bluuebunny/crossref_metadata_2025 huggingface dataset:
RADIOACTIVITY ASSESSMENT OF SURFACE SOIL IN THE VICINITY OF A URANIUM MINE IN MALAWI
Authors: Majawa Louis John , Tshivhase Victor M , Dlamini Thulani
Published: August 2022

The activity concentrations of 238U, 232Th and 40K in the soil of areas surrounding the Kayelekera uranium mine were assessed. This study aims to provide a comprehensive profile of soil radioactivity distribution in the area surrounding the uranium mine to determine radiological hazards associated with mining and processing activities. Soil samples were analysed using gamma-ray spectrometry with a high-purity germanium detector. Mean specific activities of 238U, 232Th and 40K were 58.3 ± 3.7, 40.3 ± 0.3 and 590.9 ± 63.9 Bq kg−1, respectively. Results from this study have indicated changes in radioactivity levels of naturally occurring radioactive materials in the area surrounding the understudied mine, with certain areas close to the mine site showing elevated levels of 238U, highlighting the need for systematic and periodic monitoring.
Standards of Diagnostic Validation: Recommendations for Reference Collections
Authors: Harmon Carrie L. , Castlebury Lisa A. , Boundy-Mills Kyria , Broders Kirk D. , Hyten Aimee M. , Jacobs Jonathan L. , Knight-Connoni Victoria K. , Mollov Dimitre , Riojas Marco A. , Sharma Poonam
Published: August 2022

Agricultural and ecosystem biosecurity requires accurate and reliable diagnostic data provided by systems of people, technologies, and validated diagnostic assays. Biological reference collections, including living and preserved microbe culture collections, and authenticated sequence databases are essential for development and validation of robust diagnostic assays, as well as breeding for disease resistance. However, the lack of standardized requirements for long-term preservation, curation, recordkeeping, and data provenance of collections poses a significant risk to this research. Several examples of successful collections and funding models exist, but these are disparate, disconnected, and lack standards for harmonization among them. We recommend a framework for coordinated development, long-term maintenance, and accessibility of curated sets of pathogen data representing cultures and other reference material that could serve the needs of pathogen diagnostics development, population studies, and resistance breeding efforts.

[Formula: see text] Copyright © 2023 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Cigarette smoke promotes inflammasome‐independent activation of caspase‐1 and ‐4 leading to gasdermin D cleavage in human macrophages
Authors: Buscetta Marco , Cristaldi Marta , Cimino Maura , La Mensa Agnese , Dino Paola , Bucchieri Fabio , Rappa Francesca , Amato Santina , Aronica Tommaso Silvano , Pace Elisabetta , Bertani Alessandro , Cipollina Chiara
Published: August 2022

Mechanisms and consequences of gasdermin D (GSDMD) activation in cigarette smoke (CS)‐associated inflammation and lung disease are unknown. GSDMD is a downstream effector of caspase‐1, ‐8, and ‐4. Upon cleavage, GSDMD generates pores into cell membranes. Different degrees of GSDMD activation are associated with a range of physiological outputs ranging from cell hyperactivation to pyroptosis. We have previously reported that in human monocyte‐derived macrophages CS extract (CSE) inhibits the NLRP3 inflammasome and shifts the response to lipopolysaccharide (LPS) towards the TLR4‐TRIF axis leading to activation of caspase‐8, which, in turn, activates caspase‐1. In the present work, we investigated whether other ASC‐dependent inflammasomes could be involved in caspase activation by CSE and whether caspase activation led to GSDMD cleavage and other downstream effects. Presented results demonstrate that CSE promoted ASC‐independent activation of caspase‐1 leading to GSDMD cleavage and increased cell permeability, in the absence of cell death. GSDMD cleavage was strongly enhanced upon stimulation with LPS+CSE, suggesting a synergistic effect between the two stimuli. Noteworthy, CSE promoted LPS internalization leading to caspase‐4 activation, thus contributing to increased GSDMD cleavage. Caspase‐dependent GSDMD cleavage was associated with mitochondrial superoxide generation. Increased cleaved GSDMD was found in lung macrophages of smokers compared to ex‐smokers and non‐smoking controls. Our findings revealed that ASC‐independent activation of caspase‐1, ‐4, and ‐8 and GSDMD cleavage upon exposure to CS may contribute to macrophage dysfunction and feed the chronic inflammation observed in the smokers' lung.
Facial dermatitis in a healthy 9-year-old boy
Authors: Hiep Ashley , Gross Elissa
Published: August 2022

