bluuebunny/crossref_metadata_2025 huggingface dataset:
Body Mass Index and Mortality in Cardiogenic Shock
Authors: Guglin Maya , Zweck Elric , Kanwar Manreet , Sinha Shashank S. , Bhimaraj Arvind , Li Borui , Abraham Jacob , Vallabhajosyula Saraschandra , Hernandez-Montfort Jaime , Kataria Rachna , Burkhoff Daniel , Kapur Navin K. ,   on the behalf of the Cardiogenic Shock Working Group
Published: March 2024

We explored the association of body mass index (BMI) with mortality in cardiogenic shock (CS). Using the Cardiogenic Shock Working Group registry, we assessed the impact of BMI on mortality using restricted cubic splines in a multivariable logistic regression model adjusting for age, gender, and race. We also assessed mortality, device use, and complications in BMI categories, defined as underweight (<18.5 kg/m2), normal (18.5–24.9 kg/m2), overweight (25–29.9 kg/m2), obese (30–39.9 kg/m2), and severely obese (>40 kg/m2) using univariable logistic regression models. Our cohort had 3,492 patients with CS (mean age = 62.1 ± 14 years, 69% male), 58.0% HF-related CS (HF-CS), and 27.8% acute myocardial infarction (AMI) related CS. Body mass index was a significant predictor of mortality in multivariable regression using restricted cubic splines (p < 0.0001, p = 0.194 for nonlinearity). When stratified by categories, patients with healthy weight had lower mortality (29.0%) than obese (35.1%, p = 0.003) or severely obese (36.7%, p = 0.01). In HF-CS cohort, the healthy weight patients had the lowest mortality (21.7%), whereas it was higher in the underweight (37.5%, p = 0.012), obese (29.2%, p = 0.003), and severely obese (29.9%, p = 0.019). There was no difference in mortality among BMI categories in AMI-CS.
Validation of the Mindray VS9 Vital Signs Monitor in a combined adult and pediatric population according to ISO Standard 81060-2:2018
Authors: Guo Na , Zhang Yihan , Chen Weiqiang , Zhong Hexian , Li Liping , Xie Hanbin , Zhu Wenxiu , Liu Jun , Li Shangrong
Published: March 2024

We aimed to validate the accuracy of the Mindray VS9 Vital Signs Monitor, which features the Mindray TrueBP inflation algorithm for oscillometric blood pressure (BP) measurement, to check if it complies with the International Organization for Standardization Standard (ISO 81060-2:2018) in a combined adult and pediatric population. A total of 86 participants, including both adult and pediatric subjects, were recruited. The distribution of their ages, gender, BPs and limb sizes all complied with the requirement of the ISO standard. The inflation and deflation algorithms were validated independently using the same-arm sequential BP measurement method. For each subject, the BP was first determined by two independent observers using a mercury sphygmomanometer (R1). The BP of the subject was then determined by the third observer using the test equipment (T1). Then, using a mercury sphygmomanometer, two independent observers were asked to determine the subject’s BP (R2) again. R1-T1-R2 were considered a valid pair of data. This cycle continued until 3 pairs of valid data were achieved. We collected 258 pairs of valid BP data for the validation of the inflation and deflation algorithms respectively. For validation Criterion 1, the mean ± SD of the differences between the readings obtained from the test device and reference BP was 0.0 ± 6.6/−1.8 ± 7.1 mmHg (systolic/diastolic) when the deflation algorithm was used, and 2.4 ± 6.3/ 0.3 ± 6.9 mmHg (systolic/diastolic) when the inflation algorithm was used. For validation Criterion 2, the SD of the averaged BP differences between the test device and the reference BP per subject was 5.35/6.33 mmHg (systolic/diastolic) when the deflation algorithm was used, and 5.17/5.75 mmHg (systolic/diastolic) when the inflation algorithm was used. The VS9 Vital Signs Monitor fulfilled all the criteria in the ISO Standard. Moreover, the inflation algorithm had a shorter Measure Time (by 7–21 s) and lower maximum inflation pressure (by 9.7–22 mmHg). The VS9 Vital Signs Monitor fulfilled all the requirements of the ISO Standard (ISO 81060-2:2018) in a combined adult and pediatric population and is recommended for clinical use.
Antimicrobial stewardship and molecular diagnostics: a symbiotic approach to combating resistance in the ED and ICU
Authors: De Waele Jan J. , Boelens Jerina
Published: March 2024

Purpose of review

This review aims to evaluate the incorporation of rapid molecular diagnostics (RMD) in antimicrobial stewardship programs (ASPs) in the management of patients in the emergency department (ED) and intensive care unit (ICU), highlighting a shift from conventional microbiological diagnostic tests to RMD strategies to optimize antimicrobial use and improve patient outcomes.

Recent findings

Recent advances in RMD have demonstrated the superior accuracy of RMD in identifying pathogens, combined with shorter turnaround times. RMD allows speeding up of antimicrobial decision making in the ED and facilitates faster escalation when empirical therapy was inappropriate, as well as more efficient de-escalation of empirical therapy later in the course of the treatment. Implementation of RMD however may be challenging.

