bluuebunny/crossref_metadata_2025 huggingface dataset:
Reliability of Third Ventricle Assessment by Transcranial Ultrasound: A Computational Model of the Effect of Insonation Angle
Authors: De Cassai Alessandro , Geraldini Federico , Calandra Sabrina , Munari Marina
Published: April 2022

Introduction:

Transcranial sonography (TCS) is a bedside examination which is currently used in multiple neurocritical care settings. Third ventricle ultrasound is usually a simple technique, though a large insonation angle could lead to an overestimation of third ventricular diameter. The aim of this study was to use a mathematical model to evaluate the impact of probe inclination on the false positive rate when using TCS to evaluate third ventricle enlargement.

Methods:

Using R software, we simulated a pool of 100,000 fictitious patients with a normal third ventricle size (diameter from 0 to 9 mm) in daily follow-up for ventricle enlargement for 30 consecutive days using TCS. Each day, a different, random insonation angle (α) was generated and a corresponding measured diameter calculated as: measured diameter=real diameter/cos α. If the measured diameter was >9.0 mm, the simulation registered a “misdiagnosis” episode and the simulation loop was interrupted; otherwise, the simulation continued to its thirtieth iteration.

Results:

Of the 100,000 “patient” simulations, 30,905 (30.9%) had an erroneous TCS diagnosis of ventricular enlargement. Angles of insonation >35 degrees contributed to 79.3% of the total misdiagnoses of ventricular enlargement (false positive rate, 3.71%), whereas misdiagnosis was rare when the insonation angle was ≤15 degrees (1.30% of the total misdiagnoses; false positive rate, 0.06%).

Conclusion:

Using probe inclinations <15 degrees, erroneous diagnosis of third ventricular enlargement was rare. Our results suggest that TCS has a low rate of false positives when the angle of insonation is minimized.
Omission of Axillary Staging and Survival in Elderly Women With Early Stage Breast Cancer
Authors: Castelo Matthew , Hansen Bettina E. , Paszat Lawrence , Baxter Nancy N. , Scheer Adena S.
Published: April 2022

Objectives:

Determine if axillary staging is associated with survival in elderly women with breast cancer.

Background:

Axillary staging in women ≥ 70 years with early-stage breast cancer is controversial. Older randomized evidence has not shown axillary staging improves survival, but recent observational studies have been mixed and widespread de-implementation of the practice has not occurred.

Methods:

This was a population-based cohort study using the Surveillance, Epidemiology, and End Results registry. Women ≥ 70 years diagnosed with T1–T2 invasive breast cancer from 2005 to 2015 were included. Overlap propensity score weighting was used to adjust for confounders. Overall survival (OS) was determined and hazard ratios (HRs) reported with 95% confidence intervals (CIs). Breast cancer-specific survival (BCSS) was determined using competing risks analysis and subdistribution hazard ratios (sdHRs) reported. Additional adjustment was performed for receipt of chemotherapy and radiotherapy.

Results:

One hundred forty-four thousand three hundred twenty-nine elderly women were included, of whom 22,621 (15.7%) did not undergo axillary staging. After overlap propensity score weighting, baseline characteristics were well balanced between the 2 groups. Women who did not undergo axillary staging were significantly less likely to receive chemotherapy (adjusted relative risk, 0.58; 95% CI, 0.54–0.62) or radiotherapy (adjusted relative risk, 0.53; 95% CI, 0.52–0.54), and had significantly worse OS (adjusted HR, 1.22; 95% CI, 1.19–1.25), and BCSS (adjusted sdHR, 1.14; 95% CI, 1.08–1.21) compared to those that had staging.

Conclusions:

These findings suggest elderly women with early-stage breast cancer who do not undergo axillary staging experience worse outcomes. Reasons for this disparity may be multifactorial and require further investigation.
Are Infection Rates Increased After Sterilization of the External Fixator During Staged Internal Fixation of High-Energy Tibial Plateau Fractures?
Authors: Moon Tyler James , Haase Lucas , Haase Douglas , Ochenjele George , Wise Brent , Napora Joshua
Published: April 2022

Objectives:

To compare infection rates after second-stage definitive surgery for high-energy tibial plateau fractures between groups of patients who had the external fixator prepped into the surgical field and those who did not.

Design:

Retrospective cohort study.

Setting:

Two academic Level 1 trauma centers.

Patients/Participants:

Two hundred forty-four patients met inclusion and exclusion criteria between the 2 institutions.

Intervention:

Prepping of the external fixator into the surgical field during second-stage definitive open reduction and internal fixation. 162 patients were in the prepped group, and 82 patients were in the nonprepped group.

Main Outcome Measurements:

The primary outcome was the rate of deep infection after definitive fixation. Secondary outcome was operative time.

Results:

There were no significant differences in infection rates between prepped (11.7%) and nonprepped (18.3%) groups (P = 0.162). Patients in the prepped groups had significantly decreased operative time (168.2 minutes vs. 221.9 minutes, P < 0.001) even after controlling for confounders in regression analysis.

