bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparing fear responses of two lizard species across habitats varying in human impact
Authors: Putman Breanna J , Rensel Michelle A , Schlinger Barney A , French Susannah , Blumstein Daniel T , Pauly Gregory B
Published: February 2024

Animals that are successful in urban habitats often have reduced antipredator responses toward people (sometimes called “fear” responses). However, few studies test whether sympatric species differ in their responses to humans, which may explain differing sensitivities to urbanization. Here, we quantified the behavioral and physiological responses to humans in two lizard species, side-blotched lizards (Uta stansburiana) and western fence lizards (Sceloporus occidentalis), across three different habitat types that vary in human impact: natural habitats with low levels of human activity, natural habitats with high levels of human activity, and urban habitats. We found that side-blotched lizards had longer flight initiation distances, were found closer to a refuge, and were more likely to hide than fence lizards, behaviors that could indicate greater fearfulness. Both lizard species were found closer to a refuge and were also more likely to hide in the urban habitat than in the natural habitat with low human impact, which could represent adaptive behaviors for increased risks in urban areas (e.g. cats). Western fence lizards exhibited lower body sizes and conditions in the habitats with moderate and high levels of human activity, whereas these traits did not differ among habitats in side-blotched lizards. Baseline and stress-induced corticosterone concentrations did not differ across habitats for both species, suggesting that human-impacted habitats were not stressful or that lizards had undergone habituation-like processes in these habitats. Taken together, our results highlight the importance of standardized measurements across multiple species in the same habitats to understand differential responses to human-induced environmental change.
A Novel Peritoneal Packing Method for Management of Hyperkalemia During Acute Kidney Injury in Trauma
Authors: Zimmerman Eric M , Stewart Ian J , Graham Todd L , Kovacs Timothy J , Guliashvili Tamaz , Golobish Thomas D , Ross James D
Published: February 2024

Introduction

United States Military operations in resource limited areas are increasing. Furthermore, future peer or near-peer conflicts will require caring for larger numbers of casualties with limited resources. In this setting, traditional renal replacement therapy is not feasible and novel methods are required to address severe acute kidney injury in austere environments lacking definitive therapies. Here, we describe experiments designed to determine the efficacy of a novel peritoneal packing material (Potassium Binding Pack-PBP, CytoSorbents INC) for the acute management of severe hyperkalemia.

Materials and Methods

Male swine (52 ±1 kg) were nephrectomized via midline laparotomy under a plane of anesthesia and randomized into one of two experimental groups (PBP & CON). Exogenous potassium was infused to achieve a serum potassium level of 7.5 mEq/L. Novel potassium absorbing packs (PBP) or sham packs (CON) were placed in the right and left upper quadrants, and the right and left paracolic gutters of the abdomen to simulate four-quadrant packing (n = 6, n = 5, respectively). Two liters of peritoneal dialysis fluid was instilled into the abdomen and temporary closure performed. Animals were observed for 12 hours. Serum and peritoneal fluid (dialysate) potassium levels were sampled at T = 15, 30, 60 min, and Q60min thereafter. Animals were humanely euthanized at the end of the observation period.

Results

Baseline characteristics were similar between groups. Pairwise analysis showed that serum potassium concentrations were significantly lower in the PBP group compared to CON at T = 540 and T = 720 (P = 0.006 and P = 0.015, respectively). Potassium concentrations were significantly lower in dialysate of the PBP group compared to CON at all time points after T = 15 (T = 30, P = 0.017; T = 60 through T = 720, P < 0.001).

Conclusions

This is the first demonstration of an effective technology for the management of hyperkalemia in trauma in the absence of standard of care; renal replacement therapy. We identified that PBP was able to consistently maintain a concentration gradient between dialysate in the peritoneum and system potassium concentration throughout the experiment. Furthermore, systemic potassium concentrations were reduced in a clinically relevant manner in the PBP group compared to CON. This suggests that peritoneal packing technology for the management of metabolic disturbances in trauma has potential for clinical application. These results are preliminary and should be interpreted with caution.
An Augmented Reality Rifle Qualification Test for Return-to-Duty Assessment in Service Members
Authors: Kaya Ryan D , Hastilow Karissa , Owen Kelsey M , Zimmerman Eric M , Rosenfeldt Anson B , Alberts Jay L
Published: February 2024

Introduction

Variability in return-to-duty (RTD) decision-making following mild traumatic brain injury (mTBI) is a threat to troop readiness. Current RTD assessments lack military-specific tasks and quantitative outcomes to inform stakeholders of a service member’s (SM) capacity to successfully perform military duties. Augmented reality (AR), which places digital assets in a user’s physical environment, provides a technological vehicle to deliver military-relevant tasks to a SM to be used in the RTD decision-making process. In addition to delivering digital content, AR headsets provide biomechanical data that can be used to assess the integrity of the central nervous system in movement control following mTBI. The objective of this study was to quantify cognitive and motor performance on an AR rifle qualification test (RQT) in a group of neurologically healthy military SMs.