RMD hold great value in simplifying patient management and mitigating antimicrobial exposure, particularly in settings with high levels of antimicrobial resistance where the use of broad-spectrum antimicrobials is high. While the impact on the use of antimicrobials is significant, the impact on patient outcomes is not yet clear. Successful integration of RMD in clinical decision making in the ED and ICU requires a team approach and continued education, and its use should be adapted to the local epidemiology and infrastructure.
Illness Perception and Benefit Finding of Thyroid Cancer Survivors: A Chain Mediating Model of Sense of Coherence and Self-disclosure
Authors: Zhang Xu , Huang Tingting , Sun Di , Liu Meishuo , Wang Zhiwen
Published: March 2024

Background

Benefit finding is gaining attention as a strong predictor of quality of life, but few studies have addressed the mechanisms of its development.

Objective

The purpose of this study was to determine the relationship between illness perception and benefit finding in female thyroid cancer survivors and to further elucidate the mechanisms by which illness perception contributes to benefit finding through sense of coherence and self-disclosure.

Methods

A total of 280 female thyroid cancer survivors completed the questionnaire between January and August 2023. The study investigated participants’ baseline information, illness perception, sense of coherence, self-disclosure, and benefit finding. The bootstrap method was used to test the chain mediation effect.

Results

The findings showed that in the chain-mediated model, illness perception negatively predicted sense of coherence (β = −.475, P < .001) and self-disclosure (β = −.335, P < .001). Sense of coherence positively predicted self-disclosure (β = .272, P < .001) and benefit finding (β = .251, P < .001). Self-disclosure positively predicted benefit finding (β = .213, P < .001). The separate mediating roles of sense of coherence and self-disclosure between illness perception and benefit finding were both significant, as were the chained mediating roles of sense of coherence, and self-disclosure.

Conclusion

This study provides a theoretical basis for elucidating the mechanisms of benefit finding and provides precise targets for clinical intervention.

Implications for Practice

Healthcare professionals can improve mental health outcomes by improving cancer survivors’ disease awareness, fostering their sense of coherence, and encouraging moderate self-disclosure to achieve benefit finding.
Effectiveness of Computerized Cognitive Training on Working Memory in Pediatric Cancer Survivors
Authors: Lam Katherine K. W. , Ho K. Y. , Liu Anthony P. K. , Liu Charlotte Q. , Ng Ming Hong , Lam Ting Chak , Belay Getaneh Mulualem , Hammoda Abu-Odah , Yang Funa , Yuen Wai Man , Chan Godfrey C. F.
Published: March 2024

Background

Interactive features of computerized cognitive training (CCT) may enhance adherence to training, providing a relatively low-cost intervention. A robust systematic review on the effectiveness of CCT for improving working memory (WM) among pediatric survivors with cancer is lacking.

Objective

To summarize the available evidence and determine the effectiveness of CCT for WM among pediatric survivors with cancer.

Interventions/Methods

Five databases were searched. The Effective Public Health Practice Project was used to assess the study quality. ReviewerManager was used. The primary outcome was WM performance. Secondary outcomes included processing speed, attention, intervention adherence, and number of adverse events.

Results

Six studies were included. Regarding overall quality, 1 study was weak, and 5 studies were moderate. Five studies reported a significant improvement of WM postintervention (P < .05). The meta-analysis of Cogmed interventions on symbolic WM revealed a significant difference between groups (vs placebo), with an overall pooled effect size of 0.71 (95% confidence interval, 0.02-1.41; P = .04). Two and 4 studies investigated the effects of CCT on processing speed and attention, respectively, with conflicting results. Four studies reported adherence of 80% or greater. Two studies reported no adverse events.

Conclusions

Computerized cognitive training using Cogmed has a significant positive effect on WM. The effects of CCT on processing speed and attention remain inconclusive.

Implications for Practice

More rigorous trials should be conducted to elucidate the cognitive effects of CCT, particularly processing speed and attention, in the pediatric population with cancer. Further studies should consider combining CCT with other existing interventions to strengthen their effectiveness.
A General Approach to Patients Presenting With Locally Advanced or Distant Metastatic Disease
Authors: Smithy James W. , Chapman Paul B.
Published: March 2024

The widespread adoption of immune checkpoint inhibitors and small molecule inhibitors of the MAP kinase pathway has transformed the management of locally advanced and metastatic melanoma. Here, we provide a broad overview on the use of these agents in the first-line setting, incorporating a review of the clinical literature as well as the practice patterns of our respective melanoma groups. Throughout, we highlight areas of uncertainty that provide opportunities for future clinical investigation and additional improvement in outcomes for patients with melanoma.
Local and Systemic Management Options for Melanoma Brain Metastases
Authors: Amouzegar Afsaneh , Tawbi Hussein A.
Published: March 2024

Development of brain metastasis is one of the most serious complications of advanced melanoma, carrying a significant burden of morbidity and mortality. Although advances in local treatment modalities such as stereotactic radiosurgery and breakthrough systemic therapies including immunotherapy and targeted therapies have improved the outcomes of patients with metastatic melanoma, management of patients with melanoma brain metastases (MBMs) remains challenging. Notably, patients with MBMs have historically been excluded from clinical trials, limiting insights into their specific treatment responses. Encouragingly, a growing body of evidence shows the potential of systemic therapies to yield durable intracranial responses in these patients, highlighting the need for inclusion of patients with MBMs in future clinical trials. This is pivotal for expediting the advancement of novel therapies tailored to this distinct patient population. In this review, we will highlight the evolving landscape of MBM management, focusing on local and systemic treatment strategies.
Cingulotomy: the last man standing in the battle against medically refractory poststroke pain
Authors: Kollenburg Linda , Kurt Erkan , Arnts Hisse , Vinke Saman
Published: March 2024

