bluuebunny/crossref_metadata_2025 huggingface dataset:
Microaggressions
Authors: Torino Gina C.
Published: February 2023

Dr. Chester Pierce of Harvard University is credited with coining the term microaggression in the 1970s. His first research studied the depiction of African Americans in television commercials. Not until the beginning of the twenty-first century did study on microaggressions arise. This preliminary study examined the prevalence of microaggressions in higher education. Sue and colleagues released “Racial Microaggressions in Everyday Life: Implications for Clinical Practice” in 2007. This 2007 paper, which was published in American Psychologist, expanded on the concept by constructing a taxonomy and providing numerous examples from the psychological literature. The term was added to the Merriam-Webster dictionary in 2017. Since 2007, research has been conducted on the incidence and impact of microaggressions across a variety of contexts. Microaggressions are brief, everyday, derogatory slights or insults that communicate hostility and bias (e.g., racism, sexism, heterosexism, homophobia, etc.) toward a marginalized person or group. They can be conveyed verbally, behaviorally, or environmentally. Oftentimes, microaggressions occur unconsciously but not necessarily. Their cumulative impact over time can have deleterious consequences upon individuals. For example, repeated microaggressions have been associated with depression, anxiety, suicidal ideation, negative educational and physical health outcomes, as well as higher rates of attrition in the workplace and decreased job satisfaction (just to name a few). Scholars have also developed, and managers have implemented, prevention and intervention strategies within organizations to minimize the potential impact that microaggressions can have upon individuals.
Organizational Ambidexterity
Authors: Hill Susan
Published: February 2023

“Organizational ambidexterity” refers to the ability of an organization, or a subsystem of an organization, to perform two tasks with equal skill. The terminology “ambidexterity” is metaphorical: it is the application of a human attribute (that of being equally skilled with both hands) to organizations. While early work varied in respect of the duality ambidexterity was applied to, scholars have now largely coalesced around organizational ambidexterity as referring to exploration and exploitation. These terms were introduced by James G. March, a leading figure in the Behavioral Theory of the Firm tradition, in a seminal 1991 article (March 1991, cited under Foundational Papers). The normative challenge that broadly characterizes organizational ambidexterity research is the following: How do organizations manage to effectively explore and exploit, when these likely jointly influence long-run performance but can compete for scarce resources and crowd each other out? In contrast to some schools of thought in management, such as population ecology, that see organizational adaptation as an impossible (or near impossible) feat, scholars of organizational ambidexterity assume that organizations can adapt. Moreover, organizations can, while it might present extreme management challenges, find ways to successfully explore and exploit—and to do so more or less at the same time. Scholarly literature on organizational ambidexterity started out as a trickle of articles in the 1990s, was catapulted into mainstream management scholarship in the mid- to late 2000s, and now constitutes a sizeable corpus of research, which continues to grow and mature. This bibliography provides a selective representation of works from this corpus, drawing principally on works published in the core journals within management and organization studies. It is organized into eight major sections. First, key Foundational Papers are introduced. Second, influential Reviews and Special Issues are presented. Third, Major Theories drawn on in ambidexterity research are identified. Fourth, the common Settings for Ambidexterity Research are highlighted. Fifth, as a topic that gathered a great deal of attention in the early growth phase of organizational ambidexterity research, studies addressing whether and, if so, when, ambidexterity delivers performance benefits to companies are outlined (see Organizational Ambidexterity and Performance). Sixth, under Forms of Organizational Ambidexterity, writings on the major forms through which organizations effect ambidexterity are identified. Seventh, under Individuals and Teams, research into ambidexterity focusing on human actors is overviewed. Finally, an emerging conversation on Temporal Accounts of Ambidexterity is presented.
American Southwestern Literature
Authors: CdeBaca-Cruz Lydia
Published: February 2023

If there can be said to exist any single defining feature of Latine literature of the American Southwest, its shifting, overlapping, and often conflicting colonial, indigenous, and national histories emerge as the primary contender. These histories continue to exert influence on the literature of the region. It is a literature that speaks with the multilayered voice of a people at once indigenous and migrant, a voice responding to Spanish, Mexican, and US powers yet defined not as response but rather a variable and fluid emergent expression in its own right. Defining the expanse of the region itself depends heavily on the historical period and national context under consideration. Generally speaking, the American Southwest is demarcated from the current boundaries of the US-Mexico border to the south, Texas to the east, California to the west, and Colorado, Utah, and Nevada in the north. Although literature from throughout this region, as well as what Américo Paredes termed “Greater Mexico,” exerts an influence in the study of Latine literature of the American Southwest, much scholarship has focused on the literature from Texas, New Mexico, and California, as well as from those communities in close proximity to the U.S-Mexico border as defined after the signing of the Treaty of Guadalupe-Hidalgo ended the US-Mexican War in 1848. Defining “literature” poses an additional challenge to the discussion of literature of the American Southwest, as the culture of the Southwest has so often been defined by the folk expressions of its various inhabitants. Traditional literary genres thus often share boundaries with folklore and song, blurring border lines and, at times, crossing over into the realm of the anthropological. Indeed, in the history of Chicane studies, scholars have often crossed disciplinary divides between literature, folklore studies, and anthropology. The study of Latine literature of the American Southwest is thus as expansive as the landscape itself and as multifaceted as its unique history.
Receipt of Smoking Cessation Medications Among People With and Without Human Immunodeficiency Virus in the Veterans Aging Cohort Study (2003–2018)
Authors: Shahrir Shahida , Crothers Kristina , McGinnis Kathleen A , Chan Kwun C G , Baeten Jared M , Wilson Sarah M , Butt Adeel A , Pisani Margaret A , Baldassarri Stephen R , Justice Amy , Williams Emily C
Published: February 2023

Background

Nicotine replacement therapy, bupropion, and varenicline are smoking cessation medications (SCMs) shown to be similarly effective in people with and without human immunodeficiency virus (PWH and PWoH, respectively), although rates of receipt of these medications are unknown.

