bluuebunny/crossref_metadata_2025 huggingface dataset:
Survey of Laboratory Stewardship Governance at US Academic Medical Centers
Authors: Eby Charles S , Al-Hammadi Noor , Dodds Kathy , Sunkavalli Deepak , Gronowski Ann M
Published: January 2025

Background

Efforts to appropriately utilize laboratory tests have been underway for several decades. However, limited information is available regarding the status of laboratory stewardship at academic medical centers. Prior to initiating a laboratory stewardship committee, a study was initiated to gain insights from peer institutions.

Methods

An online REDCap survey was created and emailed to US pathology department leaders at 94 academic medical centers.

Results

Response rate was 40%. Sixty-eight percent (n = 26) of respondents indicated that they have a laboratory stewardship committee. There was variability among academic medical institutions regarding governance, committee structure and responsibilities, and assessment of laboratory stewardship committee performance. There was consensus for inclusion of: hospital administration and clinical leadership; informatics (IT) support, and a multidisciplinary clinical team combined with laboratory medicine expertise. Of the 32% (n = 12) without a committee, 4 started one but found it unsustainable, and 6 were unsuccessful at starting a program. Respondents without a current laboratory stewardship program cited lack of leadership support, insufficient management and IT resources, and unclear vision and goals as major factors. Fifty-eight percent of those without a laboratory stewardship committee predicted their hospital would establish one within the next 5 years.

Conclusions

Survey results provide insights into the status of laboratory stewardship efforts at peer institutions. Awareness of the structural and leadership components critical to successful and sustained initiatives will improve the quality and value of clinical laboratory services.
Analysis of modern strategies for using artificial intelligence technologies in the creation of fantasy content
Authors: Sultan Yertay , Dautova Gulnaz , Alkebayeva Dina , Akzhigitova Akkibat , Aden Zhansaya
Published: January 2025

This study explores the integration of artificial intelligence (AI) in the creation of fantasy narratives, examining the new possibilities AI offers for authors and readers and its impact on the genre’s evolution. The study used literature review, textual analysis, comparative analysis, data analysis, experimental methods, ethical and legal examination, and data processing methods using Natural Language Processing software. Through analysis of films, video games, and qualitative text review, the research found that modern technologies—particularly AI and computer graphics—have greatly enhanced the visualization of fantasy worlds, contributing to the genre’s growing popularity. Interactive AI-driven platforms enable customized experiences, increasing engagement and satisfaction among audiences. A significant finding is that contemporary fantasy works, while retaining traditional elements like the struggle between good and evil, magic, and adventure, are now incorporating modern socio-cultural and political themes. This blend preserves the genre’s appeal to diverse audiences while keeping it relevant in today’s context. Additionally, AI opens new avenues for authors by aiding in overcoming creative blocks, generating fresh ideas, and constructing interactive worlds where readers can shape the plot or create their own characters. This not only accelerates the creative process but also enriches storytelling with more varied narratives. The study concludes that fantasy remains a powerful tool for cultural and social expression and that AI holds great potential for the genre's future growth, promising more innovative and inclusive experiences for audiences.
How welfare and credit regimes shape economic policies during times of crisis: the case of Covid-19
Authors: Laprise Marie-Lou , Wiedemann Andreas
Published: January 2025

How much economic support governments offered to households during the Covid-19 pandemic differed considerably across rich democracies. What explains this variation? We argue that institutional structures of welfare and credit regimes shape households’ abilities to address income shortfalls and, as a result, governments’ policy repertoire during crises. In countries with permissive credit regimes, economic support policies were more comprehensive when social policies were limited. Governments not only provided income support but also debt relief to shield households from default risks due to high pre-crisis debt leverage. Yet those countries ceased income support sooner as credit resumed its substitutive role vis-à-vis the welfare state. We provide evidence for our argument by examining pandemic policies from five OECD countries that vary in their social policies, credit access and household indebtedness. Our findings suggest that the privatization of risks imposes financial burdens on households that constrain governments’ policy responses in times of crisis.
The value of crypto? Sociotechnical imaginaries on cryptocurrency in YouTube content
Authors: De Keere Kobe , Trans Martin , Milan Stefania
Published: January 2025

In less than two decades, cryptocurrency has transformed from being an object of interest for an obscure online community to becoming a digital asset of global appeal. By acknowledging the importance of fictional expectations in the creation of economic value, this study addresses the question: How is the value of crypto imagined? Through quantitative and qualitative coding of 1921 YouTube video transcripts, combined with Exploratory Factor Analysis, this article maps out the sociotechnical imaginaries that attribute value to crypto, that are being disseminated on YouTube. This study identifies four distinct imaginaries that project a value on cryptocurrency: investment, utility, digital metallism, and infrastructural mutualism imaginary. This explorative analysis sheds light on the potential value consumers attribute to cryptocurrencies while opening new research avenues toward a better understanding of the market and its mediation by platform algorithms as potential market devices.
Byers v Saudi National Bank: circumventing the knowing receipt doctrine
Authors: Arvidsson Christopher
Published: January 2025

