bluuebunny/crossref_metadata_2025 huggingface dataset:
Rapid Parallel Morphological and Mechanical Diversification of South American Pike Cichlids (Crenicichla)
Authors: Burress Edward D , Piálek Lubomír , Casciotta Jorge , Almirón Adriana , Říčan Oldřich
Published: March 2022

Explosive bouts of diversification are one of the most conspicuous features of the tree of life. When such bursts are repeated in similar environments, it suggests some degree of predictability in the evolutionary process. We assess parallel adaptive radiation of South American pike cichlids (Crenicichla) using phylogenomics and phylogenetic comparative methods. We find that species flocks in the Uruguay and Iguazú River basins rapidly diversified into the same set of ecomorphs that reflect feeding ecology. Both adaptive radiations involve expansion of functional morphology, resulting in unique jaw phenotypes. Yet, form and function were decoupled such that most ecomorphs share similar mechanical properties of the jaws (i.e., jaw motion during a feeding strike). Prey mobility explained 6- to 9-fold differences in the rate of morphological evolution but had no effect on the rate of mechanical evolution. We find no evidence of gene flow between species flocks or with surrounding coastal lineages that may explain their rapid diversification. When compared with cichlids of the East African Great Lakes and other prominent adaptive radiations, pike cichlids share many themes, including the rapid expansion of phenotypic diversity, specialization along the benthic-to-pelagic habitat and soft-to-hard prey axes, and the evolution of conspicuous functional innovations. Yet, decoupled evolution of form and function and the absence of hybridization as a catalyzing force are departures from patterns observed in other adaptive radiations. Many-to-one mapping of morphology to mechanical properties is a mechanism by which pike cichlids attain a diversity of feeding ecologies while avoiding exacerbating underlying mechanical trade-offs. [Adaptive radiation; ecological opportunity; feeding kinematics; functional trade-off; hybridization; introgression.]
A Genomic Perspective on the Evolutionary Diversification of Turtles
Authors: Gable Simone M , Byars Michael I , Literman Robert , Tollis Marc
Published: March 2022

To examine phylogenetic heterogeneity in turtle evolution, we collected thousands of high-confidence single-copy orthologs from 19 genome assemblies representative of extant turtle diversity and estimated a phylogeny with multispecies coalescent and concatenated partitioned methods. We also collected next-generation sequences from 26 turtle species and assembled millions of biallelic markers to reconstruct phylogenies based on annotated regions from the western painted turtle (Chrysemys picta bellii) genome (coding regions, introns, untranslated regions, intergenic, and others). We then measured gene tree-species tree discordance, as well as gene and site heterogeneity at each node in the inferred trees, and tested for temporal patterns in phylogenomic conflict across turtle evolution. We found strong and consistent support for all bifurcations in the inferred turtle species phylogenies. However, a number of genes, sites, and genomic features supported alternate relationships between turtle taxa. Our results suggest that gene tree-species tree discordance in these data sets is likely driven by population-level processes such as incomplete lineage sorting. We found very little effect of substitutional saturation on species tree topologies, and no clear phylogenetic patterns in codon usage bias and compositional heterogeneity. There was no correlation between gene and site concordance, node age, and DNA substitution rate across most annotated genomic regions. Our study demonstrates that heterogeneity is to be expected even in well-resolved clades such as turtles, and that future phylogenomic studies should aim to sample as much of the genome as possible in order to obtain accurate phylogenies for assessing conservation priorities in turtles. [Discordance; genomes; phylogeny; turtles.]
Urinary miRNA Profiles in Chronic Kidney Injury—Benefits of Extracellular Vesicle Enrichment and miRNAs as Potential Biomarkers for Renal Fibrosis, Glomerular Injury, and Endothelial Dysfunction
Authors: Petzuch Barbara , Bénardeau Agnès , Hofmeister Lucas , Meyer Jutta , Hartmann Elke , Pavkovic Mira , Mathar Ilka , Sandner Peter , Ellinger-Ziegelbauer Heidrun
Published: March 2022

Micro-RNAs (miRNAs) are regulators of gene expression and play an important role in physiological homeostasis and disease. In biofluids, miRNAs can be found in protein complexes or in extracellular vesicles (EVs). Altered urinary miRNAs are reported as potential biomarkers for chronic kidney disease (CKD). In this context, we compared established urinary protein biomarkers for kidney injury with urinary miRNA profiles in obese ZSF1 and hypertensive renin transgenic rats. Additionally, the benefit of urinary EV enrichment was investigated in vivo and the potential association of urinary miRNAs with renal fibrosis in vitro. Kidney damage in both rat models was confirmed by histopathology, proteinuria, and increased levels of urinary protein biomarkers. In total, 290 miRNAs were elevated in obese ZSF1 rats compared with lean controls, whereas 38 miRNAs were altered in obese ZSF1 rats during 14–26 weeks of age. These 38 miRNAs correlated better with disease progression than established urinary protein biomarkers. MiRNAs increased in obese ZSF1 rats were associated with renal inflammation, fibrosis, and glomerular injury. Eight miRNAs were also changed in urinary EVs of renin transgenic rats, including one which might play a role in endothelial dysfunction. EV enrichment increased the number and detection level of several miRNAs implicated in renal fibrosis in vitro and in vivo. Our results show the benefit of EV enrichment for miRNA detection and the potential of total urine and urinary EV-associated miRNAs as biomarkers of altered kidney physiology, renal fibrosis and glomerular injury, and disease progression in hypertension and obesity-induced CKD.
Exploring New Risk Factors for Postpartum Hemorrhage: Time to Consider Gestational Age?
Authors: Reale S.C. , Bateman B.T. , Farber M.K.
Published: March 2022

