bluuebunny/crossref_metadata_2025 huggingface dataset:
Off-Translation: Bertha Pappenheim’s Yiddish-German
Authors: Johnson Matthew
Published: August 2023

This article centres on Bertha Pappenheim’s translations of Old Yiddish literature, with a particular focus on Die Memoiren der Glückel von Hameln, which was published as a private edition in Vienna in 1910. While the fact that Pappenheim translated Glikl’s Yiddish-language writings into German is well known, little attention has been paid to the particular language of the translated text or to Pappenheim’s techniques of translation more generally. This article delineates Pappenheim’s evolving approach to translation and contextualizes this approach in terms of her feminist and religious commitments. Based on both close and paratextual readings of Die Memoiren der Glückel von Hameln, it identifies a trajectory in Pappenheim’s work from ‘translation proper’ to ‘off-translation’.
Photothermal effective CeO2NPs combined in thermosensitive hydrogels with enhanced antibacterial, antioxidant and vascularization performance to accelerate infected diabetic wound healing
Authors: Zheng Zexiang , Yang Xing , Fang Min , Tian Jinhuan , Zhang Shuyun , Lu Lu , Zhou Changren , Xu Changpeng , Qi Yong , Li Lihua
Published: August 2023

Chronic diabetic wound healing remains a formidable challenge due to susceptibility to bacterial infection, excessive oxidative stress, and poor angiogenesis. To address these issues, a sodium alginate (SA) based photothermal hydrogel dressing with multifunction was fabricated to facilitate wound treatment. Ceria nanoparticles (CeO2NPs) was synthesized, and their antibacterial performance by near-infrared light triggered photothermal effects was first studied and verified in this work. In addition, to release CeO2NPs to achieve antioxidation and pro-vascularization, thermosensitive gelatin (Gel) was utilized to embed the nanoparticles in advance and then composited in SA hydrogel networks. SA network was finally strengthened by acid soaking to form partially crystalline regions to act as natural crosslinkers. Results showed that the Gel/SA/CeO2 hydrogel displayed temperature-responsive release of CeO2NPs, significant antibacterial and antioxidative activity, as well as the ability to remove without injury and promote infected diabetic wound healing with low cytotoxicity, according to antibacterial investigations, cell studies, and in vivo animal studies. This research offers not only a successful method for quickening the healing of diabetic wounds but also a fresh approach to the general use of CeO2NPs.
Adhesive ginsenoside compound K patches for cartilage tissue regeneration
Authors: Yang Jun-Ho , Shin Hyun Ho , Kim Donghyeon , Ryu Ji Hyun , Jin Eun-Jung
Published: August 2023

Biomaterial-based drug delivery systems have been developed to expedite cartilage regeneration; however, challenges related to drug recovery, validation, and efficient drug delivery remain. For instance, compound K (CK) is a major metabolite of ginsenosides that is known to protect against joint degeneration by inhibiting the production of inflammatory cytokines and the activation of immune cells. However, its effects on cartilage degradation and tissue regeneration remain unclear. Additionally, tissue-adhesive drug delivery depots that stably adhere to cartilage defects are required for CK delivery. In this study, CK-loaded adhesive patches were reported to seal cartilage defects and deliver CK to defect sites, preventing cartilage degradation and accelerating cartilage tissue regeneration. Adhesive patches are stable and suitable for application in surgical procedures under physiological conditions and show excellent adhesiveness to cartilage surfaces. In addition, there were no significant differences in the adhesive polymeric networks before and after CK loading. CK-loaded hydrocaffeic acid-conjugated chitosan patches significantly inhibited the stimulation of cartilage-degrading enzymes and apoptosis in osteoarthritic cartilage by releasing CK in cartilage defects. Additionally, the NFkB signaling pathway of released CK from the adhesive patches in the treatment of osteoarthritis is revealed. Thus, the CK-loaded adhesive patches are expected to significantly contribute to cartilage regeneration.
Existence of the Wealth-Consumption Ratio in Asset Pricing Models with Recursive Preferences
Authors: Pohl Walter , Schmedders Karl , Wilms Ole
Published: August 2023

Modern asset pricing models combine recursive preferences with complex dynamics for the underlying consumption process. The existence of solutions is for many of these models an unsettled question. This paper introduces a novel technique to prove existence and nonexistence, as well as uniqueness for models with recursive preferences. The approach applies to many models of interest, including those with long-run consumption risks, with stochastic volatility and jumps, with time-varying consumption disasters, and with smooth ambiguity aversion and learning. Collectively, the proven results settle the existence question for many of today’s leading asset pricing models.
Immediately repaired penile fractures: age is the only predictor of postoperative long-term functional outcomes
Authors: Avci Ibrahim Erkut , Yilmaz Hasan , Cinar Naci Burak , Akdas Enes Malik , Teke Kerem , Culha Mustafa Melih
Published: August 2023

Background

Penile fractures can lead to many functional complications, especially erectile dysfunction (ED). Few studies have evaluated the factors that predict late complications of an immediately repaired penile fracture.

Aim

To identify the potential predictors of long-term poor functional outcomes following immediate surgical intervention for penile fractures.

Methods

Sixty-eight consecutive patients with suspected penile fracture between 2003 and 2022 were retrospectively reviewed. Functional outcomes, postoperative complications, and follow-up duration were obtained from the records of follow-up visits. Age at presentation, location and length of the tunical tear, the presence of urethral rupture, and time to surgery were all analyzed as potential risk factors for postoperative functional outcomes.

