bluuebunny/crossref_metadata_2025 huggingface dataset:
The Feasibility and Effects of Smartphone-Based Application on Cardiac Rehabilitation for Patients After Percutaneous Coronary Intervention
Authors: Lao Sarah Sio Wa , Chair Sek Ying , Wang Qun , Leong Mirian Lap Tong
Published: April 2023

Background

Cardiac rehabilitation (CR) referral and participation are generally found to be underused worldwide. The data in Asian regions suggest significant underutilization compared with western countries.

Objectives

To promote the continuity and effects of CR, this study aimed at supporting self-care and improving CR effects in phase II CR with mobile health application for Macao patients who have undergone percutaneous coronary intervention.

Methods

The study was a randomized controlled trial conducted between January 2018 and June 2020 in a nongovernmental Hospital. Social cognitive theory was applied in the intervention for an experimental group. Measurements including anxiety and depression level, medication adherence, exercise capacity, physical activity level, cardiovascular risk modification, self-efficacy, quality of life, use of healthcare resources, mHealth CR utility, and satisfaction were analyzed.

Results

One hundred forty eligible patients were recruited, and 110 patients completed the study. Significant interventional effects of the experimental group were found on the reduction of total cholesterol, low-density lipoprotein, sitting time, anxiety level, and total anxiety and depression level (P < .05). In addition, significant improvement on the 6-minute walk test, regular exercise performance, self-efficacy of cardiac exercise and diet, and quality of life were found as interventional effects in the experimental group (P < .05). The feasibility of intervention was achieved in a satisfactory level.

Conclusions

This theoretically grounded mobile health CR study was a unique program tailor-made to meet the care needs of patients post percutaneous coronary intervention. It was feasible and effective to support CR effects and adherence and would inform further design of clinical practice and public policies.
The Mediating Role of Sleep Quality in the Association Between Negative Affect and Cognitive Function Among Patients With Nasopharyngeal Carcinoma After Intensity-Modulated Radiotherapy
Authors: Chen Ximei , Fan Yuying , Yan Minghui , Zhang Jun-e
Published: April 2023

Background

Cognitive function impairment is a severe yet largely unrecognized adverse reaction among patients with nasopharyngeal carcinoma (NPC) following radiotherapy.

Objectives

The aims of this study were to examine the level of cognitive function, explore the influencing factors of the cognitive function of NPC after intensity-modulated radiotherapy (IMRT), and identify the mediating role of sleep quality between negative affect and cognitive function.

Methods

In total, 200 patients with NPC after IMRT were recruited from a tertiary cancer center in Southern China between September 2020 and March 2021. Participants completed the demographic and disease-related questionnaire, Montreal Cognitive Assessment Scale, Profile of Mood States–Short Form, and Pittsburgh Sleep Quality Index.

Results

The mean Montreal Cognitive Assessment Scale scores were 24.42 after adjustment, with 54.5% of patients having cognitive function impairment. Education level, income, seeking rehabilitation knowledge, radiation dose, sleep quality, and negative affect entered the final regression model and explained 82.6% of cognitive function variance. The total and direct effects of negative affect and indirect effects via sleep quality on cognitive function were significant (P < .05).

Conclusions

Clinicians should pay close attention to patients with poor educational levels, low income, and having difficulties seeking rehabilitation knowledge and patients who accept higher radiation doses. Improving their sleep quality and positive affect may contribute to preventing or reducing cognitive function impairment.

Implications for Practice

Clinical nurses should pay more attention to cognitive function among NPC patients after IMRT and take effective measures or interventions to prevent and reduce their cognitive function impairment.
A Quality Improvement Approach to Violence Reduction
Authors: DeSouza Fabio , Bleich Michael
Published: April 2023

Background:

The impact of aggressive and violent behaviors directed toward staff in psychiatric facilities has layers of implications tied to recruitment and retention, cost, quality and safety.

Local Problem:

Increased patient aggressive behaviors contributed to staff dissatisfaction and high turnover rates, triggering an analysis of current aggression management approaches.

Methods:

The Plan-Do-Study-Act quality improvement method was used for this project.

Interventions:

The Dynamic Appraisal of Situational Aggression (DASA) risk assessment tool was implemented.

Results:

Daily aggression risk identification increased by 69%, and aggressive incidents toward staff and patients decreased by 64% and 28%, respectively, when the tool was completed more consistently. Surveys revealed acceptance of the tool by nurses.

Conclusions:

Quality improvement statistical tools supported evidence-based strategies. A risk for aggression assessment laid the foundations for implementing strategies for reducing aggression and violence.
Using Video to Describe the Patient-Controlled Analgesia Pump Programming Process
Authors: Manojlovich Milisa , Barwig Katie , Bekele Jember , Bradshaw Kimberly , Ali Charania Nadia Ali Muhammad , Lundy Francene , Streelman Marisa , Leech Christine
Published: April 2023

Background:

Patient-controlled analgesia (PCA) pumps are complex medical devices frequently used for postoperative pain control. Differences in how nurses program PCA pumps can lead to preventable medication errors.

Purpose:

To describe similarities and differences in how surgical nurses program PCA pumps.

Methods:

We conducted a qualitative study using video reflexive ethnography (VRE) to film nurses as they programmed a PCA pump. We spliced and collated videos into separate clips and showed to nursing leaders for their deliberation and action.