Methods

We identified patients in the Veterans Aging Cohort Study with electronic health record-documented current smoking using clinical reminder data for tobacco use (2003–2018). We measured receipt of SCMs using Veterans Affairs pharmacy data for outpatient prescriptions filled 0–365 days after current smoking documentation. We used log-linear, Poisson-modified regression models to evaluate the relative risk (RR) for receiving SCM by human immunodeficiency virus (HIV) status, the annual rate of receipt, and rate difference among PWH relative to PWoH.

Results

The sample included 92 632 patients (29 086 PWH), reflecting 381 637 documentations of current smoking. From 2003 to 2018, the proportion receiving SCMs increased from 15% to 34% for PWH and from 17% to 32% among PWoH. There was no statistical difference in likelihood of receiving SCM by HIV status (RR, 1.010; 95% confidence interval [CI], .994–1.026). Annual rates of receiving SCM increased for PWH by 4.3% per year (RR, 1.043; 95% CI, 1.040–1.047) and for PWoH by 3.7% per year (RR, 1.037; 95% CI, 1.036–1.038; rate difference +0.6% [RR, 1.006; 95% CI, 1.004–1.009]).

Conclusions

In a national sample of current smokers, receipt of SCM doubled over the 16-year period, and differences by HIV status were modest. However, fewer than 35% of current smokers receive SCM annually. Efforts to improve SCM receipt should continue for both groups given the known dangers of smoking.
The WEST Study: A Retrospective and Multicentric Study on the Impact of Steroid Therapy in West Nile Encephalitis
Authors: Colaneri Marta , Lissandrin Raffaella , Calia Matteo , Bassoli Cecilia , Seminari Elena , Pavesi Alessandro , Rovida Francesca , Baldanti Fausto , Muzzi Alba , Chichino Guido , Regazzetti Angelo , Grecchi Cecilia , Pan Angelo , Lupi Matteo , Franceschini Erica , Mussini Cristina , Bruno Raffaele
Published: February 2023

Background

The use of steroid therapy in potentially life-threatening neuroinvasive forms of West Nile infection (WNND) is controversial. The aim of this study is to assess the efficacy of steroid therapy in reducing intrahospital mortality, length of stay, and neurological sequelae at discharge.

Methods

This was a multicenter, retrospective, observational study conducted in 5 hospitals in Northern Italy, headed by the Fondazione IRCSS Policlinico San Matteo (Pavia). We extracted all patient data with WNND diagnoses, comparing patients who received steroid treatment with patients who did not receive steroid treatment between January 2014 and January 2022. Comparisons between the 2 groups were performed using chi-square tests for categorical variables and Mann-Whitney tests for non-normal continuous data, and a generalized linear model for the binomial family was carried out.

Results

Data from 65 WNND patients were extracted. Among these patients, 33 (50.7%) received steroid therapy at any point during their hospitalization. Receiving steroid therapy did not significantly reduce intrahospital mortality (odds ratio [OR], 1.70; 95% CI, 0.3–13.8; P = .89) or neurological sequelae at discharge (OR, 0.53; 95% CI, 0.16–1.76; P = .47).

Conclusions

Steroid treatment is currently used on a single-case basis in severe WNND. More prospective data are needed to demonstrate a protective effect on mortality and neurological sequelae.
Long-Term Career Earnings in Academia Might Offset the Opportunity Cost of Full-Time PhD and Postdoctoral Education for Physical Therapists Who Hold a Doctor of Physical Therapy Degree
Authors: Garbin Alexander J , Stevens-Lapsley Jennifer E , Gritz R Mark , Tucker Carole A , Bade Michael J
Published: February 2023

Objective

Rigorously trained physical therapy researchers are essential for the generation of knowledge that guides the profession. However, there is a current and projected dearth of physical therapy researchers capable of sustaining research programs in part due to perceived financial barriers associated with pursuit of a doctor of philosophy (PhD) degree, with and without postdoctoral training, following doctor of physical therapy (DPT) degree completion. This study aimed to evaluate the financial impact of PhD and postdoctoral training, including opportunity cost, years to break even, and long-term earnings.

Methods

Clinical and academic salaries were obtained via the 2016 APTA Median Income of Physical Therapist Summary Report and 2019 CAPTE Annual Accreditation Report. Salaries were adjusted to total compensation to account for benefits and compared over a 30-year period starting after DPT education. Total compensations were also adjusted to the present value, placing greater weight on early career earnings due to inflation and potential investments.