Materials and Methods

Data were collected from 111 healthy SMs who completed a basic (single-task) and complex (dual-task) RQT with a simulated M4 rifle. The complex scenario required the SM to perform the RQT while simultaneously answering arithmetic problems. Position data from the AR headset were used to capture postural sway, and the built-in microphone gathered responses to the arithmetic problems.

Results

There were no differences in the number of targets hit, trigger pull reaction time, and transition time from kneeling to standing between the basic and complex scenarios. A significant worsening in postural sway following kneel-to-stand transition was observed in the complex scenario. The average reaction time to answer the arithmetic problems was nearly 2 times slower than the average reaction time to pull the trigger to a displayed target in the complex scenario.

Conclusion

The complex scenario provoked dual-task interference in SMs as evidenced by worsening postural sway and reaction time differences between the cognitive and motor tasks. An AR RQT provides objective and quantitative outcomes during a military-specific task. Greater precision in evaluating cognitive and motor performance during a military-relevant task has the potential to aid in the detection and management of SMs and their RTD following MTBI.
Real-time monitoring of mycelial growth in liquid culture using hyphal dispersion mutant of Aspergillus fumigatus
Authors: Miyazawa Ken , Umeyama Takashi , Takatsuka Shogo , Muraosa Yasunori , Hoshino Yasutaka , Yano Shigekazu , Abe Keietsu , Miyazaki Yoshitsugu
Published: February 2024

Hyphal pellet formation by Aspergillus species in liquid cultures is one of the main obstacles to high-throughput anti-Aspergillus reagent screening. We previously constructed a hyphal dispersion mutant of Aspergillus fumigatus by disrupting the genes encoding the primary cell wall α-1,3-glucan synthase Ags1 and putative galactosaminogalactan synthase Gtb3 (Δags1Δgtb3). Mycelial growth of the mutant in liquid cultures monitored by optical density was reproducible, and the dose-response of hyphal growth to antifungal agents has been quantified by optical density. However, Δags1Δgtb3 still forms hyphal pellets in some rich growth media. Here, we constructed a disruptant lacking all three α-1,3-glucan synthases and galactosaminogalactan synthase (Δags1Δags2Δags3Δgtb3), and confirmed that its hyphae were dispersed in all the media tested. We established an automatic method to monitor hyphal growth of the mutant in a 24-well plate shaken with a real-time plate reader. Dose-dependent growth suppression and unique growth responses to antifungal agents (voriconazole, amphotericin B, and micafungin) were clearly observed. A 96-well plate was also found to be useful for the evaluation of mycelial growth by optical density. Our method is potentially applicable to high-throughput screening for anti-Aspergillus agents.
Very blue-shifted broad Hα in a low-redshift type-1.9 active galactic nucleus: a disc-emitter or a recoiling black hole scenario?
Authors: Zhang Xue-Guang
Published: February 2024

In this paper, very blue-shifted broad Hα with a shifted velocity of ∼2200 km s–1 is reported in the low-redshift type-1.9 active galactic nucleus (AGN) SDSS J1052+1036. Blue-shifted broad emission lines may arise owing to the presence of a rotating gas disc around a central black hole (BH), but may also be a signature of rare phenomena such as the gravitational wave recoil of a supermassive BH (rSMBH) or the presence of a binary BH (BBH) system. Here, owing to the higher shifted velocity of the stronger and wider blue-shifted broad Hα, the BBH system is disfavoured. Meanwhile, if this object contains a rSMBH, intrinsic obscuration with E(B –V) ≤ 0.6 should lead to a detectable broad Hβ, indicating that the rSMBH scenario is not preferred. We find that the blue-shifted broad Hα can be well explained by emission from an AGN disc, indicating that SDSS J1052+1036 is likely a disc-emitting AGN. In order to determine which scenario, a rSMBH or a disc-emitter, is preferred, a re-observed spectrum in 2025 could provide robust clues, with a disc-emitter probably leading to clear variations of peak positions, peak separations, and/or peak intensity ratios in broad Hα, but with a rSMBH scenario probably leading to no variations of peak separations in broad Hα.
The origin of lopsided satellite galaxy distribution around isolated systems in MillenniumTNG
Authors: Liu Yikai , Wang Peng , Guo Hong , Springel Volker , Bose Sownak , Pakmor Rüdiger , Hernquist Lars
Published: February 2024

Dwarf satellites in galaxy groups are distributed in an anisotropic and asymmetric manner, which is called the ‘lopsided satellite distribution’. This lopsided signal has been observed not only in galaxy pairs but also in isolated systems. However, the physical origin of the lopsided signal in isolated systems is still unknown. In this work, we investigate this in the state-of-the-art hydrodynamical simulation of the MillenniumTNG Project by tracing each system back to high redshift. We find that the lopsided signal is dominated by satellites located in the outer regions of the halo and is also dominated by recently accreted satellites. The lopsided signal originates from the anisotropic accretion of galaxies from the surrounding large-scale structure and that, after accretion, the non-linear evolution of satellites inside the dark matter halo weakens the lopsidedness. The signal decreases as cosmic time passes because of a competition between anisotropic accretion and internal evolution within dark matter haloes. Our findings provide a useful perspective for the study of galaxy evolution, especially for the origin of the spatial satellite galaxy distributions.
Benchmarking the IRDC G351.77−0.53: Gaia DR3 distance, mass distribution, and star formation content
Authors: Reyes-Reyes S D , Stutz A M , Megeath S T , Xu Fengwei , Álvarez-Gutiérrez R H , Sandoval-Garrido N , Liu H -L
Published: February 2024