(Anesthesiology. 2021;134:832–834. doi: 10.1097/ALN:0000000000003775)

All birthing centers are now required by the Joint Commission to assess postpartum hemorrhage risk before delivery. This predelivery assessment is critical to classify women as being low, medium, or high risk for hemorrhage. Identifying mothers who are at high risk for postpartum hemorrhage can help specialists including anesthesiology, obstetric, and nursing teams closely monitor the mother’s delivery and recovery, prepare blood and medical equipment preventatively, and reduce maternal morbidity and mortality. Unfortunately, postpartum hemorrhage still occurs in women without recognized risk factors.
Are We Listening? Obstetric Anesthesiology and the National Call for Birth Justice and Accountability: A Perspective From the United States
Authors: Ejiogu N.I.
Published: March 2022

(Int J Obstet Anesth. 2021;46:102978)

Black and Indigenous people in the United States are disproportionately affected by severe complications in pregnancy and childbirth. Compared with white parturients, Black parturients are 3 times more likely to die from pregnancy-related causes. This disparity takes place in the context of the COVID-19 pandemic and increased awareness of police violence, both of which disproportionately affect Black, Brown, Indigenous, poor, and disabled communities. This short report uses the author’s personal experiences to recommend steps the medical community can take to actively address birth justice.
Comparison of Videolaryngoscopy and Direct Laryngoscopy for Tracheal Intubation in Obstetrics: A Mixed-methods Systematic Review and Meta-Analysis
Authors: Howle R. , Onwochei D. , Harrison S.L. , Desai N.
Published: March 2022

(Can J Anaesth. 2021;68:546–565. doi: 10.1007/s12630-020-01908-w. Epub January 12, 2021)

While intubation is sometimes necessary, it can be especially challenging in obstetric patients. Difficult and failed intubation increases the risk of maternal and fetal adverse outcomes. To help mitigate this, videolaryngoscopy has become the standard of care because, compared with direct laryngoscopy, videolaryngoscopy has shown to decrease the occurrence of intubation failures and complications. The aim of this study is to perform a mixed-methods systematic review and meta-analysis to compare the efficiency, efficacy, and safety of videolaryngoscopy and direct laryngoscopy specifically in regards to parturients.
A Systematic Review of Meta-Analyses Comparing Direct Laryngoscopy With Videolaryngoscopy
Authors: Downey A.W. , Duggan L.V. , Adam Law J.
Published: March 2022

(Can J Anaesth. 2021;68:706–714. doi: 10.1007/s12630-021-01921-7. Epub January 29, 2021)

As videolaryngoscopy (VL) becomes a preferred technique for airway management, it is important to assess literature comparing the benefits of VL and the traditional use of direct laryngoscopy via a Macintosh blade (Mac-DL). VLs use both Macintosh and hyperangulated blades, though it is unclear whether previous studies have differentiated between blade types. The aim of this study was to review published meta-analyses of VL.
Does Anesthesia and Surgery During Pregnancy Really Affect Learning and Behavior in the Offspring: The Holy Grail in Anesthesiology Research
Authors: Fardelmann K. , Gaiser R.
Published: March 2022

(Anesth Analg. 2021;133:592–594. doi: 10.1213/ANE.0000000000005486)

This paper reviews the publication “Prenatal Exposure to General Anesthesia and Childhood Behavioral Deficit” by Ing et al (Anesth Analg. 2021 Sep 1;133(3):595–605.) which studied the effect prenatal exposure to general anesthesia can have on the child neurodevelopmentally.
Neonatal and Early Childhood Outcomes Following Maternal Anesthesia for Cesarean Section: A Population-based Cohort Study
Authors: Kearns R.J. , Shaw M. , Gromski P.S. , Iliodromiti S. , Pell J.P. , Lawlor D.A. , Nelson S.M.
Published: March 2022

(Reg Anesth Pain Med. 2021;46:482–489. Epub April 8, 2021)

The US Food and Drug Administration has previously warned that exposure to anesthetic medications during the third trimester of pregnancy or in children <3 years could affect children’s neurological development. While the literature (studies with n=310 to n=997) supports a single brief exposure to general anesthesia (GA) does not impair learning or behavior, there is no consensus regarding the long-range effects of anesthesia exposure on the fetus. Further, with the ubiquity of cesarean delivery (CD), the question of optimal mode of anesthesia for the fetus remains unclear. General anesthesia for CD may be used in situations of maternal or fetal compromise or in low-income settings where there is a lack of training in regional methods. With a global increase of CD, it is critical that anesthesia decisions be informed by better understanding of the short and long-term childhood effects following fetal exposure to GA. The aim of the study was to determine associations of exposure to spinal, epidural or GA on neonatal and childhood development outcomes during the first 1000 days of life.
The 2014 New York State Medicaid Expansion and Severe Maternal Morbidity During Delivery Hospitalizations
Authors: Guglielminotti J. , Landau R. , Li G.
Published: March 2022

(Anesth Analg. 2021;133:340–348. doi: 10.1213/ANE.0000000000005371)