Conclusions:

There is no increased risk of infection associated with prepping and maintenance of the external fixator during definitive internal fixation for high-energy tibial plateau fractures. These data suggest that this practice may lead to shorter operative times as well.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Advancing Point-of-Care Ultrasound Training in Medical Schools: Ultrasound-Guided Subclavian Vein Access Training Using Formalin-Embalmed Cadavers
Authors: Loveless Bosten A. , Muir Maxton W. , Limov Abigail L. , Fritsch Alexa R. , Thomas Rebecca J. , Yancey Taylor J. , Skidmore Chad J. , Zapata Isain , Nigh Andrew D. , Mason Nena Lundgreen
Published: April 2022

OBJECTIVES:

This brief report examines the feasibility of using formalin-embalmed cadavers in training medical students to use ultrasound guidance to access the subclavian. This novel educational approach is discussed in the context of the ongoing integration of point-of-care ultrasound training into medical education. Additionally, this report explores how cadavers can provide practical, effective, and hands-on skills training opportunities for medical students to learn to perform common clinical procedures under ultrasound guidance.

DESIGN:

This report presents subjective and objective data evaluating the utility of teaching medical students to perform ultrasound-guided subclavian vein access on formalin-embalmed cadavers.

SETTING:

Rocky Vista University College of Osteopathic Medicine in Ivins, UT.

SUBJECTS:

Twenty-five first-year medical students at Rocky Vista University.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Pre and posttraining questionnaires were administered to assess each participant’s self-confidence in using ultrasonography to access the subclavian vein of a cadaver. A statistically significant increase in participant self-confidence was observed across all questionnaire items from pre to posttraining. Objective evaluation consisted of a supervised skills test. Participants were evaluated on their ability to visualize the subclavian vein with ultrasound and achieve flashback of blood/embalming fluid into a syringe. During skills testing, the number of needle sticks and the time taken to achieve flashback were recorded for each participant. Twenty-three of the 25 participants were able to successfully complete the skills testing assessment.

CONCLUSIONS:

The formalin-embalmed cadaver can be a readily available and effective learning tool for medical education programs seeking to provide training opportunities in ultrasound-guided clinical procedures. The use of cadavers allows learners to train in a low stress and anatomically authentic environment without risk of patient discomfort.
Predicting COVID-19 Cases Among Nurses Using Artificial Neural Network Approach
Authors: Namdar Peyman , Shafiekhani Sajad , Teymori Fatemeh , Abdollahzade Sina , Maleki Aisa , Rafiei Sima
Published: April 2022

We designed a forecasting model to determine which frontline health workers are most likely to be infected by COVID-19 among 220 nurses. We used multivariate regression analysis and different classification algorithms to assess the effect of several covariates, including exposure to COVID-19 patients, access to personal protective equipment, proper use of personal protective equipment, adherence to hand hygiene principles, stressfulness, and training on the risk of a nurse being infected. Access to personal protective equipment and training were associated with a 0.19- and 1.66-point lower score in being infected by COVID-19. Exposure to COVID-19 cases and being stressed of COVID-19 infection were associated with a 0.016- and 9.3-point higher probability of being infected by COVID-19. Furthermore, an artificial neural network with 75.8% (95% confidence interval, 72.1-78.9) validation accuracy and 76.6% (95% confidence interval, 73.1-78.6) overall accuracy could classify normal and infected nurses. The neural network can help managers and policymakers determine which frontline health workers are most likely to be infected by COVID-19.
eHealth Literacy of Chinese Residents During the Coronavirus Disease 2019 Pandemic
Authors: Liu Qian , Huang Run , Xia Lin , Yang Bing Xiang , Liu Shuo , Kang Li Jun , Chen Jie , Luo Dan , Ge Hou Rui , Xie Ya Dian , Liu Zhongchun , Hu Qin , Chen Qin , Wang Xiao Qin
Published: April 2022

The Coronavirus Disease 2019 (COVID-19) pandemic has become a leading societal concern. eHealth literacy is important in the prevention and control of this pandemic. The purpose of this study is to identify eHealth literacy of Chinese residents about the COVID-19 pandemic and factors influencing eHealth literacy. A total of 15 694 individuals clicked on the link to the questionnaire, and 15 000 agreed to participate and completed the questionnaire for a response rate of 95.58%. Descriptive statistics, χ2 test, and logistic regression analysis were conducted to analyze participants' level of eHealth literacy about COVID-19 and its influencing factors. The results showed 52.2% of participants had relatively lower eHealth literacy regarding COVID-19 (eHealth literacy score ≤ 48). The scores of the information judgment dimension (3.09 ± 0.71) and information utilization dimension (3.18 ± 0.67) of the eHealth literacy scale were relatively lower. The logistics regression showed that sex, age, education level, level of uncertainty, having people around the respondent diagnosed with COVID-19, relationship with family, and relationship with others were associated to eHealth literacy (χ2 = 969.135, P < .001). The public's eHealth literacy about COVID-19 needs to be improved, especially the ability to judge and utilize online information. Close collaboration among global health agencies, governments, healthcare institutions, and media is needed to provide reliable online information to the public. Interventions to improve eHealth literacy should take into account and accentuate the importance of sex, age, educational background, level of uncertainty, exposure to disease, and social support.
Perioperative Tissue Oximetry-driven Fluid Resuscitation Improves Flap Perfusion in Autologous Free Tissue Breast Reconstruction
Authors: Karamanos Efstathios , Ahmad Hassan , Hazboun Rajaie , Lue Melinda , Saad Noah , Wang Howard
Published: April 2022

Introduction:

The use of tissue oximetry for monitoring following free tissue transfer has become a common practice to facilitate early detection of poor flap perfusion. We hypothesized that T stat readings may guide fluid administration in the postoperative period and improve perfusion in patients undergoing autologous breast reconstruction.