Results

Relative to work as a clinical physical therapist, 4 years of PhD training result in an earnings deficit of $264,854 rising to $357,065 after 2 years of additional postdoctoral training. These deficits do not persist as evidenced by a clinical physical therapist career earning $449,372 less than a nonmajority scholarship academic career (DPT to PhD to academia pathway) and $698,704 less than a majority scholarship academic career (DPT to PhD to postdoctoral training to academia pathway) over a 30-year period. Greater long-term earnings for PhD careers persist when adjusting to present value.

Conclusions

Although there is an initial opportunity cost of PhD and postdoctoral training represented by a relative earnings deficit, advanced research training results in greater long-term earnings.

Impact

The findings of this study allow physical therapists interested in pursuing PhD and postdoctoral training to be better informed about the associated financial ramifications.
Combining Cell Technologies With Biomimetic Tissue Engineering Applications: A New Paradigm for Translational Cardiovascular Therapies
Authors: Motta Sarah E , Martin Marcy , Gähwiler Eric K N , Visser Valery L , Zaytseva Polina , Ehterami Arian , Hoerstrup Simon P , Emmert Maximilian Y
Published: February 2023

Cardiovascular disease is a major cause of morbidity and mortality worldwide and, to date, the clinically available prostheses still present several limitations. The design of next-generation regenerative replacements either based on cellular or extracellular matrix technologies can address these shortcomings. Therefore, tissue engineered constructs could potentially become a promising alterative to the current therapeutic options for patients with cardiovascular diseases. In this review, we selectively present an overview of the current tissue engineering tools such as induced pluripotent stem cells, biomimetic materials, computational modeling, and additive manufacturing technologies, with a focus on their application to translational cardiovascular therapies. We discuss how these advanced technologies can help the development of biomimetic tissue engineered constructs and we finally summarize the latest clinical evidence for their use, and their potential therapeutic outcome.
Characterization of Blast Resistance in a Diverse Rice Panel from Sub-Saharan Africa
Authors: Mutiga Samuel K. , Orwa Philemon , Nganga Everlyne M. , Kyallo Martina M. , Rotich Felix , Gichuhi Emily , Kimani John M. , Mwongera David T. , Were Vincent M. , Yanoria Mary Jeanie , Murori Rosemary , Mgonja Emmanuel , Ziyomo Cathrine , Wasilwa Lusike , Bachabi Famata , Ndjiondjop Marie-Noëlle , Ouedraogo Ibrahima , Correll James C. , Talbot Nick J.
Published: February 2023

There is a recent unparalleled increase in demand for rice in sub-Saharan Africa, yet its production is affected by blast disease. Characterization of blast resistance in adapted African rice cultivars can provide important information to guide growers and rice breeders. We used molecular markers for known blast resistance genes ( Pi genes; n = 21) to group African rice genotypes ( n = 240) into similarity clusters. We then used greenhouse-based assays to challenge representative rice genotypes ( n = 56) with African isolates ( n = 8) of Magnaporthe oryzae which varied in virulence and genetic lineage. The markers grouped rice cultivars into five blast resistance clusters (BRC) which differed in foliar disease severity. Using stepwise regression, we found that the Pi genes associated with reduced blast severity were Pi50 and Pi65, whereas Pik-p, Piz-t, and Pik were associated with increased susceptibility. All rice genotypes in the most resistant cluster, BRC 4, possessed Pi50 and Pi65, the only genes that were significantly associated with reduced foliar blast severity. Cultivar IRAT109, which contains Piz-t, was resistant against seven African M. oryzae isolates, whereas ARICA 17 was susceptible to eight isolates. The popular Basmati 217 and Basmati 370 were among the most susceptible genotypes. These findings indicate that most tested genes were not effective against African blast pathogen collections. Pyramiding genes in the Pi2/9 multifamily blast resistance cluster on chromosome 6 and Pi65 on chromosome 11 could confer broad-spectrum resistance capabilities. To gain further insights into genomic regions associated with blast resistance, gene mapping could be conducted with resident blast pathogen collections.

[Formula: see text] Copyright © 2023 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Gap-Free Nuclear and Mitochondrial Genomes of Fusarium verticillioides Strain HN2
Authors: Yang Wei , Zhai Haoyu , Yang Lei , Yang Qun , Song Le , Wu Jianyu , Lai Zhibing , Li Guotian
Published: February 2023

Fusarium ear rot (FER) and Fusarium stalk rot (FSR), caused by the filamentous fungus Fusarium verticillioides, have become increasingly serious around the world. Additionally, fumonisins produced by F. verticillioides threaten food and feed security. By adding the contribution of genomic resources to better understand the pathosystem, including the mechanisms of F. verticillioides-maize interactions, and further improving the quality of the F. verticillioides genome, the gap-free nuclear genome and mitochondrial genome of F. verticillioides strain HN2 were sequenced and assembled. Using Oxford Nanopore long reads and next-generation sequencing short reads, the final 42.81-Mb genome was assembled into 12 contigs (N50 = 4.16 Mb). A total of 13,466 protein-coding genes were annotated, including 1,076 secreted proteins that contain 342 candidate effectors. In addition, we assembled the complete 53,764-bp mitochondrial genome. F. verticillioides strain 7600 genome assemblies are fragmented, and high-quality reference genomes were needed. The genomes presented here will serve as an important resource for F. verticillioides research.