This article will map a category of unconscionable transfers that can circumvent the knowing receipt doctrine by design. It exposes and charts these transfers—herein referred to as Samba Transfers—by looking at Byers v Saudi National Bank. While Byers is the model case, Samba Transfers can occur in many situations. The Supreme Court’s decision in Byers has paved the way for this category of unconscionable transfers. This is because the court dealt with the ‘knowing receipt issue’ by resorting to reasons of principle rather than focusing on the defendant’s unconscionable behaviour. This article endorses the Supreme Court’s principled approach. Still, it asks whether Samba Transfers are a cause for concern following Byers. In particular, can the law on dishonest assistance come to the rescue if a recipient of assets has used the judgment in Byers as a blueprint to evade liability in knowing receipt?
Integration of the rat liver micronucleus assay into a 28-day treatment protocol: testing the genotoxicity of 4 small-molecule nitrosamines with different carcinogenic potencies and tumor target specificities
Authors: Guo Xiaoqing , Seo Ji-Eun , Xu Hannah , Yan Jian , Malhi Pritpal , Atrakchi Aisar H , McGovern Timothy , Davis Bruno Karen L , Heflich Robert H , Chen Tao
Published: January 2025

Several potent carcinogenic nitrosamines, including N-nitrosodiethylamine (NDEA) and N-nitrosodimethylamine (NDMA), induce micronuclei in the micronucleated hepatocyte (MNHEP) assay but not in the micronucleated reticulocyte (MNRET) assay. However, the MNHEP assay is not as frequently used as the MNRET assay for evaluating in vivo genotoxicity. The present study evaluated MN formation in the liver of Big Blue transgenic rats exposed to 4 small-molecule nitrosamines, NDMA, N-nitrosodiisopropylamine (NDIPA), N-nitrosoethylisopropylamine (NEIPA), and N-nitrosomethylphenylamine (NMPA), using a repeat-dose protocol typically used for in vivo mutagenicity studies. NDMA is a potent liver carcinogen, whereas NDIPA and NEIPA are relatively weak liver carcinogens, and NMPA primarily produces esophageal tumors. Seven-week-old rats were treated with the nitrosamines for 28 consecutive days; liver was harvested 3 days after the last dose and used for conducting the flow-cytometry-based MNHEP assay. All 4 nitrosamines induced dose-dependent increases in %MNHEP and the magnitude of the responses correlated with their carcinogenicity in rat liver. These results indicate that the flow-cytometry-based MNHEP assay can be successfully integrated into 28-day repeat-dose studies, and that the MNHEP assay may be useful for evaluating the genotoxicity of nitrosamines that have different carcinogenic potencies and different tumor target specificities.
Overcoming the snakebite challenge in Sudan: a call to action
Authors: Badri Rawa , Dawood Iyas , Osman Rana , Ahmed Nayyrah , Adam Salma Ibrahim Mohammed
Published: January 2025

Snakebite envenomation is a neglected tropical disease that affects millions of people in sub-Saharan Africa, including Sudan. The severity of snakebite envenomation ranges from mild to severe, and can even lead to death. Sudan has a high burden of snakebite envenomation, with an estimated 12 632 cases and a mortality rate of 2.5% per year. The country faces several challenges in addressing snakebite envenomation, including a weak health system, limited access to healthcare facilities and a shortage of antivenom. This article highlights the challenges facing snakebite control in Sudan and provides recommendations for reducing the burden of this neglected tropical disease.
National Action Plan for the prevention and control of snakebite envenoming in India: strategies and challenges
Authors: Munshi Hrishikesh , Gajbhiye Rahul K
Published: January 2025

India accounts for one-half of global snakebite-related deaths. The recently launched National Action Plan for the Prevention and Control of Snakebite Envenoming in India is a comprehensive initiative designed to address this burden. It aims to ensure universal access to antivenom, strengthen healthcare systems, train healthcare professionals and engage traditional healers to enhance public awareness. The plan also promotes democratization and inter-sectoral collaboration, allowing states to customize their approaches, and advocates for a One Health strategy. While the plan reinforces India's commitment to sustainable development, continued political commitment, robust monitoring and evaluation, global collaborations and community ownership remain crucial for its effective implementation.
Community-based snakebite risk mapping for resource prioritisation in Eastern Province, Rwanda
Authors: Ediriweera Dileepa Senajith , Hakizimana Dieudonne , Diggle Peter J , Schurer Janna M
Published: January 2025

Background

Snakebite envenoming is a medical emergency that requires rapid access to essential medicines and well-trained personnel. In resource-poor countries, mapping snakebite incidence can help policymakers to make evidence-based decisions for resource prioritisation. This study aimed to characterise the spatial variation in snakebite risk, and in particular to identify areas of relatively high and low risk, in Eastern Province, Rwanda.

Methods

Snakebite surveillance of people bitten in 2020 was conducted in Eastern Province through household visits and case verification. Geostatistical modelling and predictive mapping were applied to data from 617 villages in six districts to develop sector-level and district-level risk maps.

Results

There were 1217 individuals bitten by snakes across six districts. The estimated population-weighted snakebite incidence in Eastern Province was 440 (95% predictive interval 421 to 460) cases per 100 000 people, corresponding to 13 500 (95% predictive interval 12 950 to 14 150) snakebite events per year. Two sectors in the southwest, Gashanda and Jarama, showed >1500 snakebite events per 100 000 annually. The lowest incidence was observed in the north.