Results:

We found nurses ignored or immediately silenced alarms, were uncertain about the correct programming sequence, and interpreted how to load a syringe in the pump in multiple ways; in addition, the PCA pump design did not align with nurses' workflow.

Conclusions:

VRE was effective in visualizing common challenges nurses experienced during PCA pump programming. Nursing leaders are planning several nursing process changes due to these findings.
Contribution of Comorbid Conditions to the Diagnosis of Insomnia
Authors: Liu Xinyue , Dibello Julia , Mott Katrina , Wang Yuanxin , Chekani Farid , Bortnichak Edward A. , Liaw Kai-Li , Zhong Wenjun
Published: April 2023

Insomnia is a common sleep disorder characterized as dissatisfaction with sleep quantity or quality resulting in distress or impairment of social, occupational, or other daily functioning. It is unknown if there are medical conditions that have strong associations with insomnia but are unrecognized in previous literature. In this cross-sectional study based on IBM Marketscan Research Databases, we measured insomnia and 78 medical conditions in patients with 2-year continuous enrollment during 2018–2019. We selected important comorbidities associated with insomnia for eight age-sex groups and built logistic regression models to measure the associations. The prevalence of diagnosed insomnia increased with age, from <0.4% in the age group 0–17 to 4%–5% in the age group ≥65. Females had a higher prevalence of insomnia than males. Anxiety and depression were two important comorbidities across all age-sex subgroups. Most odds ratios of comorbidities remained significant after adjusting for other comorbidities in regression models. We did not find any new medical conditions that had strong associations with insomnia but were unrecognized in previous literature. The findings can help physicians use comorbidities to identify patients with high risk of insomnia.
Wischnewski Spots in a Case of Hyperosmolar Hyperglycemic State
Authors: Lai Jonathan K. , Hickey Tyler B. M.
Published: April 2023

Wischnewski spots were first described as a common finding in gastric mucosa of decedents exposed to hypothermic environmental conditions. In recent literature, they were also reported in cases of diabetic ketoacidosis, pancreatitis, and fatal burns. Although Wischnewski spots are not specific to cases of hypothermia, we present a case that further supports this contention. We report a case of a middle-aged woman with type 2 diabetes who died of complications of hyperosmolar hyperglycemic state. Although there were no features of hypothermia, she presented with Wischnewski spots in the gastric mucosa. On histology, the gastric mucosa contained brown-black pigmentations with no neutrophilic infiltration. Biochemical analysis from vitreous humor and femoral blood showed marked elevation of glucose levels, low concentration of ketone bodies, pseudohyponatremia, and prerenal azotemia. The autopsy findings in this case discussion shed light to the possible genesis and pathophysiology of Wischnewski spots and highlight an additional differential diagnosis for these lesions.
Exertional-Related Sudden Cardiac Death in a Young, Presumed Healthy, and Medically Screened Population
Authors: McLeod Elizabeth V. , Walsh John C. , Haigney Mark C. , Franzos Marc Alaric , Hellwig Lydia D.
Published: April 2023

Sudden cardiac death (SCD) is defined as death from cardiac causes with loss of consciousness occurring within 1 hour of a change in cardiovascular status. As subset, SCD associated with physical exertion (SCD/E) can be defined as a cardiac event whose symptoms start during or within 1 hour of physical exertion. The US military represents a unique opportunity for studying SCD/E because of medical screening at recruitment, mandatory physical training, an active surveillance system, and centralized autopsy services. Because of medical screening, recruits are presumed healthy, but significant conditions can go undetected. We present 4 diverse cases of SCD/E in the military setting. Sudden cardiac death associated with physical exertion is often the first indication of a serious occult cardiac pathology. Postmortem genetic testing revealed a causative pathogenic mutation in 1 of 4 cases, enabling genetic testing of family members to prevent similar catastrophic loss of life, underscoring the importance of postmortem evaluation including genetic testing. Further investigations will help direct screening and prevention to capture those at risk for SCD. The cases presented in this series are a sample of the diverse etiologies and contexts surrounding SCD/E in the military setting that have been captured by Armed Forces Medical Examiner System.
Prevalence and Incidence of Pediatric Acute Respiratory Distress Syndrome in a Tertiary Academic PICU in South Africa
Authors: Lozano Ray Eleonora I. , Argent Andrew C. , Lupton-Smith Alison , Salie Shamiel , Morrow Brenda M.
Published: April 2023

Objectives:

To determine the prevalence and incidence of pediatric acute respiratory distress syndrome (pARDS) among infants and children admitted to the PICU.

Design:

A single-center descriptive point prevalence study with twice weekly data collection over a 6 months (August 2020 to February 12, 2021).

Setting:

Red Cross War Memorial Children’s Hospital, Cape Town, South Africa.

Patients:

All infants and children admitted to the PICU on study days were included.

Interventions:

Data were captured electronically on a standardized case record form using a Research Electronic Data Capture electronic database.

Measurements and Main Results:

The Pediatric Acute Lung Injury Consensus Conference criteria were used to define pARDS cases. Prevalence was calculated as the total number of pARDS cases/1,000 PICU bed days. The study included 354 patients (median [interquartile range]) 10.1 months old (1.5–61.3 mo old), with 204 males (57.6%), who occupied 879 bed days. Of these 879 bed days, 266 (30.3%; 95% CI, 27.2–33.3%) were occupied by pARDS cases, with a calculated prevalence and incidence of 302.6 of 1,000 bed days (30.3%) and 29.7% (95% CI, 26.7–32.7%), respectively. Three cases from the cohort were defined using the oxygen saturation index calculation. In cases receiving invasive ventilation (n = 494; 56.2%), pARDS severity was classified as mild (n = 143; 16.3%), moderate (n = 44; 5.0%), and severe (n = 29, 3.3%). A further 205 beds (23.3%) were occupied by patients classified as being at risk of pARDS.