Introduction:

Central poststroke pain (CPSP) places a huge burden on patient lives because patients are often refractory to conventional strategies and have little chance for spontaneous recovery. A subset of patients is even given approval for euthanasia and is without any perspective. Because the anterior cingulate cortex historically seems to be a promising target for patients with both mental and chronic pain disorders, lesioning of this central “hub” with cingulotomy may be a useful strategy for medically refractory CPSP. However, limited research is available on cingulotomy for central pain. Hence, we represent a rare case in which cingulotomy is performed on a patient with CPSP.

Objectives:

To describe the potential of cingulotomy in a case with CPSP.

Methods:

The case presented in this study concerns a 60-year-old woman who experienced CPSP, caused by a hemorrhagic stroke in the basal ganglia and thalamus. The patient visited several centers and tried multiple off-label treatments; however, she was told nothing else could be done and was even given approval for euthanasia. Hence, anterior cingulotomy was performed.

Results:

After surgery, no transient adverse events occurred, except for vocabulary disturbances post stroke, which disappeared after several weeks. After 14 weeks, changes in pain behavior were observed, followed by a decreased pain intensity. At a later follow-up, the pain had completely disappeared.

Conclusion:

Anterior cingulotomy seems to be a suitable “last-resort” option for patients with CPSP. Future research, including homogenous groups, to define the best location for lesioning is required to allow the revival of this “old” technique in the current era.
Delayed-Onset Idiopathic Intracranial Hypertension After Liposuction
Authors: Mehta Nina , Rajagopal Usha
Published: March 2024

Although systemic complications following liposuction are rare, visual impairment has been reported in a few cases and may occur for a variety of reasons. Here we present the case of a 31-year-old woman who underwent 360° liposuction and subsequently developed headaches and delayed partial visual disturbance 10 days after the procedure. She had symptoms suggestive of idiopathic intracranial hypertension, which was confirmed by lumbar puncture. A literature search revealed other case reports of visual changes or headaches following high-volume liposuction. Our case provides further evidence of a rare association between liposuction and idiopathic intracranial hypertension, emphasizing the need for thorough preoperative evaluations and the consideration of possible risks.
A Systematic Review of Registered Clinical Trials for Peripheral Nerve Injuries
Authors: Elhelali Ala , Tuffaha Sami
Published: March 2024

Upper extremity peripheral nerve injuries (PNIs) significantly impact daily functionality and necessitate effective treatment strategies. Clinical trials play a crucial role in developing these strategies. However, challenges like retrospective data collection, reporting biases, inconsistent outcome measures, and inadequate data sharing practices hinder effective research and treatment advancements. This review aims to analyze the landscape of reporting, methodological design, outcome measures, and data sharing practices in registered clinical trials concerning upper extremity PNIs. It seeks to guide future research in this vital area by identifying current trends and gaps.

A systematic search was conducted on ClinicalTrials.gov and WHO International Clinical Trials Registry Platform up to November 10, 2023, using a combination of MeSH terms and keywords related to upper extremity nerve injury. The PRISMA 2020 guidelines were followed, and the studies were selected based on predefined inclusion and exclusion criteria. A narrative synthesis of findings was performed, with statistical analysis for associations and completion rates.

Of 3051 identified studies, 96 met the inclusion criteria. These included 47 randomized controlled trials, 27 nonrandomized trials, and others. Sensory objective measures were the most common primary outcomes. Only 13 studies had a data sharing plan. The analysis revealed varied intervention methods and inconsistencies in outcome measures. There was a significant association between study funding, design, and completion status, but no association between enrollment numbers and completion.

This review highlights the need for standardized outcome measures, patient-centered assessments, and improved data sharing in upper extremity PNI trials. The varied nature of interventions and inconsistency in outcome measures indicate the necessity for more rigorous and transparent research practices to strengthen the evidence base for managing these injuries.
A Scoping Review of Interprofessional Simulation-Based Team Training Programs
Authors: Bochatay Naike , Ju Mindy , O'Brien Bridget C. , van Schaik Sandrijn M.
Published: March 2024

Summary Statement

Interprofessional simulation-based team training (ISBTT) is promoted as a strategy to improve collaboration in healthcare, and the literature documents benefits on teamwork and patient safety. Teamwork training in healthcare is traditionally grounded in crisis resource management (CRM), but it is less clear whether ISBTT programs explicitly take the interprofessional context into account, with complex team dynamics related to hierarchy and power. This scoping review examined key aspects of published ISBTT programs including (1) underlying theoretical frameworks, (2) design features that support interprofessional learning, and (3) reported behavioral outcomes. Of 4854 titles identified, 58 articles met inclusion criteria. Most programs were based on CRM and related frameworks and measured CRM outcomes. Only 12 articles framed ISBTT as interprofessional education and none measured all interprofessional competencies. The ISBTT programs may be augmented by integrating theoretical concepts related to power and intergroup relations in their design to empower participants to navigate complex interprofessional dynamics.
Inhibition of SIRT1 in the nucleus accumbens attenuates heroin addiction-related behavior by decreasing D1 neuronal autophagy
Authors: Huang Yanyan , Liu Meijun , Zheng Zhiyao , Lu Ruiping , Li Chunlu , Su Min , Li Yixin , Xia Baijuan
Published: March 2024