Methods:

Patients undergoing free flap breast reconstruction from 2015 to 2018 were reviewed. Mean percutaneous oximetry readings of the first four postoperative days were recorded. The mean change at 24 hours from the original reading was calculated (∆TO). The study population was divided in two groups based on whether administration of intravenous fluids (IVFs) was increased/maintained (group 1) or decreased (group 2) after postoperative day 1.

Results:

A total of 120 patients were identified. The mean age was 53, and mean BMI was 33. Overall, patients for whom fluid administration was decreased experienced an increase in their tissue perfusion, while patient who received a bolus or maintained the same rate of IVF experienced a decrease. Patients who had a negative ∆TO experienced a statistically significant difference between groups 1 and 2 at 24 and 72 hours (–4 versus +3 and –11 versus +13, respectively). For patients with a positive ∆TO, although decreasing fluids resulted in higher readings, it did not reach statistical significance at 24 or 72 hours (0 versus +2 and +4 versus +6, respectively).

Conclusions:

In patients undergoing free tissue breast reconstruction, tissue oximetry readings may be used as a novel guide for postoperative fluid management.
Critical Evaluation of Clinical Research in Obstetrics and Gynecology
Authors: Fisher Stephanie A. , Miller Emily S.
Published: April 2022

Within the evolving field of obstetrics and gynecology, providers should possess the ability to effectively and critically evaluate medical literature in order to best adapt and incorporate evidence-based practice. For both clinicians and researchers alike, we provide a systematic approach for reviewing a journal article published in the medical literature. We summarize the various types of study designs, with dedicated attention to observational and experimental studies, and examine sources of bias inherent to these study designs. Finally, we review important considerations when interpreting the validity and significance of the results and conclusions of a research study.
Management of Menstruation in Transgender and Gender Nonbinary Adolescents
Authors: Berrahou Iman K. , Grimes Andrew , Autry Amy M. , Hawkins Mitzi
Published: April 2022

A growing number of adolescents in the United States identify as transgender and gender nonbinary, and many will seek medical management of menstruation. In this evidence-based review, we recommend a model of gender-affirming care grounded in the tenants of reproductive justice, emphasizing patient autonomy and the development of holistic management plans centered around the patient’s unique goals for affirming their gender identity. We then review strategies for achieving menstruation suppression for transgender and gender nonbinary adolescents, including dosing considerations, menstruation, ovulation, contraceptive effects, and metabolic considerations specific to the adolescent population.
Posterior Ischemic Optic Neuropathy in the Setting of Cocaine-Induced Orbital and Sinonasal Inflammation
Authors: Lin Lisa Y. , Reshef Edith R. , Lansberg Marianella Paz , Barshak Miriam B. , Chwalisz Bart K. , Holbrook Eric H. , Wolkow Natalie
Published: April 2022

Intranasal cocaine abuse can lead to significant sinus and orbital complications, including optic neuropathy. A 46-year-old man with a history of recurrent cocaine-induced sino-orbital inflammation and infection with bony destruction presented with acute, painless, vision loss. Examination revealed no light perception vision. MRI of the orbits demonstrated new restricted diffusion of the right optic nerve on diffusion-weighted imaging and apparent diffusion coefficient sequences, consistent with posterior ischemic optic neuropathy. This is the first among cases of cocaine-induced optic neuropathy in the literature to illustrate ischemic changes on MRI in the optic nerve, highlighting the utility of diffusion-weighted imaging/apparent diffusion coefficient sequences when optic neuropathy is suspected and further suggesting an underlying ischemic etiology in similar cases.
Temporal stability of self-reported visual back pain trajectories
Authors: Nim Casper Glissmann , Kongsted Alice , Downie Aron , Vach Werner
Published: April 2022

Low back pain (LBP) follows different pain trajectories, and patients seem to recognize their trajectory. This allows self-reported visual pain trajectories (SRVTs) to support patient–provider communication. Pain trajectories appear stable over time for many patients, but the evidence is sparse. Our objectives were to investigate the (1) temporal stability of SRVTs over 1 year concerning pain intensity and course patterns and (2) association of transitions between SRVTs and changes in pain and disability. This study used data from 2 prospective primary care cohorts: the Danish Chiropractic LBP Cohort (n = 1323) and the GLA:D Back cohort (n = 1135). Participants identified one of the 8 SRVTs at baseline and 12-month follow-up, each asking about LBP trajectories the preceding year. Trajectories were described using 2 subscales (intensity and pattern). Temporal stability was quantified by “stability odds ratios” (ORs), depicting the likelihood of staying in the same SRVT after 12 months compared with baseline, and by “preference ORs,” depicting the likelihood of choosing a specific alternative SRVT at follow-up. Both ORs compare the observed proportion with the chance level. Finally, we examined associations between transitioning to a different trajectory and changes in clinical outcomes. Approximately 30% stayed in the same SRVT. The stability ORs were all >1. The preference ORs indicated that transitions occurred mainly to similar SRVTs differing in only 1 subscale. Transitions to less or more intense SRVTs were associated with changes in clinical outcomes in the expected direction. Despite distinctly different SRVTs identified, individuals reported relatively stable LBP phenotypes but with potential for change.
Predictors of Self-care Among Chinese Patients With Chronic Heart Failure
Authors: Zhang Zeyu , Koirala Binu , Gong Guilan , Bai Xue , Mao Jing , Davidson Patricia M.
Published: April 2022

Background

Self-care is important for improving the health outcomes of individuals with chronic heart failure (CHF). However, predictors of self-care behaviors remain unclear in Chinese society.