Severe maternal morbidity (SMM) during delivery is increasing in the United States and disproportionately occurs in racial and ethnic minority groups. The 2014 Medicaid expansion was implemented to provide more women access to health insurance coverage. While more low-income women became eligible for insurance coverage and received more prenatal care, it is uncertain whether maternal health outcomes improved. This study aimed to determine the impact the 2014 New York State Medicaid expansion had on SMM rates during hospital deliveries comparing low- and high-income (2013 median household income <$38,000 and ≥$38,000, respectively) women.
Mechanistic Insights into Spinal Neurones Involved in Neuraxial Opioid-induced Pruritus
Authors: Nguyen E. , Lim G. , Ross S.E.
Published: March 2022

(Br J Anaesth. 2021;126:e179–e181. doi: 10.1016/j.bja.2021.02.009)

Nearly half of obstetric patients receiving neuraxial opioids for labor or cesarean delivery report experiencing pruritus. Recent animal studies have provided insight into the mechanism of opioid-induced clinical pruritus.
Impact of New Definitions of Preeclampsia at Term on Identification of Adverse Maternal and Perinatal Outcomes
Authors: Lai J. , Syngelaki A. , Nicolaides K.H. , von Dadelszen P. , Magee L.A.
Published: March 2022

(Am J Obstet Gynecol. 2021;224:518.e1–518.e11. doi: 10.1016/j.ajog.2020.11.004. Epub November 6, 2020)

To include a more comprehensive pool of women and babies at increased risk of adverse outcomes, a more comprehensive definition of preeclampsia (PE) has been largely adopted. This study aimed to identify how varying definitions of PE at term gestation determine maternal and perinatal adverse outcomes.
Pregnant Women With Severe or Critical Coronavirus Disease 2019 have Increased Composite Morbidity Compared With Nonpregnant Matched Controls
Authors: DeBolt C.A. , Bianco A. , Limaye M.A. , Silverstein J. , Penfield C.A. , Roman A.S. , Rosenberg H.M. , Ferrara L. , Lambert C. , Khoury R. , Bernstein P.S. , Burd J. , Berghella V. , Kaplowitz E. , Overbey J.R. , Stone J.
Published: March 2022

(Am J Obstet Gynecol. 2021;224:510.e1–510.e12. doi: 10.1016/j.ajog.2020.11.022. Epub November 20, 2020)

The global coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) leads to mostly mild adverse outcomes. Due to the physiological changes during pregnancy, pregnant women are more susceptible to infection and respiratory issues. Thus, there is cause for concern that morbidity and mortality will increase for pregnant women with COVID-19 compared with nonpregnant women. This study aimed to better understand the course of COVID-19 comparing pregnant and nonpregnant women and analyzing severe and critical cases of each population.
Association of Maternal SARS-CoV-2 Infection in Pregnancy With Neonatal Outcomes
Authors: Norman M. , Navér L. , Söderling J. , Ahlberg M. , Hervius Askling H. , Aronsson B. , Byström E. , Jonsson J. , Sengpiel . , Ludvigsson J.F. , Håkansson S. , Stephansson O.
Published: March 2022

(JAMA. 2021;325:2076–2086. doi: 10.1001/jama.2021.5775)

There has been uncertainty regarding the effects of SARS-CoV-2 on neonates since the beginning of the COVID-19 worldwide pandemic, which has led to varying infant management recommendations. A balance needs to be found between interfering with the mother-infant interactions following birth and protecting the infants from SARS-CoV-2 and any adverse effects. The aim of this study was to identify associations between maternal SARS-CoV-2 positivity and adverse neonatal outcomes.
Evaluating Progestogens for Preventing Preterm Birth International Collaborative (EPPPIC): Meta-Analysis of Individual Participant Data From Randomized Controlled Trials
Authors:   EPPPIC Group
Published: March 2022

(Lancet. 2021;397:1183–1194. doi: 10.1016/S0140-6736(21)00217-8)

Preterm birth has serious consequences. Progesterone plays an important role in preventing preterm birth. As there are different kinds of progestogens (natural and semisynthetic), this analysis aims to evaluate all forms of progestogen and their effects on various outcomes.
Intracranial Hematoma and Abscess After Neuraxial Analgesia and Anesthesia: A Review of the Literature Describing 297 Cases
Authors: Bos E.M. , van der Lee K. , Haumann J. , de Quelerij M. , Vandertop W.P. , Kalkman C.J. , Hollmann M.W. , Lirk P.
Published: March 2022

(Reg Anesth Pain Med. 2021;46:337–343. doi: 10.1136/rapm-2020-102154. Epub January 13, 2021)

On occasion, neuraxial analgesia leads to severe complications and side effects such as intracranial hematoma or abscess. This study aimed to review literature cases describing intracranial hematomas or abscesses resulting from neuraxial block to analyze patient characteristics, management, and recovery to identify patients at increased risk and provide optimal care and improve outcomes.
GENERAL ANESTHESIA The Effect of COVID-19 on General Anaesthesia Rates for Caesarean Section. A Cross-sectional Analysis of 6 Hospitals in the North-west of England
Authors: Bhatia K. , Columb M. , Bewlay A. , Eccles J. , Hulgur M. , Jayan N. , Lie J. , Verma D. , Parikh R.
Published: March 2022

(Anaesthesia. 2021;76:312–319. doi: 10.1111/anae.15313. Epub November 2, 2020)