Conclusions:

The prevalence and incidence of pARDS in a South African PICU appears substantially higher than findings described in international reports. Further investigation of risk factors and outcomes is warranted.
Admission Pao 2 and Mortality Among PICU Patients and Select Diagnostic Subgroups
Authors: Holton Caroline , Lee Brian R. , Escobar Hugo , Benton Tara , Bauer Paul
Published: April 2023

OBJECTIVES:

Evaluate the relationship between admission Pao
2 and mortality in a large multicenter dataset and among diagnostic subgroups.

DESIGN:

Retrospective cohort study.

SETTING:

North American PICUs participating in Virtual Pediatric Systems, LLC (VPS), 2015–2019.

PATIENTS:

Noncardiac patients 18 years or younger admitted to a VPS PICU with admission Pao
2.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Thirteen thousand seventy-one patient encounters were included with an overall mortality of 13.52%. Age categories were equally distributed among survivors and nonsurvivors with the exception of small differences among neonates and adolescents. Importantly, there was a tightly fitting quadratic relationship between admission Pao
2 and mortality, with the highest mortality rates seen among hypoxemic and hyperoxemic patients (likelihood-ratio test p < 0.001). This relationship persisted after adjustment for illness severity using modified Pediatric Index of Mortality 3 scores. A similar U-shaped relationship was demonstrated among patients with diagnoses of trauma, head trauma, sepsis, renal failure, hemorrhagic shock, and drowning. However, among the 1,500 patients admitted following cardiac arrest, there was no clear relationship between admission Pao
2 and mortality.

CONCLUSIONS:

In a large multicenter pediatric cohort, admission Pao
2 demonstrates a tightly fitting quadratic relationship with mortality. The persistence of this relationship among some but not all diagnostic subgroups suggests the pathophysiology of certain disease states may modify the hyperoxemia association.
The Relationship Between Esophageal Pressure and Diaphragm Thickening Fraction in Spontaneously Breathing Sedated Children: A Feasibility Study
Authors: De Meyer Gregory R. , Flamey Loïc , Adriaensens Ine , Van der Aerschot Marjan , Van de Walle Hanne , Vanmarsenille Ignace , Jorens Philippe G. , Goligher Ewan C. , Saldien Vera , Schepens Tom
Published: April 2023

OBJECTIVES:

Diaphragm ultrasound is a novel alternative to esophageal pressure measurements in the evaluation of diaphragm function and activity, but data about its reliability in a pediatric setting are lacking. We aimed to compare the esophageal pressure swing (∆Pes, gold standard) with the diaphragmatic thickening fraction (DTF) as a measure of inspiratory effort in sedated children. Additionally, we studied the effect of positive end-expiratory pressure (PEEP) on the end-expiratory thickness of the diaphragm (DTee).

DESIGN:

Prospective open-label non-randomized interventional physiological cohort study.

SETTING:

Operating room in tertiary academic hospital.

PATIENTS:

Children 28 days to 13 years old scheduled for elective surgery with general anesthesia, spontaneously breathing through a laryngeal mask airway, were eligible for inclusion. Exclusion criteria were disorders or previous surgery of the diaphragm, anticipated difficult airway or acute cardiopulmonary disease. All measurements were performed prior to surgery.

INTERVENTIONS:

Patients were subjected to different levels of respiratory load, PEEP and anesthetic depth in a total of seven respiratory conditions.

MEASUREMENTS AND MAIN RESULTS:

The esophageal pressure and diaphragm thickening fraction were simultaneously recorded for five breaths at each respiratory condition. The relation between ∆Pes and DTF was studied in a mixed model. We analyzed 407 breaths in 13 patients. Both DTF (p = 0.03) and ∆Pes (p = 0.002) could detect respiratory activity, and ∆Pes and DTF were associated across respiratory conditions (p < 0.001; R
2 = 31%). With increasing inspiratory load, ∆Pes increased significantly, while DTF did not (p = 0.08). Additionally, DTee did not differ significantly between 10, 5, and 0 cm H2O PEEP (p = 0.08).

CONCLUSIONS:

In spontaneously breathing sedated children and across different respiratory conditions, DTF could differentiate minimal or no inspiratory effort from substantial inspiratory effort and was associated with ∆Pes. Increased efforts resulted in higher ∆Pes but not larger DTF.
GRAFT AND FLAP. A NOVEL ORTHOPLASTIC APPROACH TO ACHILLES TENDON SECONDARY RUPTURE
Authors: Maruccia Michele , Tedeschi Pasquale , Caizzi Gianni , Palmiotto Florianna , Di Summa Pietro G , Vicenti Giovanni , Moretti Biagio , Giudice Giuseppe , Elia Rossella
Published: April 2023