This study aimed to investigate the effects of SIRT1 modulation on heroin addiction-like behavior and its possible biological mechanisms. Wild-type C57BL/6J and Sirt1
loxp/loxpD1-Cre mice were used in this experiment, and Sirt1loxp/loxpD1-Cre(−) mice were used as a control for conditional knockout mice. Mice were divided into saline control and heroin-dependent groups. Behavioral methods were used to record the withdrawal response, conditioned place preference (CPP) changes, and open field test results. Transmission electron microscopy (TEM) was used to observe the structure of autophagosomes in nucleus accumbens (NAc) neurons. The expression of SIRT1 and autophagy-related proteins and genes, such as LC3Ⅱ, ATG5, and ATG7, was detected in the NAc of each mouse group via western blot, real-time quantitative PCR (qPCR) analyzes, and immunofluorescence. The results of this experiment showed that compared with the saline group, mice in the wild-type heroin-dependent group showed marked withdrawal symptoms, with more autophagosomes observed in NAc via TEM. Compared with wild-type and Sirt1
loxp/loxpD1-Cre(−) heroin-dependent groups, CPP formation was found to be reduced in the conditional knockout mouse group, with a significant decrease in spontaneous activity. Western blot, qPCR, and immunofluorescence results indicated that the expression of LC3Ⅱ, ATG-5, and ATG-7 was significantly reduced in the NAc of the Sirt1
loxp/loxpD1-Cre(+) group. It was still, however, higher than that in the saline control group. These results suggest that inhibition of Sirt1 expression may prevent heroin-induced addiction-related behaviors via reducing D1 neuronal autophagy.
Astronomy from the moon in the next decades: from exoplanets to cosmology in visible light and beyond
Authors: Schneider Jean , Kervella Pierre , Labeyrie Antoine
Published: March 2024

We look at what astronomy from the Moon might be like over the next few decades. The Moon offers the possibility of installing large telescopes or interferometers with instruments larger than those on orbiting telescopes. We first present examples of ambitious science cases, in particular ideas that cannot be implemented from Earth. After a general review of observational approaches, from photometry to high contrast and high angular resolution imaging, we propose as a first step a 1-metre-class precursor and explore what science can be done with it. We add a proposal to use the Earth–Moon system to test the quantum physics theory.

This article is part of a discussion meeting issue 'Astronomy from the Moon: the next decades (part 2)'.
The lunar dust environment: concerns for Moon-based astronomy
Authors: Horányi Mihály , Szalay Jamey R. , Wang Xu
Published: March 2024

The Moon has no atmosphere, hence, it offers a unique opportunity to place telescopes on its surface for astronomical observations. It is phase-locked with Earth, and its far side remains free from ground-based interference, enabling the optimal use of radio telescopes. However, the surface of the Moon, as any other airless planetary object in the solar system, is continually bombarded by interplanetary dust particles that cause impact damage and generate secondary ejecta particles that continually overturn the top layer of the lunar regolith. In addition, there is evidence, that small particles comprising the lunar regolith can be electrically charged, mobilized and transported, also representing a hazard for covering sensitive surfaces and interfering with exposed mechanical structures. In addition to the naturally occurring dust transport, rocket firings during landings and take-offs, pedestrian and motorized vehicle traffic will also liberate copious amounts of dust, representing a potential hazard for the safe and optimal use of optical platforms.

This article is part of a discussion meeting issue ‘Astronomy from the Moon: the next decades (part 2)’.
Can You Beat the Music? Validation of a Gamified Rhythmic Training in Children with ADHD
Authors: Jamey Kevin , Laflamme Hugo , Foster Nick E. V. , Rigoulot Simon , Kotz Sonja A. , Bella Simone Dalla
Published: March 2024

Neurodevelopmental disorders like ADHD can affect rhythm perception and production, impacting the performance in attention and sensorimotor tasks. Improving rhythmic abilities through targeted training might compensate for these cognitive functions. We introduce a novel protocol for training rhythmic skills via a tablet-based serious game called Rhythm Workers (RW). This proof-of-concept study tested the feasibility of using RW in children with ADHD. We administered an at-home longitudinal protocol across Canada. A total of 27 children (7-13 years) were randomly assigned to either a finger-tapping rhythmic game (RW) or a control game with comparable auditory-motor demands but without beat-synchronization (active control condition). Participants played the game for 300 minutes over two weeks. We collected data (self-reported and logged onto the device) on game compliance and acceptance. Further, we measured rhythmic abilities using the Battery for the Assessment of Auditory Sensorimotor and Timing Abilities (BAASTA). The current findings show that both games were equally played in duration, rated similarly for overall enjoyment, and relied on similar motor activity (finger taps). The children who played RW showed improved general rhythmic abilities compared to controls; these improvements were also positively related to the playing duration. We also present preliminary evidence that executive functioning improved in those who played RW but not controls. These findings indicate that both games are well-matched. RW demonstrates efficacy in enhancing sensorimotor skills in children with ADHD, potentially benefiting executive functioning. A future RCT with extended training and sample size could further validate these skill transfer effects.
Disparity of secondary prevention among patients with rheumatic heart disease: A longitudinal study in Uganda
Authors: Xu Xinpeng , Chu Emily , Miao Hui , Du Yuxian , Hoskins Ryan , Opara Chinonso C. , Minja Neema W. , Pickersgill Sarah , Atala Jenifer , Beaton Andrea Z. , Kansiime Rosemary , Longenecker Chris T. , Nakitto Miriam , Ndagire Emma , Nalubwama Hadija , Okello Emmy , Sarnacki Rachel , Pulle Jafesi , Watkins David A. , Su Yanfang
Published: March 2024