Conclusions

Considerable differences exist in snakebite risk between sectors in Eastern Province, with the highest risk concentrated in the southwest. Policymakers should consider prioritising resources related to snakebite prevention, essential medicines and health worker training in this region.
Genetic variability in snake venom and its implications for antivenom development in sub-Saharan Africa
Authors: Ayesiga Innocent , Okoro Lenz N , Taremba Chirigo , Yeboah Michael O , Naab Justine T M , Anyango Ruphline M , Adekeye John , Kahwa Ivan
Published: January 2025

Snake venom, a complex mixture of proteins, has attracted human attention for centuries due to its associated mortality, morbidity and other therapeutic properties. In sub-Saharan Africa (SSA), where snakebites pose a significant health risk, understanding the genetic variability of snake venoms is crucial for developing effective antivenoms. The wide geographic distribution of venomous snake species in SSA countries demonstrates the need to develop specific and broad antivenoms. However, the development of broad antivenoms has been hindered by different factors, such as antivenom cross-reactivity and polygenic paratopes. While specific antivenoms have been hindered by the numerous snake species across the SSA region, current antivenoms, such as SAIMR polyvalent and Premium Serums & Vaccines, exhibit varying degrees of cross-reactivity. Such ability to cross-react enables the antivenoms to target multiple components from the different snake species. The advent of biotechnological innovations, including recombinant antibodies, small-molecule drugs, monoclonal antibodies and synthetic antivenoms, presents options for eliminating limitations associated with traditional plasma-derived antivenoms. However, challenges still persist, especially in SSA, in addressing genetic variability, as evidenced by inadequate testing capacity and limited genomic research facilities. This comprehensive review explores the genetic variability of snake venoms in SSA, emphasizing the venom composition of various snake species and their interactions. This information is critical in developing multiple strategies during antivenom development. Finally, it offers information concerning the need for extensive collaborative engagements, technological advancements and comprehensive genomic evaluations to produce targeted and effective antivenoms.
Conflict between sea snakes and humans on the coast of West Bengal and Odisha, India: perception, attitudes and incidents
Authors: Patra Anweshan , Mahapatra Ardhendu Das , Malhotra Anita , Santra Vishal , Ghorai Sudipta Kumar , Annadurai D
Published: January 2025

Background

Snakebite envenoming is a critical medical emergency and significant global public health issue, with India experiencing the highest annual snakebite deaths. Sea snakes in the Indian Ocean pose a severe threat to rural fishermen due to their potent neurotoxins.

Methods

From December 2020 to December 2021, we conducted surveys at 15 fishing ports in East Medinipur, West Bengal, and Balasore, Odisha, India (between 21.805651 N 87.874188 E and 21.574851 N 87.374059 E). We interviewed 2301 fishermen in 421 group sessions to document sea snake bite incidents, outcomes and perceptions from 2012 onwards. Historical data were also retrieved from various databases and social media platforms.

Results

We recorded 166 sea snake bite cases, with 55.4% fatalities, 2.4% permanent disabilities and 41% survivors. Gill net fishermen were the most affected, with most bites occurring while handling snakes caught in nets, particularly at dawn and dusk. Fishermen reported a significant decline in sea snake populations over the past decade due to by-catch and killing practices.

Conclusions

Sea snake bites are a major occupational hazard for Indian fishermen, with high fatality rates due to limited medical access. Increased awareness, safer handling practices and improved medical infrastructure are essential to reduce mortality and conserve sea snake populations. This study highlights the need for targeted interventions in affected communities.
Effects of heparin on venom-induced consumption coagulopathy: a meta-analysis of randomized controlled trials
Authors: Huang Yu-Ning , Chang Wei-Chuan , Lin Yun-Kuan
Published: January 2025

Venom-induced consumption coagulopathy (VICC) is a serious complication of snakebites, potentially leading to life-threatening bleeding. Despite efforts to determine effective treatments other than antivenom, such as heparin, the evidence supporting their use remains insufficient. Therefore, this study aimed to perform a systematic review, meta-analysis and trial sequential analysis (TSA) to examine the effects of heparin on VICC. On 11 August 2024, a systematic search for randomized controlled trials (RCTs) investigating the effects of heparin on VICC was conducted using eight online databases. Six RCTs were included in this study. The meta-analysis revealed that heparin did not significantly reduce the mortality rate (risk ratio, 0.65; 95% CI 0.39 to 1.10). Additionally, the meta-analysis showed no significant differences in various clinical outcomes between the heparin group and control group. The TSA indicated insufficient evidence to conclude the effects of heparin on VICC mortality, and a sample size of 741 patients may be needed for further RCTs. In conclusion, our findings indicate that heparin may not significantly affect VICC outcomes. Although the current evidence is inconclusive because of the limited sample size, it highlights the need for future trials to provide more precise insights.
Evaluation of the immunogenicity of a DNA vaccine for Leishmania major based on the Leishmania-activated C kinase antigen using calcium phosphate and chitosan adjuvants
Authors: Gharaei Abdolaziz , Rahdar Mahmoud , Jorjani Oghlniaz , Saberi Sedigheh , Beiromvand Molouk , Feiz-Haddad Mohammad Hossein
Published: January 2025

Background

Leishmaniasis represents a significant parasitic disease with global health implications, and the development of an affordable and effective vaccine could provide a valuable solution. This study aimed to evaluate the immunogenicity of a DNA vaccine targeting Leishmania major specifically based on the Leishmania-activated C kinase (LACK) antigen, utilizing calcium phosphate nanoparticles (CaPNs) and chitosan nanoparticles (ChitNs) as adjuvants.