[Formula: see text] Copyright © 2023 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Topical Intervention of Natural Products Applied in Patients with Pressure Injuries: A Scoping Review
Authors: Ouchi Janaina Daniel , Pereira Regina Mara Silva , Okuyama Cristina Eunice
Published: February 2023

OBJECTIVE

Pressure injuries (PIs) represent a major medical and nursing problem in individuals with decreased or limited mobility. This scoping review aimed to map the controlled clinical trials with topical interventions of natural products applied to patients with PIs and to verify the existence of phytochemical similarities among these products.

DATA SOURCES

This scoping review was developed according to the JBI Manual for Evidence Synthesis. Controlled trials were searched in the following electronic databases from their inceptions until February 1, 2022: Cochrane Central Register of Controlled Trials, EMBASE, PubMed, SciELO, Science Direct, and Google Scholar.

STUDY SELECTION

Studies involving individuals with PIs, individuals treated with topical natural products compared to a control treatment, and outcomes with wound healing or wound reduction were included in this review.

DATA EXTRACTION

The search identified 1,268 records. Only six studies were included in this scoping review. Data were independently extracted using a template instrument from the JBI.

DATA SYNTHESIS

The authors summarized the characteristics of the six included articles, synthesized outcomes, and compared similar articles. Honey and Plantago major dressings were the topical interventions that significantly reduced wound size. The literature suggests that the effect on wound healing of these natural products may be related to the presence of phenolic compounds.

CONCLUSIONS

The studies included in this review show that natural products can positively impact the healing of PIs. However, there are limited controlled clinical trials addressing natural products and PIs in the literature.
Accuracy of Thermographic Imaging in the Early Detection of Pressure Injury: A Systematic Review
Authors: Baron Miriam Viviane , Hernandes Martins Paulo Ricardo , Brandenburg Cristine , Koepp Janine , Reinheimer Isabel Cristina , dos Santos Amanda Corrêa , dos Santos Michele Paula , Mantilla Santamaria Andres Felipe , Miliou Thomas , da Costa Bartira Ercília Pinheiro
Published: February 2023

OBJECTIVE

To verify the accuracy of thermographic images in the early detection of pressure injury (PI) in adult patients.

DATA SOURCES

Between March 2021 and May 2022, researchers searched 18 databases for relevant articles using nine keywords. In total, 755 studies were evaluated.

STUDY SELECTION

Eight studies were included in the review. Studies were included if they evaluated individuals older than 18 years who were admitted to any healthcare setting; were published in English, Spanish, or Portuguese; examined the accuracy of thermal imaging in the early detection of PI, including suspected stage 1 PI or deep tissue injury; and they compared the region of interest to another area or control group, or to the Braden Scale or Norton Scale. Animal studies and reviews, studies with contact infrared thermography, and those including stages 2, 3, 4, and unstageable PIs were excluded.

DATA EXTRACTION

Researchers examined sample characteristics and assessment measures related to image capture, including environmental, individual, and technical factors.

DATA SYNTHESIS

Across the included studies, sample sizes ranged from 67 to 349 participants, and patients were followed up for periods ranging from a single assessment up to 14 days, or until the appearance of a PI, discharge, or death. Evaluation with the infrared thermography identified temperature differentials between regions of interest and/or in comparison with risk assessment scales.

CONCLUSIONS

Evidence on the accuracy of thermographic imaging in the early detection of PI is limited.
Neonatal Electroencephalogram Electrode-Related Pressure Injury Prevention Quality Improvement Study
Authors: Blazier Laura A. , Boyle Frances A. , Cooper Kristin L. , Wing Sarah E. , Stefanescu Beatrice M.
Published: February 2023

OBJECTIVE

To lengthen the days between electroencephalogram electrode-related pressure injury (EERPI) to 100 EERPI-free days in 6 months of study implementation with a goal to maintain 200 EERPI-free days thereafter (≤1 EERPI event/year).

METHODS

This quality improvement study took place in a level IV neonatal ICU over three epochs spanning 2 years: epoch 1 or baseline (January-June 2019), epoch 2 or implementation of intervention (July-December 2019), and epoch 3 or sustainment (January-December 2020). A daily electroencephalogram (EEG) skin assessment tool, introduction in practice of a flexible hydrogel EEG electrode, and successive rapid-cycle staff-education sessions were key interventions of the study.

RESULTS

Seventy-six infants were monitored for 214 continuous EEG (cEEG) days, of which six (13.2%) developed EERPI in epoch 1. Eighty infants were monitored for 193 cEEG days, of which two (2.5%) developed EERPI in epoch 2. One hundred thirty-nine infants were monitored for 338 cEEG days, and none developed EERPI in epoch 3. There was no statistical difference with respect to the median cEEG days among study epochs. A G-chart of EERPI-free days showed an increase in EERPI-free days from an average of 34 days in epoch 1 to 182 days in epoch 2 and 365 days (or zero harm) in epoch 3. Skin erythema from EEG electrodes was noted during the study.