Before the onset of the COVID-19 (SARS-CoV-2) global pandemic, data from the National Obstetric Anaesthesia Database suggests that regional anesthesia (RA), as opposed to general anesthesia (GA), was used in 91% of all cesarean deliveries (CD) performed. In the time since COVID-19 emerged, there is evidence that regional anesthesia has been encouraged over general anesthesia in the surgical setting, including during CD. Benefits to regional anesthesia include limiting the need for aerosol-generating procedures and consequential risks on healthcare staff, decreasing the use personal protective equipment (PPE), and increasing surgical theatre turnover efficiency. There is limited information on the impact anesthesia-specific guidelines have had on actual RA and GA rates for CD during the pandemic. This study investigates changes in CD general anesthesia rates occurring during the first peak of the pandemic across six maternity units within north-west England.
Tailoring Postoperative Pain Management With a Procedure-specific Approach: How to Best Apply this Concept to Cesarean Deliveries
Authors: Landau R. , Richebé P.
Published: March 2022

(Anaesthesia. 2021;76:587–589. doi: 10.1111/anae.15251. Epub October 14, 2020)

To mitigate pain in postoperative patients, procedure-specific pain management (PROSPECT) surgeons and anesthetists have been performing systematic reviews and meta-analyses to make evidence-based and practical perioperative recommendations with a procedure-specific approach. The PROSPECT approach is now being applied to caesarean deliveries (CD) as new pain management studies and strategies have emerged. These clinical recommendations will ideally help clinicians improve maternal care, decrease hospital length of stay, reduce opioid exposure and intake, and lead to improved maternal outcomes. There is concern, however, the PROSPECT methodology is adequately patient-specific and outcome-specific for patients undergoing CD.
A shadowing program for PAs and APRNs to promote collaborative care
Authors: Nishi Laura , Soco Cheryl , Duke Rebecca , Williams Lisa
Published: March 2022

This article describes a shadowing program aimed at promoting collaborative care among PAs and NPs at an academic medical center. The program fostered interprofessional and interdisciplinary experiences to improve collaborative skills. Clinicians who completed the program had a significant improvement in collaborative competencies, as measured by the Interprofessional Collaboration Competency Attainment Survey.
The Impact of Timing on Clinical and Economic Outcomes During Inter-ICU Transfer of Acute Respiratory Failure Patients: Time and Tide Wait for No One
Authors: Nadig Nandita R. , Brinton Daniel L. , Simpson Kit N. , Goodwin Andrew J. , Simpson Annie N. , Ford Dee W.
Published: March 2022

IMPORTANCE AND OBJECTIVE:

Approximately one in 30 patients with acute respiratory failure (ARF) undergoes an inter-ICU transfer. Our objectives are to describe inter-ICU transfer patterns and evaluate the impact of timing of transfer on patient-centered outcomes.

DESIGN:

Retrospective, quasi-experimental study.

SETTING:

We used the Healthcare Cost and Utilization Project State Inpatient Databases in five states (Florida, Maryland, Mississippi, New York, and Washington) during 2015–2017.

PARTICIPANTS:

We selected patients with International Classification of Diseases, 9th and 10th Revision codes of respiratory failure and mechanical ventilation who underwent an inter-ICU transfer (n = 6,718), grouping as early (≤ 2 d) and later transfers (3+ d). To control for potential selection bias, we propensity score matched patients (1:1) to model propensity for early transfer using a priori defined patient demographic, clinical, and hospital variables.

MAIN OUTCOMES:

Inhospital mortality, hospital length of stay (HLOS), and cumulative charges related to inter-ICU transfer.

RESULTS:

Six-thousand seven-hundred eighteen patients with ARF underwent inter-ICU transfer, 68% of whom (n = 4,552) were transferred early (≤ 2 d). Propensity score matching yielded 3,774 well-matched patients for this study. Unadjusted outcomes were all superior in the early versus later transfer cohort: inhospital mortality (24.4% vs 36.1%; p < 0.0001), length of stay (8 vs 22 d; p < 0.0001), and cumulative charges ($118,686 vs $308,977; p < 0.0001). Through doubly robust multivariable modeling with random effects at the state level, we found patients who were transferred early had a 55.8% reduction in risk of inhospital mortality than those whose transfer was later (relative risk, 0.442; 95% CI, 0.403–0.497). Additionally, the early transfer cohort had lower HLOS (20.7 fewer days [13.0 vs 33.7; p < 0.0001]), and lower cumulative charges ($66,201 less [$192,182 vs $258,383; p < 0.0001]).

CONCLUSIONS AND RELEVANCE:

Our study is the first to use a large, multistate sample to evaluate the practice of inter-ICU transfers in ARF and also define early and later transfers. Our findings of favorable outcomes with early transfer are vital in designing future prospective studies evaluating evidence-based transfer procedures and policies.
Posttraumatic Stress Disorder Symptom Clusters in Surrogate Decision Makers of Patients Experiencing Chronic Critical Illness
Authors: Wendlandt Blair , Ceppe Agathe , Gaynes Bradley N. , Cox Christopher E. , Hanson Laura C. , Nelson Judith E. , Carson Shannon S.
Published: March 2022

OBJECTIVES:

Symptoms of posttraumatic stress disorder (PTSD) are common among surrogate decision makers of patients with chronic critical illness (CCI). PTSD symptoms can be categorized into clusters including intrusion, avoidance, and hyperarousal, each of which has been associated with distinct outcomes and treatment responses. Our objective was to determine which symptom cluster was predominant among surrogates of patients with CCI.

DESIGN:

Secondary analysis of data from a clinical trial of a communication intervention.

SETTING:

The original trial was conducted in medical intensive care units at three tertiary-care centers and one community hospital.