Methods

Seventy female BALB/c mice, aged 4–6 wk and weighing 20–22 g, were selected and divided into five groups, each consisting of 14 mice. The first group received the plasmid LACK vaccine (pcDN3+LACK), the second group received the pcDN3+LACK vaccine with the CaPN adjuvant (pcDN3+LACK+CaPN), the third group received the pcDN3+LACK vaccine with the ChitN adjuvant (pcDN3+LACK+ChitN), the fourth group was administered phosphate-buffered saline as a negative control and the fifth group did not receive any vaccine, serving as a positive control. The vaccination program involved two intramuscular injections at 3-wk intervals. Three weeks following the final vaccination, the mice were challenged with wild-type L. major promastigotes via intradermal injection at the base of their tails. Clinical signs and lesion sizes were evaluated biweekly using Vernier calipers. Immune responses, including levels of interferon-gamma (IFN-γ) and interleukin-4 (IL-4), were assessed using ELISA.

Results

The groups receiving pcDN3+LACK+ChitN, pcDN3+LACK+CaPN and pcDN3+LACK exhibited the highest increases in IFN-γ titers and the most significant reductions in IL-4 titers. Furthermore, lesion sizes associated with Leishmania infection were reduced in the vaccinated groups, with the most favorable outcomes observed in the pcDN3+LACK+ChitN group.

Conclusions

These findings suggest that vaccination utilizing the LACK antigen in conjunction with CaPN and ChitN adjuvants may represent an effective strategy for the control of cutaneous leishmaniasis.
An orphan viral genome with unclear evolutionary status sheds light on a distinct lineage of flavi-like viruses infecting plants
Authors: Xu Zhongtian , Zheng Luping , Gao Fangluan , Li Yiyuan , Sun Zongtao , Chen Jianping , Zhang Chuanxi , Li Junmin , Wang Xifeng
Published: January 2025

Advancements in high-throughput sequencing and associated bioinformatics methods have significantly expanded the RNA virus repertoire, including novel viruses with highly divergent genomes encoding “orphan” proteins that apparently lack homologous sequences. This absence of homologs in routine sequence similarity search complicates their taxonomic classification and raises a fundamental question: Do these orphan viral genomes represent bona ide viruses? In 2022, an orphan viral genome encoding a large polyprotein was identified in alfalfa (Medicago sativa) and thrips (Frankliniella occidentalis), and named Snake River alfalfa virus (SRAV). SRAV was initially proposed as an uncommon flavi-like virus identified in a plant host distantly related to family Flaviviridae. Subsequently, another research group showed its common occurrence in alfalfa but challenged its taxonomic position, suggesting it belongs to the family Endornaviridae. In this study, a large-scale analysis of 77 publicly available small RNA datasets indicates that SRAV could be detected across various tissues and cultivars of alfalfa, and has a broad geographical distribution. Moreover, profiles of the SRAV-derived small interfering RNAs (vsiRNAs) exhibited typical characteristics of viruses in plant hosts. The evolutionary analysis suggests that SRAV represents a unique class of plant-hosted flavi-like viruses with an unusual genome organization and evolutionary status, distinct from previously identified flavi-like viruses documented to infect plants. The latter shows a close evolutionary relationship to flavi-like viruses primarily found in plant-feeding invertebrates and lacks evidence of triggering host RNA interference (RNAi) responses so far. Moreover, mining the transcriptome shotgun assembly (TSA) database identified two novel viral sequences with a similar genome organization and evolutionary status to SRAV. In summary, our study resolves the disagreement regarding the taxonomic status of SRAV and suggests the potential existence of two distinct clades of plant-hosted flavi-like viruses with independent evolutionary origins. Furthermore, our research provides the first evidence of plant-hosted flavi-like viruses triggering the host’s RNAi antiviral response. The widespread occurrence of SRAV underscores its potential ecological significance in alfalfa, a crop of substantial economic importance.
Nonintubated video-assisted thoracic surgery: myth or reality?
Authors: Piccioni Federico , Rosboch Giulio Luca
Published: January 2025

Purpose of review

This review discusses nonintubated video-assisted thoracic surgery (NIVATS) by presenting its physiological, technical aspects and recent clinical data from the literature.

Recent findings

In the last two decades, NIVATS has gained traction as an alternative to traditional intubated thoracic surgery, offering potential benefits in terms of reduced complications, faster recovery times, and improved patient satisfaction. Several approaches to this technique have been described in the literature, mainly divided into the awake patient technique (awake-NIVATS) and the asleep patient technique (asleep-NIVATS). The availability of various sedatives, numerous devices to ensure good oxygenation, and the countless loco-regional techniques available today for pain control in the thoracic region offer the possibility to develop many anesthesia protocols in this context. Numerous studies have already shown that NIVATS is feasible and safe with proper patient selection and adequate collaboration of the surgical team. Some studies have also shown that NIVATS may improve patient outcomes, but the evidence is still limited.

Literature has demonstrated the feasibility of NIVATS and suggest that it can improve patient outcomes. High-quality international randomized multicenter studies comparing NIVATS and intubated video-assisted thoracic surgery are necessary for a strong comprehension to clarify whether it can be a technique that can guarantee safety and improve the perioperative course of patients.
Nerve Fiber Layer Schisis in Coats Disease
Authors: Burt Spencer S , Bayhaqi Yakub , Ni Shuibin , Jian Yifan , Campbell J. Peter , Young Benjamin K
Published: January 2025

Purpose:

To describe two cases of pediatric patients with Coats disease who developed nerve fiber layer (NFL) schisis.