This case report describes a boy who presented to the hospital with worsening facial rash and fevers. He had previously been prescribed mometasone cream for rosacea, which his mother applied daily for about 45 days. After a biopsy was performed, he was diagnosed with acneiform dermatitis likely secondary to topical corticosteroid use complicated by demodex folliculitis and a superimposed bacterial infection.
PAs in Puerto Rico
Authors: Weikel Kimberly , Juarez Laura , Irizarry Charity M. Ramsey
Published: August 2022

As strained as Puerto Rico's healthcare infrastructure has become in recent years, the island's medical community has long resisted the idea of the physician assistant (PA). After almost 30 years of advocating for the PA profession in Puerto Rico, Law No. 71 was enacted in August 2017, recognizing the PA profession under the title of médico asistente. Eighteen months later, in February 2019, PAs were able to apply for licensure. However, the law as written severely restricts PA medical practice. This article reviews the current status of certified PAs in Puerto Rico and what steps are being taken to establish the profession to ultimately improve health outcomes and expand access to care throughout the island.
Increased Surgeon-specific Experience and Volume is Correlated With Improved Clinical Outcomes in Lumbar Fusion Patients
Authors: Hines Kevin , Philipp Lucas , Thalheimer Sara , Montenegro Thiago S. , Gonzalez Glenn A. , Hughes Liam P. , Leibold Adam , Mahtabfar Aria , Franco Daniel , Heller Joshua E. , Jallo Jack , Prasad Srinivas , Sharan Ashwini D. , Harrop James S.
Published: August 2022

Study Design:

The present study design was that of a single center, retrospective cohort study to evaluate the influence of surgeon-specific factors on patient functional outcomes at 6 months following lumbar fusion. Retrospective review of a prospectively maintained database of patients who underwent neurosurgical lumbar instrumented arthrodesis identified the present study population.

Objective:

This study seeks to evaluate surgeon-specific variable effects on patient-reported outcomes such as Oswestry Disability Index (ODI) and the effect of North American Spine Society (NASS) concordance on outcomes in the setting of variable surgeon characteristics.

Summary of Background Data:

Lumbar fusion is one of the fastest growing procedures performed in the United States. Although the impact of surgeon-specific factors on patient-reported outcomes has been contested, studies examining these effects are limited.

Methods:

This is a single center, retrospective cohort study analyzing a prospectively maintained database of patients who underwent neurosurgical lumbar instrumented arthrodesis by 1 of 5 neurosurgery fellowship trained spine surgeons. The primary outcome was improvement of ODI at 6 months postoperative follow-up compared with preoperative ODI.

Results:

A total of 307 patients were identified for analysis. Overall, 62% of the study population achieved minimum clinically important difference (MCID) in ODI score at 6 months. Years in practice and volume of lumbar fusions were statistically significant independent predictors of MCID ODI on multivariable logistic regression (P=0.0340 and P=0.0343, respectively). Concordance with evidence-based criteria conferred a 3.16 (95% CI: 1.03, 9.65) times greater odds of achieving MCID.

Conclusion:

This study demonstrates that traditional surgeon-specific variables predicting surgical morbidity such as experience and procedural volume are also predictors of achieving MCID 6 months postoperatively from lumbar fusion. Independent of surgeon factors, however, adhering to evidence-based guidelines can lead to improved outcomes.
Lumbar Radiculopathy due to Iliacus Abscess: Diagnosis, Treatment, and Review of the Literature
Authors: Morrow Dillon , Read Connor , Powell Charles , Dunlap Burton , Colon Felipe , Miller Joseph , Cunningham Bryce
Published: August 2022

Background:

An iliopsoas abscess is a type of deep pelvic infection that presents as an uncommon cause of back pain. Patients generally present with vague and ambiguous symptoms that pose diagnostic difficulty. This case report describes a 19-year-old female who initially presented with low back pain and lower extremity lumbar radiculopathy secondary to complex iliacus deep pelvic infection. This is the second documented case of lumbar radiculopathy as the presenting symptom for iliopsoas abscess. The patient underwent surgical drainage and debridement and was prescribed intravenous culture-tailored antibiotic therapy for 6 weeks.
Enhancing Clinical Teaching in Critical Thinking, High-Value Care, and Health Care Equity
Authors: Sullivan Amy M. , Beltran Christine P. , Ranchoff Brittany L. , Hayes Margaret M. , Atkins K. Meredith , Tibbles Carrie D. , Cohen Amy P. , Cohen David A. , Huang Grace C. , Schwartzstein Richard M. ,   the Clinician Educator Research Group
Published: August 2022

Introduction:

Faculty development in the clinical setting is challenging to implement and assess. This study evaluated an intervention (IG) to enhance bedside teaching in three content areas: critical thinking (CT), high-value care (HVC), and health care equity (HCE).