Outcomes

Postoperative erectile function and intercourse satisfaction were measured by the IIEF-5 (the 5-item version of the International Index of Erectile Function). Penile curvature, a palpable nodule, and paresthesia/numbness were detected by physical examination. Uroflowmetry was used to assess urinary flow in patients who underwent urethral repair.

Results

Fifty-eight patients were analyzed. The mean ± SD age was 38.1 ± 10.4 years; the median follow-up was 79.0 months (range, 13-180); the median time to surgery was 9.8 hours (4-30); and the median tunical tear length was 15.5 mm (4-40). Urethral rupture was observed in 8 patients (13.8%). In univariable analyses, urethral rupture was associated with postoperative complications (P = .034). In addition, age at presentation and tunical tear size were significantly associated with postoperative complications and ED (P < .05). However, in multivariable analyses, only age at presentation significantly predicted postoperative complications and ED (P = .004 and P = .037).

Clinical Implications

Age at presentation is the most important factor determining the prognosis of immediate surgical repair of the penile fracture, which aids in predicting potential complications and discussing them with patients prior to surgical intervention and during the follow-up period.

Strengths and Limitations

The study’s retrospective design is an important limitation. Furthermore, there were no data on an IIEF-5 outcome measuring preoperative erectile function.

Conclusion

These results revealed an association between (1) urethral rupture, longer tunical tears, and older age and (2) the development of late complications. The remarkable finding of this study was that age at presentation was the only significant predictor of functional complications based on multivariable analyses. This relationship also remained robust in tests evaluating the covariance of the effects of aging on ED.
Engineering Critical Residues of SOX9 Discovers a Variant With Potent Capacity to Induce Chondrocytes
Authors: Sekiguchi Yuya , Fukuda Aya , Nishimura Ken , Hisatake Koji
Published: August 2023

Articular cartilage plays vital roles as a friction minimizer and shock absorber during joint movement but has a poor capacity to self-repair when damaged through trauma or disease. Cartilage tissue engineering is an innovative technique for cartilage regeneration, yet its therapeutic application requires chondrocytes in large numbers. Direct reprogramming of somatic cells to chondrocytes by expressing SOX9, KLF4, and c-MYC offers a promising option to generate chondrocytes in sufficient numbers; however, the low efficiency of the reprogramming system warrants further improvement. Here we referred to structural and functional features of SOX9 and performed alanine-scanning mutagenesis of functionally critical residues in the HMG box and at putative posttranslational modification (PTM) sites. We discovered that a SOX9 variant H131A/K398A, doubly mutated in the HMG box (H131) and at a PTM site (K398), significantly upregulated expression of chondrogenic genes and potently induced chondrocytes from mouse embryonic fibroblasts. The H131A/K398A variant remained unsumoylated in cells and exhibited a stronger DNA-binding activity than wild-type SOX9, especially when complexed with other proteins. Our results show that the novel SOX9 variant may be useful for efficient induction of chondrocytes and illuminate the strategic feasibility of mutating a transcription factor at functionally critical residues to expedite discovery of an optimized reprogramming factor.
14‐3‐3 Proteins stabilize actin and vimentin filaments to maintain processes in renal glomerular podocyte
Authors: Yasuda Hidenori , Fukusumi Yoshiyasu , Zhang Ying , Kawachi Hiroshi
Published: August 2023

14‐3‐3 proteins are a ubiquitously expressed family of adaptor proteins. Despite exhibiting high sequence homology, several 14‐3‐3 isoforms have isoform‐specific binding partners and roles. We reported that 14‐3‐3β interacts with FKBP12 and synaptopodin to maintain the structure of actin fibers in podocytes. However, the precise localization and differential role of 14‐3‐3 isoforms in kidneys are unclear. Herein, we showed that 14‐3‐3β in glomeruli was restricted in podocytes, and 14‐3‐3σ in glomeruli was expressed in podocytes and mesangial cells. Although 14‐3‐3β was dominantly co‐localized with FKBP12 in the foot processes, a part of 14‐3‐3β was co‐localized with Par3 at the slit diaphragm. 14‐3‐3β interacted with Par3, and FKBP12 bound to 14‐3‐3β competitively with Par3. Deletion of 14‐3‐3β enhanced the interaction of Par3 with Par6 in podocytes. Gene silencing for 14‐3‐3β altered the structure of actin fibers and process formation. 14‐3‐3β and synaptopodin expression was decreased in podocyte injury models. In contrast, 14‐3‐3σ in podocytes was expressed in the primary processes. 14‐3‐3σ interacted with vimentin but not with the actin‐associated proteins FKBP12 and synaptopodin. Gene silencing for 14‐3‐3σ altered the structure of vimentin fibers and process formation. 14‐3‐3σ and vimentin expression was increased in the early phase of podocyte injury models but was decreased in the late stage. Together, the localization of 14‐3‐3β at actin cytoskeleton plays a role in maintaining the foot processes and the Par complex in podocytes. In contrast, 14‐3‐3σ at vimentin cytoskeleton is essential for maintaining primary processes.
Myopathy in systemic sclerosis
Authors: Connolly Caoilfhionn M. , Paik Julie J.
Published: August 2023

Purpose of review

Systemic sclerosis associated myopathy (SSc-AM) is a complex, heterogenous disease that is associated with poor outcomes. SSc-AM lacks a clear definition, and continues to be poorly recognized. The purpose of this review is to provide a contemporary overview of the clinical, serological and pathophysiologic findings in SSc-AM to guide optimal recognition and management of this challenging disease manifestation.