While intensively studied, it remains unclear how the star formation (SF) in infrared dark clouds (IRDCs) compares to that of nearby clouds. We study G351.77-0.53 (henceforth G351), a cluster-forming filamentary IRDC. We begin by characterizing its young stellar object (YSO) content. Based on the average parallax of likely members, we obtain a Gaia distance of $\sim \, 2.0\pm 0.14$ kpc, resolving the literature distance ambiguity. Using our Herschel-derived N(H2) map, we measure a total gas mass of 10 200 M⊙ (within 11 pc2) and the average line-mass profile of the entire filament, which we model as $\lambda =~1660 (w/\rm pc)^{0.62}\, \, {\rm M}_{\odot }\, \rm {pc}^{-1}$. At w < 0.63 pc, our λ profile is higher and has a steeper power-law index than λ profiles extracted in Orion A and most of its substructures. Based on the YSOs inside the filament area, we estimate the SF efficiency (SFE) and SF rate (SFR). We calculate a factor of 5 incompleteness correction for our YSO catalogue relative to Spitzer surveys of Orion A. The G351 SFE is ∼1.8 times lower than that of Orion A and lower than the median value for local clouds. We measure SFR and gas masses to estimate the efficiency per free-fall time, ϵff. We find that ϵff is ∼1.1 dex below the previously proposed mean local relation, and $\sim \, 4.7\times$ below Orion A. These observations indicate that local SF-relations do not capture variations present in the Galaxy. We speculate that cloud youth and/or magnetic fields might account for the G351 inefficiency.
Contribution of zinc accumulation to ischemic brain injury and its mechanisms about oxidative stress, inflammation, and autophagy: an update
Authors: Yang Xueqi , Li Wei , Ding Mao , Liu Ke Jian , Qi Zhifeng , Zhao Yongmei
Published: February 2024

Ischemic stroke is a leading cause of death and disability worldwide, and presently, there is no effective neuroprotective therapy. Zinc is an essential trace element that plays important physiological roles in the central nervous system. Free zinc concentration is tightly regulated by zinc-related proteins in the brain under normal conditions. Disruption of zinc homeostasis, however, has been found to play an important role in the mechanism of brain injury following ischemic stroke. A large of free zinc releases from storage sites after cerebral ischemia, which affects the functions and survival of nerve cells, including neurons, astrocytes, and microglia, resulting in cell death. Ischemia-triggered intracellular zinc accumulation also disrupts the function of blood–brain barrier via increasing its permeability, impairing endothelial cell function, and altering tight junction levels. Oxidative stress and neuroinflammation have been reported to be as major pathological mechanisms in cerebral ischemia/reperfusion injury. Studies have showed that the accumulation of intracellular free zinc could impair mitochondrial function to result in oxidative stress, and form a positive feedback loop between zinc accumulation and reactive oxygen species production, which leads to a series of harmful reactions. Meanwhile, elevated intracellular zinc leads to neuroinflammation. Recent studies also showed that autophagy is one of the important mechanisms of zinc toxicity after ischemic injury. Interrupting the accumulation of zinc will reduce cerebral ischemia injury and improve neurological outcomes. This review summarizes the role of zinc toxicity in cellular and tissue damage following cerebral ischemia, focusing on the mechanisms about oxidative stress, inflammation, and autophagy.
Beyond network centrality: individual-level behavioral traits for predicting information superspreaders in social media
Authors: Zhou Fang , Lü Linyuan , Liu Jianguo , Mariani Manuel Sebastian
Published: February 2024

Understanding the heterogeneous role of individuals in large-scale information spreading is essential to manage online behavior as well as its potential offline consequences. To this end, most existing studies from diverse research domains focus on the disproportionate role played by highly connected ‘hub’ individuals. However, we demonstrate here that information superspreaders in online social media are best understood and predicted by simultaneously considering two individual-level behavioral traits: influence and susceptibility. Specifically, we derive a nonlinear network-based algorithm to quantify individuals’ influence and susceptibility from multiple spreading event data. By applying the algorithm to large-scale data from Twitter and Weibo, we demonstrate that individuals’ estimated influence and susceptibility scores enable predictions of future superspreaders above and beyond network centrality, and reveal new insights into the network positions of the superspreaders.
Infectious Diseases Physician Management of Cryptococcal Meningitis in North America—Is Single High-Dose Liposomal Amphotericin B Being Used?
Authors: Bahr Nathan C , Beekmann Susan E , Polgreen Philip M , Walker Jeremey B , Spec Andrej , Boulware David R , Baddley John W
Published: February 2024

Background

Several recent randomized trials have been conducted in resource-limited settings for cryptococcal meningitis that have rapidly innovated international guidelines. The 2010 Infectious Diseases Society of America (IDSA) cryptococcal meningitis guideline has not been updated with recent trials. The 2022 AMBITION-cm trial found that a single 10-mg/kg dose of liposomal amphotericin B plus daily flucytosine and fluconazole for 2 weeks was noninferior to 1 week of amphotericin B deoxycholate with flucytosine. It is unknown whether physicians in high-resource settings are using this regimen or more traditional regimens.