PATIENTS:

Patients with CCI (≥7 d of mechanical ventilation and not expected to die or to be weaned from the ventilator in the subsequent 72 hr) and their surrogates.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Surrogate PTSD symptoms were measured 90 days after onset of patient CCI using the Impact of Events Scale-Revised (IES-R). The IES-R includes a total score (range, 0–88, higher scores indicate severe symptoms) as well as three subscales that assess intrusion, avoidance, and hyperarousal (range of intrusion and avoidance scores 0–32 and range of hyperarousal score 0–24). Intrusion symptoms were most severe (mean score, 10.3; 95% CI, 9.3–11.2), followed by avoidance (mean score, 8.0; 95% CI, 7.2–8.8). Hyperarousal symptoms were lowest (mean score, 5.1; 95% CI, 4.5–5.7). In a multivariable linear regression model, we found that surrogates of patients who died had higher odds of intrusion (β, 5.52; p < 0.0001) and avoidance (β, 3.29; p = 0.001) symptoms than surrogates of patients who lived, even after adjusting for baseline symptoms of anxiety and depression. Patient death was not associated with hyperarousal symptoms.

CONCLUSIONS:

Intrusive thoughts are the most severe PTSD symptom in surrogates of patients experiencing CCI, with intensified symptoms among surrogates of patients who died. These results have the potential to inform tailored treatment strategies to reduce PTSD symptoms in this population.
The Inpatient Nursing Leadership Perspective of Using Mobile Technology at the Bedside
Authors: Giannini Rose C.
Published: March 2022

Introducing technology to support patient care in today's complex healthcare organizations can be innovative yet challenging. Managers are often not included in technology decisions that affect their nursing units, and less often is manager insight into the project taken into consideration. Studies that describe the executive-level role and information technology are helpful but not specific to managers' perspectives. The purpose of this project was to identify the factors related to managers' perceptions about the use of mobile technology at the bedside. Mobile technology includes using smartphones for communication and documentation of patient care. Inpatient nurse managers participated in focus groups; semi-structured interview questions were administered. Nurse managers overwhelmingly indicated they should be involved in technology-related projects that affect their units. Nurse managers have a central role in supporting changes that occur with implementing technology and should be involved at the inception of the innovation. Understanding these associated complex factors is necessary to address issues and promote strategies for the successful implementation of mobile technology. Manager inclusion has far-reaching potential as they can serve as sounding boards and conduits to nursing staff, subsequently promoting engagement and adoption of the technology.
Perception of Healthcare Workers on the Integration of Electronic Health Records in Primary Health Centers in Nigeria
Authors: Ojo Iyanuoluwa Oreofe , Müller Staub Maria , Akinola Busayo , Adereti Stella
Published: March 2022

The study aim was to assess the perception of healthcare workers in primary healthcare centers toward the integration of EHRs into practice. A descriptive cross-sectional design was used. Out of 10 primary healthcare centers, 120 healthcare workers were selected by simple random sampling, whereas 109 questionnaires were fit for analysis. Data were collected using a questionnaire, and both descriptive and inferential statistics were used for data analyses. The findings revealed that the healthcare workers disagreed on EHR integration. They believed that user resistance, missing funds, and unavailability of knowledgeable support personnel are challenges that are hindering EHR integration. Also, limited training on how to use EHRs and lack of computer literacy were identified as challenges. Based on the literature and findings of this study, EHRs can improve the quality of the given patient care, reduce errors, increase productivity, and enable standardization of care. Therefore, education on EHR implementation and funding are needed to successfully integrate EHRs into primary healthcare centers in Nigeria.
Critical Care Nurses' Perceptions of Clinical Alarm Management on Nursing Practice
Authors: Shih Yu-Shan , Lee Ting-Ting , Mills Mary Etta
Published: March 2022

The alarm management of physiological monitoring systems is a key responsibility of critical care nurses. However, the high numbers of false and nonactionable (true but clinically irrelevant) alarms cause distractions to healthcare professionals, interruptions to nursing workflow, and ignoring of crucial tasks. Therefore, understanding how nurses manage large amounts of alarms in their daily work could provide a direction to design interventions to prevent adverse patient care effects. A qualitative design with focus group interviews was conducted with 37 nurses in Taiwan. Content analysis was performed to analyze the interview data, and four main themes were derived: (1) the foundation stone of critical care nursing practice; (2) a trajectory adaptation of alarms management; (3) adverse impacts on the quality of care and patient safety; and (4) a hope for multimodal learning alternatives and wireless technology. Nurses manage alarm parameter settings influenced not only by their knowledge and skills of patient care, but also in accordance with the three dimensions of technology, human, and organization evaluation framework. Customized alarm management training alternatives, patient-centered care values, and application of wireless technology are the suggested approaches to enhance nursing care and minimize the risk of adverse events.
Helicobacter pylori may participate in the development of inflammatory bowel disease by modulating the intestinal microbiota
Authors: Bai Xiaoyin , Jiang Lingjuan , Ruan Gechong , Liu Tingting , Yang Hong
Published: March 2022