Recent findings

There have been several advances in diagnostic techniques to facilitate characterization of SSc-AM, including muscle MRI, in which findings were correlated to distinct histopathologic categories of muscle involvement in SSc, histopathologic findings of prominent fibrosis or inflammation on biopsy, and the identification of novel autoantibodies associated with SSc-AM, which may be associated with distinct clinical phenotypes. In one of the largest studies to date, 17% of a well phenotyped SSc cohort were found to have myopathy, which was an independent risk of death, even after adjusting for potential confounders, further highlighting the importance of timely recognistion and management of SSc-AM.

There is increasing recognition of the importance of SSc-AM. Novel diagnostic tools provide the opportunity for more detailed insights into pathophysiologic mechanisms, which may facilitate the development of a rigorous consensus definition of SSc-AM.
Severe Intervertebral Vacuum Phenomenon is Associated With Higher Preoperative Low Back Pain, ODI, and Indication for Fusion in Patients With Degenerative Lumbar Spondylolisthesis
Authors: Camino-Willhuber Gaston , Schönnagel Lukas , Caffard Thomas , Zhu Jiaqi , Tani Soji , Chiapparelli Erika , Arzani Artine , Shue Jennifer , Duculan Roland , Bendersky Mariana , Zelenty William D. , Sokunbi Gbolabo , Lebl Darren R. , Cammisa Frank P. , Girardi Federico P. , Mancuso Carol A. , Hughes Alexander P. , Sama Andrew A.
Published: August 2023

Study Design:

Retrospective study of prospective collected data.

Objective:

To analyze the association between intervertebral vacuum phenomenon (IVP) and clinical parameters in patients with degenerative spondylolisthesis.

Summary of Background Data:

IVP is a sign of advanced disc degeneration. The correlation between IVP severity and low back pain in patients with degenerative spondylolisthesis has not been previously analyzed.

Methods:

We retrospectively analyzed patients with degenerative spondylolisthesis who underwent surgery. Vacuum phenomenon was measured on computed tomography scan and classified into mild, moderate, and severe. A lumbar vacuum severity (LVS) scale was developed based on vacuum severity. The associations between IVP at L4/5 and the LVS scale, preoperative and postoperative low back pain, as well as the Oswestry Disability Index was assessed. The association of IVP at L4/5 and the LVS scale and surgical decision-making, defined as decompression alone or decompression and fusion, was assessed through univariable logistic regression analysis.

Results:

A total of 167 patients (52.7% female) were included in the study. The median age was 69 years (interquartile range 62–72). Overall, 100 (59.9%) patients underwent decompression and fusion and 67 (40.1%) underwent decompression alone. The univariable regression demonstrated a significantly increased odds ratio (OR) for back pain in patients with more severe IVP at L4/5 [OR=1.69 (95% CI 1.12–2.60), P=0.01]. The univariable regressions demonstrated a significantly increased OR for increased disability with more severe L4/L5 IVP [OR=1.90 (95% CI 1.04–3.76), P=0.04] and with an increased LVS scale [OR=1.17 (95% CI 1.02–1.35), P=0.02]. IVP severity of the L4/L5 were associated with higher indication for fusion surgery.

Conclusion:

Our study showed that in patients with degenerative spondylolisthesis undergoing surgery, the severity of vacuum phenomenon at L4/L5 was associated with greater preoperative back pain and worse Oswestry Disability Index. Patients with severe IVP were more likely to undergo fusion.
Developing Mixed-effects Models to Optimize Prediction of Postoperative Outcomes in a Modern Sample of Over 450,000 Patients Undergoing Elective Cervical Spine Fusion Surgery
Authors: Shahrestani Shane , Brown Nolan J. , Yue John K. , Tan Lee A
Published: August 2023

Study Design:

A retrospective cohort.

Objective:

We utilize big data and modeling techniques to create optimized comorbidity indices for predicting postoperative outcomes following cervical spine fusion surgery.

Summary of Background Data:

Cervical spine decompression and fusion surgery are commonly used to treat degenerative cervical spine pathologies. However, there is a paucity of high-quality data defining the optimal comorbidity indices specifically in patients undergoing cervical spine fusion surgery.

Methods:

Using data from 2016 to 2019, we queried the Nationwide Readmissions Database (NRD) to identify individuals who had received cervical spine fusion surgery. The Johns Hopkins Adjusted Clinical Groups (JHACG) frailty-defining indicator was used to assess frailty. To measure the level of comorbidity, Elixhauser Comorbidity Index (ECI) scores were queried. Receiver operating characteristic curves were developed utilizing comorbidity indices as predictor variables for pertinent complications such as mortality, nonroutine discharge, top-quartile cost, top-quartile length of stay, and 1-year readmission.