Objective

The aims of this study were to explore predictors of self-care in Chinese patients with CHF and clarify the complex relationships between predictors and self-care behaviors guided by the Situation-Specific Theory of Heart Failure Self-Care.

Methods

A cross-sectional study was conducted among individuals hospitalized with CHF in China. Person, problem, and environmental factors pertaining to self-care were collected by a questionnaire survey. Self-care was assessed by the Self-Care of Heart Failure Index version 6. Direct and indirect relationships between factors and self-care behaviors and the mediating role of self-care confidence were analyzed by the structural equation model.

Results

In total, 204 participants were involved in this study. The Situation-Specific Theory of Heart Failure Self-Care model demonstrated a good fit (root mean square error of approximation, 0.046; goodness of fit index, 0.966; normed fit index, 0.914; comparative fit index, 0.971). Inadequate self-care capabilities were common among Chinese patients with CHF. Person-related factors (female gender, higher monthly income and educational level), problem-related factors (severe New York Heart Association function class and better instrumental activities of daily living), and environmental factors (better social support and living in more developed areas) were significant predictors of better self-care behaviors (P < .05). These associations were partly or fully mediated by self-care confidence.

Conclusion

The Situation-Specific Theory of Heart Failure Self-Care can be used to guide research and practice in patients with CHF. Interventions and policies on promoting self-care in Chinese population living with CHF are encouraged, particularly for underserved populations.
Linkage of Optimism With Depressive Symptoms Among the Stroke Survivor and Caregiver Dyads at 2 Years Post Stroke
Authors: Chung Misook L. , Miller Jennifer L. , Lee Suk Jeong , Son Youn-Jung , Cha Geunyeong , King Rosemarie B.
Published: April 2022

Background

Depressive symptoms are substantial among stroke survivors and their caregivers in poststroke management. Optimism and social support are known to protect against depressive symptoms. However, little is known about how optimism and social support contribute to depressive symptoms among stroke survivor–caregiver dyads. The study's purpose was to examine actor and partner effects of optimism on depressive symptoms through perceived social support among stroke survivors and caregiver dyads in the chronic stage of rehabilitation.

Methods

Stroke survivors and caregivers (N = 105 dyads) completed the survey at 2 years of follow-up after the first stroke. Depressive symptoms, optimism, and perceived social support were assessed using the Center for Epidemiologic Studies-Depression, the Life Orientation Test, and the Interpersonal Support Evaluation List. The Actor-Partner Interdependence Model Extended to Mediation analysis was used to test the indirect effect of optimism on depressive symptoms through perceived social support.

Results

Higher optimism was significantly associated with lower depressive symptoms for caregivers (direct actor effect, −0.6844; 95% confidence interval [CI], −0.9844 to −0.3844) and stroke survivors (direct partner effect, −0.4189; 95% CI, −0.0789 to −0.0889). Perceived social support availability significantly mediated the association between optimism and depressive symptoms for stroke survivors (indirect effect, −0.1957; 95% CI, −0.3923 to −0.0670). Caregiver perceived social support availability was also a significant mediator between caregivers' optimism and stroke survivors' depressive symptoms (indirect effect, 0.1658; 95% CI, 0.0559–0.3128).

Conclusions

Intervention improving dyad members' optimism and social support would be beneficial to improve depressive symptoms of the stroke survivors and caregivers in chronic stroke management.
Workplace Bullying and Incivility in Physical Therapist Education Programs
Authors: Schwarz Brandy , Miller Haylie
Published: April 2022

Introduction.

Workplace bullying and incivility have been recognized as significant problems in both clinical and academic environments. These negative behaviors can lead to disengagement, stress, and lost productivity. The purposes of this study were to 1) identify predictors of bullying experiences and 2) assess the prevalence of being bullied among faculty and staff working in physical therapist education programs across the United States.

Review of Literature.

More than one-third of US workers are bullied or have witnessed bullying in the workplace. When these disruptive behaviors occur within the context of physical therapist education, the impact can be detrimental to teaching and learning, clinical practice, and individual well-being.

Subjects.

Participants included 529 Doctor of Physical Therapy faculty and staff.

Methods.

Respondents completed the uncivil workplace behavior questionnaire—revised and negative acts questionnaire—revised.

Results.

Survey results revealed that 32.5% of academic faculty had experienced bullying within the last 6 months.

Discussion and Conclusion.

The prevalence of bullying and incivility in academic physical therapy programs approaches that of the general workforce in the United States. Physical Therapy education programs must take an active role in preventing, recognizing, and managing uncivil behaviors in the academic environment.
Bleeding Risk With Cold Snare Polypectomy of ≤10 mm Pedunculated Colon Polyps
Authors: Fatima Hala , Tariq Tooba , Gilmore Ashley , Kim Hak Nam , Tang John , Ghabril Marwan , Abdeljawad Khaled
Published: April 2022

Objectives:

Pedunculated polyps (PPs) in the colon are usually resected with hot snare polypectomy to prevent immediate postpolypectomy bleeding (IPPB). This study aimed to evaluate the safety of CSP of <10 mm PPs.

