CI: 99.9955%–99.9978%). The most informative procedure codes involved open nondiagnostic excision or resection of the duodenum (0DB90ZZ and 0DT90ZZ) and pancreas (0FBG0ZZ and 0FTG0ZZ).

Conclusion:

An ICD-10-PCS definition of pancreaticoduodenectomy using codes for (1) open or percutaneous endoscopic excision or resection of the pancreas and (2) similar codes for the duodenum, consistent with coding guidelines, has satisfactory test characteristics. We suggest researchers consider such characteristics in defining pancreaticoduodenectomy using ICD-10-PCS.
S-100 and MATH-1 Protein Expressions Can Be Useful for the Prediction of Clinical Outcome in Neuroblastoma Patients
Authors: Sanlav Gamze , Baran Burçin , Kum Özşengezer Selen , Kizmazoğlu Deniz , Altun Zekiye , Aktaş Safiye , Olgun Nur
Published: November 2023

Neuroblastoma (NB) is the most frequent extracranial solid tumor of childhood, remarkable for its broad spectrum of clinical behavior. This diversity in behavior correlates closely with defined clinical and biological features and combinations of prognostic variables are used for risk-group assignment. S-100 proteins have roles in differentiation and were shown to be frequently dysregulated in NB. MATH-1 protein plays role in neuronal cell differentiation through development. However, up to date, there are no studies evaluating the relationship between MATH-1 and NB. Grb2-associated binding (Gab) proteins have roles in the regulation of cell growth and differentiation. Gab1 was reported to be related to poor survival of high-risk NB patients. The aim of this study was to investigate the relationship between differentiation-related S-100, MATH-1, and Gab1 proteins and risk group and/or stages of NB. A significant relation was found between S-100 and early stages of NB. This study also revealed a significant association between MATH-1 and low-risk groups. S-100 and MATH-1 were also shown to provide survival advantages among stages and risk groups. The findings of this study support the assumption that S-100 and MATH-1 can be potential prognostic biomarkers for staging and risk-group assignment of NB patients. These proteins can be useful tools for clinicians to guide through treatment options, especially for the evaluation of tumor differentiation.
Factors Affecting Nursing Students’ Reflective Thinking During Simulation Debriefing
Authors: Kim Giyon , Issenberg S. Barry , Roh Young Sook
Published: November 2023

Background:

Although reflective thinking is regarded as an important learning aspect of debriefing, the factors that can affect reflective thinking during simulation debriefing remain unclear.

Purpose:

This study aimed to identify factors affecting reflective thinking during simulation debriefing among nursing students.

Methods:

This study used a cross-sectional descriptive survey design with a convenience sample of 198 Korean nursing students. Participants completed a structured web-based self-administered questionnaire regarding the reflective learning continuum, psychological safety, learner communications skills, and debriefing process design. Multiple regression analyses were used to identify the factors affecting reflective thinking.

Results:

Significant factors were debriefing process design, learner communication skills, student-to-student interactions, and instructor-to-student interactions. Psychological safety did not affect the reflective thinking of nursing students.

Conclusions:

Nurse educators should design and implement strategies to maintain effective debriefing processes, improve communication skills, and facilitate student-to-student and instructor-to-student interactions to promote reflective thinking during simulation debriefing.
Spiritual Care in Undergraduate Nursing Education
Authors: Willett Tanya Sherry lee , Honan Deena , Wills Amanda , Younas Ahtisham
Published: November 2023

Background:

The growth of international migration and globalization has increasingly diversified patient populations, emphasizing the need for nursing students to provide competent spiritual care.

Purpose:

To understand the teaching and learning strategies used to prepare undergraduate nursing students for spiritual care.

Methods:

An integrative review with deductive data analysis was used to evaluate, analyze, and synthesize diverse research methodologies.

Results:

Three educational approaches were identified, including passive, reflective, and combinatory approaches. The combinatory approach appears most appropriate for diverse learning styles within a student group.

Conclusions:

No one strategy is best, but any combination of educational strategies can positively impact spiritual care competency within clinical practice.
A post-transplant infection by Nocardia cyriacigeorgica
Authors: Gandham Nageswari , Kannuri Sriram , Gupta Aryan , Mukhida Sahjid , Das Nikunja , Mirza Shahzad
Published: November 2023

Nocardia are Gram-positive, acid-fast, filamentous bacteria that cause opportunistic infections in susceptible populations. We describe a case of post-transplant infection of pulmonary nocardiosis caused by the rare strain

Nocardia cyriacigeorgica

and the challenges faced in reaching a definitive diagnosis. This case report emphasizes on keeping nocardiosis as a differential diagnosis in transplant recipients, as this disease is largely underdiagnosed and underreported.
Lysinibacillus irui sp. nov., isolated from Iru, fermented African locust beans
Authors: Akintayo Stephen Olusanmi , Neumann Bernd , Fischer Martin , Henkel Marius , Lilge Lars , Hausmann Rudolf
Published: November 2023