Background

Rheumatic heart disease (RHD) is most prevalent in socially disadvantaged settings, placing a severe burden on patients and their households. The study aims to investigate the disparity of healthcare costs, including financial and time costs, among RHD patients in Uganda.

Methods

We enrolled 54 RHD households from the Uganda National RHD Registry between June 2019 and February 2021. The patients were interviewed in baseline and 12-month follow-up surveys. A random-effect model was applied to examine the disparity of RHD financial and time costs. Our primary outcomes are the total outpatient costs for RHD patients’ most recent visit, consisting of direct medical costs, direct non-medical costs, and time costs.

Results

Following the COVID-19 pandemic, the total financial cost of outpatient visits for RHD patients increased by 9 USD on average (P<0.01), with the change primarily driven by non-medical costs such as transportation and food (5.8 USD,P<0.05). Direct medical costs also increased significantly in the pandemic, with an average increase of 3.2 USD (P<0.1). Compared with their counterparts, non-medical costs were higher for patients with poor infrastructure, with less education, who were older, and who were male. Patients with employment experienced a higher time cost than those without (3.3 hours,P<0.01).

Conclusions

The COVID-19 pandemic significantly increased RHD outpatient costs, mainly caused by the increase in non-medical costs. Our study implies that improving infrastructure, investing in education, and providing employees with time to seek care have the potential to reduce non-medical barriers to RHD secondary prevention.
APP and its intracellular domain modulate Alzheimer’s disease risk gene networks in transgenicAPPswandPSEN1M146Iporcine models
Authors: Habekost Mette , Poulsen Ebbe T. , Enghild Jan J. , Denham Mark , Jørgensen Arne Lund , Qvist Per
Published: March 2024

Alzheimer’s disease (AD) is a progressive neurodegenerative disorder and the most frequent cause of dementia. The disease has a substantial genetic component comprising both highly penetrant familial mutations (APP,PSEN1,andPSEN2) and sporadic cases with complex genetic etiology. Mutations inAPPandPSEN1/2alter the proteolytic processing of APP to its metabolites, including Aβ and APP Intracellular Domain (AICD). In this study, we use transgenic porcine models carrying the humanAPPswandPSEN1M146Itransgenes to demonstrate the pathobiological relevance of transcriptional regulation facilitated by APP and its AICD domain. Through molecular characterization of hippocampal tissue, we describe the differential expression of gene sets that cluster in molecular pathways with translational relevance to AD. We further identify phosphorylated and unphosphorylated AICD in differential complexes with proteins implicated in signal transduction and transcriptional regulation. Integrative genomic analysis of transcriptional changes in somatic cell cultures derived from pigs treated with γ-secretase inhibitor demonstrates the importance of γ-secretase APP processing in transcriptional regulation. Our data supports a model in which APP and, in particular, its AICD domain, modulates gene networks associated with AD pathobiology through interaction with signaling proteins.

One Sentence Summary

Utilizing transgenic porcine models, our study reveals that Alzheimer’s disease-related mutations affect neuronal gene expression and highlights the role of the AICD domain of APP in modulating gene networks associated with Alzheimer’s pathobiology.
Highly efficient tamoxifen-inducible Cre recombination in embryonic, larval and adult zebrafish
Authors: Bakūnaitė Edita , Gečaitė Emilija , Lazutka Justas , Balciunas Darius
Published: March 2024

We have generated transgenic lines containing zebrafish-optimized CreERT2recombinase under the control of a recombinantubbRpromoter consisting of the zebrafish ubiquitin promoter supplemented with an intronic enhancer from the carpbeta-actin2gene. These lines enable highly efficient tamoxifen-inducible recombination in embryonic, larval and adult zebrafish.

The ability to inactivate gene function in an adult organism is essential for studies of biological processes such as regeneration and behavior. This is best achieved by engineering an allele which could be conditionally inactivated using Cre recombinase and subsequently inactivating gene function using a drug-inducible Cre recombinase. Several recent studies clearly demonstrate feasibility of engineering such conditional alleles in zebrafish. Meanwhile, achieving sufficient degree of recombination to induce complete loss of function has remained a major limitation. Herein we address this limitation by engineering a recombinant ubiquitin promoterubbRconsisting of the zebrafishubiquitinpromoter supplemented with an intronic enhancer from the carpbeta-actin2gene. Using phiC31-mediated targeted integration, we demonstrate thatubbRclearly outperforms both parental promoters as well as currently available ubiquitous CreERT2driver lines at all embryonic and larval stages tested. Furthermore, theubbR:CreERT2driver line we generated enables near-complete inactivation of floxed alleles in adult zebrafish hearts. Finally, we demonstrate that ourubbRpromoter retains high activity when integrated at other genomic loci, making it uniquely suitable for robust expression of transgenes at all stages of zebrafish ontogenesis.