Materials and Methods:

Patients undergoing colonoscopy from February 18, 2019, to April 24, 2020, and were found to have at least 1 ≤10 mm PP resected with CSP were included prospectively in a continuous quality improvement project to assess the risk of IPPB and delayed postpolypectomy bleeding. Polyp location, size, and pathology, as well as the method of resection, were recorded. In addition, we assessed the occurrence and severity of IPPB and the need for intervention.

Results:

We found 239 eligible polyps in 182 patients. The mean (SD) age was 58.8 (8.3) years, and 61% were males. IPPB occurred in 72 of 239 polyps, corresponding to a per-polyp bleeding percentage of 30.1% and in 65 of 182 patients, equating to a per-patient bleeding rate of 35.7%. We successfully treated bleeding by endoscopic hemostasis in 57%; the remaining 31 polyps (43%) did not require endoscopic intervention. There was no association between IPPB with age, gender, or use of aspirin or antithrombotic agents. In the bivariate model, polyp size and pathology were not associated with the risk of IPPB. Right-sided polyps were associated with a reduced risk of IPPB in the bivariate model by 61% (odds ratio=0.39; 95% confidence interval, 0.21-0.74; P=0.0057). In the multivariate model, choking the polyp base decreased the likelihood of IPPB by 97% (odds ratio=0.03; 95% confidence interval, 0.00-0.86; P=0.0459). There were no instances of delayed bleeding, perforation, or postpolypectomy syndrome.

Conclusions:

CSP can be used for resection of ≤10 mm PPs. It is associated with a lower risk of immediate bleeding than the common perception among gastroenterologists.
Clinical Adverse Events and Device Failures Reported for the Captivator and Duette Endoscopic Mucosal Resection (EMR) Systems
Authors: Hagenstein Lauren D. , Dubrouskaya Katsiaryna , Ramai Daryl , Adler Douglas G.
Published: April 2022

Introduction:

Endoscopic mucosal resection (EMR) is a widely used technique for the removal of precancerous or select cancerous mucosal-based lesions. Two systems used for EMR of upper gastrointestinal lesions are the Duette EMR kit and the Captivator EMR kit. The aim of this study is to analyze the reports submitted to the Food and Drug Administration’s (FDA) Manufacturer and User Facility Device Experience (MAUDE) database for patient-related adverse events and device failures associated with these EMR kits.

Methods:

We analyzed postmarketing data from the FDA MAUDE from August 2004 to August 2021.

Results:

Eighty-four MAUDE reports were found in the study period from August 2004 to August 2021. In total, device issues comprised 36.9% of the reports (n=31) and patient adverse events comprised 63.09% of the reports (n=53). Device issues that were reported included, but were not limited to, band placement/deployment failure (8.1%), suture breakage (7.31%), and snare breakage (4.94%). Patient adverse events that were reported included, but were not limited to, bleeding (25.9%), perforation (7.31%), and snare breakage (4.94%).

Conclusion:

Captivator EMR and Duette EMR have similar patterns of technical failure and clinical adverse events. More MAUDE reports exist for Duette EMR, possibly due to its longer duration of commercial availability.
Immunotherapy-induced Colitis
Authors: Vaziri Haleh , Turshudzhyan Alla , Vecchio Eric
Published: April 2022

Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of a variety of malignancies including advanced melanoma, non–small cell lung cancer, renal cell carcinoma, head and neck cancers among others. Since their introduction, there has been significant improvement in survival and prognosis in patients with advanced malignancies. Unfortunately, improved outcomes have come at a price of significant immune-related adverse events, with those of the gastrointestinal tract being the most common. Gastrointestinal immune-related adverse events frequently present as diarrhea and colitis, the severity of which can range from mild diarrhea to fulminant colitis with intestinal perforation. Currently, management of ICI-induced colitis is primarily guided by retrospective studies and expert opinion. A significant number of ICI-induced colitis responds to high-dose corticosteroids; however, some patients require further therapy with biologics. There is limited information on the factors which may predispose patients to ICI-induced colitis. Future research elucidating these risk factors along with development of a scoring system could allow for risk-stratification of patients before initiation of ICI therapy. Such a system may help clinicians and patients keep a high index of suspicion regarding ICI-induced colitis and could hopefully reduce the incidence of severe cases. Similarly, future studies should investigate protective factors against ICI-induced colitis, which could potentially allow more patients to safely benefit from ICI therapy.
Advancing Nursing Leadership Science Through an Innovative Research-Practice Partnership
Authors: Nelson-Brantley Heather V. , Prestia Angela , Warshawsky Nora E. , Ferren Melora
Published: April 2022

The Association for Leadership Science in Nursing and American Organization for Nursing Leadership Foundation have formed a new research-practice collaborative. The collaborative allows for a synergistic approach to the advancement of leadership science. This article discusses the impetus for the collaborative, its structure, and how its synergy of research and practice expertise provides immense opportunity for robust, practice-relevant research.
Selecting an Instrument for Assessing the Risk of Patient Violence Across a Healthcare System
Authors: Emmerling Sheryl A. , Croland Jennifer A. , Nimtz-Rusch Kelly L.
Published: April 2022