Methods:

The Communities of Practice model and Theoretical Domains Framework informed IG development. Three multidepartmental working groups (WGs) (CT, HVC, HCE) developed three 2-hour sessions delivered over three months. Evaluation addressed faculty satisfaction, knowledge acquisition, and behavior change. Data collection included surveys and observations of teaching during patient care. Primary analyses compared counts of post-IG teaching behaviors per hour across intervention group (IG), comparison group (CG), and WG groups. Statistical analyses of counts were modeled with generalized linear models using the Poisson distribution.

Results:

Eighty-seven faculty members participated (IG n = 30, CG n = 28, WG n = 29). Sixty-eight (IG n = 28, CG n = 23, WG n = 17) were observed, with a median of 3 observation sessions and 5.2 hours each. Postintervention comparison of teaching (average counts/hour) showed statistically significant differences across groups: CT CG = 4.1, IG = 4.8, WG = 8.2; HVC CG = 0.6, IG = 0.9, WG = 1.6; and HCE CG = 0.2, IG = 0.4, WG = 1.4 (P < .001).

Discussion:

A faculty development intervention focused on teaching in the context of providing clinical care resulted in more frequent teaching of CT, HVC, and HCE in the intervention group compared with controls. WG faculty demonstrated highest teaching counts and provide benchmarks to assess future interventions. With the creation of durable teaching materials and a cadre of trained faculty, this project sets a foundation for infusing substantive content into clinical teaching.
Prognostic Effect of the Controlling Nutritional Status Score in Patients With Esophageal Cancer Treated With Immune Checkpoint Inhibitor
Authors: Chang Lele , Cheng Qian , Ma Yue , Wu Chunlong , Zhang Xuemei , Ma Qian , He Lei , Li Qingwei , Tao Ji
Published: August 2022

In recent years, a growing number of clinical studies have shown that immune checkpoint inhibitor (ICI) can increase the remission rate and improve the prognosis of patients with esophageal cancer. The Controlling Nutritional Status (CONUT) score is a novel nutritional indicator that can predict the prognosis of certain malignancies. We retrospectively analyzed the clinical data of 69 patients with advanced esophageal cancer treated with ICI and assessed the relationship between clinicopathological factors including CONUT score, systemic immune-inflammatory index (SII), and neutrophil-to-lymphocyte ratio and the prognosis. We found the CONUT score and SII, neutrophil-to-lymphocyte ratio were an independent prognostic factor for overall survival (P<0.05). Furthermore, among patients treated with ICI, a high CONUT score was associated with a significantly worse progression-free survival (PFS) and overall survival compared with a low CONUT group. In conclusion, the CONUT can be used to predict the efficacy and prognosis of ICI therapy in patients with esophageal cancer. Our studies have shown that the CONUT score can be used as an effective indicator for the prognosis of patients with esophageal cancer receiving ICI.
Perioperative Management of Ulcerative Colitis: A Systematic Review
Authors: Lee Kate E. , Faye Adam S. , Vermeire Séverine , Shen Bo
Published: August 2022

BACKGROUND:

Patients with ulcerative colitis may require colectomy for severe disease unresponsive or refractory to pharmacological therapy. Managing ulcerative colitis is complicated as there are many factors at play, including patient optimization and treatment; the guidance varies on the ideal perioperative use of corticosteroids, immunomodulators, biologics, and small molecule agents.

OBJECTIVE:

A systematic literature review was performed to describe the current status of perioperative management of ulcerative colitis.

DATA SOURCES:

PubMed and Cochrane databases were used.

STUDY SELECTION:

Studies between January 2000 and January 2022, in any language, were included. Articles regarding pediatric or endoscopic management were excluded.

INTERVENTIONS:

Perioperative management of ulcerative colitis was included.

MAIN OUTCOME MEASURES:

Successful management, including reducing surgical complication rates, was measured.

RESULTS:

A total of 121 studies were included in this review, including 23 meta-analyses or systematic reviews, 25 reviews, and 51 cohort studies.

LIMITATIONS:

Qualitative review including all study types. The varied nature of study types precludes quantitative comparison.

CONCLUSION:

Indications for colectomy in UC include severe disease unresponsive to medical treatment and colitis-associated neoplasia. Urgent colectomy has a higher mortality rate than elective colectomy. Corticosteroids are associated with postsurgical infectious complications and should be stopped or weaned before surgery. Biologics are not associated with adverse postoperative effects and do not necessarily need to be stopped preoperatively. Additionally, the clinician must assess individuals’ comorbidities, nutrition status, and risk of venous thromboembolism. Nutritional imbalance should be corrected, ideally at preoperative period. Postoperatively, corticosteroids can be tapered based on the length of preoperative corticosteroid use.
Component blood transfusion used to treat massive postoperative hemorrhage after resection of a thoracic tumor: a case report
Authors: Zou Bin , Fan Haiyin , Guo Changying
Published: August 2022

Introduction and importance:

Perioperative bleeding is a common complication of thoracic surgery. Massive bleeding after thoracic surgery usually requires secondary thoracotomy to achieve hemostasis. We report a patient who developed massive hemorrhage after resection of a large thoracic tumor. Such a massive hemorrhage has not been performed with secondary thoracotomy, which has not been reported yet.