The Achilles tendon rupture represents one of the most common tendon ruptures. Although its primary repair remains the treatment of choice, surgical complications, such as secondary rupture and tendon exposure, require salvage procedures. This study aims to present our orthoplastic approach for the functional reconstruction of composite secondary Achilles tendon defects. Seven patients with chronic open wound and large Achilles tendon defects (Kuwada type IV) underwent one-stage reconstruction between October 2018 and October 2020. The average soft tissue defect was 126,2 (range, 86,1–175,9 cm2) with a tendon gap of 8,2 cm (range, 7,1–10,3 cm). A combined team of orthoplastic surgeons performed the reconstructive procedure with a turndown gastrocnemius fascial flap and a fascia lata autograft for the tendon reconstruction and a free fasciocutaneous anterolateral thigh flap for soft tissue coverage (graft and flap). Subjective evaluation and quality-of-life measures were obtained preoperatively and 12 months postoperatively using AOFAS and SF-36 questionnaire. Mean follow-up was 18,3 months (range, 12–24 months). Flap survival was 100%. Overall range of motion of the reconstructed side was 87% of the unaffected side (54 degrees vs. 62 degrees). The SF-36 and AOFAS scores of all patients improved significantly (p < 0.005) at 12 months of follow-up. Microsurgical approach combined with orthopedic techniques can solve complex cases of Achilles tendon secondary rupture providing a reconstructed tendon that achieves satisfactory anatomical shape and function.
Parents’ Perceptions of Social Media Use by Pediatric Plastic Surgeons
Authors: Huffman Samuel S. , Hetzler Peter T. , Baker Stephen B. , Vercler Christian J. , Fan Kenneth L.
Published: April 2023

Background:

Pediatric craniofacial surgeons face specific ethical and professional concerns regarding the growth of social media use in plastic surgery. We sought to elucidate parents’ views on social media use by pediatric craniofacial surgeons. In addition, the study examines issues of consent, assent, and exploitation.

Methods:

An anonymous 51-question, multiple-choice survey investigating parents’ views of pediatric plastic surgeons’ social media use was crowdsourced through Prolific.Co.

Results:

Six hundred eighty-one parents responded to the survey. Of the 656 included respondents, 88% to 93% believe that surgeons need to obtain consent from the parents to post pictures of the pediatric patient on social media, regardless of age. Respectively, 84.5% and 75% of respondents believe the surgeon needs to document assent from the 12- and 10-year-old patient. Parents who follow plastic surgeons on social media are more likely to agree that assent needs to be documented from all pediatric patients, regardless of age, before posting pictures on social media. The mean age at which respondents believe physicians should be required to elicit assent from the pediatric patient to post pictures was 9.65-years-old. Approximately 40% of respondents felt that patients portrayed in pictures on social media were being exploited, irrespective of the child’s stated age.

Conclusion:

Plastic surgeons need to recognize parents’ perceptions regarding social media use when considering posting pictures of pediatric patients on social media. The data suggest that surgeons should elicit assent from patients as young as 9-years-old prior to posting pictures on social media.
“A Road Map to Creating a High-Quality Clinical Database in Plastic Surgery”
Authors: Irgebay Zhazira , Bruce Madeleine K. , Fantuzzo Jennifer A. , Beiriger Justin W. , Anstadt Erin E. , Dvoracek Lucas A. , Smetona John , Losee Joseph E. , Goldstein Jesse A.
Published: April 2023

Background:

Detailed in-house databases are a staple of surgical research and a crucial source of data for many studies from which clinical guidelines are built. Despite the importance of generating a clear and thorough developmental design, the literature on database creation and management is limited. Here we present our stepwise single institution process of developing a clinical facial fracture database.

Methods:

We outline the process of development of a large single-institution clinical pediatric facial fracture database. We highlight critical steps from conception, regulatory approval, data safety/integrity, human resource allocation, data collection, quality assurance, and error remediation. We recorded patient characteristics, comorbidities, details of the sustained fracture, associated injuries, hospitalization information, treatments, outcomes, and follow-up information on REDCap (Research Electronic Data Capture). Protocols were created to ensure data quality assurance and control. Error identification analysis was subsequently performed on the database to evaluate the completeness and accuracy of the data.

Results:

A total of 4451 records from 3334 patients between 2006 and 2021 were identified and evaluated to generate a clinical database. Overall, there were 259 incorrect entries out of 120,177 total entries, yielding a 99.8% completion rate and a 0.216% error rate.

Conclusion:

The quality of clinical research is intrinsically linked to the quality and accuracy of the data collection. Close attention must be paid to quality control at every stage of a database setup. More studies outlining the process of database design are needed to promote transparent, accurate, and replicable research practices.
Understanding Factors Associated with Paid Malpractice Claims in Plastic Surgery
Authors: Remington Austin C. , Schaffer Adam , Hespe Geoffrey E. , Yugar Carlos J. , Sherif Rami , Vercler Christian J.
Published: April 2023

Background:

Few studies have investigated malpractice broadly in the field of plastic surgery. The purpose of this analysis was to characterize plastic surgery malpractice cases and examine factors influencing malpractice case outcomes, thereby identifying areas of patient safety concern.

Methods:

The Candello database, which catalogs approximately 30% of all paid and unpaid malpractice claims in the United States, was utilized to obtain cases involving plastic surgery closed between 2009 and 2018. A total of 2674 cases were identified. A multivariable regression model was developed to analyze factors associated with a malpractice case closing with indemnity payment.

Results:

A total of 716 (26.8%) of claims resulted in an indemnity payment. The clinical severity was determined to be high in 229 cases (8.6%). Emotional trauma (n=558, 20.9%) was the most frequently cited injury category. Major differences between procedure groups were not observed, with consistent severity of injury across categories. Poor surgical technique, problems with communication among providers, inadequate informed consent, and deficient documentation were significant factors predictive of malpractice cases closing with payment. Issues with technical performance resulting in a known complication and patient factors were protective against paid claims.