Methods

We developed an electronic survey in June 2023 to better understand whether physician members of the IDSA Emerging Infections Network (EIN) and Mycoses Study Group Education and Research Consortium (MSG-ERC) had used the AMBITION-cm induction regimen, would use the regimen in hypothetical clinical scenarios, and what perceived barriers to use existed.

Results

A total of 242 of 561 (43%) physicians responded to the survey, of whom 205 provided care for persons with cryptococcal meningitis in the last year. Overall, 29 (14%) had used the AMBITION-cm regimen, and 176 (86%) had not. In various hypothetical clinical scenarios, only ∼10% of 209 respondents selected the AMBITION-cm regimen as preferred. Perceived barriers to uptake included the applicability of trials performed in low-resource settings to high-resource settings, that the regimen is not recommended in the 2010 IDSA guidelines, and the applicability to persons without HIV.

Conclusions

Most respondents had not used the single-dose liposomal amphotericin B regimen, but the regimen is being used. Further study of this regimen in other patient populations and settings is necessary.
Discrimination in Multiphase Systems: Evidence from Child Protection
Authors: Baron E Jason , Doyle Joseph J , Emanuel Natalia , Hull Peter , Ryan Joseph
Published: February 2024

We develop empirical tools for studying discrimination in multiphase systems and apply them to the setting of foster care placement by child protective services. Leveraging the quasi-random assignment of two sets of decision-makers—initial hotline call screeners and subsequent investigators—we study how unwarranted racial disparities arise and propagate through this system. Using a sample of over 200,000 maltreatment allegations, we find that calls involving Black children are 55% more likely to result in foster care placement than calls involving white children with the same potential for future maltreatment in the home. Call screeners account for up to 19% of this unwarranted disparity, with the remainder due to investigators. Unwarranted disparity is concentrated in cases with potential for future maltreatment, suggesting that white children may be harmed by “underplacement” in high-risk situations.
Quantifying demand and willingness to pay for local food production
Authors: Ortez Mario , Thompson Taylor , Kilders Valerie , Widmar Nicole Olynk
Published: February 2024

The location of production and processing has had an increasingly prominent role in discussions regarding food systems today. Acknowledging the increasing importance, we study consumer preferences for and perception of local products with a particular focus on how willingness to pay (WTP) for local origin indication differs across products, types of designations, and rurality of the individual's geographic location. Using data collected through an online survey, we focused on Indiana residents’ preferences for sweet corn and Barbecue (BBQ) sauce with the sample representing both rural and urban consumers across all twelve economic growth regions in the state. Results reveal significant premiums for local products, with variations in WTP for certain local indications across rural and urban respondents. We also find that the marketing channel (farmer's market, direct from producer, or retail/grocery store) significantly influences respondents’ WTP for the two products, with results varying across the two products.
Can Italian forced heirship rights be enforced in England? Some remarks on the Del Curto decision
Authors: Panico Paolo
Published: February 2024

This case concerns the enforcement in England of a judgment where an Italian court ordered that the natural daughter of a deceased should receive a certain share of her father’s estate. It is not the assertion of a forced heirship entitlement but the application of Italian intestacy rules. The Master’s decision raises some questions as to the enforceability in England of an Italian judgment in a matter of succession. It is hoped that this will be clarified on appeal.
Almond hulls and shells as an alternative fiber source in limit-fed growing beef cattle diets
Authors: Duncan Zachary M , DeBord Zachary L , Pflughoeft Madison G , Suhr Kyler J , Hollenbeck William R , Brazle Frank K , Wecker Haley K , Paulk Chad B , Titgemeyer Evan C , Olson K C , Blasi Dale A
Published: February 2024

