bluuebunny/crossref_metadata_2025 huggingface dataset:
Authoritarian Othering Back and Feminist Subversion: Rethinking Transnational Feminism in Russia and Serbia
Authors: Bias Leandra
Published: August 2023

This article examines the effect of rising authoritarianism on Russian and Serbian feminists. In both cases, regimes rely on what I term “Othering back.” Using “gender ideology” as a proxy for Western imperialism, they reappropriate postcolonial frames to reject democratization and human rights. In such a context, the critical argument that transnational feminism is an exercise of Western Othering to reify power relations no longer resonates with feminists on the ground. To them it dangerously resonates with their own regime’s discourse. The article first traces how the regimes conduct authoritarian Othering back. Based on interpretive discourse analysis, applied to sixty-nine interviews, it then shows how Russian and Serbian feminists make sense of this political environment and the new strategies they derive from their interpretation: the need for discursive subversion that articulates alternative imaginaries of transnational feminism that cannot be reappropriated by the regime.
2-Chloro-3,7,8-tribromodibenzofuran as a new environmental pollutant inducing atypical ultrasonic vocalization in infant mice
Authors: Kimura Eiki , Suzuki Go , Uramaru Naoto , Kakeyama Masaki , Maekawa Fumihiko
Published: August 2023

Epidemiological and experimental studies indicate that maternal exposure to environmental pollutants impairs the cognitive and motor functions of offspring in humans and laboratory animals. Infant ultrasonic vocalizations (USVs), the communicative behavior of pups toward caregivers, are impaired in rodent models of neurodevelopmental disorders, suggesting a useful method to evaluate the developmental neurotoxicity of environmental pollutants. Therefore, we investigated USVs emitted by mouse pups of dams exposed to 2-chloro-3,7,8-tribromodibenzofuran (TeXDF) and 1,2,3,7,8-pentabromodibenzofuran (PeBDF), which are detected in the actual environment. The USV duration and number in the pups born to dams administered with TeXDF 40 μg/kg body weight (b.w.), but not 8 μg/kg b.w., on gestational day (GD) 12.5, were significantly lower than those in the corresponding pups on postnatal days 3–9. Conversely, there was no statistical change in the USVs emitted by the pups of dams administered with PeBDF 35 or 175 μg/kg b.w. on GD 12.5. To examine whether maternal exposure leads to behavioral impairments in adulthood, we analyzed exploratory behaviors in a novel environment using IntelliCage, a fully automated testing apparatus for group-housed mice. Neither TeXDF nor PeBDF exposure induced significant differences in offspring exploration. Considered together, our findings revealed that TeXDF induces atypical USV emission in infant mice, suggesting the importance of further studies on the risk assessment of mixed brominated/chlorinated dibenzo-p-dioxins and dibenzofurans.
Involvement of functional senescence in efavirenz-induced toxicity in fruit fly
Authors: Iorjiim Walter Mdekera , Omale Simeon , Ede Samuel , Ugokwe Chinelo Vera , Alemika Taiwo Emmanuel
Published: August 2023

Background

We aimed in this article to assess the likeliness of efavirenz to induce functional senescence in Drosophila melanogaster (fruit fly).

Methods

Ten different concentrations of EFV were mixed with fly food and fed to 3-day-old flies orally for a 7 day LC50 calculation. Drug concentrations from LC50 were selected for a 28 day survival to determine the duration of treatment for behavioral and biochemical assays. A 5day feeding plan was used to investigate the effects of the drug on organismal, neuromuscular, reproductive, and metabolic senescence. An in silico study was executed to decipher a molecular interaction of Drosophila enzymes glutathione-s-transferase (GST) or acetylcholinesterase (AChE) with EFV.

Results

The calculated LC50 of EFV was 118 mg/10-g fly diet. The test drug induced a significant (P < 0.05) increase in fly mortality, climbing difficulty, and procreative deficits after a 5 day oral exposure. Similarly, there were significant (P < 0.05) biochemical alterations, which suggested in vivo biochemical damage against total thiols (T-SH), SOD (superoxide dismutase), CAT (catalase), GST, AChE, and MDA (malondialdehyde) in the test flies compared to the control groups. In silico study revealed a significantly (P < 0.05) higher binding energy between EFV and the active amino acids of fly AChE and GST when compared to the substrates or standard inhibitors respectively.

Conclusion

EFV exhibited ecotoxic potentials evidenced by age-related deficits in the fly’s functional integrity such as sluggish movement, procreative deficiency, increased mortality, and oxidant-antioxidant inequality. Results from in silico study suggested antagonism against GST and AChE activities as a likely mechanism of EFV-induced toxicity in the fruit fly.
Disseminated Bacillus Calmette–Guérin infection: role of imaging in the evaluation of complications
Authors: Rajabi Ardeshir , Pouladfar Gholamreza , Dehghan Yasamin , Jafarpour Zahra , Dehghan Alireza
Published: August 2023

Background

The Bacillus Calmette–Guerin (BCG) vaccine is generally used to prevent tuberculosis, particularly meningeal and miliary types, in childhood. This vaccine can rarely cause complications of varying severity, ranging from localized disease to a severe diffuse type known as disseminated BCG infection. Imaging modalities play an important role in the evaluation of different complications of disseminated BCG infection. This study aimed to assess and describe the imaging findings of disseminated BCG infection in order to help clinicians diagnose this life-threatening infection more accurately.