Inflammatory bowel disease (IBD) is a non-specific inflammatory disease of the gastrointestinal (GI) tract that is generally accepted to be closely related to intestinal dysbiosis in the host. GI infections contribute a key role in the pathogenesis of IBD; however, although the results of recent clinical studies have revealed an inverse correlation between Helicobacter pylori (H. pylori) infection and IBD, the exact mechanism underlying the development of IBD remains unclear. H. pylori, as a star microorganism, has been a focus for decades, and recent preclinical and real-world studies have demonstrated that H. pylori not only affects the changes in the gastric microbiota and microenvironment but also influences the intestinal microbiota, indicating a potential correlation with IBD. Detailed analysis revealed that H. pylori infection increased the diversity of the intestinal microbiota, reduced the abundance of Bacteroidetes, augmented the abundance of Firmicutes, and produced short-chain fatty acid-producing bacteria such as Akkermansia. All these factors may decrease vulnerability to IBD. Further studies investigating the H. pylori-intestinal microbiota metabolite axis should be performed to understand the mechanism underlying the development of IBD.
Novel insights into the effect of Xiaoyao san on corticosterone-induced hepatic steatosis: inhibition of glucocorticoid receptor/perilipin-2 signaling pathway
Authors: Gong Lian , Wang Guo-En , Ma Qing-Yu , Hao Wen-Zhi , Xian Min-Hua , Wu Yan-Ping , Kurihara Hiroshi , He Rong-Rong , Chen Jia-Xu
Published: March 2022

Objective:

Xiaoyao san (XYS) is a classic traditional Chinese medicinal formula. It has been clinically administered to regulate liver function. However, its mechanisms in glucocorticoid-induced hepatic steatosis are unknown. This study aimed to investigate whether XYS protects against corticosterone (CORT)-induced hepatic steatosis, and to explore its mechanism.

Methods:

High-fat diet mice induced with hepatic steatosis by 2 mg/kg CORT were administered 2.56 g/kg or 5.12 g/kg XYS daily for 7 weeks. The effects of XYS on hepatic steatosis in mice were evaluated by H&E and Oil Red O staining and by measuring their plasma lipids (triglyceride, total cholesterol, and free fatty acids). The mechanism of XYS against hepatic steatosis was investigated by network pharmacology, immunohistochemistry, western blotting, and gain-of-function/loss-of-function experiments.

Results:

XYS alleviated CORT-induced steatosis, decreased plasma lipids, and inhibited glucocorticoid receptor (GR) activation in the liver. Network pharmacology data indicated that XYS may have mitigated hepatic steatosis via GR which mediated adipose differentiation-related protein (ADFP). Gain-of-function/loss-of-function experiments in vitro confirmed that GR positively regulated ADFP expression.

Conclusions:

XYS ameliorated CORT-induced hepatic steatosis by downregulating the GR/ADFP axis and inhibiting lipid metabolism. Our studies implicate that XYS is promising as a therapy for CORT-induced hepatic steatosis, and lay the foundation for designing novel prophylactic and therapeutic strategies on CORT-induced hepatic steatosis.
The National Psoriasis Foundation Recognizes the Critical Role of Nurses in Caring for the Psoriatic Disease Community
Authors: Howard Leah , Bell Stacie
Published: March 2022

When the National Psoriasis Foundation (NPF) began a new 5-year strategic plan on July 1, 2019, it was understood that to achieve the lofty goals laid out in the plan, partnership with many different healthcare stakeholders would be critical. Although numerous advancements in care and new treatment options have changed the prognosis for individuals diagnosed with psoriasis and psoriatic arthritis, many still face obstacles in living with and managing their disease. To support the community in overcoming these challenges, the NPF provides education, resources, and connection to the psoriatic disease community directly to individuals living with the disease. The Foundation also offers education and resources directly to the nurses and other healthcare professionals who care for individuals living with psoriatic disease—all to improve their lives and to optimize health outcomes. These efforts are complimented by the work done to support the other half of the NPF mission—lead collaborative, transformational research toward a cure.
Surfing After Hip Resurfacing Surgery
Authors: Vanlommel Jan , Goldhofer Markus , Walter William L.
Published: March 2022

Objective:

There is no information about surfing after hip resurfacing arthroplasty (HRA). We did a retrospective study aiming to evaluate the safety and feasibility to resume surfing—an extreme sport with high-impact physical activity—after HRA.

Design:

Retrospective case series.

Setting:

Specialist Orthopaedic Group, Mater Hospital Sydney, NSW, Australia.

Patients:

We evaluated 45 patients who practiced surfing before the onset of pain and hip surgery. Complete clinical and radiographical follow-up and a completed questionnaire were available for 37 (82%) patients.

Interventions:

Hip resurfacing arthroplasty.

Main outcome measures:

Postel-Merle d'Aubigne score, the Oxford hip score, the Harris hip score, and the University of California at Los Angeles activity score. Radiographical evaluation at 6 weeks, 3, and 12 months after surgery and yearly thereafter. Return to surf rates using a specific questionnaire. Complications and failures during follow-up.

Results:

All clinical scores improved significantly after HRA. Eight of 37 (22%) patients stopped surfing after their HRA. More than 80% of patients commenced surfing within the first 6 months after surgery. During surfing, 21 patients (72%) were completely pain free.

Conclusion:

No literature exists regarding the return to a high-impact sport as surfing after HRA. Most of our patients (71%) were able to return at least to their preoperative level of surfing after surgery. No complications related to this sport activity were observed during short-term follow-up. We believe that surfing is compatible with HRA, but long-term studies are necessary to assess the influence of this extreme sport on loosening and revision rates.
Cardiac Remodeling in Elite Aquatic Sport Athletes
Authors: Coates Alexandra M. , Cheung Christian P. , Currie Katharine D. , King Trevor J. , Mountjoy Margo L. , Burr Jamie F.
Published: March 2022

Objective:

To characterize and compare the sport-specific cardiac structure of elite swimmers (SW), water polo players (WP), and artistic swimmers (AS).

Design:

A cross-sectional assessment of elite aquatic athletes' hearts.