Almond hulls and shells are a by-product of almond production that can be incorporated as a feed ingredient in beef cattle diets. Three experiments were conducted to determine the effects of hammermill screen size on almond hull and shell bulk density and inclusion of ground or non-ground almond hulls and shells in limit-fed growing diets on growth performance, diet digestibility, and ruminal fermentation characteristics of beef cattle. In experiment 1, almond hulls and shells were ground with a laboratory-scale hammermill using no screen, a 11.1-mm screen, a 19.1-mm screen, or a 25.4-mm screen. Each screen-size treatment was ground at three separate time points (n= 3 replications/treatment). Grinding almond hulls and shells with no screen increased bulk density by 111% and minimized proportions of fine particles; therefore, almond hulls and shells ground using no screen were included as a treatment in the following experiments. In experiment 2, 364 steers (initial body weight [BW]: 257± 20.7 kg) were blocked by truckload (n = 4), stratified by BW, and assigned to pen within block. Pens were randomly assigned to 1 of 4 experimental diets (n= 10 pens/treatment). The control diet (CON) contained (DM basis) 39.5% dry-rolled corn, 7.5% supplement, 40% wet-corn gluten feed, and 13% prairie hay. Non-ground (13AH) or ground (13GAH) almond hulls and shells replaced prairie hay and were fed at 13% of diet DM or non-ground almond hulls and shells were fed at 26% of diet DM and replaced 13% prairie hay and 13% dry-rolled corn (26AH). Diets were limit-fed at 2.2% of BW daily (DM basis) for 56 d. Overall average daily gains (ADG) were greater (P ≤ 0.05) for CON, 13AH, and 13GAH compared with 26AH. In addition, ADG from days 14 to 56 were greater (P= 0.03) for 13GAH and tended to be greater (P = 0.09) for 13AH compared with CON. Experiment 3 was a 4 × 4 replicated Latin square in which 8 ruminally cannulated heifers (initial BW = 378 ± 44.0 kg) were fed diets from experiment 2. Apparent dry matter digestibility did not differ (P = 0.21) among treatments. Total ruminal volatile fatty acid concentrations were greater (P ≤ 0.03) for 13GAH and 13AH compared with 26AH and tended (P = 0.06) to be greater for 13GAH compared with CON. Overall, almond hulls and shells can be utilized as an alternative to prairie hay in limit-fed growing diets without negatively influencing rates of gain or diet digestibility.
Beyond Skin Deep: Diagnostic Correlations Between Radiology and Dermatology: Part 2—Inflammatory Disorders and Arthritides
Authors: Fischer Sarah , Toker Michelle , Jaller Jose A. , Goldman Jessica , Shah Pooja R. , Wu Benedict , Mardakhaev Edward
Published: February 2024

Many disease processes demonstrate both dermatologic and radiologic findings. Through improved understanding of these manifestations, we can improve our diagnostic abilities and collaborate more effectively with clinicians. Part 1 of this review covers classic dermatologic and radiologic findings of disease processes, categorized as infectious diseases, neoplastic disorders, and genetic syndromes. Part 2 focuses on inflammatory disorders and arthritides. Although the list of disease processes with dermatologic and radiologic findings is extensive, this review focuses on a collection of diseases, which are either common or with particularly classic and notable manifestations. With a heightened understanding of these manifestations, radiologists can more effectively guide clinicians in ordering appropriate radiologic examinations, and together can efficiently arrive at accurate diagnoses for our patients.
Universal Fetal Echocardiography for Pregestational Diabetes Mellitus
Authors: Savitsky Leah M. , Hamilton Caitlin , Sterrett Mary , Olerich Kelsey , Ma Kimberly , Albright Catherine M.
Published: February 2024

OBJECTIVE:

To evaluate the cost effectiveness of universal fetal echocardiogram for patients with pregestational diabetes mellitus by first-trimester hemoglobin A1c (Hb A1c) level.

METHODS:

We developed a cost-effectiveness model comparing two strategies of screening for critical fetal congenital heart disease among patients with diabetes: universal fetal echocardiogram and fetal echocardiogram only after abnormal findings on detailed anatomy ultrasonogram. We excluded ventricular septal defect, atrial septal defects, and bicuspid aortic valve from the definition of critical fetal congenital heart disease. Probabilities and costs were derived from the literature. We used individual models to evaluate different scenarios: first-trimester Hb A1c lower than 6.5%, Hb A1c 6.5–9.0%, and Hb A1c higher than 9.0%. Primary outcomes included fetal death, neonatal death, and false-positive and false-negative results. A cost-effectiveness threshold was set at $100,000 per quality-adjusted life-year. Univariable sensitivity analyses were performed to investigate the drivers of the model.

RESULTS:

Universal fetal echocardiogram is not cost effective except for when first-trimester Hb A1c level is higher than 9.0% (incremental cost-effectiveness ratio $638,100, $223,693, and $67,697 for Hb A1c lower than 6.5%, 6.5–9.0%, and higher than 9.0%, respectively). The models are sensitive to changes in the probability of congenital heart disease at a given Hb A1c level, as well as the cost of neonatal transfer to a higher level of care. Universal fetal echocardiogram became both cost saving and more effective when the probability of congenital heart disease reached 14.48% (15.4 times the baseline risk). In the Monte Carlo simulation, universal fetal echocardiogram is cost effective in 22.7%, 48.6%, and 62.3% of scenarios for each of the three models, respectively.

CONCLUSION:

For pregnant patients with first-trimester Hb A1c levels lower than 6.5%, universal fetal echocardiogram was not cost effective, whereas, for those with first-trimester Hb A1c levels higher than 9.0%, universal fetal echocardiogram was cost effective. For those with intermediate Hb A1c levels, universal fetal echocardiogram was cost effective in about 50% of cases; therefore, clinical judgment based on individual patient values, willingness to pay to detect congenital heart disease, and resource availability needs to be considered.
Skeletal Traction for Isolated Femur Fractures Does not Reduce Opioid Consumption
Authors: Mullis Brian , Caballero Jesse , Seetharam Abhijit , Pitz Lauren Ingrid , Gaski Greg E
Published: February 2024

OBJECTIVES:

Isolated femoral shaft fractures can be treated preoperatively with skeletal traction (TXN) or maintenance of a position of comfort (COMF). The goal of this retrospective review was to determine if preoperative opioid consumption differs significantly between these forms of treatment.