Case presentation:

A 76-year-old man was suffering from chest pain for 3 weeks. Chest computed tomography showed a large thoracic tumor with a maximum diameter of ~160 mm. Tumor puncture cytology showed no cancer cells, but histopathologic examination revealed large amount of necrotic tissue. After detailed preoperative evaluation, the patient underwent tumor resection and pleural peeling. The patient developed massive thoracic hemorrhage after the surgery. This postoperative intrathoracic hemorrhage was controlled by infusion of large amounts of cryoprecipitate and other blood products.

Conclusions:

Our experience with this patient suggests that massive hemorrhage in such cases can be managed by blood transfusion instead of secondary thoracotomy. The key point is determining whether the hemorrhage is due to oozing from surgical wound or an active vascular bleed.
Two Independent Capsules Surrounding a Single Textured Implant in Ehlers-Danlos Syndrome
Authors: Padmanabhan Jagannath , Liu Farrah C. , Sivaraj Dharshan , Henn Dominic , Chen Kellen , Simon Devorah R. , Barrera Janos A. , Gurtner Geoffrey C.
Published: August 2022

Textured breast implants are associated with prolonged inflammation leading to increased risk for complications such as the development of anaplastic large cell lymphoma. The underlying molecular mechanisms that drive increased inflammation toward textured implants (compared with smooth implants) remain poorly understood. Here, we present the first known case of a patient with Ehlers-Danlos syndrome (EDS) who developed two independent fibrotic capsules around a single textured silicone implant. The patient was found to have one internal capsule tightly adherent to the implant and a second external capsule that was attached to the surrounding tissue. We observed that the internal implant-adherent capsule was composed of a highly aligned and dense collagen network, completely atypical for EDS and indicative of a high mechanical stress environment. In contrast, the external nonadherent capsule, which primarily interacted with the smooth surface of the internal capsule, displayed disorganized collagen fibers with no discernible alignment, classic for EDS. Remarkably, we found that the internal capsule displayed high activation of monocyte chemoattractant protein-1, a mechanoresponsive inflammatory mediator that was not elevated in the disorganized external capsule. Taken together, these findings demonstrate that the tight adhesion between the textured implant surface and the internal capsule creates a high mechanical stress environment, which is responsible for the increased local inflammation observed in the internal capsule. This unique case demonstrates that mechanical stress is able to override genetic defects locally in collagen organization and directly connects the textured surface of implants to prolonged inflammation.
AGGREGATIBACTER ENDOPHTHALMITIS IN A PATIENT WITH DENTOPHOBIA
Authors: Mejaddam Assem , Pircher Achmed
Published: August 2022

Purpose:

To describe a rare case of unilateral, endogenous endophthalmitis caused by Aggregatibacter aphrophilus (HACEK group) confirmed in vitreous and blood cultures, in a patient with dentophobia.

Methods:

Case report.

Patients:

A seventy-five-year-old male patient with Type 2 diabetes, previous myocardial infarction, and pacemaker implantation.

Results:

Patient was observed with sudden loss of vision at the Department of Ophthalmology, Uppsala University. Initial diagnosis was posterior vitreous detachment and anterior uveitis, but progression of disease led to vitrectomy, which actually demonstrated endophthalmitis and growth of A. aphrophilus of the HACEK group. Aggregatibacter bacteremia and pacemaker endocarditis were also identified and dental examination confirmed growth of Aggregatibacter in the oral cavity. Intravitreal treatment with ceftazidime and vancomycin according to Endophthalmitis Vitrectomy Study protocol was administered with quick resolution of endophthalmitis.

Conclusion:

Aggregatibacter endophthalmitis is a rare, but devastating cause of vision loss where immediate diagnosis may be delayed. Prompt diagnosis may be facilitated by a thorough medical history and early vitreous biopsy. Systemic investigation by an infectious disease specialist and multidisciplinary assessment are mandatory. Ophthalmologic treatment is effective with intravitreal injections of ceftazidime and vancomycin.
The Case Against Stapedectomy as a Core Competency for General Practice: A Study of Care Patterns in the Department of Defense
Authors: Adams Jason K. , Malka Ronit E. , Marinelli John P. , Esquivel Carlos R. , Newberry Travis R. , Spear Samuel A. , Erbele Isaac D.
Published: August 2022

Objective

Stapedectomy remains a key indicator case reportable to the Accreditation Council of Graduate Medical Education despite the decline in the incidence of otosclerosis over the last half century. This study compared the rates of stapedectomy performed by otolaryngologists at academic and nonacademic centers.