Results:

A total of 453,717 patients were eligible. Nonroutine discharges occurred in 93,961 (20.7%) patients. The mean adjusted all-payer cost for the procedure was $22,573.14±18,274.86 (top quartile: $26,775.80) and the mean length of stay was 2.7±4.4 days (top quartile: 4.7 d). There were 703 (0.15%) mortalities and 58,254 (12.8%) readmissions within 1 year postoperatively. Models using frailty+ECI as primary predictors consistently outperformed the ECI-only model with statistically significant P-values for most of the complications assessed. Cost and mortality were the only outcomes for which this was not the case, as frailty outperformed both ECI and frailty+ECI in cost (P<0.0001 for all) and frailty+ECI performed as well as ECI alone in mortality (P=0.10).

Conclusions:

Our data suggest that frailty+ECI may most accurately predict clinical outcomes in patients receiving cervical spine fusion surgery. These models may be used to identify high-risk populations and patients who may necessitate greater resource utilization following elective cervical spinal fusion.
Ocular Surface Homeostasis After Scleral Lens Usage
Authors: Ballet Brice , Behaegel Joséphine , Reppe Sjur , Consejo Alejandra , Aass Hans Christian , Utheim Tor Paaske , Koppen Carina , Ní Dhubhghaill Sorcha
Published: August 2023

Objectives:

The aim of this prospective study is to examine the effects of 5 hours of well-fitted, mini–scleral contact lens (mini-SL) wear on the tear film cytokine expression in healthy eyes.

Methods:

Twenty-three healthy participants were included in the study. One eye of each participant was selected at random, and a mini-SL measuring 16.5 mm in diameter was fitted by an experienced contact lens specialist. The contact lens remained in place for 5 hours. Precorneal tear fluid was collected using capillary tubes at three different time points: baseline before SL insertion (T0), after 5 hours of SL wear (T1), and 3 hours after SL removal (T2). The concentration of 40 inflammatory cytokines at the three different time points was determined using multiplex bead assay.

Results:

Mini–scleral lens wear did not result in significant changes in the cytokine-to-protein ratio after 5 hours of wear on a healthy eye.

Conclusions:

Although a well-fitted mini-SL reduces the rate at which the precorneal tear film is refreshed, 5 hours of lens wear did not appear to significantly affect the tears cytokine-to-protein ratio, suggesting that scleral lenses have minimal impact on corneal cytokine expression.
UPDOs Protective Styles, a Multilevel Intervention to Improve Pre-exposure Prophylaxis Uptake Among Black Cisgender Women: Pretest–Posttest Evaluation
Authors: Randolph Schenita D. , Johnson Ragan , Jeter Elizabeth , McGee Kara , Johnson Allison
Published: August 2023

In the United States, Black cisgender women account for one in five new HIV infections with Black Americans, accounting for 57% of new diagnoses in the South. Pre-exposure prophylaxis (PrEP) is 99% effective at preventing HIV. Still, Black women's uptake remains at 2% due to multiple documented barriers, including lack of awareness and knowledge, mistrust, stigma, and low perceived risk. Culturally relevant interventions leveraging trusted venues, such as beauty salons, can overcome these barriers. This article reports preliminary results of an intervention to improve PrEP knowledge and awareness, PrEP stigma, PrEP trust, and uptake among Black cisgender women. This multilevel, mixed-methods study used a community-engagement approach to develop and pilot a salon-based intervention, Using PrEP and Doing it for Ourselves (UPDOs) Protective Styles. The intervention improved knowledge, awareness, and trust around PrEP among Black cisgender women. PrEP use stigma within interpersonal relationships decreased, but low perceived risk and social stigma remained constant. Culturally and socially acceptable interventions like UPDOs Protective Styles can model health care delivery to improve trust, thus improving uptake over time for this population.
Lipoprotein(a) and calcific aortic valve disease: current evidence and future directions
Authors: Lan Nick S.R. , Khan Zahid , Watts Gerald F.
Published: August 2023

Purpose of review

Calcific aortic valve disease (CAVD), the most common cause of aortic stenosis (AS), is characterized by slowly progressive fibrocalcific remodelling of the valve cusps. Once symptomatic, severe AS is associated with poor survival unless surgical or transcatheter valve replacement is performed. Unfortunately, no pharmacological interventions have been demonstrated to alter the natural history of CAVD. Lipoprotein(a) [Lp(a)], a low-density lipoprotein-like particle, has been implicated in the pathophysiology of CAVD.

Recent findings

The mechanisms by which Lp(a) results in CAVD are not well understood. However, the oxidized phospholipids carried by Lp(a) are considered a crucial mediator of the disease process. An increasing number of studies demonstrate a causal association between plasma Lp(a) levels and frequency of AS and need for aortic valve replacement, which is independent of inflammation, as measured by plasma C-reactive protein levels. However, not all studies show an association between Lp(a) and increased progression of calcification in individuals with established CAVD.

Epidemiologic, genetic, and Mendelian randomization studies have collectively suggested that Lp(a) is a causal risk factor for CAVD. Whether Lp(a)-lowering can prevent initiation or slow progression of CAVD remains to be demonstrated.
Micronutrient intake to protect against osteoporosis during and after critical illness
Authors: Nair Priya , Orford Neil , Kerschan-Schindl Katharina
Published: August 2023

Purpose of review

Improved survival from critical illness has enhanced the focus on ways to augment functional outcomes following discharge from the Intensive Care Unit. An area that is gaining increased attention is the effect of critical illness on bone health and fragility fractures following the episode. This review discusses the micronutrients that may play a role in bone metabolism and the potential benefits of their supplementation to prevent osteoporosis. These include calcium, phosphorous, magnesium, vitamin D, vitamin C, vitamin K, and certain trace elements.