Physical violence is one of the leading causes of nurse injury in the workplace. Studies indicate patients most often incite the violence and both patient and organization factors contribute to violent events. It has been suggested that an assessment be done upon admission to identify those patients at risk for violent behavior. To implement this intervention, organizations must objectively select a screening instrument that is accurate, easy to use, and appropriate for multiple patient populations.
Changes in Testing and Diagnoses of Sexually Transmitted Infections and HIV During the COVID-19 Pandemic
Authors: Chang Jennifer J. , Chen Qiaoling , Dionne-Odom Jodie , Hechter Rulin C. , Bruxvoort Katia J.
Published: April 2022

We evaluated changes in rates of testing and diagnoses of sexually transmitted infections during the 2017–2020 period at Kaiser Permanente Southern California. During the COVID-19 pandemic period, we observed profound reductions in testing and fewer diagnoses of chlamydia, gonorrhea, and HIV compared with prepandemic periods, but syphilis diagnoses rates increased by 32%.
Career Development in Pediatric Emergency Medicine
Authors: Chumpitazi Corrie E. , Allister Lauren , Cho Christine , Hoffmann Jennifer A. , Hsu Deborah , Iyer Maya , Mangold Karen , Marino Meg , Randell Kimberly A. , Ponce Haley , Hariharan Selena
Published: April 2022

Objectives

The Women in Pediatric Emergency Medicine (PEM) subcommittee of the American Academy of Pediatrics Section on Emergency Medicine identified 2 top priorities for 2021: career development and mentorship/sponsorship. The objective of this study was to catalog and delineate the career development domains for women physicians in PEM.

Methods

After a review of the literature to identify the key areas for gaps for women in PEM, we used Q sort methodology to elicit domains for this subcommittee to address by survey of a national sample.

Results

One hundred fourteen discrete potential areas of interest for career development were identified by the working group based on salient themes from the literature and personal experiences. Forty-one Women in PEM subcommittee members (27%) completed the survey. The career development topics were sorted into the domains of personal (40.4%; n = 46), administrative (28.1%; n = 32), research (10.5%; n = 12), teaching (10.5%; n = 12), service (7.0%; n = 8), and clinical (3.5%; n = 4).

Conclusions

This study demonstrates that the career development needs of women in PEM include a range of personal, teaching, research, administrative, clinical, and service domains. However, more than two-thirds of the career development topics were categorized into just 2 domains, administrative and personal.
The Feasibility of Using Point-of-Care Ultrasound During Cardiac Arrest in Children
Authors: Leviter Julie I. , Chen Lei , O'Marr Jamieson , Riera Antonio
Published: April 2022

Introduction

Resuscitation guidelines emphasize minimal interruption of compressions during cardiopulmonary resuscitation. Point-of-care ultrasound (POCUS) enables the clinician to visualize cardiac contractility and central artery pulsatility. The apical 4-chamber (A4), subxiphoid (SX), and femoral artery views may be used when defibrillator pads or active compressions preclude parasternal cardiac views. We hypothesized that clinicians can rapidly obtain interpretable POCUS views in healthy children from the A4, SX, and femoral positions.

Methods

A prospective study of pediatric emergency medicine providers in an urban academic hospital was performed. Stable patients of 12 years or younger were scanned. Sonologists were each allotted 10 seconds to acquire A4, SX, and femoral views. Two attempts at each view were allowed. The primary outcome was whether cardiac and femoral artery scans were interpretable for contractility and pulsatility, respectively. The secondary outcome was whether cardiac scans were interpretable for effusion or right ventricular strain. A POCUS expert reviewed scans to confirm interpretability.

Results

Twenty-two sonologists performed a total of 50 scans on 22 patients. A view that was interpretable for contractility was obtained on the first attempt in 86% of A4 and 94% of SX scans. A femoral view that was interpretable for pulsatility was obtained on the first attempt in 74% of scans. Expert review was concordant with sonologist interpretation.

Conclusions

Pediatric emergency medicine physicians can obtain interpretable cardiac and central artery views within 10 seconds most of the time. Point-of-care ultrasound has the potential to enhance care during pediatric resuscitation. Future studies on the impact of POCUS pulse checks in actual pediatric resuscitations should be performed.
Significance of lymph node fine needle aspiration for the diagnosis of HIV-associated lymphoma in a low-resource setting
Authors: Vogt Samantha L. , Maloma Lucia , Xian Rena R. , Ambinder Richard F. , Philip Vinitha , Patel Moosa , Martinson Neil A. , Omar Tanvier
Published: April 2022

Objective:

Fine needle aspiration (FNA) is an early step in the work-up of lymphadenopathy in people living with HIV (PLWH). We set out to characterize the FNA cytology in PLWH and report on the time to lymphoma diagnosis through the FNA clinics in the public healthcare system in Johannesburg, South Africa.

Design:

Retrospective review of laboratory database

Methods:

A retrospective chart review of patients undergoing FNA through the department of cytopathology at the National Health Laboratory Service (NHLS) was undertaken. Results of FNAs performed between March to May 2018 were reviewed. Medical record chart abstraction included general demographics, HIV status, site and results of FNA, prior history of malignancy and other laboratory data.