Methods

This retrospective study was performed on 44 hospitalized children diagnosed with disseminated BCG infection. The results of radiographs, sonography, computerized tomography (CT) scan and magnetic resonance imaging were compiled in a checklist and were then assessed by a radiology resident and a board-certificated radiologist. The radiological findings from various imaging modalities were presented descriptively and the frequency of different parameters was reported.

Results

Axillary lymphadenopathy at the vaccinated side was frequent and was often associated with abscesses. However, abscesses in other body regions were uncommon. The most common abdominal imaging findings were enlarged liver and spleen accompanied by multiple hypoechoic and hypodense nodules on ultrasound and CT scans, respectively. Furthermore, diffuse or multifocal pulmonary opacities were the most frequent findings on chest X-rays and CT scans.

Conclusion

Characteristic imaging findings of disseminated BCG infection play a vital role in the early diagnosis of this infection. The study findings demonstrated the importance of radiological imaging in the diagnosis and evaluation of the complications of disseminated BCG infection.
A novel role of RNase L in the development of nonalcoholic steatohepatitis
Authors: Chen Guanmin , Zhao Xiaotong , Dankovskyy Maksym , Ansah‐Zame Abigail , Alghamdi Uthman , Liu Danting , Wei Ruhan , Zhao Jianjun , Zhou Aimin
Published: August 2023

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease and affects about 25% of the population globally. NAFLD has the potential to cause significant liver damage in many patients because it can progress to nonalcoholic steatohepatitis (NASH) and cirrhosis, which substantially increases disease morbidity and mortality. Despite the key role of innate immunity in the disease progression, the underlying molecular and pathogenic mechanisms remain to be elucidated. RNase L is a key enzyme in interferon action against viral infection and displays pleiotropic biological functions such as control of cell proliferation, apoptosis, and autophagy. Recent studies have demonstrated that RNase L is involved in innate immunity. In this study, we revealed that RNase L contributed to the development of NAFLD, which further progressed to NASH in a time‐dependent fashion after RNase L wild‐type (WT) and knockout mice were fed with a high‐fat and high‐cholesterol diet. RNase L WT mice showed significantly more severe NASH, evidenced by widespread macro‐vesicular steatosis, hepatocyte ballooning degeneration, inflammation, and fibrosis, although physiological and biochemical data indicated that both types of mice developed obesity, hyperglycemia, hypercholesterolemia, dysfunction of the liver, and systemic inflammation at different extents. Further investigation demonstrated that RNase L was responsible for the expression of some key genes in lipid metabolism, inflammation, and fibrosis signaling. Taken together, our results suggest that a novel therapeutic intervention for NAFLD may be developed based on regulating the expression and activity of RNase L.
A Case of Asymptomatic Arrhythmia
Authors: Kupchik Nicole , Green Joel
Published: August 2023

Editor's note: This is the next installment in a series on electrocardiogram (ECG) interpretation. Nurses in all settings should know the basics, as medications and physiological changes can cause cardiac arrhythmias. Each article will start with a brief case scenario and an ECG strip and then take you step by step through analyzing the heart rhythm.
Substance Use Symptom Checklist Is Useful in Primary Care
Authors: Rosenberg Karen
Published: August 2023

According to this study:
Exploring plagiarism
Authors: Hilliard Wanda , Hobbs Stacy , Jimenez Rosalinda
Published: August 2023

Plagiarism is a common issue in academic and professional communities. This article discusses ways to avoid plagiarism by identifying valuable resources, such as appropriate paraphrasing, creative work organizing, and new technology. Understanding copyright law safeguards is critical to avoiding plagiarism.
The case against futility
Authors: Gibson Jennifer A.
Published: August 2023

“Futility” is a common concept and terminology used in healthcare. This article uses a 2021 case to explore the concept and use of “futility” by considering its critiques. This article also discusses alternative ways to more clearly communicate concerns about medically harmful or inappropriate and non-beneficial uses of life-sustaining treatments.
Predictors of Low Risk for Delirium during Anesthesia Emergence
Authors: Dragovic Srdjan , Schneider Gerhard , García Paul S. , Hinzmann Dominik , Sleigh Jamie , Kratzer Stephan , Kreuzer Matthias
Published: August 2023

Background

Processed electroencephalography (EEG) is used to monitor the level of anesthesia, and it has shown the potential to predict the occurrence of delirium. While emergence trajectories of relative EEG band power identified post hoc show promising results in predicting a risk for a delirium, they are not easily transferable into an online predictive application. This article describes a low-resource and easily applicable method to differentiate between patients at high risk and low risk for delirium, with patients at low risk expected to show decreasing EEG power during emergence.

Methods

This study includes data from 169 patients (median age, 61 yr [49, 73]) who underwent surgery with general anesthesia maintained with propofol, sevoflurane, or desflurane. The data were derived from a previously published study. The investigators chose a single frontal channel, calculated the total and spectral band power from the EEG and calculated a linear regression model to observe the parameters’ change during anesthesia emergence, described as slope. The slope of total power and single band power was correlated with the occurrence of delirium.