Conclusions:

Overall, both the financial and clinical severity of malpractice claims in plastic surgery were relatively low. Multiple factors were found to be associated with a case closing with an indemnity payment. Taken together, these data highlight the importance of the informed consent process and managing expectations in the clinical care of surgical patients.
Tick-borne encephalitis
Authors: Johnson Nicholas , Migné Camille V. , Gonzalez Gaëlle
Published: April 2023

Purpose of review

Tick-borne encephalitis continues to be one of the most significant causes of viral encephalitis in Europe and Asia. This review will focus on recent developments in the epidemiology, pathogenesis and therapeutic approaches related to infection with tick-borne encephalitis virus.

Recent findings

There is a growing consensus that tick-borne encephalitis viruses are increasing in geographical range, with countries previously free of disease reporting detection of both human cases and presence of virus within indigenous tick populations. The drivers for this are multifactorial but underpinned by human-mediated climate change. Recent developments in pathogenesis have focussed on the intracellular response to infection, particularly in different cell types within the central nervous system (CNS) that are revealing the array of cellular networks triggered by infection. This in turn highlights the need for small molecule therapeutics, such as nucleoside analogues, that can enter the CNS, and the intracellular environment, to inhibit virus replication following neuroinvasion.

Based on continued epidemiological surveillance, tick-borne encephalitis viruses will increasingly affect human populations in Europe and Asia. Much of the research highlighted in this review demonstrates incremental advances in our understanding of these viruses. However, more is required if effective prevention and treatment of this devastating encephalitic viruses are to be realized.
Creation of a Novel Child Simulator and Curriculum to Optimize Administration of Seizure Rescue Medication
Authors: Stredny Coral M. , Sheehan Theodore , Clark Justice , Tishel Catherine , Gagnon Colleen , Kelly Tara , Cahill Cheryl , O'Connell Brianna , Graber Kelsey , Loan Gregory , Wilson Stephen , Forbes Peter W. , Loddenkemper Tobias , Weinstock Peter H.
Published: April 2023

Introduction

Although most cases of pediatric convulsive status epilepticus start in the prehospital setting, many patients do not receive treatment. The use of prehospital seizure rescue medications by caregivers is crucial, but studies suggest a lack of proper training on medication use.

Methods

We created a novel proof of principle mannequin and simulation for training proper administration of rectal diazepam, with a scoring paradigm to standardize and assess the educational process.

Results

Twenty-three health care providers (nurses and nurse practitioners, residents/fellows, and attending physicians) and 5 patient guardians/parents were included in the study. The rectal diazepam simulator displayed a high degree of physical and emotional realism (mean ≥ 4/5 on Likert scale survey) that effectively decreased time to treatment (−12.3 seconds; SD, 16.3) and improved the accuracy of medication delivery in a simulation setting (−4.2 points; SD, 3.1). The scoring technique had appropriate interrater reliability (≥86% on all but 2 prompts) and was a feasible instrument to assess the effectiveness of the educational intervention.

Conclusions

A unique procedure-focused child simulator and rescue medication score offer an innovative and effective means to train caregivers on the use of lifesaving seizure rescue medications.
The Effects of Reflective Pauses on Performance in Simulation Training
Authors: Lee Joy Y. , Donkers Jeroen , Jarodzka Halszka , Sellenraad Géraldine , Faber Tjitske J.E. , van Merriënboer Jeroen J.G.
Published: April 2023

Introduction

The reflective pause, taking a pause during performance to reflect, is an important practice in simulation-based learning. However, for novice learners, it is a highly complex self-regulatory skill that cannot stand alone without guidance. Using educational theories, we propose how to design cognitive and metacognitive aids to guide learners with the reflective pause and investigate its effects on performance in a simulation training environment.

Methods

These effects are examined in four aspects of performance: cognitive load, primary performance, secondary performance, and encapsulation. Medical students (N = 72) performed tasks in simulation training for emergency medicine, under 2 conditions: reflection condition (n = 36) where reflection was prompted and guided, and control condition (n = 36) without such reflection.

Results

The effects of reflective pauses emerged for 2 aspects of performance: cognitive load decreased and secondary performance improved. However, primary performance and encapsulation did not show significant difference.

Conclusions

The results demonstrate that reflective pauses with cognitive and metacognitive aids implemented can enhance some aspects of performance. We suggest that to secure these effects, feedback during reflection and an adaptation period should be provided.
Alcanivorax quisquiliarum sp. nov., isolated from anaerobic fermentation liquid of food waste by high-throughput cultivation
Authors: An Miao-Miao , Shen Lei , Liang Rui-Na , Lu Yan-Juan , Zhao Guo-Zhu
Published: April 2023

Strain CY1518T was isolated from an anaerobic fermentation liquid of food waste treatment plant in Beijing, PR China, and characterized to assess its taxonomy. Cells of CY1518T were Gram-stain-negative, oxidase-negative, catalase-positive and ellipsoidal. Growth occurred at 20–42 °C (optimum, 37 °C), pH 6.0–10.0 (optimum, pH 8) and with 0–6.0 % (w/v) NaCl (optimum, 1.5%). Phylogenetic analysis based on 16S rRNA gene sequences indicated that strain CY1518T belongs to the genus