Study Design

Retrospective review.

Setting

Tertiary referral academic centers, nonacademic centers, and civilian purchased-care across the Department of Defense between 2015 and 2020.

Patients

Department of Defense beneficiaries with otosclerosis near a military treatment facility with an otolaryngologist.

Interventions

Stapedectomy (Current Procedural Terminology codes 69,660, 69,661, and 69,662).

Main Outcome Measures

Number of stapedectomies performed by setting.

Results

From 2015 to 2020, 426 stapedectomies were performed at or near a military treatment facility with an otolaryngologist (274 directly by military otolaryngologists, 152 by community providers). Military providers performed 94% of stapedectomies at or near military academic centers, versus only 30% at or near nonacademic centers (p < 0.0001). Among the 60 stapedectomies performed at nonacademic centers, only 30 were performed by general otolaryngologists (7% of all stapedectomies performed; 11% of procedures by military providers) while the rest were performed by fellowship-trained otologist or neurotologist.

Conclusions

Low stapes surgical volume by military general otolaryngologists reinforces recent epidemiologic trends and suggests that few general otolaryngologists graduate residency with sufficient competency to pursue independently performing stapedectomy or have difficulty maintaining competency after graduation.
Cochlear implantation for paediatric and adult cases of unilateral and asymmetric hearing loss
Authors: Thompson Nicholas J. , Brown Kevin D. , Dillon Margaret T.
Published: August 2022

Purpose of review

Children and adults with unilateral or asymmetric hearing loss (UHL/AHL) have poorer spatial hearing (e.g. speech understanding in complex maskers and localization) and quality of life compared with peers with normal hearing bilaterally. Patients with UHL/AHL experience limited benefits with contralateral-routing technologies (e.g. bone conduction, CROS hearing aid systems). Cochlear implantation allows for stimulation of the auditory pathway for the poorer hearing ear. The present study reviews the recent literature on outcomes of cochlear implant use for recipients with UHL/AHL.

Recent findings

Recent research corroborates previous investigations of the significant benefits on measures of spatial hearing, tinnitus severity and quality of life for adult cochlear implant recipients. These benefits are also observed in pediatric cochlear implant recipients, with an association of better outcomes with younger ages at implantation for congenital cases and shorter durations of UHL/AHL for acquired cases. In addition, randomized trials demonstrate better outcomes with cochlear implant use versus contralateral-routing technologies.

Cochlear implantation supports better spatial hearing and quality of life in children and adults with UHL/AHL as compared to alternative listening conditions. Current research supports the expansion of candidacy criteria and insurance coverage for cochlear implantation for patients with UHL/AHL to improve their binaural hearing.
Impact of unilateral hearing loss in early development
Authors: Bell Rebecca , Mouzourakis Maggie , Wise Sean R.
Published: August 2022

Purpose of review

The purpose of this review is to provide an update on current literature as it relates to the impact of unilateral hearing loss for the pediatric population.

Recent findings

Current studies further corroborate past research findings which reveal the potential consequences of unilateral hearing loss on spatial hearing, language, and neurocognitive functioning. Deficits among children with unilateral hearing loss may parallel those seen in children with bilateral hearing loss, further challenging historic views that hearing in one ear in childhood is sufficient for normal development. The potential deficiencies seen in children with unilateral hearing loss can be subtler than those seen with bilateral hearing loss, but may nonetheless also impact school performance, patient fatigue, parental stress, and quality of life. Early interventions within a sensitive period of development of the central auditory system may circumvent potential barriers in cognitive, academic, and psychosocial development.

This review synthesizes the latest research on the impact of unilateral hearing loss in childhood and the role for possible interventions. The summarized information may serve to support the development of new guidelines for the evaluation and treatment of children with unilateral hearing loss.
Mediation of Self-Management and Treatment Adherence Health-Related Quality of Life for Adolescents With Congenital Heart Disease
Authors: Shackleford Jenna L. , Spratling Regena , Kelley Susan J.
Published: August 2022

Background

Improved autonomy, relatedness, competence, self-management, and treatment adherence have been linked to better health-related quality of life (HRQOL) in adolescents with chronic illnesses. Nonetheless, potential mediating relationships among these concepts have not been investigated. Mediation research is necessary to fully examine ways to improve health and other outcomes for adolescents living with chronic illnesses.