Setting:

The athletes' village at the 2019 FINA World Championships.

Participants:

Ninety athletes from swimming (SW) (20 M/17 F), water polo (WP) (21 M/9 F), and artistic swimming (AS) (23 F).

Assessment and Main Outcome Measures:

An echocardiographic assessment of cardiac structure was performed on noncompetition days.

Results:

Male SW displayed primarily eccentric volume-driven remodeling, whereas male WP had a greater incidence of pressure-driven concentric geometry (SW = 5%, WP = 25%) with elevated relative wall-thickness (RWT) (SW = 0.35 ± 0.04, WP = 0.44 ± 0.08,P< 0.001). Female SW and WP hearts were similar with primarily eccentric-remodeling, but SW and WP had greater concentricity index than artistic swimmers (SW = 6.74 ± 1.45 g/(mL)2/3, WP = 6.80 ± 1.24 g/(mL)2/3, AS = 5.52 ± 1.08 g/(mL)2/3,P= 0.007). AS had normal geometry, but with increased posterior-wall specific RWT (SW = 0.32 ± 0.05, AS = 0.42 ± 0.11,P= 0.004) and greater left atrial area than SW (SW = 9.7 ± 0.9 cm2/m2, AS = 11.0 ± 1.1 cm2/m2,P= 0.003). All females had greater incidence of left ventricular (LV) posterior/septal wall-thickness ≥11 mm than typically reported (SW = 24%, WP = 11%, AS = 17%).

Conclusions:

Male athletes presented classic sport-specific differentiation, with SW demonstrating primarily volume-driven eccentric remodelling, and WP with greater concentric geometry indicative of pressure-driven remodeling. Female SW and WP did not display this divergence, likely because of sex-differences in adaptation. AS had unique LV-specific adaptations suggesting elevated pressure under low-volume conditions. The overall incidence of elevated wall-thickness in female athletes may point to an aquatic specific pressure-stress.
Pediatric Donor Cell Acute Lymphoblastic Leukemia Following Bone Marrow Transplant for GATA2 Mutation
Authors: Scheuermann Amanda , Moskop Amy , Hopp Amanda , Bone Kathleen , Drendel Holli M. , Talano Julie , Harker-Murray Paul , Astle John
Published: March 2022

Donor cell leukemia is a rare complication following hematopoietic stem cell transplant (HSCT). There are currently few reports in children and only rare, reported cases of donor-derived myelodysplastic syndrome/acute myeloid leukemia in patients with an underlying germline GATA2 mutation. Most reported cases are myeloid in origin and occur following related HSCT. We present a 3-year-old female who developed a donor-derived B-cell acute lymphoblastic leukemia 2 years post unrelated HSCT for GATA2 germline mutation.
The Impact of Primary Language Spoken on the Pain Experience of Children With Cancer
Authors: Acosta Erika , Agbayani Crystle-Joie G. , Jenkins Brooke N. , Cortes Haydee G. , Kain Zeev N. , Fortier Michelle A.
Published: March 2022

The purpose of the current prospective cohort study was to determine if acculturation, measured by primary language spoken, impacts the pain response of children being treated for cancer during an experimental pain task. Sixty-seven Spanish-speaking and English-speaking children ages 6 to 18 years being treated for cancer provided ratings of pain and upset severity during the completion of the cold pressor task (CPT). One week following the CPT, participants provided their recollection of average pain and upset during the CPT. Repeated measures analysis of variance revealed Spanish-speaking children reported significantly higher pain (F
1,64=5.58, P=0.02) and upset (F
1,64=7.69, P=0.007) ratings during the CPT compared with English-speaking children. Also, Spanish-speaking children were over 4 times as likely to remove their hands from the water before the CPT 4-minute uninformed ceiling compared with English-speaking children (P=0.002). These findings suggest that cultural and contextual factors, including the level of acculturation, are important considerations in the assessment and management of pain in children with cancer. Future research should continue to examine the mechanisms underlying the association between acculturation and the symptom experience for children receiving treatment for cancer.
Characteristics Associated With Repeated Evaluations for Urinary Tract Infections in Older Women: A Case-Control Study
Authors: Bradley Megan S. , Stanger Michael , Ford Cassie , Lowder Jerry , Handa Victoria L.
Published: March 2022

Objectives

The aims of this study were to estimate the incidence of repeated evaluations for urinary tract infection (UTI) after a single occurrence and to identify characteristics associated with repeated evaluations in a female Medicare population.

Methods

This was a case-control study of women aged 65 years or older undergoing incident outpatient evaluation for UTI between the years of 2011 and 2018. We defined UTI evaluation as an outpatient encounter with diagnostic codes for UTI and an order for urine culture. We excluded women with diagnostic codes suggestive of a complicated UTI. Among all women with an incident UTI evaluation, cases were defined as those with repeated evaluations, defined as either a total of ≥2 UTI evaluations in 6 months and/or ≥3 in 1 year. The characteristics of cases versus controls were compared with both an unadjusted and adjusted logistic regression model.

Results

Our overall cohort consisted of 169,958, of which 13,779 (8.1%) had repeated evaluations for UTI. In unadjusted analyses, cases were more likely to be older than 75 years, of White race, and to have cardiovascular conditions, diabetes, dementia, renal disease, and chronic obstructive pulmonary disease (all P's < 0.01) as compared with controls. In adjusted analysis, ages 75 years to 84 years (P < 0.01) and ages older than 84 years (P < 0.01) along with multiple medical comorbidities were significant risk factors for repeated evaluations for UTI. Black women had lower odds of repeated evaluations for UTI (P < 0.01).