Alcanivorax

, with the highest sequence similarity to

Alcanivorax pacificus

W11-5T (95.97 %), followed by

Alcanivorax indicus

SW127T (95.08%). The similarity between strain CY1518T and other strains of

Alcanivorax

was less than 95 %. The genomic DNA G+C content of strain CY1518T was 60.88 mol%. The average nucleotide identity, average amino acid identity and digital DNA–DNA hybridization values between strain CY1518T and the closely related taxa

A. pacificus

W11-5T and

A. indicus

SW127T were 77.61, 78.03 and 21.2 % and 74.15, 70.02 and 19.3%, respectively. The strain was able to use d-serine, Tween 40 and some organic acid compounds for growth. The polar lipids comprised aminophospholipid, diphosphatidylglycerol, glycolipid, an unknown polar lipid, phosphatidylethanolamine, phosphatidylglycerol and phospholipid. The principal fatty acids (>5 %) were C19 : 0 cyclo ω8c (36.3%), C16 : 0 (32.3%), C12 : 0 3-OH (8.3%) and C12 : 0 (7.6%). Based on its phenotypic, genotypic and genomic characteristics, strain CY1518T represents a novel species in the genus

Alcanivorax

, for which the name Alcanivorax quisquiliarum sp. nov. is proposed. The type strain is CY1518T (=GDMCC 1.2918T=JCM 35120T).
Ferranicluibacter rubi gen. nov., sp. nov., a new member of family Rhizobiaceae isolated from stems of elmleaf blackberry (Rubus ulmifolius Schott) in Northwest Spain
Authors: Roca-Couso Rocio , Flores-Felix Jose David , Igual Jose M. , García-Fraile Paula , Velázquez Encarna , Rivas Raúl
Published: April 2023

Strain CRRU44T was isolated from the stems of Rubus ulmifolius plants growing in Salamanca (Spain). The phylogenetic analysis of the 16S rRNA gene sequence places this strain within the family

Rhizobiaceae

showing that it is equidistant to the type species of several genera from this family with similarity values ranging from 91.0 to 96.3 %. Strain CRRU44T formed a divergent lineage which clustered with

Endobacterium cereale

RZME27T,

Neorhizobium galegae

HAMBI540T and

Pseudorhizobium pelagicum

R1-200B4T. The phylogenomic analysis showed that strain CRRU44T was equal to or more distant from the remaining genera of the family

Rhizobiaceae

than other genera among them. The calculated average nucleotide identity based on blast and average amino acid identity values with respect to the type species of all genera from the family

Rhizobiaceae

were lower than 78.5 and 76.5 %, respectively, which are the currently cut-off values proposed to differentiate genera within this family. All these results together with those from phenotypic and chemotaxonomic analyses support that strain CRRU44T represents a novel species of a novel genus within the family

Rhizobiaceae

, for which the name Ferranicluibacter rubi gen. nov., sp. nov. is proposed (type strain CRRU44T=CECT 30117T=LMG 31822T).
Characterization of emergent toxigenic M1UK
Streptococcus pyogenes and associated sublineages
Authors: Li Ho Kwong , Zhi Xiangyun , Vieira Ana , Whitwell Harry J. , Schricker Amelia , Jauneikaite Elita , Li Hanqi , Yosef Ahmed , Andrew Ivan , Game Laurence , Turner Claire E. , Lamagni Theresa , Coelho Juliana , Sriskandan Shiranee
Published: April 2023

Streptococcus pyogenes

genotype emm1 is a successful, globally distributed epidemic clone that is regarded as inherently virulent. An emm1 sublineage, M1UK, that produces increased levels of SpeA toxin was associated with increased scarlet fever and invasive infections in England in 2015/2016. Defined by 27 SNPs in the core genome, M1UK is now dominant in England. To more fully characterize M1UK, we undertook comparative transcriptomic and proteomic analyses of M1UK and contemporary non-M1UK
emm1 strains (M1global). Just seven genes were differentially expressed by M1UK compared with contemporary M1global strains. In addition to speA, five genes in the operon that includes glycerol dehydrogenase were upregulated in M1UK (gldA, mipB/talC, pflD, and phosphotransferase system IIC and IIB components), while aquaporin (glpF2) was downregulated. M1UK strains have a stop codon in gldA. Deletion of gldA in M1global abrogated glycerol dehydrogenase activity, and recapitulated upregulation of gene expression within the operon that includes gldA, consistent with a feedback effect. Phylogenetic analysis identified two intermediate emm1 sublineages in England comprising 13/27 (M113SNPs) and 23/27 SNPs (M123SNPs), respectively, that had failed to expand in the population. Proteomic analysis of invasive strains from the four phylogenetic emm1 groups highlighted sublineage-specific changes in carbohydrate metabolism, protein synthesis and protein processing; upregulation of SpeA was not observed in chemically defined medium. In rich broth, however, expression of SpeA was upregulated ~10-fold in both M123SNPs and M1UK sublineages, compared with M113SNPs and M1global. We conclude that stepwise accumulation of SNPs led to the emergence of M1UK. While increased expression of SpeA is a key indicator of M1UK and undoubtedly important, M1UK strains have outcompeted M123SNPs and other emm types that produce similar or more superantigen toxin. We speculate that an accumulation of adaptive SNPs has contributed to a wider fitness advantage in M1UK on an inherently successful emm1 streptococcal background.
Systematic mediation and interaction analyses of kidney function genetic loci in a general population study
Authors: Ghasemi-Semeskandeh Dariush , Emmert David , König Eva , Foco Luisa , Gögele Martin , Barin Laura , Fujii Ryosuke , Fuchsberger Christian , Peters Dorien J.M. , Pramstaller Peter P. , Pattaro Cristian
Published: April 2023