CONCLUSIONS

The structured study interventions eliminated EERPI events in infants monitored with cEEG. Preventive intervention at the cEEG-electrode level coupled with skin assessment successfully reduced EERPIs in neonates.
A basic guide to discharging the postsurgery patient with an ostomy to the community
Authors: Rodriguez Thureiyya
Published: February 2023

It's often the direct care nurse's responsibility to provide education on the discharge process from the time of admission to enhance the patient's overall well-being postsurgery.
Understanding dysgraphia
Authors: Gary Annette , Moore Amy , Hilliard Wanda , Day Mercedes , Boswell Brandon , Barnhill Marilyn
Published: February 2023

Nurses at every stage should be aware of dysgraphia, an easily missed neurologic disorder. Use this article to help identify signs and symptoms, and learn about diagnostics and how to support your patient.
Stroke program development
Authors: Franks-Meeks Sherron
Published: February 2023

Standardizing care can be daunting, but it's well worth the effort. Use this article on stroke program development to better understand the process to standardize stroke care to improve stroke outcomes for your patient(s).
De novo myelodysplastic syndrome in a Rothmund-Thomson Syndrome patient with novel pathogenic RECQL4 variants
Authors: Jiang Chuanhe , Zhang Hao , Zhao Chuxian , Wang Luxiang , Hu Xiaoxia , Pan Zengkai
Published: February 2023

Rothmund-Thomson syndrome (RTS) is a rare autosomal-recessive disorder with clinical features consisting of rash, poikiloderma, sparse hair, short stature, juvenile cataracts, skeletal abnormalities, and cancer predisposition. Genetic studies involving detection of pathogenic RECQL4 variants provide the diagnostic certitude. Osteosarcoma was found in two-thirds RECQL4-mutated RTS patients, while hematological malignancies were rarely reported. The variant diversity of RECQL4 gene has not been fully identified and mutations associated with hematologic malignancies are not well described. In this study, we presented a pedigree of RTS from a Chinese family, among which the proband was diagnosed with de novo myelodysplastic syndrome (MDS). Comprehensive medical examination and chromosome karyotyping were performed on the proband. Whole exome sequencing (WES) was performed on the proband, his sister and his mother. The familial cosegregation of sequence variants derived from WES was conducted by polymerase chain reaction–based Sanger sequencing. Structures of candidate RECQL4 mutants were done by in silico analysis to assess pathogenicity. Three novel RECQL4 germline variants, including c.T274C, c.G3014A, and c.G801C, were identified by WES and validated by Sanger sequencing. Prediction of conformation indicated that the structural stability of human RECQL4 protein was largely affected with these variants. The co-occurring U2AF1 p.S34F and TP53 p.Y220C mutations might contribute to the development of MDS. Our study expands the mutational spectrum of RECQL4 and provides underlying molecular mechanism for the development of MDS in RTS patients.
Emulating Target Trials to Avoid Immortal Time Bias – An Application to Antibiotic Initiation and Preterm Delivery
Authors: Caniglia Ellen C. , Zash Rebecca , Fennell Christina , Diseko Modiegi , Mayondi Gloria , Heintz Jonathan , Mmalane Mompati , Makhema Joseph , Lockman Shahin , Mumford Sunni L. , Murray Eleanor J. , Hernández-Díaz Sonia , Shapiro Roger
Published: February 2023

Background:

Randomized trials in pregnancy are extremely challenging, and observational studies are often the only option to evaluate medication safety during pregnancy. However, such studies are often susceptible to immortal time bias if treatment initiation occurs after time zero of follow-up. We describe how emulating a sequence of target trials avoids immortal time bias and apply the approach to estimate the safety of antibiotic initiation between 24 and 37 weeks gestation on preterm delivery.

Methods:

The Tsepamo Study captured birth outcomes at hospitals throughout Botswana from 2014 to 2021. We emulated 13 sequential target trials of antibiotic initiation versus no initiation among individuals presenting to care <24 weeks, one for each week from 24 to 37 weeks. For each trial, eligible individuals had not previously initiated antibiotics. We also conducted an analysis susceptible to immortal time bias by defining time zero as 24 weeks and exposure as antibiotic initiation between 24 and 37 weeks. We calculated adjusted risk ratios (RR) and 95% confidence intervals (CI) for preterm delivery.

Results:

Of 111,403 eligible individuals, 17,009 (15.3%) initiated antibiotics between 24 and 37 weeks. In the sequence of target trials, RRs (95% CIs) ranged from 1.04 (0.90, 1.19) to 1.24 (1.11, 1.39) (pooled RR: 1.11 [1.06, 1.15]). In the analysis susceptible to immortal time bias, the RR was 0.90 (0.86, 0.94).

Conclusions:

Defining exposure as antibiotic initiation at any time during follow-up after time zero resulted in substantial immortal time bias, making antibiotics appear protective against preterm delivery. Conducting a sequence of target trials can avoid immortal time bias in pregnancy studies.
Postpartum Aeromonas hydrophila Peritonitis and Bacteremia
Authors: Zimilover Adam , Wang Taylor , Sheppard Acacia , Hirschberg Carly I. , Epstein Marcia
Published: February 2023

Aeromonas species can be the source of severe infections in immunocompromised individuals. We present a case of a 35-year-old pregnant patient who developed postpartum septic shock and acute decompensated heart failure in the setting of Aeromonas hydrophilia peritonitis and bacteremia. Her severe presentation was thought to have occurred secondary to underlying liver dysfunction and preeclampsia. We additionally discuss the common presentations and sources of Aeromonas infections along with risk factors for severe systemic disease.
Leuconostoc lactis Bacteremia and Neutropenic Fever
Authors: Bush Larry M. , Williams Justin
Published: February 2023