Methods:

Observational case series.

Results:

Two male pediatric patients, ages 2 and 14, who were being treated for Coats disease were found to have NFL schisis on optical coherence tomography. Both were treated with panretinal photocoagulation (PRP) and indirect laser. The 14-year-old patient has had recurrent disease with a most recent visual acuity of 20/80+1 in the affected eye. The 2-year-old patient continues to be followed after receiving two rounds of PRP, followed by two rounds of superotemporal laser.

Conclusion:

Nerve fiber layer schisis is a rare manifestation of Coats disease.
Epstein-Barr Virus-Associated Frosted Branch Angiitis: A Case Report and Brief Review
Authors: Cao Angela A. , Curran Christian D. , Diaz Pedro Monsalve , Hause Emily , Koozekanani Dara , Johnson Max R. , Armbrust Karen R.
Published: January 2025

Purpose:

To report the clinical presentation, treatment course, and outcome of a case of bilateral frosted branch angiitis (FBA) and neuroretinitis associated with acute Epstein-Barr virus (EBV) infection in a pediatric patient with Turner Syndrome.

Methods:

Case report with multimodal ocular imaging and extensive systemic workup.

Results:

A 16-year-old female with Turner syndrome presented with acute bilateral vision loss, hearing loss, and ataxia. Ocular examination showed bilateral extensive perivascular sheathing, optic disc edema, and macular exudates. Fluorescein angiography showed focal retinal ischemia and late optic disc leakage in both eyes. Macular optical coherence tomography was remarkable for intraretinal and subretinal fluid with scattered hyperreflective foci in both eyes. MRI brain and orbits showed a supratentorial T2 signal without enhancement, consistent with inactive vasculopathy. Results of a broad systemic workup were notable only for elevated EBV viral capsid antigen IgM with undetectable EBV viral capsid antigen IgG. After treatment with intravenous methylprednisolone followed by oral prednisone, the patient’s best corrected visual acuity in both eyes improved from 20/200 to 20/20.

Conclusion:

Ocular symptoms and imaging biomarkers in this case of EBV-associated FBA resolved after high-dose systemic corticosteroid monotherapy. Although treatment with antiviral medications is reported in other FBA cases associated with acute EBV infection, this case underscores the treatable nature of this disease without antivirals, the use of which are not supported by the broader literature for EBV infection or post-viral inflammation.
Hypertension Self-Management Among African American Adults
Authors: Sharma Dhruvangi P. , Aycock Dawn M. , Kelley Susan J. , Gaillard Trudy
Published: January 2025

Hypertension disproportionately affects African Americans, and adequate blood pressure (BP) control remains a challenge. Self-management of hypertension is critical for improving BP control and reducing hypertension-related morbidities.

Objectives

The objective of this study is to describe hypertension self-management (HTN-SM) behaviors and the relationship between HTN-SM and self-reported BP in middle- to older-aged African American adults.

Methods

A cross-sectional correctional design was used, and African Americans 45 years and older were recruited through flyers. Data were collected using self-report surveys, including the Self-Care of Hypertension Inventory, administered via Qualtrics or by telephone interviews.

Results

Participants (N = 142) had a mean age of 63.04 years (SD = 12.0 years). One hundred sixteen (82%) were female and had lived with hypertension for 13.7 years (SD = 11.1 years). For those who could recall their most recent BP (n = 99, 70%), the average systolic BP was 133 (SD = 13.4) and diastolic BP was 80 (SD = 10.7). Thirty-six (36%) participants had BP readings considered stage 2 hypertension (ie, ≥140/90 mm Hg), and 37 (37%) had readings ≥130/80 mm Hg, considered stage 1 hypertension. The mean hypertension self-care maintenance score used to assess HTN-SM was 58.14 ± 16.67; 28% had adequate scores (≥70). Medication adherence, keeping healthcare provider appointments, and eating fruits and vegetables were the most frequent behaviors, whereas asking for low salt, low fat foods, and exercising were the least frequent. Higher hypertension self-care maintenance scores were significantly associated with lower BP readings.

Conclusions

A significant portion of participants had BP considered “uncontrolled” and low self-care maintenance scores. Facilitating HTN-SM is critical for lowering BP; therefore, assessment of HTN-SM is recommended for understanding potential barriers.
Moral Distress Consultation Services: Insights From Unit- and Organizational-Level Leaders
Authors: Amos Vanessa , Whitehead Phyllis , Epstein Beth
Published: January 2025

Goal:

The objective of this study was to better understand how healthcare systems’ unit- and system-level leaders perceive and experience moral distress consultation services, including their utility, efficacy, and sustainability.

Methods:

A multimethod design was conducted in tandem across two academic medical centers with longstanding and active moral distress consultation services. Moral distress data for healthcare providers participating in moral distress consultation were collected. The authors also conducted interviews about moral distress consultation with unit and organizational leaders using a semistructured interview format. They analyzed interview transcripts using both inductive and deductive coding strategies. Relevant themes and categories were then transferred onto a thematic map for final analysis.