Chronic kidney disease (CKD) is a complex disease affecting >10% of the global population, with large between-and within-continent variability reflecting major environmental effects. To identify molecular targets for treatment, genome-wide association study meta-analyses (GWAMAs) of CKD-defining traits have identified hundreds of genetic loci in aggregated populations. However, while GWAMAs estimate the average allelic effect across studies, single population studies may be relevant to unravel specific mechanisms. To assess whether an individual study from a specific population could extend existing knowledge on kidney function genetics, we selected 147 kidney function relevant loci identified by a large GWAMA, assessing their association with the glomerular filtration rate estimated from serum creatinine (eGFRcrea) in the Cooperative Health Research In South Tyrol (CHRIS) study (n=10,146), conducted in an Alpine region where thyroid dysfunction is common. We replicated associations with single nucleotide polymorphisms (SNPs) at 11 loci, showing up-to-5.4 times larger effect sizes than in the corresponding GWAMA, not explainable by minor allele frequency differences. Systematic mediation analysis across 70 quantitative traits identified serum magnesium and the activated partial thromboplastin time as partial mediators of the eGFRcrea associations atSHROOM3andSLC34A1, respectively. Given that free triiodothyronine and thyroxine were effect modifiers across all loci, we conducted SNP-by-thyroid stimulating hormone (TSH) interaction analyses, identifying significant interactions atSTC1: SNPs had larger effects on eGFRcrea at higher TSH levels, possibly reflecting stanniocalcin-1 autocrine and paracrine role. Individual population studies can help characterize genetic associations. The interplay between phenotypes atSHROOM3andSLC34A1and the role of thyroid function as a genetic effect modifier warrant further investigations.
An accuracy study of the YouDiagnose disease predictive model based on a double-validated real-world dataset from the UK
Authors: Misro Aswini , Sharma Vikash , Kadoglou Naim
Published: April 2023

Through the utilisation of algorithms and data-driven analytics, predictive technology can be leveraged to provide clinicians with invaluable insight into their patients’ conditions, allowing for more accurate, informed, and timely decision-making in the fast-paced clinical environment. This study aims to provide a preliminary proof of concept with a double-validated real-world dataset from the UK. The YouDiagnose predictive model, developed using retrospective data from over 41,257 patients’ data, was assessed by testing it with a double-validated real-world dataset from the UK and the machine predictions have been compared here with the final diagnosis of the diseases as the gold standard. Out of the total of 433 cases, 60 cases had a mismatch in their prediction, all of them being cancer overdiagnosis, resulting in a lower specificity rate of 84.3%. The combined prediction accuracy at the first prediction level was 86% (n=373) while prediction 1-3 combined was successful in predicting diseases in 93% of the cases when evaluated against the gold standard. The model accurately predicted all 52 cases of cancer, indicating a 100% sensitivity rate. The study shows that the tool can be used in the frontline to accurately screen patients with a high level of confidence in the inclusion of cancer patients. This tool’s high sensitivity means that there is little chance of missing any cancer cases.
iSPAN: Improved prediction of outcomes post thrombectomy with Machine Learning
Authors: Kelly Brendan S , Mathur Prateek , Duignan John , Power Sarah , H Lee Edward , Huang Yuhao , Vaca Silvia D , Prolo Laura M , Yeom Kristen W , Lawlor Aonghus , Killeen Ronan P
Published: April 2023

Background

This study aimed to develop and evaluate a machine learning model and a novel clinical score for predicting outcomes in stroke patients undergoing endovascular thrombectomy.

Methods

This retrospective study included all patients aged over 18 years with an anterior circulation stroke treated at a thrombectomy centre from 2010 to 2020. External validation data was obtained. The primary outcome variable was day 90 mRS ≥3. Existing clinical scores (SPAN and PRE) and Machine Learning (ML) models were compared. A novel clinical score (iSPAN) was derived by adding an optimised weighting of the most important ML features to the SPAN and compared results.

Results

812 patients were initially included (397 female, average age 73), 62 for external validation. The best performing clinical score and ML model were SPAN and XGBoost (sensitivity specificity and accuracy 0.967, 0.290, 0.628 and 0.783, 0.693, 0.738 respectively). A significant difference was found overall and XGBoost was more accurate than SPAN (p< 0.0018). The most important features were Age, mTICI and total number of passes. The addition of 11 points for mTICI of ≤ 2B and ≥ 3 points for 3 passes to the SPAN achieved the best accuracy and was used to create the iSPAN. iSPAN was not significantly less accurate than XGBoost (p>0.5). In the external validation set, iSPAN and SPAN achieved sensitivity, specificity, and accuracy of (0.735, 0.862, 0.79) and (0.471, 0.897, 0.67), respectively.

Conclusions

iSPAN incorporates machine-derived features to achieve better predictions compared to existing scores. It is not inferior to the XGB model and is externally generalisable.

Key Points

An XGB model performed better than existing scores and other tested models for prognostication post EVT.

It identified mTICI and number of passes as important and modifiable factors.