Findings

Although there is sound physiological basis for the involvement of these micronutrients in bone health and fracture prevention, there are few clinically relevant publications in this area with calcium and vitamin D being the best studied to date.

In the absence of high-quality evidence in critically ill populations, attention to measurement and supplementation of these micronutrients as per current guidelines outlining micronutrient requirements in enteral and parenteral nutrition might mitigate bone loss and its sequelae in the recovery phase from critical illness.
Diagnosis and practical management of digoxin toxicity: a narrative review and consensus
Authors: Andrews Paul , Anseeuw Kurt , Kotecha Dipak , Lapostolle Frédéric , Thanacoody Ruben
Published: August 2023

There are currently no universally accepted guidelines for the management of digoxin toxicity. In the absence of clinical practice guidelines, a set of consensus recommendations for management of digoxin toxicity in the clinical setting were developed through a modified Delphi approach. The recommendations highlight the importance of early recognition of signs of potentially life-threatening toxicity that requires immediate treatment with digoxin-specific antibodies. The consensus identifies a straightforward approach to dosing immune antibody fragments according to the presence or absence of signs of life-threatening toxicity. Supportive measures and management of specific signs of toxicity are also covered.
Screening for cryptococcal antigen in asymptomatic people with HIV: urgent need in Eastern India
Authors: Chakravarty Jaya , Reddy Sudheer , Gupta Munesh K. , Tilak Ragini , Diwaker Chakra , Sundar Shyam
Published: August 2023

Objective:

Cryptococcal meningitis (CM) is a leading cause of mortality in people with HIV (PWH). Despite recommendation by the National programme, cryptococcal antigen (CrAg) screening in PWH with CD4+ <200/μl has not been implemented in practice. Therefore, we conducted a prospective study in government funded Antiretroviral treatment centre to determine the prevalence of asymptomatic cryptococcal antigenemia in PWH with CD4+ cell count <200 cells/μl, subclinical cryptococcal meningitis in serum CrAg positive subjects and their outcome.

Method:

Serum CrAg (BIOSYNEX CryptoPS) screening was conducted in newly diagnosed asymptomatic retro-positive adults with CD4+ <200/μl between January 2021 and March 2022. We also conducted cerebrospinal fluid (CSF) CrAg testing in all PWH who were serum CrAg positive and appropriate therapy was instituted. All the enrolled participants were followed up till February 2023.

Result:

Among enrolled 142 PWH patients, 22 (15.49%) were positive for serum CrAg. Among these 22, seven (31.8%) patients had CD4+ cell count between 100 and 199 cells/μl. CSF CrAg was positive in 11 (50%) serum CrAg positive cases. Serum CrAg positivity was significantly associated with low CD4+ cell count, poor clinical stage and concomitant Pneumocystis pneumonia. However, mortality was not significantly different in Serum CrAg positive and negative PWH. None of the deaths in CrAg positive PWH was due to cryptococcal disease.

Conclusion:

Higher prevalence of cryptococcal antigenemia and subclinical CM among PWH with CD4+ cell count <200 cells/μl with good treatment outcomes with therapy reiterates the need for CrAg screening among PWH in Eastern India.
Perception of Health Care Professionals Toward Hospital Accreditation at Johns Hopkins Aramco Healthcare
Authors: Al-Sayedahmed Huda , Al-Qaaneh Ayman , Al-Tawfiq Jaffar , Al-Dossary Basmah , Al-Yami Saeed
Published: August 2023

Background and Objectives:

The quality of health care relies on achieving the best quality and patient safety goals, and accreditation plays a fundamental role in achieving these goals through compliance with standards that guide excellence. Accreditation also helps streamline operations and supports evidence-based quality improvement plans. This study aims to evaluate the perception of health care professionals on the accreditation process and its impact on the quality of health care and patient safety.

Methods:

This is a cross-sectional questionnaire survey distributed via the SuccessFactors website and made accessible to all hospital staff.

Results:

The online questionnaire was completed by 2047 participants, representing 51% of the entire hospital staff at Johns Hopkins Aramco Healthcare (JHAH). Overall analysis indicated a positive perception of accreditation benefits among health care employees (as indicated by participation in accreditation activities and/or preparation for the survey visits) and reflected on patient health care quality and safety dimensions, with an overall Likert median score of 4.0 (interquartile range = 3.7-5.0; P < .05).

Conclusion:

The outcomes of our study confirm that JHAH employees perceived a positive impact of accreditation on health care quality improvement and patient safety. Also, the study supports considering accreditation as a fundamental requirement to improve health care system processes. However, it is critical to sustain quality of services over time during accreditation cycles.
Quality Objectives in Standardized Quality Management Systems
Authors: Bugdol Marek
Published: August 2023

Background and Objectives:

The effectiveness of a quality management system consistent with the ISO 9001 standard depends on how quality objectives are established and pursued. The aims of this article are to identify quality objectives in selected certified organizations providing medical services, assess their compliance with the requirements of the ISO 9001 standard, and determine factors influencing such objectives.