Results

Of 169 patients, 32 (19%) showed delirium. Patients whose total EEG power diminished the most during emergence were less likely to screen positive for delirium in the postanesthesia care unit. A positive slope in total power and band power evaluated by using a regression model was associated with a higher risk ratio (total, 2.83 [95% CI, 1.46 to 5.51]; alpha/beta band, 7.79 [95% CI, 2.24 to 27.09]) for delirium. Furthermore, a negative slope in multiple bands during emergence was specific for patients without delirium and allowed definition of a test for patients at low risk.

Conclusions

This study developed an easily applicable exploratory method to analyze a single frontal EEG channel and to identify patterns specific for patients at low risk for delirium.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Understanding Geospatial Trends in Lumbar Fusion Incidence and Technique in Medicare Populations
Authors: Peterman Nicholas , Shivdasani Krishin , Naik Anant , Yeo Eunhae , Simon Joshua , Garst Jonathan , Moawad Christina , Stauffer Catherine , Kaptur Bradley , Arnold Paul M.
Published: August 2023

Study Design.

Retrospective study with epidemiologic analysis of public Medicare data.

Objective.

This study seeks to utilize geospatial analysis to identify distinct trends in lumbar fusion incidence and techniques in Medicare populations.

Summary of Background Data.

With an aging population and new technologies, lumbar fusion is an increasingly common procedure. There is controversy, however, regarding which indications and techniques achieve optimal outcomes, leading to significant intersurgeon variation and potential national disparities in care.

Materials and Methods.

Medicare billing datasets were supplemented with Census Bureau socioeconomic data from 2013 to 2020. These databases listed lumbar fusions billed to Medicare by location, specialty, and technique. Hotspots and coldspots of lumbar fusion incidence and technique choice were identified with county-level analysis and compared with Mann-Whitney U. A linear regression of fusion incidence and a logistic regression of lumbar fusion hotspots/coldspots were also calculated.

Results.

Between 2013 and 2020, 624,850 lumbar fusions were billed to Medicare. Lumbar fusion hotspots performed fusions at nearly five times the incidence of coldspots (101.6–21.1 fusions per 100,000 Medicare members) and were located in the Midwest, Colorado, and Virginia while coldspots were in California, Florida, Wisconsin, and the Northeast. Posterior and posterolateral fusion were the most favored techniques, with hotspots in the Northeast. Combined posterior and posterolateral fusion and posterior interbody fusion was the second most favored technique, predominantly in Illinois, Missouri, Arkansas, and Colorado.

Conclusions.

The geographic distribution of lumbar fusions correlates with variations in residency training, fellowship, and specialty. The geospatial patterning in both utilization and technique reflects a lack of consensus in the application of lumbar fusion. The strong variance in utilization is a potentially worrying finding that could suggest that the nonstandardization of lumbar fusion indication has led to both overtreatment and undertreatment across the nation.

Level of Evidence.

Level 3—retrospective.
Auranofin inhibits the occurrence of colorectal cancer by promoting mTOR-dependent autophagy and inhibiting epithelial-mesenchymal transformation
Authors: Zhang Mei , Yang Dong-yuan , He Zhi-yi , Wu Yu , Tian Xiu-yun , Huang Qing-yang , Ma Wang-bo , Deng Min , Wang Qi-zhi , Yan Shan-jun , Zheng Hai-lun
Published: August 2023

Colorectal cancer (CRC) is one of the world’s most common and deadly cancers. According to GLOBOCAN2020’s global incidence rate and mortality estimates, CRC is the third main cause of cancer and the second leading cause of cancer-related deaths worldwide. The US Food and Drug Administration has approved auranofin for the treatment of rheumatoid arthritis. It is a gold-containing chemical that inhibits thioredoxin reductase. Auranofin has a number of biological activities, including anticancer activity, although it has not been researched extensively in CRC, and the mechanism of action on CRC cells is still unknown. The goal of this research was to see how Auranofin affected CRC cells in vivo and in vitro. The two chemical libraries were tested for drugs that make CRC cells more responsive. The CCK-8 technique was used to determine the cell survival rate. The invasion, migration, and proliferation of cells were assessed using a transwell test and a colony cloning experiment. An electron microscope was used to observe autophagosome formation. Western blotting was also used to determine the degree of expression of related proteins in cells. Auranofin’s tumor-suppressing properties were further tested in a xenograft tumor model of human SW620 CRC cells. Auranofin dramatically reduced the occurrence of CRC by decreasing the proliferation, migration, and invasion of CRC cells, according to our findings. Through a mTOR-dependent mechanism, auranofin inhibits the epithelial-mesenchymal transition (EMT) and induces autophagy in CRC cells. Finally, in-vivo tests revealed that auranofin suppressed tumor growth in xenograft mice while causing no harm. In summary, auranofin suppresses CRC cell growth, invasion, and migration. Auranofin inhibits the occurrence and progression of CRC by decreasing EMT and inducing autophagy in CRC cells via a mTOR-dependent mechanism. These findings suggest that auranofin could be a potential chemotherapeutic medication for the treatment of human CRC.
Improved understanding of the respiratory drive pathophysiology could lead to earlier spontaneous breathing in severe acute respiratory distress syndrome
Authors: Petitjeans Fabrice , Leroy Sandrine , Pichot Cyrille , Ghignone Marco , Quintin Luc , Longrois Dan , Constantin Jean-Michel
Published: August 2023