Objectives

The purpose of this study was to examine the relationship among the three innate needs (autonomy, relatedness, and competence) of the self-determination theory (SDT)—self-management and treatment adherence—and its relationship to HRQOL for adolescents with congenital heart disease (CHD). The current study examined the potential mediation effects of self-management and treatment adherence on the relationship between the three SDT variables on HRQOL.

Methods

Ninety-two adolescents with CHD completed self-report surveys (Basic Psychological Needs Autonomy and Relatedness subscales, Generalized Self-Efficacy Scale, UNC TRxANSITION Scale, and Pediatric Quality of Life 4.0 Generic Core Scale). Exploratory multiple regression and the bootstrap method were used to examine the relationship between the SDT variables and HRQOL and test whether these relationships were mediated by self-management and treatment adherence after controlling for covariates.

Results

The mediation hypothesis was not supported, indicating that self-management and treatment adherence do not mediate the relationship between the SDT variables and HRQOL for adolescents with CHD. However, multiple regression findings suggest optimizing autonomy and competence contributes to better self-management and treatment adherence and that better autonomy, competence, and relatedness improves HRQOL.

Discussion

The findings in this study indicate that studies with larger samples are needed if self-management and treatment adherence mediates the innate needs and HRQOL in adolescents with CHD. Future research focusing on other potential mediators affecting the relationship with HRQOL is warranted to improve the transition into adulthood.
Using Data Analytics to Improve Nursing Home Quality
Authors: Pitocco Christine , Sexton Thomas R.
Published: August 2022

Background:

There exists an array of quality performance measures for nursing homes. They can confuse consumers, administrators, and government regulators. Our methodology provides a unified multidimensional evaluation.

Objective:

To present a methodology to perform a multidimensional assessment of each nursing home within any specified group of nursing homes to aid policy makers, administrators, and consumers with a clear, easy-to-interpret evaluation of a nursing home quality performance.

Methods:

We use data envelopment analysis (DEA) to integrate several quality measures into a comprehensive benchmarking model. We present statewide results comparing DEA performance scores with the Five-Star rating using data from New York State (NYS) Department of Health.

Results:

In total, 212 of the 526 nursing homes performed as well as possible. Public nursing homes are most likely to lie on the frontier and have the highest average performance scores. The relationship between the DEA-based performance scores and the NYS Five-Star quality ratings is very weak.

Conclusion:

DEA is a comprehensive methodology for measuring nursing home quality. The DEA factor performance scores provide detailed information for individual nursing homes, enabling administrators to benchmark their facility's quality performance and to focus quality improvement efforts more effectively.
Achieving Consensus Among Stakeholders Using the Nominal Group Technique: A Perinatal Quality Collaborative Approach
Authors: Moore Matthew D. , Hall Allyson G. , Wingate Martha S. , Ford Eric W.
Published: August 2022

Background and Objectives:

Public health systems exhibiting strong connections across the workforce experience substantial population health improvements. This is especially important for improving quality and achieving value among vulnerable populations such as mothers and infants. The purpose of this research was to demonstrate how Alabama's newly formed perinatal quality collaborative (Alabama Perinatal Quality Collaborative [ALPQC]) used evidenced-based processes to achieve consensus in identifying population quality improvement (QI) initiatives.

Methods:

This multiphase quantitative and qualitative study engaged stakeholders (n = 44) at the ALPQC annual meeting. Maternal and neonatal focused QI project topics were identified and catalogued from active perinatal quality collaborative websites. The Delphi method and the nominal group technique (NGT) were used to prioritize topics using selected criteria (impact, enthusiasm, alignment, and feasibility) and stakeholder input.

Results:

Using the Delphi method, 11 of 27 identified project topics met inclusion criteria for stakeholder consideration. Employing the NGT, maternal projects received more total votes (n = 535) than neonatal projects (n = 313). Standard deviations were higher for neonatal projects (SD: feasibility = 10.9, alignment = 17.9, enthusiasm = 19.2, and impact = 22.1) than for maternal projects (SD: alignment = 5.9, enthusiasm = 7.3, impact = 7.9, and feasibility = 11.1). Hypertension in pregnancy (n = 117) and neonatal abstinence syndrome (n = 177) achieved the most votes total and for impact (n = 35 and n = 54, respectively) but variable support for feasibility.