Methods:

The first theoretical part of the article is based on a systematic literature review. The empirical part contains an analysis of documentation related to quality management systems and conducted audits. The data were collected during 42 quality management system audits conducted in 16 health care organizations in the years 2015-2020. Uncategorized interviews were conducted with quality management system representatives. The data were verified by interviews with 6 management system auditors having at least 15 years' experience in auditing health care organizations. The assessment of the methodological correctness is based on the ISO 9001:2015 standard criteria.

Results:

The most frequently formulated quality objectives include improving customer satisfaction, task-based objectives related to planned works, improvements, and development of new medical services. The quality objectives fulfill the requirements of the ISO 9001 standard. However, they are not ambitious. The most significant factors influencing the processes of goal setting are economic (financial incentives, available resources for modernization), social (community needs), and managerial (the scope of performed analyses, the quality of the audit process, and the calculation of necessary effort).

Conclusions:

Health care organizations need to pursue more ambitious objectives, intensify the use of performed medical analyses, and integrate quality objectives into management remuneration systems.
Reduction of Chest Drain Overuse Through Implementation of a Pleural Drainage Order Set
Authors: Tajarernmuang Pattraporn , Valenti David , Gonzalez Anne V. , Artho Giovanni , Tsatoumas Mary , Beaudoin Stéphane
Published: August 2023

Background and Objectives:

Small chest drains are used in many centers as the default drainage strategy for various pleural effusions. This can lead to drain overuse, which may be harmful. This study aimed to reduce chest drain overuse.

Methods:

We studied consecutive pleural procedures performed in the radiology department before (August 1, 2015, to July 31, 2016) and after intervention (September 1, 2019, to January 31, 2020). Chest drains were deemed indicated or not based on criteria established by a local interdisciplinary work group. The intervention consisted of a pleural drainage order set embedded in electronic medical records. It included indications for chest drain insertion, prespecified drain sizes for each indication, fluid analyses, and postprocedure radiography orders. Overall chest drain use and proportion of nonindicated drains were the outcomes of interest.

Results:

We reviewed a total of 288 procedures (pre-intervention) and 155 procedures (post-intervention) (thoracentesis and drains). Order-set implementation led to a reduction in drain use (86.5% vs 54.8% of all procedures, P < .001) and reduction in drain insertions in the absence of an indication (from 45.4% to 29.4% of drains, P = .01). The need for repeat procedures did not increase after order-set implementation (22.0% pre vs 17.7% post, P = .40). Complication rates and length of hospital stay did not differ significantly after the intervention. More pleural infections were treated with drain sizes of 12Fr and greater (31 vs 70%, P < .001) after order-set deployment, and direct procedural costs were reduced by 27 CAN$ per procedure.

Conclusion:

Implementation of a pleural drainage order-set reduced chest drain use, improved procedure selection according to clinical needs, and reduced direct procedural costs. In institutions where small chest drains are used as the default drainage strategy for pleural effusions, this order set can reduce chest drain overuse.
Designing and Evaluating an Emotionally Responsive Virtual Patient Simulation
Authors: Xu Jiayi , Yang Lei , Guo Meng
Published: August 2023

Introduction

Virtual patient (VP) simulations have been widely used for healthcare training, education, and assessment. However, few VP systems have integrated emotion sensing and analyzed how a user's emotions may influence the overall training experience. This article presents a VP that can recognize and respond to 5 human emotions (anger, disgust, fear, joy, and sadness), as well as 2 facial expressions (smiling and eye contact).

Methods

The VP was developed by combining the capabilities of a facial recognition system, a tone analyzer, a cloud-based artificial intelligence chatbot, and interactive 3-dimensional avatars created in a high-fidelity game engine (Unity). The system was tested with healthcare professionals at Changzhou Traditional Chinese Medicine Hospital.

Results

A total of 65 participants (38 females and 27 males) aged between 23 and 57 years (mean = 38.35, SD = 11.48) completed the survey, and 19 participants were interviewed. Most participants perceived that the VP was useful in improving their communication skills, particularly their nonverbal communication skills. They also reported that adding users' affective states as an additional interaction increased engagement of the VP and helped them build connections with the VP.

Conclusions

The emotionally responsive VP seemed to be functionally complete and usable. However, some technical limitations need to be addressed before the system's official implementation in real-world clinical practice. Future development will include improving the accuracy of the speech recognition system, using more sophisticated emotion sensing software, and developing a natural user interface.
A Comparison of Virtual Reality to Traditional Simulation in Health Professions Education
Authors: Foronda Cynthia L. , Gonzalez Laura , Meese Merrick M. , Slamon Nicholas , Baluyot Mariju , Lee Jiye , Aebersold Michelle
Published: August 2023