The epidemiology of bacteremic infections in neutropenic patients has shifted from a previous majority involving gram-positive cocci to an increasing preponderance of gram-negative Enterobacteriaceae species and Pseudomonas aeruginosa. Recommended empiric antimicrobial treatment regimens include an antipseudomonal β-lactam or carbapenem agent while considering risk factors for the possibility of extended-spectrum β-lactamase– or carbapenemase-producing organisms. The addition of vancomycin is generally reserved for the chance of gram-positive cocci infection, principally in patients with central intravascular catheters or soft tissue infections. Persistent or breakthrough bacteremia despite receiving this glycopeptide drug should prompt the clinician to contemplate not only the possibility of vancomycin-resistant enterococci, but also other organisms that possess intrinsic resistance vancomycin, including Leuconostoc species.
Area Deprivation Index and Distress Community Index Scores Are Not Associated With Short-Term and Long-Term Extracorporeal Life Support Outcomes
Authors: Rali Aniket S. , Larson Emilee E. , Tran Lena E. , Rahaman Zakiur M. , Charles Lawrence J. , Stokes John W. , Chin Clifford , Hilton Alistair , Gannon Whitney D. , Bacchetta Matthew D. , Shah Ashish S.
Published: February 2023

Distressed Communities Index (DCI) and Area Deprivation Index (ADI) are two composite ranking scores that report community level socioeconomic status (SES) by ZIP codes. The objective of this study was to evaluate the impact of SES as estimated by DCI and ADI scores on short-term and long-term outcomes after extracorporeal life support (ECLS) at a quaternary medical center. All patients on ECLS between January 1, 2015 and August 31, 2020 (N = 428) at Vanderbilt University Medical Center in Nashville, Tennessee, had their ADI and DCI scores calculated. Primary outcome was mortality during index hospitalization, and secondary outcome was survival to end of study follow-up. There was no significant difference in primary outcome between the top 25% ADI vs. bottom 75% ADI (53.8% vs. 50.6%; p = 0.56) or between top 25% DCI vs. bottom 75% DCI (56.1 vs. 49.2; p = 0.21). Adjusted odds ratio for the primary outcome with ADI and DCI was 1.13 (95% CI, 0.63–2.0; p = 0.67) and 1.28 (95% CI, 0.70–2.34; p = 0.41), respectively. Additionally, there was no significant difference in long-term survival curves based on their ADI or DCI scores. In conclusion, SES as estimated by baseline DCI and ADI scores does not appear to impact short- or long-term survival post-ECLS at a large volume center.

http://links.lww.com/ASAIO/A951
Epidemiologic Assessment of Pediatric Inflammatory Bowel Disease Presentation in NYC During COVID-19
Authors: Rosenbaum Janet E. , Ochoa Kenny Castro , Hasan Faria , Goldfarb Alexa , Tang Vivian , Tomer Gitit , Wallach Thomas
Published: February 2023

Inflammatory bowel disease (IBD) pathogenesis is thought to be induced by a mix of genetic susceptibility, microbial populations, and immune triggers such as infections. Severe acute respiratory syndrome coronavirus 2 (SARS-nCoV2) may have increased capacity to generate autoimmune disease as evidenced by known spikes in diseases such as type 1 diabetes mellitus. Public health interventions like masking and closures additionally created remarkable drops in typical viral infections, with remarkable shifts in influenza-like illness reporting in 2020. This study aims to evaluate the impact of SARS-nCoV2 and associated interventions on pediatric IBD presentation in New York City using records of new diagnoses at a consortium of 4 institutions between 2016 and June 2022. We fit time series model (autoregressive integrated moving average model) to monthly and quarterly number of cases of each disease for January 2016–March 2020 and forecast the period between April 2020 and June 2022. We note no decrease in ulcerative colitis (UC) or Crohn disease (CD) in the aftermath of historic low levels of overall viral illness, and statistically significant increases in CD diagnoses and elevation in UC diagnoses creating a trend suggesting overall increase in IBD diagnoses exceeding the baseline rate of increase. These data suggest a possible linkage between SARS-nCoV2 infection rates and subsequent pediatric IBD presentation.
A review of the scope of direct-to-consumer sexually transmitted infection testing services offered on the internet
Authors: Manca Ellie , Van der Pol Barbara , Exten Cara , Pinto Casey N.
Published: February 2023

Background

The prevalence of sexually transmitted infections (STIs) is at an all-time high. Direct-to-consumer STI testing services may help alleviate this undue health burden. These products are sold online and rarely require interaction with a healthcare professional (HCP). Vendors offer STI self-collection kits or prescriptions for HCP specimen collection. The objective was to understand the scope of direct-to-consumer STI testing services offered and provide recommendations for consumers and industry.

Methods

Seven volunteers searched for “STD tests” on Google from February 1 through March 31, 2021 and shared their top three results. The study team extracted data from consumer-facing information on each website. Descriptive statistics and thematic qualitative analyses were performed.

Results

Twenty vendors were identified. Most vendors (95%) used Clinical Laboratory Improvement Amendments (CLIA)-certified or College of American Pathologists (CAP) accredited laboratories. Analyses distinguished between STI self-collection kits (n = 9) using independent laboratories and HCP specimen collection (n = 10) which used commercial laboratories (n = 1 offered both). The STI self-collection kits were cheaper per test and bundle on average (eg, $79.00 vs $106.50 for chlamydia/gonorrhea), and more closely aligned with clinical recommendations compared with the HCP specimen collection options. Websites often contained inaccurate or misleading information (n = 13), often promoting testing outside of the recommendations.