METHODS:

Design:

Case-control retrospective study

Setting:

Two academic level 1 trauma centers

Patient Selection Criteria:

Patients presenting to the emergency department with isolated OTA/AO 32A-C femoral shaft fractures from 2017-2020.

Outcome Measures and Comparisons:

The primary outcome was preoperative opioid consumption (morphine milligram equivalents (MME)) comparing patients treated with application of skeletal traction (TXN) or placed in a position of comfort (COMF).

RESULTS:

Two hundred and twenty patients were studied (COMF n=167, TXN n=53). Multivariate regression analysis revealed significantly greater preoperative opioid consumption in the Emergency Department (ED) for the TXN group compared to COMF (2.6 more MME [CI 0.23,4.96], p=0.031)). There was no difference in preoperative opioid consumption between groups on the hospital floor (p=0.811) nor during the entire preoperative course (p=0.486). The total preoperative rate of opioid consumption (MME/hour) did not differ (p=0.825).

CONCLUSIONS:

Patients with isolated femoral shaft fractures treated preoperatively with skeletal traction consumed more opioids in the ED compared to patients treated in a position of comfort but no difference in opioid consumption was observed between groups for the entire preoperative course. A position of comfort may be considered as an acceptable alternative to skeletal traction for patients with isolated femur fractures.

LEVEL OF EVIDENCE:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Recent advances in cancer-associated fibroblast: Biomarkers, signaling pathways, and therapeutic opportunities
Authors: Zhou Donger , Zheng Lei
Published: February 2024

Anti-cancer therapies usually focus on tumor cells, but non-tumor stromal components in the tumor microenvironment also play vital roles in tumor initiation and progression, which may be the prognostic factors and potential therapeutic targets. Cancer-associated fibroblasts (CAFs) are the essential component in the tumor environment, exhibiting high heterogeneity in their cell origin and phenotype with diverse functions that influence tumor angiogenesis, immune systems, and metabolism. Single-cell RNA sequencing and genetically engineered mouse models have increased our understanding of CAF diversity, and many subtypes have been defined. However, the precise functions of these subtypes need to be studied and validated. Studies of signaling pathways and epigenetic changes in CAFs facilitate understanding of the phenotypes of CAFs and the crosstalk between tumor cells and CAFs to provide potential therapeutic targets. Some clinical trials, including phase III trials targeting CAFs, have been performed recently. However, few of these trials have generated promising results, which indicates that the complexity of CAFs in the tumor microenvironment remains largely unknown, and in-depth investigations of CAFs should be performed. This review summarizes the research on CAFs, focusing on the heterogeneity of their phenotypes and functions, specific signaling pathways, and the therapeutic strategies involving CAFs. Additionally, we briefly discuss the current technologies commonly used in CAF studies and describe the challenges and future perspectives of CAF research.
The History of Vertical Flight and Air Medical Transport
Authors: Asberry Cassandra , Copper Donny
Published: February 2024

Vertical flight was sought-after by scientists for centuries, finding early beginnings in children's toys and slowly developing into the modern helicopter. For centuries, true success was elusive, and many machines failed to achieve safe, controlled flight. Despite slow progress, vertical flight enthusiasts were unrelenting and continued trialing new concepts until one finally rose above the rest. As technology advanced, the critical role of helicopters in medical evacuation became apparent. Throughout recent history, continuous progress in vertical flight technology has led to widespread and multifaceted use of helicopters in civilian and military medical operations.
Multidisciplinary Collaboration Within Air Medical Transport
Authors: Martini Alaina , Boswell Stephanie , Faiello Russ , Toy Jeffrey
Published: February 2024

The success of each air medical transport mission is dependent on the coordinated efforts of communications specialists, aviation personnel, medical crew members, referring hospitals, local emergency medical services, and fire and law enforcement personnel. Expedited, efficient, and safe patient transport is made possible through the collaboration of all the aforementioned disciplines. In this specialized, unpredictable, and high-pressure environment, each entity plays its own crucial role in rapidly delivering critical care directly to the patient in need.
Implementation and Management of a Flight Program
Authors: Myrgo Candice J.
Published: February 2024

Air medical transport of critically ill and injured patients began during World War II. Now air transport has become an integral part of health care, nationally and internationally. With the development of portable medical equipment critical care has extended beyond the hospital by bringing critical care to the scene or to rural hospitals. Air medical programs transport critically ill and injured patients by helicopter or airplane while continuously providing critical care enroute. These transports are interfacility from accident scenes, disaster areas, and remote locations where the patient is transported to a tertiary care center so that definitive care will be provided. The 2 modes of air transport are rotor wing (helicopters) and fixed wing (airplanes). Air medical transport is utilized when ground transportation is not conducive to patient criticality or location relative to a tertiary care center. There are many factors to consider when choosing a mode of transport, and each mode has its own unique advantages and disadvantages. Air medical programs place emphasis on clinical care, safety, and quality assurance, with the patient being the focused beneficiary. This article addresses implementation and management of rotor wing air medical transport with a focus on standards of care, safety, and quality.
Application of End-Tidal CO2 Monitoring to ICU Management
Authors: Owens Bradley , Hall Chris
Published: February 2024