Results:

Five hundred and thirty-nine lymph node FNAs were performed on PLWH. Pathological findings included tuberculosis 47% (252), inadequate sampling 14% (75), reactive adenopathy 13% (71), benign pathology 12% (63), suspicious for lymphoproliferative neoplasm 8% (45), other malignancy 4% (21) and inflammation 2% (n = 12). Only 53% (24) of lymphomas were confirmed by biopsy. Those not confirmed had a high mortality (57%) and loss to follow-up rate (29%) over the following year. The median diagnostic interval exceeded 8 weeks from time of FNA to lymphoma diagnosis.

Conclusions:

FNA is an important screening modality in this high HIV and TB burden region. Patients with cytology suggestive for lymphoma, but without biopsy confirmation, have a high mortality rate suggesting undiagnosed lymphoma. A better understanding of the barriers to appropriate diagnostic triage for lymphoma is needed.
Usefulness of Computed Tomography Angiography in the Preoperative Workup of Patients With Colorectal Cancer
Authors: Canedo-Antelo María , García-Figueiras Roberto , Quintero- Rivera Juan Carlos , Huelga-Zapico Emilio , Junquera-Olay Sonsoles , Fernández-López Fernando , Baleato-González Sandra
Published: April 2022

Objectives

The objective of this study is to analyze the main patterns of branching of the inferior mesenteric artery (IMA) and to determine if your knowledge changes the surgical strategy in the colorectal cancer.

Methods

This retrospective study included 63 patients with cancer of the sigmoid or rectum. We assessed the patterns of IMA in 3 subtypes: type A (independent left colic artery [LCA]), type B (LCA and sigmoid artery arising in a common trunk) and type C (LCA, sigmoid artery, and superior rectal artery with a common origin). Colorectal surgeons evaluated how the vascular map changed the type of IMA ligation.

Results

Inferior mesenteric artery branching was classified as type A in 55.6% patients, type B in 23.8%, and type C in 20.6%. Knowledge of the vascular map changed the type of ligation from high to low in 20 of the 50 patients who were candidates for surgery. The change was possible in tumors located in the sigmoid colon and the rectosigmoid junction with the type A or B branching.

Conclusions

Preoperative Multidetector Computed Tomography angiography can define the pattern of IMA branching. Based on this information, a low ligation can be performed in tumors located in sigmoid colon and rectosigmoid junction with IMA branching types A and B.
Growth of Sobolev norms and loss of regularity in transport equations
Authors: Crippa Gianluca , Elgindi Tarek , Iyer Gautam , Mazzucato Anna L.
Published: April 2022

We consider transport of a passive scalar advected by an irregular divergence-free vector field. Given any non-constant initial data

ρ
¯

∈

H
loc
1

(

R

d

)

,

d
≥
2

, we construct a divergence-free advecting velocity field

v

(depending on

ρ
¯

) for which the unique weak solution to the transport equation does not belong to

H

loc

1

(

R

d

)

for any positive time. The velocity field

v

is smooth, except at one point, controlled uniformly in time, and belongs to almost every Sobolev space

W

s
,
p

that does not embed into the Lipschitz class. The velocity field

v

is constructed by pulling back and rescaling a sequence of sine/cosine shear flows on the torus that depends on the initial data. This loss of regularity result complements that in
Ann. PDE
, 5(1):Paper No. 9, 19, 2019.

This article is part of the theme issue ‘Mathematical problems in physical fluid dynamics (part 1)’.
Systematic search for extreme and singular behaviour in some fundamental models of fluid mechanics
Authors: Protas Bartosz
Published: April 2022

This review article offers a survey of the research program focused on a systematic computational search for extreme and potentially singular behaviour in hydrodynamic models motivated by open questions concerning the possibility of a finite-time blow-up in the solutions of the Navier–Stokes system. Inspired by the seminal work of Lu & Doering (2008Ind. Univ. Math.57, 2693–2727), we sought such extreme behaviour by solving PDE optimization problems with objective functionals chosen based on certain conditional regularity results anda prioriestimates available for different models. No evidence for singularity formation was found in extreme Navier–Stokes flows constructed in this manner in three dimensions. We also discuss the results obtained for one-dimensional Burgers and two-dimensional Navier–Stokes systems, and while singularities are ruled out in these flows, the results presented provide interesting insights about sharpness of different energy-type estimates known for these systems. Connections to other bounding techniques are also briefly discussed.

This article is part of the theme issue ‘Mathematical problems in physical fluid dynamics (part 1)’.
Steady thermal convection representing the ultimate scaling
Authors: Motoki Shingo , Kawahara Genta , Shimizu Masaki
Published: April 2022

Nonlinear simple invariant solutions representing the ultimate scaling have been discovered to the Navier–Stokes equations for thermal convection between horizontal no-slip permeable walls with a distanceHand a constant temperature differenceΔT. On the permeable walls, the vertical transpiration velocity is assumed to be proportional to the local pressure fluctuations, i.e.w=±βp/ρ(Jiménezet al.2001J. Fluid Mech.,442, 89–117. (doi:10.1017/S0022112001004888)). Two-dimensional steady solutions bifurcating from a conduction state have been obtained using a Newton–Krylov iteration up to the Rayleigh numberRa∼108for the Prandtl numberPr=1, the horizontal periodL/H=2and the permeability parameterβU=0–3,Ubeing the buoyancy-induced terminal velocity. The wall permeability has a significant impact on the onset and the scaling properties of the found steady ‘wall-bounded’ thermal convection. The ultimate scalingNu∼Ra1/2has been observed forβU>0at highRa, whereNuis the Nusselt number. In the steady ultimate state, large-scale thermal plumes fully extend from one wall to the other, inducing the strong vertical velocity comparable with the terminal velocityUas well as intense temperature variation ofO(ΔT)even in the bulk region. As a consequence, the wall-to-wall heat flux scales withUΔTindependent of thermal diffusivity, although the heat transfer on the walls is dominated by thermal conduction.