Optimisation of the respiratory drive, as early as possible in the setting of severe acute respiratory distress syndrome (ARDS) and not its suppression, could be a new paradigm in the management of severe forms of ARDS. Severe ARDS is characterised by tachypnoea and hyperpnoea, a consequence of a high respiratory drive. Some patients require endotracheal intubation, controlled mechanical ventilation (CMV) and paralysis to prevent overt ventilatory failure and self-inflicted lung injury. Nevertheless, intubation, CMV and paralysis do not address per se the high respiratory drive, they only suppress it. Optimisation of the respiratory drive could be obtained by a multimodal approach that targets attenuation of fever, agitation, systemic and peripheral acidosis, inflammation, extravascular lung water and changes in carbon dioxide levels. The paradigm we present, based on pathophysiological considerations, is that as soon as these factors have been controlled, spontaneous breathing could resume because hypoxaemia is the least important input to the respiratory drive. Hypoxaemia could be handled by combining positive end-expiratory pressure (PEEP) to prevent early expiratory closure and low pressure support to minimise the work of breathing (WOB). ‘Cooperative’ sedation with alpha-2 agonists, supplemented with neuroleptics if required, is the pharmacological adjunct, administered immediately after intubation as the first-line sedation regimen during the multimodal approach. Given relative contraindications (hypovolaemia, auriculoventricular block, sick sinus syndrome), alpha-2 agonists can help attenuate or moderate fever, increased oxygen consumption VO2, agitation, high cardiac output, inflammation and acidosis. They may also help to preserve microcirculation, cognition and respiratory rhythm generation, thus promoting spontaneous breathing. Returning the physiology of respiratory, ventilatory, circulatory and autonomic systems to normal will support the paradigm of optimised respiratory drive favouring early spontaneous ventilation, at variance with deep sedation, extended paralysis, CMV and use of the prone position as therapeutic strategies in severe ARDS.

GLOSSARY

Glossary and Abbreviations_SDC, http://links.lww.com/EJAIC/A55
Innovation Programs Match Need With Speed in Hospital Rapid-Cycle Improvement Efforts
Authors: Ibata Brent , Olver Jim , Kashman Scott
Published: August 2023

The simple fact is that hospitals that do not innovate today may not be solvent tomorrow. Although not every hospital has a budget for a million-dollar innovation laboratory, a pop-up innovation lab can be set up for less than $1,000 with materials available at a local superstore. In 2014, Drs. Ibata and Olver visited leading innovation labs to identify best practices for curricula and materials. The site visits were funded by a grant to support the development of a rapid-cycle innovation training program. The lessons learned are shared here with sample agendas and material lists to set up a low-cost innovation lab. This article also describes half-day and full-day rapid-cycle innovation workshops. These workshops combine design thinking and the rapid-cycle plan-do-check-act improvement method with improvisational theater games to arrive at outside-the-box solutions to intractable healthcare delivery problems.
A Healthcare System Looks Within to Improve Outcomes
Authors: Wharton Monica , Jacobs Paula
Published: August 2023

Healthcare organizations are facing exponential growth in change—not just to compete, but to survive. Amid the widening gap between expenses and reimbursements, hospitals must manage the adoption of expensive advanced technologies, continuous synthesis of emerging clinical knowledge, intensive regulatory readiness, and public ranking of quality outcomes. And they must handle all this as patient expectations grow. At Methodist Le Bonheur Healthcare (MLH), we have approached these challenges by nurturing an organizational mindset of transformational innovation. The ability to harness the collective brainpower of 12,000 MLH associates to find cost reductions, operational efficiencies, and better ways to provide patient care has proven invaluable when facing the demands to do more with less. Achieving this degree of engagement began with full transparency of the challenges we face as an organization, clearly articulating the need to change, and providing a structured approach to capture and respond to suggestions from the workforce. The Power of One Idea program, a platform for listening and learning, has enabled the workforce to answer that call and make an impressive impact: $17 million in cost savings and previously untapped revenues. In return, the forward-thinking associates submitting those ideas have shared in those savings and realized more than $1.5 million in extra income. The Performance Excellence Award, a program to seek out best practices in safety, efficiency, or effectiveness, also has enriched the business with at least 100 proven approaches to advance care delivery.
Comparison of two objective methods for measuring postoperative toric intraocular lens orientation under the natural pupil
Authors: Jiang Yuanfeng , Gao Yichen , Yang Jun , Chen Xiteng , Zhao Fangyu , Li Meisa , Lin Song , Bu Shaochong , Tian Fang
Published: August 2023

Purpose:

To evaluate and compare the accuracy of iTrace and CASIA2 in measuring the postoperative orientation of toric intraocular lens (IOL) without mydriasis.

Setting:

Tianjin Medical University Eye Hospital, Tianjin, China.

Design:

Prospective cohort study.

Methods:

Patients with SN6AT toric IOLs implanted after cataract surgery were enrolled. 1 month after surgery, the toric IOL orientation were measured by iTrace and CASIA2 in non-mydriatic, semi-dark conditions. Then, the toric axis was directly reviewed using the slit-lamp under full mydriasis. Axis measurement differences between each of the 2 devices and the slit-lamp, described as their relative differences (RDs), were calculated and compared. The percentage of RDs within 5 degrees, within 10 degrees and greater than 30 degrees were analyzed.