Waveform capnography is a noninvasive measurement of ventilation and perfusion commonly employed in the prehospital setting. It is easy to apply, and modern cardiac monitors are equipped with the necessary ports and capability to display results. Despite its ease of use, end-tidal CO2 monitoring has not yet achieved widespread adoption within the hospital setting. It is routinely used in the emergency department and by anesthesiologists, but its application could support ICU management in critically ill patients. Its use is routinely supported by multiple professional societies, and it has been recommended as a requirement in all cardiac arrests. Careful analysis of the waveform and expired carbon dioxide can guide therapy for patients experiencing respiratory emergencies, hemodynamic compromise, metabolic acidosis, and shock due to trauma, hypovolemia, or sepsis. Use of capnography throughout the hospital could improve patient outcomes and prevent unidentified deterioration.
Pain management after open colorectal surgery
Authors: Uten Thomas , Chesnais Maximilien , van de Velde Marc , Raeder Johan , Beloeil Hélène ,   the PROSPECT Working group of the European Society of Regional Anaesthesia Pain therapy (ESRA)
Published: February 2024

BACKGROUND

Open colectomy is still performed around the world and associated with significant postoperative pain.

OBJECTIVES

Unpublished recommendations based on a systematic review were proposed by the PROcedure SPECific postoperative pain managemenT (PROSPECT) group in 2016. We aimed to update these recommendations by evaluating the available literature and develop recommendations for optimal pain management after open colectomy according to the PROSPECT methodology.

DESIGN AND DATA SOURCES

A systematic review using the PROSPECT methodology was undertaken. Randomised controlled trials and systematic reviews published in the English language from 2016 to 2022 assessing postoperative pain after open colectomy using analgesic, anaesthetic or surgical interventions were identified. The primary outcome included postoperative pain scores.

RESULTS

The previous 2016 review included data from 93 studies. Out of 842 additional eligible studies identified, 13 new studies were finally retrieved for analysis. Intra-operative and postoperative interventions that improved postoperative pain were paracetamol, epidural analgesia. When epidural is not feasible, intravenous lidocaine or bilateral TAP block or postoperative continuous pre-peritoneal infusion are recommended. Intra-operative and postoperative Cyclo-oxygenase (COX)-2 specific-inhibitors or non-steroidal anti-inflammatory drugs (NSAIDs) are recommended for colonic surgery.

CONCLUSIONS

The analgesic regimen for open colectomy should include intra-operative paracetamol and COX-2 specific inhibitors or NSAIDs (restricted to colonic surgery), epidural and continued postoperatively with opioids used as rescue analgesics. If epidural is not feasible, bilateral TAP block or IV lidocaine are recommended. Safety issues should be highlighted: local anaesthetics should not be administered by two different routes at the same time. Because of the risk of toxicity, careful dosing and monitoring are necessary.
AI-based predictive modeling: applications in cardiology
Authors: Abbas Ghulam H.
Published: February 2024

Predictive analytics have emerged as a powerful tool in cardiology, revolutionizing how patient care is delivered by leveraging artificial intelligence (AI) and machine learning (ML) algorithms. Healthcare professionals can now forecast the occurrence and progression of cardiovascular diseases with unprecedented accuracy. This breakthrough technology possesses the ability to fundamentally transform the field of cardiology, facilitating early detection, personalized treatment methodologies, and improving patient outcomes. The utilization of predictive analytics based on AI and ML represents a significant advancement that can optimize resource allocation, enhance clinical decision-making, and most importantly, benefit those affected by heart conditions. As the technology continues to grow more sophisticated through ongoing research and development, its full potential to revolutionize cardiovascular medicine and benefit patients worldwide has yet to be fully realized.
A randomized-controlled pilot trial of telemedicine-delivered cognitive-behavioral therapy tailored for interstitial cystitis/bladder pain syndrome
Authors: McKernan Lindsey C. , McGonigle Trey , Vandekar Simon N. , Crofford Leslie J. , Williams David A. , Clauw Daniel J. , Bruehl Stephen , Corbett Blythe A. , Dmochowski Roger R. , Walsh Elizabeth G. , Kelly Anna Grace , Sutherland Susanna L. , Connors Erin L. , Ryden Anna , Reynolds William Stuart
Published: February 2024

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a debilitating urologic pain condition with few treatment advances in the past 25 years. Individuals with IC/BPS often experience significant psychological distress, which worsens symptoms and functioning. To date, there have been no large-scale, randomized controlled trials (RCTs) of comprehensive psychological interventions for IC/BPS. We conducted a 2:1 RCT of an 8-session patient-informed cognitive-behavioral therapy (CBT) intervention designed for IC/BPS for reducing pain-related symptoms and improving quality of life, delivered through telemedicine. Individuals with IC/BPS (N = 78) were randomized to receive either 8 weeks of CBT specifically designed for IC/BPS (n = 52) or an attention control condition (n = 26). Urologic symptoms (Genitourinary Pain Index, GUPI), pain-related symptoms, affective distress, and quality of life were evaluated before, immediately after, and 3 months posttreatment. Both conditions reported significant but similar reductions (P = 0.922) in the a priori primary outcome of genitourinary symptoms at posttreatment (GUPI reduction = 6.6 vs 4.8, for CBT and control, respectively) and long-term follow-up (8.1 vs 6.6, for CBT and control). However, the CBT group had significantly greater improvement in Patient Global Impression of Change (PGIC) scores and was significantly more likely to be treatment responders (PGIC ≥ 6) (37% vs 8%, P = 0.019 for CBT and control), with a large relative effect size (OR = 6.68). A subgroup analysis of CBT recipients showed that responders (PGIC