Highlights

Used targeted integration to directly compare differentCreERT2drivers

Generated a ubiquitousubbR:CreERT2driver line capable of near-complete inactivation of floxed genes in adult zebrafish hearts

Demonstrated that the recombinantubbRpromoter is suitable for robust transgene expression when integrated at different genomic loci
The promises and pitfalls of disaster aid platforms: a case study of Lebanon’s 3RF
Authors: Harb Mona , Bloemeke Sophie , Atallah Sami , Zoughaib Sami
Published: March 2024

Purpose

Using critical disaster studies and state theory, we assess the disaster aid platform named Lebanon Reconstruction, Reform and Recovery Framework (3RF) that was put in place by international donors in the aftermath of the Beirut Port Blast in August 2020, in order to examine the effectiveness of its inclusive decision-making architecture, as well as its institutional building and legislative reform efforts.

Design/methodology/approach

The paper uses the case study approaach and relies on two original data sets compiled by authors, using desk reviews of academic literature and secondary data, in addition to 24 semi-structured expert interviews and participant observation for two years.

Findings

The aid platform appears innovative, participatory and effectively functioning toward recovery and reform. However, in practice, the government dismisses CSOs, undermines reforms and dodges state building, whereas the 3RF is structured in incoherent ways and operates according to conflicting logics, generating inertia and pitfalls that hinder effective participatory governance, prevent institutional building, and delay the making of projects.

Research limitations/implications

The research contributes to critical scholarship as it addresses an important research gap concerning disaster aid platforms’ institutional design and governance that are under-studied in critical disaster studies and political studies. It also highlights the need for critical disaster studies to engage with state theory and vice-versa.

Practical implications

The research contributes to evaluations of disaster recovery processes and outcomes. It highlights the limits of disaster aid platforms’ claims for participatory decision-making, institutional-building and reforms.

Originality/value

The paper amplifies critical disaster studies, through the reflexive analysis of a case-study of an aid platform.
Impact of touristic sustainability on satisfaction with touristic services in a world heritage city. The case of the equestrian show in Córdoba (Spain)
Authors: Fernández Gallardo Jose A. , Hernandez Rojas Ricardo
Published: March 2024

Purpose

The main objective of this research is to analyze satisfaction with tourist services linked to the concept of sustainability in the context of a visit to the so-called equestrian show. The equestrian show adds values from the cultures that passed through the city. Specifically, the study focuses on tourist loyalty based on satisfaction with tourist services, satisfaction with the equestrian show and its overall quality. The fieldwork has been conducted in Córdoba, Spain. There are few studies on the relationship between tourist services linked to the concepts of sustainability and loyalty from the perspective of equestrian show management, making this a novel contribution to research.

Design/methodology/approach

The methodology used is based on a partial least squares structural equation modeling (PLS-SEM) approach.

Findings

To achieve the proposed objective, a structured questionnaire was used, and the results obtained confirm that satisfaction with tourist services linked to the concept of sustainability and the assessment of quality positively influence tourist loyalty. Consequently, they recommend returning to the destination and repeating the visit.

Originality/value

Heritage in Córdoba, Spain, is internationally recognized. Its uniqueness, with four world inscriptions along with the cultures that inhabited it, left a material heritage legacy in the city. Over time, this legacy has made it a magnet for visitors, making it essential to delve into its management and how concepts such as satisfaction with tourist services, combined with sustainability, impact the improvement of the visit.
Lessons learned from the pandemic: expanding the collaboration between clinical and logistics activities in a hospital
Authors: Beaulieu Martin , Roy Jacques , Chênevert Denis , Rebolledo Claudia , Landry Sylvain
Published: March 2024

Purpose

The Covid-19 pandemic generated significant changes in the operating methods of hospital logistics departments. The objective of this research is to understand how these changes took place, what collaboration mechanisms were developed with clinical authorities and, to what extent, logistics and clinical care activities should be decoupled to maximize each area's contribution?

Design/methodology/approach

The case study is selected to investigate practices implemented during the COVID-19 pandemic in hospitals in Canada. The pandemic presented an opportunity to contrast practices implemented in response to this crisis with those historically used in this environment.

Findings

The strategy of decoupling logistical tasks of an operational nature from clinical activities is well-founded and helps free clinical staff from tasks for which they are not trained. However, the decoupling of operational tasks should be combined with an integration of the clinical information flow to the logistics hub players. With this clinical information, the logistics hub can generate its full potential enabling better inventory management decisions to be made.