With the increasing availability of virtual reality (VR) and its lower overall costs of use, the objective of this review was to compare VR to traditional simulation in terms of learning outcomes. Studies were included if they met the following criteria: (a) research study (of any design), (b) focused on learners in health professions, and (c) compared VR with traditional simulation. Studies were excluded for the following reasons: (a) not a research study, (b) focused on learners outside health professions, (c) used screen-based or computer-based simulation, (d) used a task trainer, and (e) did not involve a comparison of VR to traditional simulation. The searches were run on November 11 and 12, 2021, in CINAHL via EBSCO, Ovid Embase, ERIC via EBSCO, IEEE Xplore, Ovid Medline, Ovid PsycINFO, Scopus, and Web of Science Core Collection. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines guided the review. A team of researchers applied Kirkpatrick's Levels, Melnyk's Levels of Evidence, and Critical Appraisal Skills Programme guidelines to assess the level of evidence and look for bias. Fifteen studies were reviewed including 11 randomized controlled trials. The lead researcher synthesized the study results into 3 categories: (1) traditional simulation performed better, (2) VR performed better, and (3) comparable outcomes. There is insufficient evidence to endorse one form of simulation (VR or traditional) as more effective at this time. The body of evidence contained too few studies to draw meaningful conclusions to answer the guiding question. The studies covered a large range of modalities, learner groups, and healthcare topics, preventing a meta-analysis. Based on the literature and experience, we recommend that VR experiences be proctored, include debriefing, have a backup plan for cybersickness or myopia, and have time and costs documented. Use of VR is likely to expand; thus, research is needed to inform the best contexts and applications.
Nursing assessments of women with hypertensive disorders during labor in an academic medical center in Mississippi: a best practice implementation project
Authors: Price Tara , Palokas Michelle , Patel Nital
Published: August 2023

Objectives:

The objective of this project was to promote evidence-based practices regarding the nursing assessment of pregnant women with hypertensive disorders admitted to the intrapartum unit.

Introduction:

Hypertension during pregnancy has been associated with adverse maternal and fetal outcomes. Ongoing evaluation and nursing care are key in the prevention of complications resulting from hypertensive disorders in pregnancy.

Methods:

The implementation of this best practice project was guided by the JBI Model of Evidence-based Healthcare and used the JBI Practical Application of Clinical Evidence System and Getting Research into Practice audit and feedback strategy to promote evidence-based practices regarding the nursing assessment of pregnant women with hypertensive disorders admitted to an intrapartum unit. Eight audit criteria that were representative of best-practice recommendations for nursing assessment of pregnant women with hypertensive disorders were used. A baseline audit was conducted, followed by the implementation of multiple strategies that were determined by the key stakeholders. The project was finalized with a follow-up audit to determine a change in compliance with best-practice recommendations.

Results:

Baseline audits revealed an average 45% compliance rate with the eight best practice audit criteria. An on-site simulation event, which included a nursing assessment of normal and abnormal lung sounds along with the hands-on practice of deep tendon reflexes, was provided by project members. Evidence-based assessment guidelines were presented and reviewed with all participants. Input from the nursing staff was gathered regarding current documentation practices and electronic health record accessibility. As a result, an electronic health record change was requested, and improvements in nursing practice were observed for five of the eight audit criteria. Follow-up audits revealed an average compliance rate of 73% for all eight audit criteria, a 28% improvement.

Conclusion:

Continuing nursing education and ongoing competency refreshers can affect the quality of client care and outcomes by offering occasions to improve or strengthen clinical expertise and proficiency. For this project, the simulation training event improved nursing staff compliance with best practices.
Continued adaptation of A/H2N2 viruses during pandemic circulation in humans
Authors: Kutter Jasmin S. , Linster Martin , de Meulder Dennis , Bestebroer Theo M. , Lexmond Pascal , Rosu Miruna E. , Richard Mathilde , de Vries Robert P. , Fouchier Ron A. M. , Herfst Sander
Published: August 2023

Influenza A viruses of the H2N2 subtype sparked a pandemic in 1957 and circulated in humans until 1968. Because A/H2N2 viruses still circulate in wild birds worldwide and human population immunity is low, the transmissibility of six avian A/H2N2 viruses was investigated in the ferret model. None of the avian A/H2N2 viruses was transmitted between ferrets, suggesting that their pandemic risk may be low. The transmissibility, receptor binding preference and haemagglutinin (HA) stability of human A/H2N2 viruses were also investigated. Human A/H2N2 viruses from 1957 and 1958 bound to human-type α2,6-linked sialic acid receptors, but the 1958 virus had a more stable HA, indicating adaptation to replication and spread in the new host. This increased stability was caused by a previously unknown stability substitution G205S in the 1958 H2N2 HA, which became fixed in A/H2N2 viruses after 1958. Although individual substitutions were identified that affected the HA receptor binding and stability properties, they were not found to have a substantial effect on transmissibility of A/H2N2 viruses via the air in the ferret model. Our data demonstrate that A/H2N2 viruses continued to adapt during the first year of pandemic circulation in humans, similar to what was previously shown for the A/H1N1pdm09 virus.
School Closures due to Seasonal Influenza: Experience from Eleven Influenza Seasons – United States, 2011–2022
Authors: Zviedrite Nicole , Jahan Ferdous , Zheteyeva Yenlik , Gao Hongjiang , Uzicanin Amra
Published: August 2023

While there are numerous studies about influenza pandemic-associated school closures, literature is scant regarding closures associated with seasonal influenza. To address this knowledge gap, we conducted systematic daily online searches from August 1, 2011– June 30, 2022, to identify public announcements of unplanned school closures in the US lasting ≥1 day, selecting those that mentioned influenza and influenza-like illness (ILI) as reason for school closure (ILI-SCs). We studied ILI-SC temporal patterns and compared them with reported outpatient ILI-related healthcare visits and laboratory confirmed influenza hospitalizations with attention to the difference between the pre-COVID-19 pandemic and the COVID-19-affected years. We documented that ILI-SCs occurred annually and concurrently with, and likely as a consequence of, widespread illness. The strongest correlations were primarily observed during influenza A (H3N2)-dominant seasons. ILI-SCs were heavily centered in HHS Region 4 and disproportionately impacted rural and lower-income communities.