A Gram-positive, motile, aerobic, rod-shaped, endospore-forming strain designated IRB4-01T was isolated from fermented African locust beans (Iru) obtained from Bodija market in the city of Ibadan, southwestern Nigeria, during a screening process from food-related sources. IRB4-01T grew at 10–50 °C (optimum, 35–37 °C), pH 6–10 (optimum, pH 7) and in 0–6 % NaCl (optimum, 1–3 %). Phylogenetic analyses based on 16S rRNA and combined short- and long-read genome sequencing revealed that IRB4-01T is closely related to

Lysinibacillus cavernae

SYSU K30005T and

Lysinibacillus boronitolerans

10aT. The cell-wall peptidoglycan type was A4α (Lys–Asp), containing the diagnostic diamino acid lysine. The major polar lipids in strain IRB4-01T were diphosphatidylglycerol, phosphatidylethanolamine, phosphatidylglycerol and an unidentified phospholipid, while the predominant menaquinone was MK-7. The major cellular fatty acids were iso-C15 : 0, anteiso-C15 : 0 and iso-C16 : 0. Genomic DNA G+C content was 37.4  mol%, while the digital DNA–DNA hybridization revealed 33.6 and 32.3 % relatedness to

L. cavernae

SYSU K30005T and

L. boronitolerans

10aT, respectively. Based on phenotypic, physiological and chemotaxonomic characteristics, as well as genome comparisons, strain IRB4-01T represents a novel species of the genus

Lysinibacillus

, for which the name Lysinibacillus irui sp. nov. is proposed. The type strain is IRB4-01T (NCIMB 15452T=LMG 32887T). Hybrid genome data are provided on the NCBI database using the Bioproject number PRJNA906010 and accession numbers CP113527 and CP113528. Additionally, a representative 16S rRNA sequence is available with the GenBank accession number OQ566940.
Overview of the 8thSocial Media Mining for Health Applications (#SMM4H) Shared Tasks at the AMIA 2023 Annual Symposium
Authors: Klein Ari Z. , Banda Juan M. , Guo Yuting , Schmidt Ana Lucia , Xu Dongfang , Flores Amaro Jesus Ivan , Rodriguez-Esteban Raul , Sarker Abeed , Gonzalez-Hernandez Graciela
Published: November 2023

The aim of the Social Media Mining for Health Applications (#SMM4H) shared tasks is to take a community-driven approach to address the natural language processing and machine learning challenges inherent to utilizing social media data for health informatics. The eighth iteration of the #SMM4H shared tasks was hosted at the AMIA 2023 Annual Symposium and consisted of five tasks that represented various social media platforms (Twitter and Reddit), languages (English and Spanish), methods (binary classification, multi-class classification, extraction, and normalization), and topics (COVID-19, therapies, social anxiety disorder, and adverse drug events). In total, 29 teams registered, representing 18 countries. In this paper, we present the annotated corpora, a technical summary of the systems, and the performance results. In general, the top-performing systems used deep neural network architectures based on pre-trained transformer models. In particular, the top-performing systems for the classification tasks were based on single models that were pre-trained on social media corpora. To facilitate future work, the datasets—a total of 61,353 posts—will remain available by request, and the CodaLab sites will remain active for a post-evaluation phase.
A Novel Hierarchical Network-Based Approach to Unveil the Complexity of Functional Microbial Genome
Authors: Lu Yuntao , Li Qi , Li Tao
Published: November 2023

Biological networks are pivotal in elucidating intricate biological processes. While substantial research has delved into interspecies environmental interactions within biological networks, intraspecific functional gene interactions within individual microbes remain relatively untapped. The burgeoning availability of microbiome datasets underscores the imperative for a refined examination of microbial genome structures and functions. We innovatively introduce the concept of “Solid Motif Structures (SMS)” through a meticulous biological network analysis of genomes from the same genus, aiming to bridge the gap between the structural and functional intricacies of microbial genomes. Harnessing publicly available data from 162 high-qualityMicrocystisgenomes, a globally prevalent freshwater cyanobacterium instrumental in microbial ecosystems, a comprehensive genome structure network forMicrocystiswas delineated. Employing a state-of-the-art deep learning scheme, we discerned 27 pivotal functional subnetworks and an array of functionally-associated SMS. Incorporating metagenomic data from seven geographically diverse lakes, we embarked on an exhaustive analysis of the functional stability ofMicrocystisacross varied environmental matrices. This culminated in the identification of distinct functional interaction models for each lake. Our research amalgamates these insights into a comprehensive resource repository, furnishing unparalleled perspectives into the functional interplay withinMicrocystis. Leveraging advanced biological network analysis, our study pioneers the delineation of a novel network granularity, facilitating a more lucid comprehension of the dynamic interplay between genome structure and function interactions in microorganisms of the same genus. This study shed light on the plasticity and conservation of microbial functional genomes across diverse environments, offering insights into their evolutionary trajectories.