Originality/value

The concept of decoupling is studied to identify configurations that offer the best benefits for clinical staff.
Linking temperature sensitivity of mangrove communities, populations and individuals across a tropical‐temperate transitional zone
Authors: Kang Yiyang , Kaplan David A. , Osland Michael J.
Published: March 2024

Climate change is reshaping coastal wetlands worldwide, driving ecosystem shifts like mangrove poleward expansion into saltmarshes in tropical‐temperate transitional zones. Though warming is recognized as the primary driver, a lack of detailed field studies limits our ability to predict mangrove responses to rapid climate warming.

Here, we characterized how mangroves vary across a temperature gradient at 18 sites along Florida's Gulf of Mexico coast (USA). We used minimum air temperature (Tmin) derived from daily data from 1989 to 2021 as the independent variable and applied plot‐based and synoptic approaches to quantify species‐specific mangrove variation at community, population, and individual levels. We then used these results to spatially project future mangrove ecosystem properties under multiple warming scenarios.

Across the Tmin gradient from −10.8 to −1.4°C, mangrove canopy height and coverage ranged from 0.4 to 11.5 m and 15% to 98%, respectively, with both exhibiting sigmoidal increases with Tmin. Estimated mangrove aboveground biomass ranged from 0 to 496.7 Mg/ha and showed a positive linear relationship with Tmin due both to the tall tree stratum's increased biomass per tree and higher abundance.

While the population abundance and coverage of Rhizophora mangle and Laguncularia racemosa had positive linear relationships with Tmin, Avicennia germinans exhibited a significant quadratic relationship, reflecting the higher freeze tolerance of this species. Such tolerance may stem from A. germinans' higher morphological plasticity observed at the individual level, adapting to cold stress by exhibiting a more shrub‐like architecture at colder sites.

Based on these field‐derived quantitative relationships, we projected substantial increases in mangrove coverage and canopy height near current range limits, with tall A. germinans dominating in the north and R. mangle dominating the centre and south of the study region.

Synthesis. To better predict the ecological consequences in coastal wetlands under future climate change, it is essential to understand how mangroves respond to winter temperature regimes across a temperature gradient. Collectively, these cross‐level and species‐specific results advance our understanding of mangrove temperature sensitivity and provide information about the future of coastal wetland structure and function in response to a changing climate.
Decoupling in hybrid arrangements: Insights from the Australian defence industry
Authors: Sardeshmukh Shruti , Oak Mandar , Mackay Will
Published: March 2024

The Australian Industry Capability (AIC) program presents an example of hybridity where national security interests are served through a complex partnership between the Department of Defence, global prime contractors, and small and medium‐sized Australian companies. Through a qualitative interview study of stakeholders in the defence industry by and triangulating findings from publicly available defence industry documents, this study aims to document the decoupling associated with the AIC program. We find that complexity and opacity, stemming from hybridity, create decoupling in the implementation of the AIC program. We also find that a lack of accountability and monitoring contributes to decoupling. We advance the literature on hybridity into the context of multi‐organisational arrangements in a unique industry and identify how decoupling can impede the achievement of policy objectives in the context of complex hybrid arrangements.

Points for practitioners

The Australian Industry Capability (AIC) program represents a case of complex hybrid arrangement in public sector management involving the defence industry.

Hybridity of AIC arrangements creates challenges of complexity and opacity, creating conditions that give rise to decoupling. Lack of accountability and monitoring exacerbates these challenges.

Potential for coupling is identified with recommendations provided.
Choosing Wisely audit: CT KUB ordering in emergency department renal colic presentations
Authors: Yousif Fahad , Campbell Katie
Published: March 2024

Objective

Our aim was to safely reduce unnecessary CT KUBs (kidneys, ureters, bladder) in patients with renal colic.

Methods

This was a before and after intervention observational study of 74 patients in April 2023 and 57 patients in October 2023.

Results

Seventy‐five per cent of patients with suspected renal colic underwent a CT KUB in the pre‐audit period. Following education, an update in the ED Renal Colic Policy, electronic medical record ordering and short stay pathway, a re‐audit was undertaken in October 2023 resulting in an absolute reduction of 15% of CT KUBs ordered.

Conclusions

Audit interventions can reduce unnecessary CT KUBs in renal colic.
Characteristics of sleep in children with heavy prenatal alcohol exposure
Authors: Inkelis Sarah M. , Soja Jacqueline , Mattson Sarah N. , Chambers Christina D. , Bhattacharjee Rakesh , Thomas Jennifer D.
Published: March 2024

Background

Sleep plays an important role in neurodevelopment. However, the effects of prenatal alcohol exposure on sleep quality have been understudied, despite reports of sleep disturbance in infants prenatally exposed to alcohol and elevated levels of sleep problems reported by caregivers of children with fetal alcohol spectrum disorders. The current study characterizes sleep in children with prenatal alcohol exposure using both objective (actigraphy) and subjective (questionnaires, sleep diaries) methods.

Methods

Participants aged 6–10 years, with and without prenatal alcohol exposure, were included in the study (alcohol‐exposed [AE]: n = 35; control [CON]: n = 39). Objective sleep was measured via 24‐h actigraphy for 2 weeks. Parents completed sleep diaries and sleep questionnaires (Children's Sleep Habits Questionnaire, Pediatric Sleep Questionnaire). Multivariate analysis of variance was used to characterize the sleep profile (objective, subjective) and examine group differences.