Principal Findings:

Twenty moral distress consults (10 at each institution) were held during the five-month study period. The mean reported moral distress score for all preconsult participants (n = 52) was 6.9 (SD = 2.5), with scores ranging from 0 to 10. In the combined presurvey and postsurvey group (n = 22), the mean moral distress score was 5.9 (SD = 2.2) prior to the consult and 5.3 (SD = 2.7) after the consult. Participants indicated that moral distress causes were primarily team-level-focused prior to moral distress consultation and system-level-focused after consultation. As consult data were collected, eight unit- and system-level leaders were interviewed. Leaders described moral distress consultation as valuable and empowering to unit-based staff. They endorsed the service’s ability to create safe spaces for open communication about morally distressing events. Leaders also suggested the need for more diverse professional representation (outside of nursing) among consultants and participants, as well as more transparent and consistent education plans related to the service, not only to increase leaders’ knowledge and awareness of moral distress, but also to increase the visibility of the consult service, both within and outside the organization. Finally, leadership teams valued qualitative accounts of morally distressing events from staff.

Practical Applications:

Addressing moral distress requires intentional and systemic collaboration, including open communication between moral distress consultation leaders, participants, and unit- and system-level leadership teams. Transparent education plans, broad professional representation, and flexible success measures—including both quantitative and qualitative metrics—are necessary and should be considered for any current or developing moral distress consultation services.
Expert Consensus on an Exercise Prescription Framework for Older People Living With HIV in a South African Setting—A Delphi Study
Authors: Chetty Levin , Cobbing Saul , Chetty Verusia
Published: January 2025

Well-established, regular exercise interventions for older people living with HIV (OPLWH) are beneficial. However, the fundamental principles of exercise prescription for this population have not been sufficiently explored. An expert panel of health care professionals engaged in a modified Delphi technique to explore their perceptions of, and gain their consensus on, an exercise prescription framework for OPLWH in a resource-poor South African setting. A high level of agreement among participants was determined using a priori threshold of 80% agreement and an interquartile range of ≤ 1. Expert consensus was reached on a structured, multifaceted exercise prescription and also fundamental principles, such as multidisciplinary engagement and team collaboration, pre-exercise health screening, and exercise supervision. These were viewed as necessary components of a framework to improve the integration of exercise rehabilitation in the treatment, care, and support for OPLWH.
Association of quantitative flow ratio with in-stent restenosis in patients with unstable angina undergoing percutaneous coronary intervention
Authors: Liu Dongchao , Xue Zheng , Qi Jingxian , Yin Liang , Duan Bing , Gao Bulang , Mi Jie
Published: January 2025

Objective

To investigate the association of post–percutaneous coronary intervention (PCI) quantitative flow ratio (QFR) with in-stent restenosis (ISR) in patients with unstable angina.

Materials and methods

Patients treated with PCI and follow-up for ISR were divided into a poor QFR group (QFR < 0.91) and a good QFR group with (QFR ≥ 0.91). All clinical data were analyzed.

Results

Among 143 patients enrolled, 57 (39.9%) patients were in the poor QFR group and 86 (60.1%) in the good QFR group. After stenting, the stenosis was decreased to 0 from ≥80% before PCI. At 10-month follow-up, the incidence of ISR in the good QFR group was 6.9%, significantly lower than 33.9% in the poor QFR group (P < 0.05). QFR < 0.91 was a significant (P = 0.002) risk factor for ISR, 4.25 times that of patients with QFR ≥ 0.91. After adjusting for age and sex, the risk of developing ISR in patients with poor QFR was 4.51 times that in patients with good QFR [95% confidence interval (CI): 1.76–11.54, P = 0.002], and QFR < 0.91 (adjusted risk ratio: 6.57, 95% CI: 2.45–17.60, P < 0.001) and diabetes (adjusted risk ratio: 7.23, 95% CI: 2.81–18.60, P < 0.001) were two independent risk factors for ISR.

Conclusion

A positive linear relationship exists between QFR and ISR after adjusting for age and sex, and poor QFR < 0.91 after PCI is a significant independent risk factor for ISR among unstable angina patients undergoing PCI.
Evaluation of Phoenix Sepsis Score Criteria: Exploratory Analysis of Characteristics and Outcomes in an Emergency Transport PICU Cohort From the United Kingdom, 2014–2016
Authors: Carter Michael J. , Hageman Joshua , Feinstein Yael , Herberg Jethro , Kaforou Myrsini , Peters Mark J. , Nadel Simon , Edmonds Naomi , Pathan Nazima , Levin Michael , Ramnarayan Padmanabhan
Published: January 2025

Objectives:

To assess characteristics and outcomes of children with suspected or confirmed infection requiring emergency transport and PICU admission and to explore the association between the 2024 Phoenix Sepsis Score (PSS) criteria and mortality.

Design:

Retrospective analysis of curated data from a 2014–2016 multicenter cohort study.

Setting:

PICU admission following emergency transport in South East England, United Kingdom, from April 2014 to December 2016.

Patients:

Children 0–16 years old (n = 663) of whom 444 (67%) had suspected or confirmed infection.

Interventions:

None.