Results:

77 eyes of 70 patients were included. Generally, the mean toric axis measurement RDs of CASIA2 and iTrace were 9.24 ± 10.53 degrees and 13.89 ± 15.47 degrees respectively (P = .04). For CASIA2 (72 eyes), 54.17% (39), 72.22% (52), and 4.17% (3) of eyes had RDs within 5 degrees, within 10 degrees and greater than 30 degrees, compared with 40.00% (28), 61.43% (43) and 12.86% (9) for iTrace (70 eyes). The 95% limits of agreements of CASIA2 with slit-lamp was narrower than that of iTrace with slit-lamp. The median RD of CASIA2 was significantly smaller in eyes with pupil ≥4 mm under dark condition compared with eyes with pupil <4 mm (P = .03).

Conclusions:

CASIA2 demonstrates greater precision in measuring toric IOL orientation under non-mydriatic conditions compared with iTrace. Moreover, the accuracy of CASIA2 is enhanced in cases of pupil >4 mm.
Electronic alerts in acute kidney injury: why does evidence of benefit remain elusive?
Authors: Horne Kerry , Noble Rebecca , Karelia Shivaali , Selby Nicholas M.
Published: August 2023

Purpose of review

Acute kidney injury (AKI) is a common syndrome characterized by a sudden reduction in kidney function. It is strongly associated with high mortality and longer, more expensive hospital stays. As AKI often presents silently, a lack of recognition can prevent recommended standards of care. Over the last decade or more, electronic alerts (eAlerts) for AKI have been studied and implemented to address this. This review will summarize the major randomized trials in this area.

Recent findings

A number of randomized trials now exist that study the effectiveness of AKI eAlerts in isolation or as part of more complex interventions. Varying results arise from differences in study design, healthcare system in which the eAlert is introduced, nature of alert, supporting interventions, implementation plan, stated aim (prevention or treatment of established AKI) and choice of outcome measures.

Current randomized trial evidence does not show any benefit of eAlerts on mortality. However, variously reported reductions in AKI incidence, AKI progression and AKI duration support a conclusion that strategies incorporating eAlerts can meaningfully benefit delivery of AKI care. Future work should consider how best eAlerts can be utilised, targeted and implemented.
Monte Carlo simulation of SPECT characterization for 223Ra post-injection scintigraphy
Authors: Saikouk Hind , El Khayati Naïma , Matrane Aboubakr
Published: August 2023

Objectives

223Ra is a promising α-emitting radionuclide for prostate cancer metastasis palliative treatment. Post-injection scintigraphy is of major importance to verify the concentration of the radiopharmaceutical in the targeted sites. Given the low activity administered to patients, the choice of acquisition parameters, including the collimator type, the energy window’s width and the photopeak energy to be used, is primordial for the image quality. The purpose of our work was to select the SPECT configuration suitable for 223Ra post-injection scintigraphy.

Methods

We conducted simulation studies with a Symbia T6 Siemens SPECT-CT, available in our department. 223Ra photons energy spectra were assessed for low energy high resolution (LEHR), medium energy (ME) and high energy (HE) collimators. Then, depending on the energy window, we calculated the scatter fraction, the sensitivity and the spatial resolution.

Results

Scatter fraction was low for all collimators; however, the contribution of photons that scattered more than twice under the low energy photopeaks was important in the case of LEHR. Sensitivity’s best values were obtained in the case of the LEHR collimator; nevertheless, the spatial resolution was very low for this collimator. The latter was best for ME and HE collimators.

Conclusion

A combination between a good sensitivity, a high spatial resolution and a low scatter fraction has been determined in the case of the ME collimator, followed by HE collimator as an alternative. To increase the image acquisition statistics with ME collimator, we recommend to use simultaneous energy windows: 20% centered at 82 keV, 20% centered at 154 keV and 20% centered at 270 keV.
A Co-Designed Online Education Resource on Gastrostomy Feeding for Parents and Caregivers to Support Clinical Care
Authors: Murphy Nada , Ravikumara Madhur , Butterworth Mary , Glasson Emma , Rennison Catherine , Prevett Bree , Fitzpatrick Jayne , Phillips Wayne , Burton Christel , Downs Jenny ,   the Co-Design Reference Group
Published: August 2023

Objective:

Children with complex needs and severe disability may undergo gastrostomy insertion to support feeding difficulties. Parent education programs are critical components of clinical care pathways but there is little information on parent-reported educational needs. This study describes the collaborative process that yielded a resource to assist parents considering gastrostomy tube placement for their children, and the evaluation of the resource.

Methods:

A qualitative descriptive study was conducted to identify parent needs for gastrostomy education. Based on these data and codesigning with parents with a child with gastrostomy tube, an online resource comprising video and written materials was developed. Twenty parents then evaluated its suitability for parent learning.

Results:

Data describing parent needs were coded into categories which represented the gastrostomy “journey”—Decision Making, Hospital Stay and Living with Gastrostomy. Called Nourish, the gastrostomy training resource comprised 19 videos and 18 accompanying worksheets. Twenty parent caregivers rated it highly for its support for learning, confidence building, and planning.