Integrating these into the SPAN score (iSPAN) was not inferior to the XGB model and is generalisable and easier to use and interpret.
Data Quality of Out-Of-Pocket Payment on Institutional Delivery in India
Authors: Mohanty Sanjay K. , Dwivedi Laxmi Kant , Sharma Santosh Kumar , Ramesh Sowmya , Gautam Priyanka , Maiti Suraj , Nair Saritha , Singh S. K.
Published: April 2023

Estimates of out-of-pocket (OOP) payment on health care are increasingly used in research and policy. In India, estimates of OOP payment are usually derived from health surveys carried out by the National Sample Survey (NSS). The questions on OOP payment on delivery care have recently integrated in the last two rounds of India’s National Family and Health Survey (NFHS-4 & NFHS-5). There are several issues relating to design of questions, reporting and recording of responses that have bearing on reliability of OOP estimates. This paper compares the OOP estimates from latest rounds of two of the large-scale population-based surveys; NFHS-5, 2019-21 and the National Sample Survey (NSS), 2018. We also highlight the type of question canvassed and its implications on OOP estimates of NFHS-5 survey. We used 155,624 births that were reported between in NFHS-5 and a total of 27,664 hospitalised cases for delivery care that were recorded in 75thround of NSS health survey, 2018. We have used descriptive statistics and two-part regression model to examine variations of OOP across surveys. We found large variations in distribution of OOP payment in NFHS-5 and NSS survey. Based on births during the five years preceding the survey, the OOP payment on institutional birth from public health centres in India from NFHS-5 was INR 2,894 (95% CI:2843-2945) compared to INR 2,738 (95% CI: 2644-2832) from NSS. Variations are similar for those availing services from private health centres. Controlling for socio-economic and demographic characteristics, the OOP payment from NFHS was lower among poorest and higher among richest compared to NSS. The variations in OOP across two surveys were larger across states of India. The variations in OOP payment across surveys were possibly due to structure of questions, recall bias, and variations in price level. We suggest to canvass standardised questions across surveys to obtain reliable OOP estimates across surveys.
‘Finding light in the darkness’: exploring comedy as an intervention for eating disorder recovery
Authors: Declercq Dieter , Kafle Eshika , Peters Jade , Raby Sam , Chawner Dave , Blease James , Foye Una
Published: April 2023

Purpose

Eating disorders remain a major health concern with the incidence of these illnesses has increased since the Covid-19 pandemic. With increased demands on treatments and service provision, and evidence that waiting for treatment is harmful, it is important that research explores novel and innovative adjuncts within interventions for individuals experiencing eating disorders. There is growing evidence highlighting that arts’ interventions are beneficial for recovery from eating disorders, with comedy workshops specifically, have shown promising results for recovery.

Design

The study used a qualitative interview study design, utilising pre, post and three-month follow-up individual interviews and workshop observations, to explore the feasibility of conducting a comedy intervention for people in recovery from eating disorders (n=10).

Findings

Findings show the comedy intervention had high acceptability and feasibility. For most individuals, participating in the course had positive outcomes, including promoting personal recovery across all five elements of the CHIME framework. Unique assets of the course included providing participants with an opportunity to distance themselves from everyday worries of living with an ED; the opportunity to cognitively reframe situations by making them the object of humour; and it provided a safe space to (re-)build a positive sense of self and develop self-acceptance through humour and play by challenging unhealthy perfectionism.

Originality

This study highlights that such innovative approaches can positively support personal recovery for people with eating disorders, with findings providing evidence that this comedy intervention acts to address elements of the CHIME framework to encourage and enable positive outcomes among participants.
Family Research of Microbes Linked to Respiratory Infections (FAMILY Micro) observational study: Assessing the use of minimally invasive self-sampling methodologies at home for long-term monitoring of the oral, nasal and hand microbiota of adults and children within UK families
Authors: Nikolaou E. , German E.L. , Howard A. , Nabwera H.M. , Matope A. , Robinson R. , Shiham F. , Liatsikos K. , McNamara C. , Kattera S. , Carter K. , Parry C.M. , Read J.M. , Allen S.J. , Urban B.C. , Hawcutt D.B. , Hill H. , Collins A.M. , Ferreira D.M.
Published: April 2023

Background

Monitoring the presence of commensal and pathogenic microorganisms in the human oral, nasal and hand niches as determinants for respiratory tract infections is of critical global relevance as was evident during the COVID-19 pandemic. However, community-based surveillance is difficult because current sampling methods are not optimal for a wide age range of participants, particularly young children. We designed a platform of minimally invasive self-sampling at home and assessed its use for longitudinal monitoring of the oral, nasal and hand microbiota of adults and children within families.

Methods

Healthy families with two adults and up to three children, living in and near Liverpool, United Kingdom, self-collected saliva, nasal lining fluid using synthetic absorptive matrices and hand swabs at home every two weeks for six months. Questionnaires were used to collect demographic and epidemiological data and assess feasibility and acceptability. At the end of the study, participants were invited to take part in an interview.

Results

Thirty-three families completed the study. Sample collection using our approach was acceptable to 25/33 (76%) families, as sampling was fast (76%), easy (76%) and painless (60%). Saliva and hand sampling was acceptable to all participants of any age, whereas nasal sampling was accepted mostly by adults and children older than 5 years.

Conclusion

Multi-niche self-sampling at home can be used by adults and children for longitudinal microbial surveillance, providing key data for monitoring respiratory infections.