Conclusions

Direct-to-consumer STI testing services are part of an emerging market lacking regulation. Consumers should select vendors offering prescriptions for HCP specimen collection at CAP accredited and CLIA-certified laboratories. Vendors should provide a screening tool to assess individual patient risk prior to test purchase.
Protecting Sleep Hygiene in the PICU: A Quality Improvement Project
Authors: Dean Nathan P. , Bhattarai Sopnil , Rooney Sara , Gaskell Christy P.
Published: February 2023

OBJECTIVES:

To increase the number of nights without sleep interruptions for routine tasks in recovering PICU patients.

DESIGN:

Prospective quality improvement project.

SETTING:

Single-center, free-standing, tertiary children’s hospital.

PATIENTS:

Patients admitted to the PICU for greater than 72 hours and eligible for early mobilization.

INTERVENTIONS:

A multidisciplinary sleep hygiene team was created to improve sleep hygiene in critically ill patients eligible for early mobilization. This team rewrote local nursing policies to avoid routine tasks between 11 pm and 5 am. The team provided periodic control chart updates to staff detailing progress made protecting sleep. Discussions of sleep hygiene were added to the daily goal sheet and a sleep hygiene order set was created. Finally, the PICU quality dashboard was modified to show whether a sleep hygiene order set was initiated in eligible patients.

MEASUREMENTS AND MAIN RESULTS:

Routine tasks were defined as daily chest radiographs, baths, routine tracheostomy care, central line dressing changes, twice daily medications, weights, and Foley care. After a year of data collection, avoidance of routine pupillary examinations was added to the sleep protection criteria. Baseline data was collected for 2 months prior to the creation of the sleep hygiene team. Screening of eligible patients occurred 1 week each month. The data were analyzed utilizing control charts. Baseline data demonstrated 32% of PICU patients without sleep interruptions. The centerline increased to 58% after the initial interventions but dropped to 33% after inclusion of pupillary checks. Following the introduction of the daily goal sheet, sleep hygiene order set, and tracking on the quality board, 49% of patients went without interruptions.

CONCLUSIONS:

The initiation of a sleep hygiene team along with retiming routine tasks, daily discussions on rounds with the daily goal sheet, introduction of a sleep hygiene order set, and transparent tracking improved the percentage of patients with protected sleep.
Improvement in Multidisciplinary Provider Rounding (Surgical Rounds) in the Pediatric Cardiac ICU: An Application of Lean Methodology*
Authors: Brown Tyler N. , Justice Lindsey , Malik Farhan , Lehenbauer David , O’Donnell Alan , Brown James M. , Powers Tricia , Neogi Smriti , Cooper David S. , Mah Kenneth E.
Published: February 2023

Objectives:

Provider-only, combined surgical, and medical multidisciplinary rounds (“surgical rounds”) are essential to achieve optimal outcomes in large pediatric cardiac ICUs. Lean methodology was applied with the aims of identifying areas of waste and nonvalue-added work within the surgical rounds process. Thereby, the goals were to improve rounding efficiency and reduce rounding duration while not sacrificing critical patient care discussion nor delaying bedside rounds or surgical start times.

Design:

Single-center improvement science study with observational and interventional phases from February 2, 2021, to July 31, 2021.

Setting:

Tertiary pediatric cardiac ICU.

Participants:

Cardiothoracic surgery and cardiac intensive care team members participating in daily “surgical” rounds.

Interventions:

Implementation of technology automation, creation of work instructions, standardization of patient presentation content and order, provider training, and novel role assignment.

Measurements and Main Results:

Sixty-one multidisciplinary rounds were observed (30 pre, 31 postintervention). During the preintervention period, identified inefficiencies included prolonged preparation time, redundant work, presentation variability and extraneous information, and frequent provider transitions. Application of targeted interventions resulted in a 26% decrease in indexed rounds duration (2.42 vs 1.8 min; p = 0.0003), 50% decrease in indexed rounds preparation time (0.53 vs 0.27 min; p < 0.0001), and 66% decrease in transition time between patients (0.09 vs 0.03 min; p < 0.0001). The number of presenting provider changes also decreased (9 vs 4; p < 0.0001). Indexed discussion duration did not change (1 vs 0.98 min; p = 0.08) nor did balancing measures (bedside rounds and surgical start times) change (8.5 vs 9 min; p = 0.89 and 38 vs 22 min; p = 0.09).

Conclusions:

Lean methodology can be effectively applied to multidisciplinary rounds in a joint cardiothoracic surgery/cardiac intensive care setting to decrease waste and inefficiency. Interventions resulted in decreased preparation time, transition time, presenting provider changes, total rounds duration indexed to patient census, and anecdotal improvements in provider satisfaction.
Recently Acquired Blood-borne Virus Infections in Australian Deceased Organ Donors: Estimation of the Residual Risk of Unexpected Transmission
Authors: Dutch Martin J. , Seed Clive R. , Cheng Anthea , Kiely Philip , Patrick Cameron J. , Opdam Helen I. , Knott Jonathan C.
Published: February 2023

Background:

Unexpected donor-derived infections of hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV are rare but important potential complications of deceased organ transplantation. The prevalence of recently acquired (yield) infections has not been previously described in a national cohort of Australian deceased organ donors. Donor yield infections are of particularly significance, as they can be used to gain insights in the incidence of disease in the donor pool and in turn, estimate the risk of unexpected disease transmission to recipients.