Conclusion:

The process that created Nourish generated a useful resource for parents considering or managing gastrostomy tube feedings for their child. Positive feedback suggests that this approach could be a valuable adjunct to clinical care.
Wide Institutional Variability in the Treatment of Pediatric Critical Asthma: A Multicenter Retrospective Study
Authors: Rogerson Colin M. , Hogan Alexander H. , Waldo Briana , White Benjamin R. , Carroll Christopher L , Shein Steven L.
Published: August 2023

OBJECTIVES:

Children with status asthmaticus refractory to first-line therapies of systemic corticosteroids and inhaled beta-agonists often receive additional treatments. Because there are no national guidelines on the use of asthma therapies in the PICU, we sought to evaluate institutional variability in the use of adjunctive asthma treatments and associations with length of stay (LOS) and PICU use.

DESIGN:

Multicenter retrospective cohort study.

SETTING:

Administrative data from the Pediatric Health Information Systems (PHIS) database.

PATIENTS:

All inpatients 2–18 years old were admitted to a PHIS hospital between 2013 and 2021 with a diagnostic code for asthma.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

This study included 213,506 inpatient encounters for asthma, of which 29,026 patient encounters included care in a PICU from 39 institutions. Among these PICU encounters, large variability was seen across institutions in both the number of adjunctive asthma therapies used per encounter (min: 0.6, median: 1.7, max: 2.5,p< 0.01) and types of adjunctive asthma therapies (aminophylline, ipratropium, magnesium, epinephrine, and terbutaline) used. The center-level median hospital LOS ranged from 1 (interquartile range [IQR]: 1, 3) to 4 (3, 6) days. Among all the 213,506 inpatient encounters for asthma, the range of asthma admissions that resulted in PICU admission varied between centers from 5.2% to 47.3%. The average number of adjunctive therapies used per institution was not significantly associated with hospital LOS (p= 0.81) nor the percentage of encounters with PICU admission (p= 0.47).

CONCLUSIONS:

Use of adjunctive therapies for status asthmaticus varies widely among large children’s hospitals and was not associated with hospital LOS or the percentage of encounters with PICU admission. Wide variance presents an opportunity for standardizing care with evidence-based guidelines to optimize outcomes and decrease adverse treatment effects and hospital costs.
Experiences of persons with lower limb amputation after prosthetic rehabilitation in Ghana: A qualitative inquiry
Authors: Dordunu Rebecca , Adjei Charles Ampong , Kyei Josephine Mpomaa , Ani-Amponsah Mary
Published: August 2023

Background:

Lower limb amputations (LLAs) have long been associated with physical, social, and psychological consequences. Individuals with LLAs have challenges with mobility and often become isolated from their social networks. Disability rehabilitation technologies such as prosthetic devices are used to improve the mobility capabilities of lower limb amputees. To improve clinical outcomes, feedback from the prosthetic users is a key element to consider.

Objectives:

The study sort to explore the experiences of lower-limb prosthetic users after prosthetic rehabilitation in a prosthetic and orthotic rehabilitation center in the Eastern Region of Ghana.

Study design:

This study adopted an exploratory descriptive qualitative study design.

Methods:

A purposive sampling technique and semistructured interview guide was used to interview 17 participants by the first author. The social model of disability underpinned the study. Lower-limb prosthetic users (≥18 years) with unilateral LLA attending outpatient follow-up at a prosthetic and orthotic rehabilitation center were recruited. The interviews were audio recoded, transcribed verbatim, and analyzed using the procedure for thematic content analysis by Braun and Clarke (2013).

Results:

Participants reported injuries and tingling in their residual limb. Internal stigma resulting from negative comments and labeling from the public were reported. Prosthetic users experienced empathy and being treated as weaklings by their family/peers. Participants avoided relationships because of recurrent rejection, embarrassment, fear of sexual abuse, and exploitation. As a coping method, some participants chose to isolate themselves to avoid humiliation and public disgrace. Other coping mechanisms included watching television, listening to music, conversing with others, ignoring criticism, and having faith in God.

Conclusion:

Participants’ narrative in this study gave insight into the varied lived experiences on the individual level, family/peer level, and the coping mechanisms used. Challenges relating to discomfort from the prosthesis, internal stigma, relationship avoidance, and altered sexual life should be given much attention and used in implementing initiatives to improve clinical outcomes.
Diagnostic Yield of Investigations in Symmetric Optic Neuropathy
Authors: Handzic Armin , Xie Jim S. , Margolin Edward A.
Published: August 2023

Background:

Symmetric optic neuropathy (SON) is commonly seen in neuro-ophthalmic practice and is often discovered incidentally. Although multiple investigations might be performed to discover the underlying cause, they are not always indicated. The aim of this study was to report a clinically reasonable and cost-effective approach to investigating patients with SON.

Methods:

SON was defined as bilateral optic neuropathy with normal and/or symmetrically decreased central visual acuity, absence of relative afferent pupillary defect, presence of symmetric optic disc pallor, symmetric thinning of peripapillary retinal nerve fiber layer on optical coherence tomography, and absence of other identifiable causes of optic neuropathy. Records of all patients diagnosed with SON seen at a tertiary university-affiliated neuro-ophthalmology practice from 2016 to 2022 were reviewed to identify the yield of various investigations. Clinical data from the initial and last follow-up visit were obtained. Subgroup analysis was performed to ascertain whether diagnostic yield is higher in patients with severe visual loss (central acuity worse than 20/40) compared with those with mild visual loss (acuity 20/40 or better).