Article summary line

Influenza-related school closures occurred annually in the US and their temporal patterns mirror the general patterns of influenza activity on both national and regional levels as observed through routine surveillance of medically attended ILI.
Population mortality before and during armed conflict in Yemen: geospatial and statistical analysis of cemetery data
Authors: Checchi Francesco , Besson Emilie Koum , Ali Ola , Alhaffar Mervat , Saeed Naji , Vasquez Yolanda , Freemantle Terri , Ashraf Momin , Reeve Chris , Scott Colin , Lingard Timothy , Norris Andy
Published: August 2023

Since 2014, Yemen is affected by crisis conditions due to armed conflict. Evidence on the impact of this large-scale crisis on mortality is lacking. We analysed archive very high-resolution satellite imagery from a sample of Yemeni subdistricts to quantify changes in burial incidence attributable to the crisis.

We identified possible cemeteries through remote and ground sources in 24 sampled subdistricts. After initial triage and extensive steps to improve the interpretability of archive imagery spanning the period 2011 to 2021, a pool of crowd workers, supervised by expert analysts and aided by an automated algorithm, annotated surface area and grave counts in sequential images from a set of analysis-eligible cemeteries. We complemented these longitudinal observations with data on different predictors including three crisis proxies (incidence of insecurity events, price of staple cereal, internal displacement), and fitted statistical models to compare predicted burials under observed and assumed counterfactual (no crisis) conditions.

We identified 561 potential cemeteries within 24 sampled subdistricts, but excluded most due to inability to geolocate them or see the cemetery and/or graves in available imagery, yielding an effective sample of 110 image observations across 35 cemeteries in 10 subdistricts. Burial rate generally decreased between 2014-2018 and rose sharply thereafter. Alternative regression models suggested that most cemeteries would have experienced lower burial rate under non-crisis conditions, with a crisis to non-crisis ratio of about two overall. The incidence of insecurity events appeared positively associated with burial rate.

This unprecedented-scale geospatial analysis of cemeteries suggests an increase in burial rates attributable to crisis conditions in a non-representative, disproportionately urban sample of Yemen. The study identifies key challenges of such an analysis. We discuss possible methodological ways forward to further explore the feasibility and validity of this option for mortality estimation in settings with insufficient vital events registration and limited ground access.
Aberrant activation of the innate immune sensor PKR by self dsRNA is prevented by direct interaction with ADAR1
Authors: Sinigaglia Ketty , Cherian Anna , Vukic Dragana , Melicherova Janka , Linhartova Pavla , Du Qiupei , Zerad Lisa , Stejskal Stanislav , Malik Radek , Prochazka Jan , Bondurand Nadège , Sedlacek Radislav , O’Connell Mary A. , Keegan Liam P.
Published: August 2023

Loss of dsRNA editing by Adar1 leads to aberrant interferon induction inAdarnull mouse embryos.Adar Mavsmutants, in which this interferon induction is prevented, die within two weeks of birth. We show here that early death of pups is reduced inAdar Mavs EIF2αk2(Pkr) mutants, identifying PKR as the second aberrantly activated dsRNA sensor inAdarmutant mice. In intestines ofAdar Mavspups transit amplifying progenitor cells in intestinal crypts die and intestinal villi are lost in pups before death; intestinal defects are prevented inAdar Mavs Eifak2. In human A549 lung cancer cells ADAR1 forms a complex with PKR. AlphaFold modelling predicts a direct inhibitory interaction of ADAR1 dsRBDIII with the PKR near the kinase active site and a new mode for ADAR1 dsRNA-binding. Mutations at residues required for ADAR1 dsRNA binding or for predicted PKR contacts, prevent interaction with PKR.
Heterogeneity of synaptic connectivity in the fly visual system
Authors: Cornean Jacqueline , Molina-Obando Sebastian , Gür Burak , Bast Annika , Ramos-Traslosheros Giordano , Chojetzki Jonas , Lörsch Lena , Ioannidou Maria , Taneja Rachita , Schnaitmann Christopher , Silies Marion
Published: August 2023

Visual systems are homogeneous structures, where repeating columnar units are stereotypically arranged to retinotopically cover the visual field. Each of these columns contain many of the same neuron types that are distinguished by anatomic, genetic and – generally – by functional properties. However, there are exceptions to this rule. In the 800 visual columns of theDrosophilaeye, there is an anatomically and genetically identifiable cell type with variable functional properties, Tm9. Since anatomical connectivity shapes functional neuronal properties, we identified the presynaptic inputs of several hundred Tm9s across both optic lobes using the FAFB connectome dataset and FlyWire analysis. Our work shows that Tm9 has three major, stereotypic, and many weaker, sparsely distributed inputs. This differs from the presynaptic connectivity of neurons with uniform properties, Tm1 and Tm2, which have only one major, and more stereotypic inputs than Tm9. Within the heterogeneous circuit architecture, we identified specific motifs, such as a set of wide-field neurons, which can be the source of the variable Tm9 physiology. Genetic synapse labeling combined with expansion microscopy showed that the heterogeneous wiring exists across individuals. Together, our data argue that the visual system uses heterogeneous, distributed circuit properties to achieve robust visual processing.