Measurements and Main Results:

The PSS was calculated as a sum of four individual organ subscores (respiratory, cardiovascular, neurological, and coagulation) using the worst values during transport (i.e., from referral until the time of PICU admission). A score cutoff of greater than or equal to 2 points was used to define sepsis; and septic shock was defined as sepsis plus 1 or more cardiovascular subscore points. Sepsis occurred in 260 of 444 children (58.6%) with suspected or confirmed infection, with septic shock occurring in 177 of 260 (68.1%) of those with sepsis. A PSS score greater than or equal to 2 points occurred in 37 of 67 bronchiolitis cases, 19 of 35 meningoencephalitis cases, 30 of 47 pneumonia/empyema cases, 38 of 46 septic/toxic shock cases, nine of 15 severe sepsis cases, and 58 of 118 definite viral infections. Overall, 14 of 444 children died (3.2%). There were 12 deaths in the 260 children with PSS greater than or equal to 2, and two deaths in the 184 children with PSS less than 2 (4.6% vs. 1.1%; absolute difference, 3.5%; 95% CI, 0.1–6.9%; p = 0.04).

Conclusions:

In 2014–2016, over half of the critically ill children undergoing emergency transport to PICU with presumed or confirmed infection, and meeting retrospectively applied PSS criteria for sepsis, had a range of clinical diagnoses including bronchiolitis, meningoencephalitis, and pneumonia/empyema. Furthermore, the PSS criteria for categorization of sepsis and septic shock were associated with outcome and may be of value in future risk-stratification in clinical trials.
Demographic and clinical factors associated with functional changes in Long-Covid
Authors: Mazer Barbara , Feldman Debbie Ehrmann
Published: January 2025

Many people experience symptoms months or years following COVID-19 infection. The impact of these symptoms on daily functioning and factors associated with functional decline are not well understood. This study aimed to describe functional changes among persons with Long-Covid and explore associated sociodemographic and clinical factors. 2764 adults who tested positive for COVID-19 were recruited at >12 weeks after diagnosis. Participants responded to an electronic survey [Newcastle Post-COVID Syndrome Questionnaire (symptoms); COVID-19 Yorkshire Rehabilitation Screen (activities; perceived global health, mobility, personal care, daily activities)]. 37.8% were classified as having Long-Covid based on the positive response to “Are you still troubled by symptoms?”. The majority of them reported a decline in global health, mobility, and participation in daily activities. Common changes in function included fatigue, breathlessness upon climbing stairs and when dressing, decline in participation in usual activities, anxiety, pain/discomfort, and reduced concentration. Having COVID-19 > 1 year prior was associated with change in perceived global health (OR = 1.5). Being infected >12 months prior (OR = 1.5), hospitalized for COVID-19 (OR = 2.2-2.4), >1 chronic comorbid conditions (OR = 1.6), and obesity (OR = 1.6) were associated with functional decline. Many of those infected with COVID-19 experience long-lasting symptoms impacting daily functioning. Multidisciplinary medical and rehabilitation services are needed to help improve recovery and maximize functioning.
Application of Hyaluronic Acid Linear Stereoscopic Stack Volume Enhancement Injection Technique in Nasal Reshaping
Authors: Dong Ruiping , Lei Jiaqi , Liu Qingyang
Published: January 2025

Hyaluronic acid (HA) injection, traditionally used for non-surgical rhinoplasty, is often associated with adverse effects such as increased nasal dorsum width. This study introduces the linear stereoscopic stack volume enhancement (LSSVE) injection technique as a solution for patients with low-profile noses, aiming to improve the nasal dorsum dimension, prevent long-term nasal widening, and address related concerns. A retrospective analysis was conducted on the clinical registry data of patients treated at Shanghai Phiskin Clinic from December 2020 to June 2024, who received HA injections using the LSSVE technique. Each rhinoplasty patient received a personalized injection, with doses ranging from 0.59 to 1.03 mL, adjusted based on specific characteristics of their nose and forehead. The procedure utilized a 25G blunt cannula to administer HA between the nasal bone periosteum and fascial layer using the LSSVE technique. The primary endpoint was patient improvement assessed 6 months post-injection using the Global Aesthetic Improvement Scale (GAIS), evaluated by a blinded assessor. In addition, patient satisfaction and complications were assessed. A total of 189 patients (181 females and 28 males) were included in the study, all of whom received a single HA LSSVE injection. Six months post-injection, the GAIS improvement rate was 82.83%, with a patient satisfaction rate of 84.83%. The injection effect was maintained for 6 months without any nasal dorsum widening, and a significant increase in the nasofrontal angle was observed (P<0.001). No long-term complications were reported post-injection. The LSSVE injection technique demonstrated effectiveness in overcoming the limitations of traditional HA rhinoplasty and preventing long-term nasal dorsum widening.
Long-Term Series of Custom-Bone Hydroxyapatite Cranioplasty: Outcomes and Survival at 15 Years
Authors: Carbonaro Riccardo , Ghiringhelli Gaia , Nataloni Angelo , Amendola Francesco , Catapano Simone , Vaienti Luca , Umana Giuseppe E. , Fricia Marco , Zingaretti Nicola , Zanotti Bruno
Published: January 2025

Introduction:

Cranioplasty (CP) is a surgical procedure used to repair or reconstruct bone defects in the skull. As CP is not without risk, identifying the safest reconstruction technique is essential to achieve optimal functional recovery. While heterologous prostheses such as HA address issues related to storage and preservation of autograft and help prevent bone resorption, they are associated with a specific spectrum of risks, including infection, dislocation, and fracture. The aim of our article is to evaluate the safety and performance of HA cranioplasty through a retrospective study conducted at 2 centres with extended follow-up of up to 15 years. This study represents one of the most comprehensive and long-term analyses available and provides important insights into the efficacy of this material in clinical practice.