Results:

One hundred thirty-six patients met inclusion criteria. Testing for OPA1 and OPA2 mutations had the highest diagnostic yield (16.0%), followed by mitochondrial genome sequencing (13.6%), serum vitamin B12 (6.1%), and serum folate (1.6%). MRI brain was performed in 54.4% of patients and had a diagnostic yield of only 5%. Both patients who had abnormal MRI had symptoms of demyelination at presentation. Patients were followed for a mean of 15.0 (SD 21.3) months. The most frequently identified etiologies of SON were Leber hereditary optic neuropathy (8.1%), alcohol/tobacco amblyopia (7.4%), vitamin B12 deficiency (5.9%), and dominant optic atrophy (2.9%). Patients with severe visual impairment were more likely to have a final diagnosis compared with those with milder visual impairment (63.9% vs 12.0%, P < 0.001).

Conclusions:

The diagnostic yield of investigating SON in patients with preserved visual function, normal diet, and absence of other neurological symptoms is very low. It is reasonable to observe patients with SON with mild visual impairment, reserving costly investigations for those with the visual acuity worse than 20/40 or progressive course.
Nine Neuroimaging-AI Endophenotypes Unravel Disease Heterogeneity and Partial Overlap across Four Brain Disorders
Authors: WEN Junhao , Tian Ye Ella , Yang Zhijian , cui yuhan , erus guray , hwang gyujoon , Varol Erdem , boquetipujadas aleix , Chand Ganesh , Nasrallah Ilya M. , Satterthwaite Theodore , Shou Haochang , Shen Li , Toga Arthur W. , Zalesky Andrew , Davatzikos Christos
Published: August 2023

Disease heterogeneity poses a significant challenge for precision diagnostics. Recent work leveraging artificial intelligence has offered promise to dissect this heterogeneity by identifying complex intermediate brain phenotypes, herein called dimensional neuroimaging endophenotypes (DNEs). We advance the argument that these DNEs capture the degree of expression of respective neuroanatomical patterns measured, offering a dimensional neuroanatomical representation for studying disease heterogeneity and similarities of neurologic and neuropsychiatric diseases. We investigate the presence of nine such DNEs derived from independent yet harmonized studies on Alzheimer's disease (AD1-2)1, autism spectrum disorder (ASD1-3)2, late-life depression (LLD1-2)3, and schizophrenia (SCZ1-2)4, in the general population of 39,178 participants in the UK Biobank study. Phenome-wide associations revealed prominent associations between the nine DNEs and phenotypes related to the brain and other human organ systems. This phenotypic landscape aligns with the SNP-phenotype genome-wide associations, revealing 31 genomic loci associated with the nine DNEs (Bonferroni corrected P-value < 5x10-8/9). The DNEs exhibited significant genetic correlations, colocalization, and causal relationships with multiple human organ systems and chronic diseases. A causal effect (odds ratio=1.25 [1.11, 1.40], P-value=8.72x10-4) was established from AD2, characterized by focal medial temporal lobe atrophy, to AD. The nine DNEs, along with their polygenic risk scores, significantly enhanced the predictive accuracy for 14 systemic disease categories, particularly for conditions related to mental health and the central nervous system, as well as mortality outcomes. These findings underscore the potential of the nine DNEs to capture the expression of disease-related brain phenotypes in individuals of the general population and to relate such measures with genetics, lifestyle factors, and chronic diseases. All results are publicly available at https://labs-laboratory.com/medicine/.
Association between self-reported STI symptoms and stillbirth in sub-Saharan Africa using nationally representative household surveys
Authors: Pulver Skylar , Pinto Casey N. , Ba Djibril M. , Risher Kathryn A.
Published: August 2023

Stillbirths are a known outcome of untreated sexually transmitted infections (STIs). Sub-Saharan Africa (SSA) shares a disproportionate burden of both stillbirths (2015: 29/1000 births vs 3/1000 births in high income countries globally) and STIs. Nationally representative survey data can inform stillbirth prevention measures in multiple countries in the SSA region, with greater generalizability than clinic-based studies. We assessed the association between any self-reported STI symptoms (STI diagnosis, abnormal genital discharge, genital sore or ulcer) in the last 12 months and stillbirth in the prior five years, among women aged 15-49 years participating in nationally representative Demographic and Health Surveys (DHS) in 19 countries in SSA between 2015-2021 and reporting a pregnancy in the five years prior to interview. We used multivariable logistic regression models adjusting for maternal age, wealth index, education level of mother, cigarette smoking behaviors, health care utilization and country of residence. Among 160,995 SSA women who reported being pregnant at least once between 2011-2021, 18.0% (25,596) reported any STI symptom in the prior year and 1.9% (3,205) reported a stillbirth in the past five years. Women who self-reported STI symptoms in the past year had 1.30 (95% CI 1.16-1.47) times the odds of stillbirth in the prior five years compared to women who did not report STI symptoms. Women 35-49 years old had 1.17 (95% CI 1.04-1.33) times the odds of stillbirth compared to those 15-24 years old. The association found between self-reported STI symptoms and stillbirth highlights the need for increased screening for STI symptoms and subsequent treatment among pregnant women in SSA.
Network state changes in sensory thalamus represent learned outcomes
Authors: Hasegawa Masashi , Huang Ziyan , Gründemann Jan
Published: August 2023