Conclusions:

Together, these techniques achieved valid consensus across multidisciplinary stakeholders in alignment with state public health priorities. This model can be used in other settings to integrate stakeholder input and enhance the value of a common population QI agenda.
Prevalence of Oral Exostoses in Northern China During the Past Six Millennia—From a Sex and Age Perspective
Authors: Lu Mengting , Kang Ting , Kong Yujia , Chen Xuepeng , Shao Jinling
Published: August 2022

This study is intended to investigate oral exostoses of 5 sample populations, spanning over 6000 years, from the same region of Northern China, to determine the significance of sex and age on the development of oral exostoses during each time period. The samples analyzed were 306 dry jaws from human skeletons, which were excavated from 4 archeological sites: Banpo (6700–5600 y BP), Shaolingyuan (3000 y BP), Shanren (2200 y BP), and Chang’an (1000–1300 y BP), as well as the modern Xi’an district. The sex and the age of the samples at death were estimated. The degree of buccal exostosis (BE), torus mandibularis (TM), and torus palatinus (TP) and the TP shape were recorded. The results showed BEs in the Banpo and Chang’an regions, TMs in the Banpo region were more often diagnosed in males than in females. Conversely, females in Shaolingyuan showed a higher prevalence and severity of TM than that in males. The occurrence of BEs in the Shanren and Xi’an regions, TMs in the Banpo, Chang’an, and Xi’an regions, as well as TPs in the Banpo region significantly increased with age at death. In conclusion, sex differences and increasing trends with age in relation to oral exostoses were found in samples from Northern China during the past six millennia.
Intraoperative Electromyography in Awake Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Case Study on Nerve Activation Under the Effects of Local Anesthesia
Authors: Wehab Zaman , Tabarestani Troy Q. , Abd-El-Barr Muhammad M. , Husain Aatif M.
Published: August 2022

With the versatility of lumbar spine surgery continually expanding, intraoperative electromyography (EMG) has become a common adjunct used to reduce risk of nerve injury and postoperative neurologic deficit. EMG monitoring has been deemed particularly useful in the minimally invasive transforaminal lumbar interbody fusion. A more recent evolution of the minimally invasive transforaminal lumbar interbody fusion entails complete percutaneous access to the disc through Kambin's triangle, followed by a percutaneous lumbar interbody fusion. Given the lack of direct visualization of nervous structures with percutaneous entrance into the disc, there is risk of injury to surrounding nervous structures with this approach. In effort to reduce risk of nerve injury, application of triggered EMG to gauge proximity of nervous tissue has been evaluated. Recently, patients presenting with contraindications or concerns for general anesthesia have been offered the alternative to undergo their procedure with spinal anesthesia, allowing them to remain awake. Spinal anesthesia entails intrathecal administration of local anesthetic, which mechanistically acts to reduce overall excitability of surrounding neural structures. However, nerve activation under conditions of local anesthetic is relatively unknown, and the ability of triggered EMG monitoring to reliably detect nerve proximity becomes questionable. This case report demonstrates nerve activation at thresholds comparable with those seen under general anesthesia. Although this has sparked interest in the possibility that local anesthetic may not remarkably affect nerve excitability as measured by triggered EMG activation, further investigation is recommended to reliably apply triggered EMG monitoring in awake spine surgery.
Association of Cerebral and Systemic Physiology With Quantitative Electroencephalographic Characteristics of Early Posttraumatic Seizures
Authors: Appavu Brian L. , Fox Jordana , Kuwabara Michael , Burrows Brian T. , Temkit M.'Hamed , Adelson Phillip D.
Published: August 2022

Purpose:

Early posttraumatic seizures (EPTS) occur after pediatric traumatic brain injury and have been associated with unfavorable outcomes. We aimed to characterize the relationship among quantitative EEG characteristics of early posttraumatic seizures, cerebral and somatic physiologic measures.

Methods:

Differences in baseline physiologic, neuroimaging, and demographic characteristics between those with and without early posttraumatic seizures were investigated using Mann–Whitney U test or Fisher exact test. Multivariable dynamic structural equations modeling was used to investigate time series associations between ictal quantitative EEG characteristics with intracranial pressure, arterial blood pressure, heart rate (HR), and cerebral regional oximetry. Quantitative EEG characteristics included amplitude, total power, spectral edge frequency, peak value frequency, complexity, and periodicity.

Results:

Among 72 children, 146 seizures were identified from 19 patients. Early posttraumatic seizures were associated with younger age (P = 0.0034), increased HR (P = 0.0018), and increased Glasgow Outcome Scale—Extended scores (P = 0.0377). Group dynamic structural equations modeling analysis of the first seizure for patients demonstrated that intracranial pressure is negatively associated with spectral edge frequency (standardized regression coefficient −0.12, 99% credible interval [−0.21 to −0.04]), and HR is positively associated with peak value frequency (standardized regression coefficient 0.16, [0.00–0.31]). Among nine patients with seizures arising over the frontal lobe regions, HR was positively associated with peak value frequency (standardized regression coefficient 0.26 [0.02–0.50]) and complexity (standardized regression coefficient 0.14 [0.03–0.26]). Variation in strength and direction of associations was observed between subjects for relationships that were significant during group analysis.