6) displayed significant reductions in genitourinary symptoms (P = 0.023), pain intensity (P = 0.027), and pain interference (P = 0.013) posttreatment. Telemedicine-delivered pain CBT for IC/BPS shows promise for improving outcomes, and this trial demonstrates the need for larger RCTs of CBT for IC/BPS.
A basic solution for a complex problem: does treatment of metabolic acidosis slow CKD progression?
Authors: Bodker Kevin , Freidin Natalie , Arora Nayan
Published: February 2024

Purpose of this review

Metabolic acidosis is frequently encountered in patients with chronic kidney disease (CKD), with increasing prevalence as kidney function worsens. Treating electrolyte disturbances is the sine qua non of Nephrologists, and alkali therapy to normalize serum bicarbonate levels and slow progression of kidney disease has been embedded in clinical practice guidelines for decades on the basis of animal models and controversial clinical trials. This review will critically appraise the literature base for this recommendation and determine whether the available evidence supports this common practice, which is a timely endeavor considering the impending demotion of metabolic acidosis treatment from recommendation to practice point in forthcoming KDIGO guidelines.

Recent findings

Earlier, open-label, studies supporting the utility of sodium bicarbonate therapy to slow progression of chronic kidney disease have been challenged by more recent, blinded, studies failing to show benefit on CKD progression. This was further demonstrated in the absence of concomitant sodium administration with the hydrochloric acid binder veverimer, which failed to demonstrate benefit on renal death, end stage kidney disease or 40% reduction in estimated glomerular filtration rate in a large multicenter trial.

The current body of literature does not support the routine treatment of metabolic acidosis in patients with CKD and the authors agree with the forthcoming KDIGO guidelines to de-emphasize this common practice.
Prediction models for earlier stages of chronic kidney disease
Authors: Alexiuk Mackenzie , Tangri Navdeep
Published: February 2024

Purpose of review

Identifying patients with risk of developing progressive chronic kidney disease (CKD) early is an important step in improving kidney care. This review discusses four recently developed models, two which predict risk of new onset disease, and two which predict progression earlier in the course of disease.

Recent findings

Several models predicting CKD incidence and progression have been recently developed and externally validated. A connecting theme across these models is the use of data beyond estimated glomerular filtration rate, allowing for greater accuracy and personalization. Two models were developed with stratification by diabetes status, displaying excellent model fit with and without variables like use of diabetes medication and hemoglobin A1C. Another model was designed to be patient facing, not requiring the knowledge of any laboratory values for use. The final model was developed using lab data and machine learning. These models demonstrated high levels of discrimination and calibration in external validation, suggesting suitability for clinical use.

Models that predict risk of CKD onset and progression have the potential to significantly reduce disease burden, financial cost, and environmental output from CKD through upstream disease prevention and slowed progression. These models should be implemented and evaluated prospectively in primary care settings.
Bringing Delirium to Light
Authors: Savino Theresa , Vergara Franz H. , Ramos Mary Dioise , Warzecha Deborah
Published: February 2024

Background:

Delirium is a serious complication in patients in the critical care unit (CCU) that may lead to prolonged hospitalization if left undetected. The CCU at our hospital does not have a framework for determining delirium that could affect patient outcomes and discharge planning.

Primary Practice Setting:

CCU in a community hospital.

Method:

A posttest-only design was used for this study. We established a framework for the early assessment of delirium, educated and trained nurses to detect delirium, collaborated with the informatics department, intensivist, nursing, respiratory therapy and worked with case management to deploy the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). We used a one-tailed independent t test to determine the impact of CAM-ICU on length of stay (LOS). Cross-tabulation and chi-square tests were used to examine the impact of CAM-ICU tool on home care utilization between the intervention and comparison groups.

Results:

There was a 3.12% reduction in LOS after implementing the CAM-ICU tool. Also, a reduction in home care service utilization demonstrated statistical significance (p = .001) between the intervention group (62.5%; n = 177) and the comparison group (37.5%; n = 106).

Implications for Case Management Practice:

Case managers are essential in improving care transitions. Case managers need to become competent in understanding the implications of the CAM-ICU tool because of their relevant role in the multidisciplinary rounds as advocates to improve care transitions across the continuum of care. Case managers need to have an understanding on how to escalate when changes in the Richmond Agitation-Sedation Scale scores occur during the multidisciplinary rounds because it can affect care coordination throughout the hospital.

Conclusions:

Implementing the CAM-ICU decreased LOS, and reduced health care utilization. The early identification of patients with delirium can affect the outcomes of critically ill patients and entails multidisciplinary collaboration.