Methods:

We conducted a retrospective review of all patients who commenced workup for donation in Australia between 2014 and 2020. Yield cases were defined by having both unreactive serological screening for current or previous infection and reactive nucleic acid testing screening on initial and repeat testing. Incidence was calculated using a yield window estimate and residual risk using the incidence/window period model.

Results:

The review identified only a single yield infection of HBV in 3724 persons who commenced donation workup. There were no yield cases of HIV or HCV. There were no yield infections in donors with increased viral risk behaviors. The prevalence of HBV, HCV, and HIV was 0.06% (0.01–0.22), 0.00% (0–0.11), and 0.00% (0–0.11), respectively. The residual risk of HBV was estimated to be 0.021% (0.001–0.119).

Conclusions:

The prevalence of recently acquired HBV, HCV, and HIV in Australians who commence workup for deceased donation is low. This novel application of yield-case-methodology has produced estimates of unexpected disease transmission which are modest, particularly when contrasted with local average waitlist mortality. Supplemental Visual Abstract;
http://links.lww.com/TXD/A503.
Protection From Second Warm Ischemic Injury Using a Thermal Barrier Bag in Kidney Transplantation
Authors: Ide Kentaro , Nakano Ryosuke , Imaoka Yuki , Sakai Hiroshi , Ono Kosuke , Tanimine Naoki , Tahara Hiroyuki , Ohira Masahiro , Ueda Keiko , Hirata Taizo , Kobayashi Eiji , Ohdan Hideki
Published: February 2023

Background.

Second warm ischemic injury during vascular anastomosis not only adversely affects immediate posttransplant function but also affects long-term patient and graft survival. We developed a pouch-type thermal barrier bag (TBB) composed of a transparent, biocompatible insulation material suitably designed for kidneys and conducted the first-in-human clinical trial.

Methods.

A living-donor nephrectomy was performed using a minimum skin incision procedure. After back table preparation, the kidney graft was placed inside the TBB and preserved during vascular anastomosis. The graft surface temperature was measured before and after vascular anastomosis using a noncontact infrared thermometer. After completion of the anastomosis, the TBB was removed from the transplanted kidney before graft reperfusion. Clinical data, including patient characteristics and perioperative variables, were collected. The primary endpoint was safety, which was assessed by evaluating adverse events. The secondary endpoints were the feasibility, tolerability, and efficacy of the TBB in kidney transplant recipients.

Results.

Ten living-donor kidney transplant recipients with a median age of 56 y (range, 39–69 y) were enrolled in this study. No serious adverse events related to the TBB were observed. The median second warm ischemic time was 31 (27–39) min, and the median graft surface temperature at the end of anastomosis was 16.1 °C (12.8–18.7 °C).

Conclusions.

TBB can maintain transplanted kidneys at a low temperature during vascular anastomosis, which contributes to the functional preservation of transplanted kidneys and stable transplant outcomes.
A Cost-Effectiveness Model to Determine Ostomy-Related Costs of Care and Health Outcomes Among People With an Ostomy in Canada Using a Ceramide-Infused Skin Barrier
Authors: LeBlanc Kimberly , Furtado Stephanie , Mings Deborah , Martin Melanie , Evans Michele , Eaves Deanna , Skountrianos George
Published: February 2023

PURPOSE:

The aim of this study was to determine whether a difference exists in the financial impact of the use of a 2-piece ceramide-infused skin barrier (CIB) versus standard of care barrier (SOC) in Ontario and Alberta using a cost-effectiveness model over a 1-year period for people with a fecal or urinary ostomy.

DESIGN:

A cost-effectiveness model adapted from a previously published work.

SUBJECTS AND SETTING:

The model was populated with data inputs from a hypothetical cohort of 1000 individuals in Ontario and 4000 in Alberta. Model results were assessed for robustness via the use of deterministic and probabilistic sensitivity analyses. The provinces of Ontario and Alberta were chosen because cost data were readily accessible. The combined population of these provinces accounts for 50% of Canada's population.

RESULTS:

An expected cost savings of Can$443.13 (US $322.60) and Can$243.84 (US $177.52) per user for the hypothetical cohort of 1000 individuals in Ontario and 4000 in Alberta per year was obtained for those using a CIB versus a non-infused skin barrier in Ontario and Alberta, respectively. The incremental cost effectiveness ratio (ICER) of CIB to SOC per peristomal skin complication (PSC) avoided and per quality-adjusted life day (QALD) gained was approximately Can$2702 (US $1967)/PSC and Can$1266 (US $922)/QALD for Ontario and approximately Can$1487 (US $1083)/PSC and Can$697 (US $507)/QALD for Alberta. Analysis indicated CIBs remained cost-effective across all sensitivity analyses performed.

CONCLUSIONS:

Finding suggest that a CIB is cost-effective when compared to a barrier not infused with ceramide when applied to persons with an ostomy and residing in the provinces of Alberta and Ontario.