Conclusions:

Quantitative EEG characteristics of pediatric early posttraumatic seizures are associated with variable changes in cerebral and systemic physiology, with spectral edge frequency negatively associated with intracranial pressure and peak value frequency positively associated with HR.
Behavioural outcomes following in utero exposure to anti-seizure medication: protocol for a systematic review
Authors: Honybun Eliza , Cockle Emily , Malpas Charles B , O’Brien Terence J. , Vajda Frank J.E. , Perucca Piero , Rayner Genevieve
Published: August 2022

Introduction

Prenatal exposure to certain antiseizure medications (ASMs) has been associated with increased risk of adverse neurodevelopmental outcomes in offspring. While the cognitive and intellectual outcomes of ASM-exposed offspring have been well-described, the long-term behavioural and functional sequalae in these children have received less attention. This systematic review aims to synthesise evidence on the relationship between prenatal ASM exposure and postnatal adverse neurodevelopmental outcomes, focusing on non-cognitive and intellectual domains of neurodevelopment including reduced social, emotional, behavioural, and adaptive functioning, as well as the frequency of neurodevelopmental and psychiatric disorders. This will have meaningful clinical implications for how we counsel women taking ASMs in pregnancy.

Methods and analysis

Studies reporting predefined neurodevelopmental outcomes will be identified by electronic searches of MEDLINE, PsychINFO, EMBASE, as well as additional manual and grey literature searches. Eligible studies will report outcomes of offspring exposed to ASMs in utero either prospectively or retrospectively from 1990 to present, with screening performed in duplicate. We will use the Newcastle-Ottawa Scale to conduct methodological quality assessments of included observational studies. A narrative synthesis will be used to report on the review findings. Meta-analysis is not anticipated.

Ethics and dissemination

Ethics clearance is not required for the current study. The systematic review will be prepared as a journal article and published in a peer-reviewed journal upon completion.

PROSPERO registration number

PROSPERO CRD42021281919

Article Summary

Strengths and limitations of this study

This protocol was developed and written according to the PRISMA-P guidelines

Publication of this protocol ensures transparency and reproducibility of the methods of the systematic review, as well as reduces the likelihood of review duplication

Restricting publications to English only may introduce bias whereby some relevant data is not included

Meta-analysis is not likely to be possible due to heterogeneity in study methodology, reducing the strength of the conclusions that can be drawn

Targeting psychosocial and behavioural outcomes allows for a more nuanced understanding of the long-term clinical consequences of prenatal ASM-exposure
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Defining clusters of epidemiologically-related infections is a common problem in the surveillance of infectious disease. A popular method for generating clusters is pairwise distance clustering, which assigns pairs of sequences to the same cluster if their genetic distance falls below some threshold. The result is often represented as a network or graph of infections. A connected component is a set of interconnected nodes in a graph that are not connected to any other node. The current approach to pairwise clustering is to map clusters to the connected components of the graph. However, the distance thresholds typically used for viruses like HIV-1 tend to yield components that exclude large numbers of infections as unconnected nodes. This is problematic for public health applications of clustering, such as tracking the growth of clusters over time. We propose that this problem can be addressed with community detection, a class of clustering methods being developed in the field of network science. A community is a set of nodes that are more densely inter-connected relative to the number of connections to external nodes. Thus, a connected component may be partitioned into two or more communities. Here we describe community detection methods in the context of genetic clustering for epidemiology, demonstrate how a popular method (Markov clustering) enables us to resolve variation in transmission rates within a giant connected component of HIV-1 sequences, and identify current challenges and directions for further work.
Decades of Trivers-Willard research on humans: what conclusions can be drawn?
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The Trivers-Willard hypothesis predicts that parents in good condition are positively biased towards sons, while parents in poor condition are positively biased towards daughters. An extensive literature testing this hypothesis has accumulated in the last five decades. We take stock of results concerning humans in a systematic review, which yielded 87 articles, reporting a total of 821 hypothesis tests. A p-curving analysis did not reveal a pattern of p-values consistent with p-hacking. Effects are consistent with the Trivers-Willard hypothesis overall. We then went on to check whether there was a difference between sex ratio and post-birth investment. Theoretical work suggests that, the conditions under which the Trivers-Willard hypothesis is verified should be more restrictive in the case of post-birth investment than for sex ratio. We explored this question in two ways and obtained mixed results. We put forward recommendations for future studies that aim to further assess the validity of the Trivers-Willard hypothesis or mechanisms subtending it, and we discuss the implications of different ways of measuring parental status and investment.
Chromosome 9p21.3 Coordinates Cell Intrinsic and Extrinsic Tumor Suppression
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