Thalamic brain areas play an important role in adaptive behaviors. Nevertheless, the population dynamics of thalamic relays during learning across sensory modalities remain mostly unknown. Using a cross-modal sensory reversal learning paradigm combined with deep brain two-photon calcium imaging of large populations of auditory thalamus (MGB) neurons, we identified that MGB neurons are biased towards reward predictors independent of modality. Additionally, functional classes of MGB neurons aligned with distinct task periods and behavioral outcomes, both dependent and independent of sensory modality. During non-sensory delay periods, MGB ensembles developed coherent neuronal representation as well as distinct co-activity network states reflecting predicted task outcome. These results demonstrate flexible cross-modal ensemble coding in auditory thalamus during adaptive learning and highlight its importance in brain-wide cross-modal computations during complex behavior.

Deep brain imaging reveals flexible network states of sensory thalamus predicting task outcome in mice.
D-ꞵ-hydroxybutyrate stabilizes hippocampal CA3-CA1 circuit during acute insulin resistance
Authors: Kula Bartosz , Antal Botond , Weistuch Corey , Gackière Florian , Barre Alexander , Velado Victor , Hubbard Jeffrey M , Kukley Maria , Mujica-Parodi Lilianne R , Smith Nathan A
Published: August 2023

1.

The brain primarily relies on glycolysis for mitochondrial respiration but switches to alternative fuels such as ketone bodies (KBs) when less glucose is available. Neuronal KB uptake, which does not rely on glucose transporter 4 (GLUT4) or insulin, has shown promising clinical applicability in alleviating the neurological and cognitive effects of disorders with hypometabolic components. However, the specific mechanisms by which such interventions affect neuronal functions are poorly understood. In this study, we pharmacologically blocked GLUT4 to investigate the effects of exogenous KB D-ꞵ-hydroxybutyrate (D-ꞵHb) on mouse brain metabolism during acute insulin resistance (AIR). We found that both AIR and D-ꞵHb had distinct impacts across neuronal compartments: AIR decreased synaptic activity and long-term potentiation (LTP) and impaired axonal conduction, synchronization, and action potential (AP) properties, while D-ꞵHb rescued neuronal functions associated with axonal conduction, synchronization, and LTP.

2.

Significance statement

This study investigates the impact of acute insulin resistance on the functionality of the hippocampal circuit and the potential protective effects of ketone body supplementation. By inhibiting GLUT4 receptors to induce acute insulin resistance, we reveal several detrimental changes caused by impaired neuronal glucose uptake. These changes include impairments in synaptic activity, axonal conduction, and neuronal firing properties. The study further examines the distinctive effects of acute insulin resistance and the rescue agent D-βHb on synaptic activity, long-term potentiation, axonal conduction, synchronization, and neuronal firing. By shedding light on neuronal responses during insulin resistance, this investigation advances our understanding of neurological disorders associated with hypometabolism and highlights the potential therapeutic value of D-βHb.
The basement membrane regulates the cellular localization and the cytoplasmic interactome of Yes-Associated Protein (YAP) in mammary epithelial cells
Authors: Manucci Antonio Carlos , Fiore Ana Paula Zen Petisco , Genesi Giovani Luiz , Bruni-Cardoso Alexandre
Published: August 2023

The Hippo pathway, a signaling cascade involved in the regulation of organ size and several other processes, acts as a conduit between ECM cues and cellular responses. We asked whether the basement membrane (BM), a specialized ECM component known to induce quiescence and differentiation in mammary epithelial cells, would regulate the localization, activity and interactome of YAP, a Hippo pathway effector. To address this question, we used a broad range of experimental approaches, including 2D and 3D cultures of both mouse and human mammary epithelial cells, as well as the developing mouse mammary gland. In contrast to malignant cells, non-tumoral cells cultured with a reconstituted BM (rBM) displayed higher concentrations of YAP in the cytoplasm. Incidentally, when in the nucleus of rBM-treated cells, YAP resided preferentially at the nuclear periphery. In agreement with our cell culture experiments, YAP exhibited cytoplasmic predominance in ductal cells of developing mammary epithelia, where a denser BM is found. Conversely, terminal end bud (TEB) cells with a thinner BM displayed higher nucleus-to-cytoplasm ratios of YAP. Bioinformatic analysis revealed that genes regulated by YAP were overrepresented in the transcriptomes of microdissected TEBs. Consistently, mouse epithelial cells exposed to the rBM expressed lower levels of YAP-regulated genes, although the protein level of YAP and Hippo components were slightly altered by the treatment. Mass spectrometry analysis identified a differential set of proteins interacting with YAP in cytoplasmic fractions of mouse epithelial cells in the absence or presence of rBM. In untreated cells, YAP interactants were enriched in processes related to ubiquitin-mediated proteolysis, whereas in cells exposed to rBM YAP interactants were mainly key proteins related to amino acid, amino sugar and carbohydrate metabolism. Collectively, our multifaceted approach unraveled that the BM induces YAP translocation or retention in the cytoplasm of non-tumoral epithelial cells and that in the cytoplasm YAP seems to undertake novel functions in metabolic pathways.