This article is part of the theme issue ‘Mathematical problems in physical fluid dynamics (part 1)’.
Metagenomics analysis of cultured mucosal bacteria from colorectal cancer and adjacent normal mucosal tissues
Authors: Zhu Yubing , Ma Ling , Wei Wenting , Li Xiang , Chang Yuxiao , Pan Zhiyuan , Gao Hong , Yang Ruifu , Bi Yujing , Ding Lei
Published: April 2022

Introduction. Colorectal cancer (CRC) is one of the most common cancers worldwide. Multiple risk factors are involved in CRC development, including age, genetics, lifestyle, diet and environment. Of these, the role of the gut microbiota in cancer biology is increasingly recognized.

Hypothesis/Gap Statement. Micro-organisms have been widely detected in stool samples, but few mucosal samples have been detected and sequenced in depth.

Aim. Analysis of cultured mucosal bacteria from colorectal cancer and adjacent normal mucosal tissues with metagenomics sequencing.

Methodology. Twenty-eight paired tumour and non-tumour tissues from 14 patients undergoing surgery for CRC were analysed. We removed the influence of eukaryotic cells via culture. The composition of mucosal microbiota in intestinal mucosa were detected and analysed with metagenomic sequencing.

Results. Compared with non-cultured mucosal sample, 80 % bacteria species could be detected after culture. Moreover, after culture, additional 30 % bacteria could be detected, compared with non-cultured samples. Since after culture it was difficult to estimate the original abundance of microbiome, we focused on the identification of the CRC tissue-specific species. There were 298 bacterial species, which could only be cultured and detected in CRC tissues.

Myroides odoratimimus

and

Cellulophaga baltica

could be isolated from all the tumour samples of 14 CRC patients, suggesting that these species may be related to tumour occurrence and development. Further functional analysis indicated that bacteria from CRC tissues showed more active functions, including basic metabolism, signal transduction and survival activities.

Conclusion. We used a new method based on culture to implement information on prokaryotic taxa, and related functions, which samples were from colorectal tissues. This method is suitable for removing eukaryotic contamination and detecting micro-organisms from other tissues.
Parental behaviour in choosing snacks for children aged six to ten: the role of mothers' nutritional awareness
Authors: De Cianni Rachele , Pippinato Liam , Zanchini Raffaele , Brun Filippo , Di Vita Giuseppe , Mancuso Teresina
Published: April 2022

Purpose

The objective of this study is to investigate the role of mothers in administering afternoon snacks to children aged between 6 and 10. Through an exploratory analysis, this study aims at identifying how sociodemographic characteristics of mothers and children and objective and subjective nutritional awareness of the parent influences healthy or unhealthy food choices for the children.

Design/methodology/approach

An online survey was submitted to 242 mothers of children attending primary school. Non-parametric correlation using Spearman's coefficient was adopted as an exploratory analysis tool.

Findings

The analysis shows that the mothers' level of education and income influence the purchase of snack products. More permissive parents tend to be less well-off, have more than one child and also purchase sweet treats, salty snacks, and sugary drinks more frequently. Furthermore, the results show that parents' perceived subjective awareness is actually lower than their objective awareness, but also that both types of knowledge positively influence the purchase of healthy snacks.

Originality/value

There is extensive research documenting the importance of parents in reducing the risk of obesity; however, their influence on snack intake has not been widely discussed. Furthermore, the association between the occurrence of obesity and parents' behaviour regarding their children's snacking remains unclear. To bridge this gap, this study focuses on a meal which is often linked to poor eating habits: the afternoon snack.
Firm-serving or public-serving? Analyzing public responses to employee volunteer program communication
Authors: Shi Duli
Published: April 2022

Purpose

Drawing on the elaboration likelihood model, this study aims to examine how employee volunteer program (EVP) type, corporate visual identity, and issue involvement affect external publics' attributions of EVPs and attitudes toward the company.

Design/methodology/approach

A 2 (EVP type: skills-based vs. not-skills-based) × 2 (salience of corporate visual identity: high vs. low) randomized experiment was conducted with 157 participants from Amazon's Mechanical Turk. A fictitious company and its EVP messages were created to control for the company's existing reputation and participants' past experiences with the company.

Findings

Participants responded positively toward EVP messages regardless of the EVP type. However, salient corporate visual identity significantly aroused participants' more attributed firm-serving motives, which led to more negative attitudes toward the company. Next, issue involvement presented its value in EVP communication as highly involved participants displayed favorable attributions of EVPs and positive attitudes toward the company.

Originality/value

This study approaches EVPs as an important CSR practice and expands the discussion on strategic CSR communication by uncovering the roles of central and peripheral cues in public responses to EVP messages. Moreover, the findings highlight the importance of fostering and enhancing publics' issue involvement in achieving successful EVP communication.