Results

There were no group differences on actigraphy metrics averaged across 2 weeks. However, the AE group showed significantly greater intraindividual variability on most actigraphy measures, particularly total sleep time, percent sleep, wake after sleep onset, and number of wake bouts. Parents reported significantly more sleep problems in the AE group than in the CON group, primarily driven by night wakings, parasomnias (e.g., sleepwalking), snoring, and daytime sleepiness. These effects were more severe in children >8.5 years of age.

Conclusions

Despite similar 2‐week average sleep outcomes, children with prenatal alcohol exposure showed greater intraindividual sleep variability and parents reported more sleep problems related to sleep behavior and snoring. These difficulties with sleep may be related to other cognitive and behavioral outcomes. Importantly, sleep is a modifiable behavior, and interventions that focus on variability in sleep, particularly in sleep duration, can impact the quality of life in children with prenatal alcohol exposure and their families.
Letter: Thioguanine, an underutilised option in inflammatory bowel disease?
Authors: Chetwood John D. , Paramsothy Sudarshan , Leong Rupert W.
Published: March 2024

LINKED CONTENT

This article is linked to Vasudevan et al papers. To view these articles, visit https://doi.org/10.1111/apt.17831 and https://doi.org/10.1111/apt.17957
Therapeutic drug monitoring, liquid biopsies or pharmacogenomics for prediction of human drug metabolism and response
Authors: Ingelman‐Sundberg Magnus , Molden Espen
Published: March 2024

Pharmacokinetics plays a central role in understanding the significant interindividual differences that exist in drug metabolism and response. Effectively addressing these differences requires a multi‐faceted approach that encompasses a variety of tools and methods. In this review, we examine three key strategies to achieve this goal, namely pharmacogenomics, therapeutic drug monitoring (TDM) and liquid biopsy‐based monitoring of hepatic ADME gene expression and highlight their advantages and limitations. We note that larger cohort studies are needed to validate the utility of liquid biopsy‐based assessment of hepatic ADME gene expression, which includes prediction of drug metabolism in the clinical setting. Modern mass spectrometers have improved traditional TDM methods, offering versatility and sensitivity. In addition, the identification of endogenous or dietary markers for CYP metabolic traits offers simpler and more cost‐effective alternatives to determine the phenotype. We believe that future pharmacogenomic applications in clinical practice should prioritize the identification of missing heritable factors, using larger, well‐characterized patient studies and controlling for confounding factors such as diet, concomitant medication and physical health. The intricate regulation of ADME gene expression implies that large‐scale studies combining long‐read next‐generation sequencing (NGS) of complete genomes with phenotyping of patients taking different medications are essential to identify these missing heritabilities. The continuous integration of such data into AI‐driven analytical systems could provide a comprehensive and useful framework. This could lead to the development of highly effective algorithms to improve genetics‐based precision treatment by predicting drug metabolism and response, significantly improving clinical outcomes.
Home participation and personal and environmental factors in children and adolescents with Down syndrome
Authors: Brugnaro Beatriz Helena , Fernandes Gesica , De Campos Ana Carolina , Pavão Silvia Letícia , Pfeifer Luzia Iara , Kraus de Camargo Olaf , Hlyva Oksana , Rocha Nelci Adriana Cicuto Ferreira
Published: March 2024

Aim

To describe current home participation (frequency, involvement) and caregiver's desire for change in home participation of children and adolescents with Down syndrome, as well as home environmental factors, and to explore the associations of personal and environmental factors with current participation and caregiver's desire for change.

Method

Eighty‐two caregivers (mean age = 45 years 10 months) of children and adolescents with Down syndrome (mean age = 10 years 7 months) were surveyed about the child's home participation and environmental factors using the Participation and Environment Measure‐Children and Youth. Furthermore, children's personal and environmental factors were collected. Results are reported using descriptive analysis and correlations (Spearman's rank correlation coefficients and Mann–Whitney U test) to describe the relationship between current participation and caregiver's desire for change, with personal and environmental factors as ordinal and nominal variables respectively (p < 0.05).

Results

Children's participation was highest with regard to personal care management and lowest with regard to school‐related activities. Most caregivers desired change in homework and household chores. Greater frequency was associated with male sex, caregiver less rigorous social distancing due to the COVID‐19 pandemic, and children receiving therapies. Greater involvement was associated with younger age in children and higher environmental support. Older age in children was associated with caregiver's greater desire for change.

Interpretation

Personal and environmental factors correlated with participation in specific ways. Creative strategies to promote participation that consider caregiver's wishes should be undertaken.
The effects of stress testing on US banks' off‐balance sheet activities
Authors: Calice Giovanni , Savoia Francesco
Published: March 2024

This paper investigates the effects of the new post‐financial crisis regulatory regime – risk‐based capital ratios (RBC) and stress tests – on banks' off‐balance sheet activities (OBS). We use a panel of US bank holding companies over the period 2001–2018 to examine the relationship between banks' capital levels and OBS activities. Our major finding is that banks significantly reduced their OBS exposure following the introduction of the new capital regulatory framework requirements. In particular, we show that tighter regulatory RBC resulted in a reduction of OBS activities in well‐capitalised banks. Conversely, we find that under‐capitalised banks increased their OBS activities, which suggests the possibility of regulatory arbitrage.