Conclusions

Among women with a single UTI evaluation, repeated evaluations for UTI were associated with older age, White race, and medical comorbidities. Future studies should investigate racial disparities seen in care-delivery behavior and/or care-seeking behavior.
Complications After Vaginal Vault Suspension Versus Minimally Invasive Sacrocolpopexy in Women With Elevated Body Mass Index: A Retrospective Cohort Study Using Data From the National Surgical Quality Improvement Program Database
Authors: Stairs Jocelyn , Minassian Vatche , Clancy Aisling
Published: March 2022

Importance

Overweight and obese women represent a growing share of pelvic floor reconstruction surgeons’ practices. Determining perioperative risk specific to this population is essential to inform decision making regarding operative approach in this population.

Objective

The aim of the study was to compare surgical complications among overweight and obese women undergoing apical compartment prolapse surgery by either minimally invasive abdominal or vaginal approach.

Study Design

The American College of Surgeons National Surgical Quality Improvement Database was used to identify overweight and obese patients (body mass index ≥ 25) undergoing either minimally invasive sacrocolpopexy (MISC) or vaginal vault suspension (VVS) in the form of a sacrospinous vault fixation or uterosacral ligament fixation for pelvic organ prolapse from 2012 to 2019. Odds ratios for surgical complications, readmission, and reoperation were estimated using multivariable logistic regression.

Results

Of 8,990 eligible patients, 5,851 underwent a VVS and 3,139 patients underwent MISC. There was a greater odds of any complication in the first 30 days following VVS (n = 608 [10.4%]) compared with MISC (n = 247 [7.9%]; odds ratio, 1.27; 95% confidence interval, 1.08–1.48) on multivariable analysis. Urinary tract infections (UTIs) were the most common complication and were more likely following VVS (112 (3.6%) versus 350 (6.0%), P < 0.001). When UTIs were excluded, there was no difference in complications between approaches (1.00; 95% CI, 0.82–1.22). There were no statistically significant odds of readmission, reoperation, or serious complications between approaches.

Conclusions

Vaginal vault suspension may be associated with a higher odds of any complication compared with MISC in overweight and obese women, but the rate of serious complications, readmission, and reoperation are low, and approaches were comparable when considering complications other than UTI.
Riparian buffers maintain aquatic trophic structure in agricultural landscapes
Authors: Champagne Emily J. , Guzzo Matthew M. , Gutgesell Marie K. , McCann Kevin S.
Published: March 2022

Local and regional habitat conditions associated with agricultural activity can fundamentally alter aquatic ecosystems. Increased nutrient inputs, channelization and reduced riparian habitat both upstream and locally contribute to the degradation of stream ecosystems and their function. Here, we examine stream food webs in watersheds that feed into Lake Erie to determine the effects of agricultural land cover on major food web energy pathways and trophic structure. Given that higher agricultural intensity can increase nutrient runoff and reduce the riparian zone and litter in-fall into streams, we predicted that generalist fish would derive less energy from the terrestrial pathway and become more omnivorous. Consistent with these predictions, we show that both mean terrestrial energy use and trophic position of the resident top consumer, creek chub (
Semotilus atromaculatus
), decrease with local agricultural intensity but not with watershed-level agriculture intensity. These findings suggest that local riparian buffers can maintain trophic structure even in the face of high whole-watershed agricultural intensity.
David James Thouless. 21 September 1934—6 April 2019
Authors: Leggett Anthony J.
Published: March 2022

David Thouless was one of the leading theoretical condensed matter physicists of his generation. He pointed out (with Kosterlitz) that two-dimensional or quasi-two-dimensional physical systems undergo a completely novel type of phase transition; he developed a highly original approach to the theory of localization of electrons in disordered solids; and with his co-authors pioneered the use of topological considerations in the analysis of many-body systems, a technique that gives a very intuitive understanding of the quantum Hall effect and is at the basis of the modern field of topological insulators and superconductors. In 2016 he was awarded the Nobel Prize in physics for ‘theoretical discoveries of topological phase transitions and topological phases of matter’.
On the design of particle filters inspired by animal noses
Authors: Yuk Jisoo , Chakraborty Aneek , Cheng Shyuan , Chung Chun-I , Jorgensen Ashley , Basu Saikat , Chamorro Leonardo P. , Jung Sunghwan
Published: March 2022

Passive filtering is a common strategy to reduce airborne disease transmission and particulate contaminants across scales spanning orders of magnitude. The engineering of high-performance filters with relatively low flow resistance but high virus- or particle-blocking efficiency is a non-trivial problem of paramount relevance, as evidenced in the variety of industrial filtration systems and face masks. Next-generation industrial filters and masks should retain sufficiently small droplets and aerosols while having low resistance. We introduce a novel 3D-printable particle filter inspired by animals’ complex nasal anatomy. Unlike standard random-media-based filters, the proposed concept relies on equally spaced channels with tortuous airflow paths. These two strategies induce distinct effects: a reduced resistance and a high likelihood of particle trapping by altering their trajectories with tortuous paths and induced local flow instability. The structures are tested for pressure drop and particle filtering efficiency over different airflow rates. We have also cross-validated the observed efficiency through numerical simulations. We found that the designed filters exhibit a lower pressure drop, compared to commercial masks and filters, while capturing particles bigger than approximately 10 μm. Our findings could facilitate a novel and scalable filter concept inspired by animal noses.