Methods:

Data were collected from patients who underwent CP between December 2001 and December 2008. The authors conducted a retrospective study of a case series of 101 adult and paediatric patients who received custom-made HA implants after craniotomy for various reasons. The primary endpoint was to evaluate prosthesis survival and explantation rates. Secondary endpoints included the incidence of adverse events and the rate of surgical revision.

Results:

Over a period of 7 years (from December 2001 to December 2018), a total of 101 patients who underwent CP with custom-made HA prostheses. Skull reconstruction with CP was performed immediately in 22 cases. All patients were initially evaluated 30 days after CP, with subsequent follow-ups at 6 months, 12 months, 24 months, and then at 3, 4, 5, 10, and 15 years. Major complications requiring explantation were observed in 9 patients: The reasons for explantation were as follows: 3 cases of infection, 2 cases of tumour recurrence, 2 cases of fracture, 1 case of cicatrial retraction, and 1 case of cerebral hemorrhage. Minor complications occurred in 10 cases and resolved without the need for explantation of the HA prosthesis. At the 15-year follow-up, radiographic and clinical evaluations of 41 patients confirmed optimal results, with complete and stable integration of the implant into the surrounding bone and no significant resorption or migration.

Conclusions:

This study provides a comprehensive long-term evaluation of custom HA CP, providing valuable insight into its efficacy and safety over a 15-year follow-up period. Our findings support the viability of HA as a material for cranial reconstruction, demonstrating a high prosthesis survival rate with stable integration in the majority of patients.
Identification of de-novo CREBBP gene variants in patients with Rubinstein–Taybi syndrome
Authors: Ji Qinghong , Ma Weihong , Xin Gang , Xin Qian , Duan Shuhong , Ding Mingxia , Dong Lihua , Li Zhiqiang , Hong Fanzhen
Published: January 2025

Rubinstein–Taybi syndrome (RSTS) is an autosomal dominant genetic disease characterized by growth retardation, psychomotor retardation, and distinctive facial features. It is primarily caused by mutations in CREBBP or EP300. In this study, we aimed to describe the clinical manifestations and genetic analyses of two cases with RSTS. Clinical analysis was performed on two cases with RSTS. Molecular diagnoses were made via whole exome sequencing, and potential pathogenic variants were filtered and selected. PCR followed by Sanger sequencing was used to verify candidate variants in the family members. Case 1 involved a 7-year-old boy (patient 1) who exhibited delayed language development, growth retardation, and intellectual disability. We did not find any other characteristics of RSTS, such as thumb or hallux abnormalities. Case 2 involved a fetus who had severe congenital heart disease, low conus medullaris, and a large gallbladder. Whole exome and Sanger sequencing results revealed that a missense mutation c.5120G>A (p. Cys1707Tyr) was present in patient 1 and that the fetus carried a heterozygous nonsense mutation c.1984C>T (p. Gln662Ter). In conclusion, whole exome sequencing combined with Sanger sequencing revealed that c.5120G>A (p. Cys1707Tyr) and c.1984C>T (p. Gln662Ter) are two new mutation sites that cause RSTS. This study expands the clinical phenotypes and is helpful in identifying gene-phenotype correlations in RSTS.
Multi-modal image analysis for large scale cancer tissue studies within IMMUcan
Authors: Eling Nils , Dorier Julien , Rusakiewicz Sylvie , Liechti Robin , Devanand Preethi , Daniel Michelle , Windhager Jonas , Fernandez Bruno Palau , Déglise Sophie , Despland Lucie , Benyagoub Abdelkader , Loboda Alexander , Sandkuijl Daaf , Parsotam Nikesh , Hong Henoch S , Morfouace Marie , Guex Nicolas , Coukos George , Bodenmiller Bernd , Tissot Stephanie , Schulz Daniel
Published: January 2025

Motivation

Multiplexed imaging is increasingly used to study tissue architecture in health and disease. To investigate the cancer tumor microenvironment, typically either tissue micro-arrays or small patient cohorts are used to collect and process data. However, studies performed over the course of years, collecting data from thousands of samples are rare and require specialized workflows to ensure sample throughput and reproducibility for data production and processing. Here, we present two such workflows for multiplexed immunofluorescence and imaging mass cytometry of cancer tissues which are applied to a total of roughly 10’000 samples from 2500 patients over six years.

In cancer research, multiplexed imaging allows detailed characterization of the tumor microenvironment (TME) and its link to patient prognosis. The IMMUcan consortium collects multi-modal imaging data from thousands of cancer patients to perform broad molecular and cellular spatial profiling across five cancer indications. Here, we describe two workflows for multiplexed immunofluorescence (mIF) and imaging mass cytometry (IMC) developed within IMMUcan to enable analysis of thousands of cancer tissues. IFQuant supports web-based, user-friendly, and reproducible analysis of mIF data. High sample throughput for IMC is achieved by optimizing experimental protocols and developing a robotic arm for automated slide loading. We provide a resource of 350’000 manually labelled cells across 180 cancer samples to accurately annotate cell phenotypes in IMC. All major cell phenotypes and tissue structures correlate well between mIF and IMC. These pipelines form the basis for multiplexed image analysis within IMMUcan and provide computational tools for the larger community.