bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of noninvasive embryo viability testing versus conventional IVF on the live birth rate in IVF/ICSI patients: a study protocol for a double-blind, multicenter, randomized controlled trial
Authors: Cheng Yan-Fei , Zhang Cui-Lian , Liu Yun , Ou Jian-Ping , Chen Lei , Cai Gui-Feng , Yang Zu , Ye Tian-Min , Wang Jun , Xie Juan-Ke , Xiong Ping , Zhang Xi-Ya , Li Min , Xu Wei-Biao , Wang Xiao-Qing , Kong Ling-Yin , Liang Bo , Wang Xiao-Hong , Wang Yue-Qiang , Yao Yuan-Qing
Published: September 2023

Background

Preimplantation genetic testing for aneuploidy (PGT-A) was demonstrated to be superior to conventional IVF in reducing the incidence of miscarriage and abnormal offspring after the first embryo transfer (ET). PGT-A requires several embryo trophectoderm cells, but its negative impacts on embryo development and long-term influence on the health conditions of conceived children have always been a concern. As an alternative, noninvasive PGT-A (niPGT-A) approaches using spent blastocyst culture medium (SBCM) achieved comparable accuracy with PGT-A in several pilot studies. The main objective of this study is to determine whether noninvasive embryo viability testing (niEVT) results in better clinical outcomes than conventional IVF after the first embryo transfer. Furthermore, we further investigated whether niEVT results in higher the live birth rate between women with advanced maternal age (AMA, > 35 years old) and young women or among patients for whom different fertilization protocols are adopted.

Methods

This study will be a double-blind, multicenter, randomized controlled trial (RCT) studying patients of different ages (20–43 years) undergoing different fertilization protocols (in vitro fertilization [IVF] or intracytoplasmic sperm injection [ICSI]). We will enroll 1140 patients at eight reproductive medical centers over 24 months. Eligible patients should have at least two good-quality blastocysts (better than grade 4 CB). The primary outcome will be the live birth rate of the first embryo transfer (ET). Secondary outcomes will include the clinical pregnancy rate, ongoing pregnancy rate, miscarriage rate, cumulative live birth rate, ectopic pregnancy rate, and time to pregnancy.

Discussion

In this study, patients who undergo noninvasive embryo viability testing (niEVT) will be compared to women treated by conventional IVF. We will determine the effects on the pregnancy rate, miscarriage rate, and live birth rate and adverse events. We will also investigate whether there is any difference in clinical outcomes among patients with different ages and fertilization protocols (IVF/ICSI). This trial will provide clinical evidence of the effect of noninvasive embryo viability testing on the clinical outcomes of the first embryo transfer.

Trial registration

Chinese Clinical Trial Registry (ChiCTR) Identifier: ChiCTR2100051408. 9 September 2021.
Ultrasonography characteristics of cystic components in primary salivary gland tumors
Authors: Ding AngAng , Lv Huan , Cao Jinye , Wang Xin , Xiong Ping
Published: September 2023

Objectives

The present study aimed to characterize the ultrasonography (US) features of cystic components in salivary gland tumors (SGTs).

Materials and methods

A total of 207 patients (218 lesions) with pathologically confirmed primary SGTs were analyzed. Preoperative US revealed the presence of cystic components in lesions. Lesion size, shape, margin, and US findings of the cystic components, including number, distribution, margin, occupying rate, and internal characteristics, were evaluated.

Results

Similarities were observed between the US performance of benign SGTs (B-SGTs) and malignant SGTs (M-SGTs) with cystic components. Differences in sex and age of patients, number, distribution, and internal characteristics of cystic components were statistically significant. For SGTs with cystic components, the proportions of M-SGTs to ill-defined margins (P = 0.002), eccentric distribution (P = 0.019), and none of the internal characteristics (P = 0.019) were significantly higher than those of B-SGTs. Younger age (P = 0.001), eccentric distribution (P = 0.034) and ill-defined margin (P < 0.001) were risk factors for diagnosing M-SGTs. Cystic component features needed to be combined with lesion indicators (border and shape) to improve diagnostic sensitivity.

Conclusions

US features of the B-SGTs and M-SGTs were significantly different. Cystic component is of interest in the US-related differential diagnosis of B-SGT and M-SGT.

Clinical relevance

Cystic components are potentially valuable in the differential diagnosis of B-SGTs and M-SGTs on US.
Social vulnerability, impacts and adaptations strategies in the face of natural hazards: insight from riverine islands of Bangladesh
Authors: Hossain Babul , Shi Guoqing , Ajiang Chen , Sohel Md. Salman , Yijun Liu
Published: September 2023

Background

Bangladesh is one of the countries at risk of natural disasters due to climate change. In particular, inhabitants of its riverine islands (char) confront ongoing climatic events that heighten their vulnerability. This study aims to assess social vulnerability, impacts, and adaptation strategies to climate change in the riverine island areas of Bangladesh.

Methods

A mixed-method approach incorporating qualitative and quantitative procedures was used on data collected from 180 households of riverine islands in Gaibandha, Bangladesh. The social vulnerability of riverine island communities was assessed based on their adaptation capacity, sensitivity, and exposure to climatic stressors.

Results

The findings show that char dwellers' vulnerability, impacts, and adaptation capability to climate change vary significantly depending on their proximity to the mainland. Social vulnerability factors such as geographical location, fragile and low-grade housing conditions, illiteracy and displacement, climate-sensitive occupation and low-income level, and so on caused to the in-height vulnerability level of these particular areas. This study also displays that climate change and its associated hazards cause severe life and livelihood concerns for almost all households. In this case, the riverine dwellers employed several adaptation strategies to enhance their way of life to the disaster brought on changing climate. However, low education facilities, deficiency of useful information on climate change, poor infrastructure, and shortage of money are still the supreme hindrance to the sustainability of adaptation.

Conclusion

The findings underscore the importance of evaluating the susceptibility of local areas to climate change and emphasize the need for tailored local initiatives and policies to reduce vulnerability and enhance adaptability in communities residing in char households.
Potential predictive effect of mechanical properties of the plantar skin and superficial soft tissue, and vibration perception on plantar loading during gait in individuals with diabetes
Authors: Monteiro Renan L. , Drechsel Tina J. , Ferreira Jane Suelen S. P. , Zippenfennig Claudio , Sacco Isabel C. N.
Published: September 2023

Background

This exploratory study aimed to investigate the extent to which mechanical properties of the plantar skin and superficial soft tissue (hardness, stiffness, and thickness) and vibration perception thresholds (VPTs) predict plantar pressure loading during gait in people with diabetes compared to healthy controls.

Methods

Mechanical properties, VPTs, and plantar loadings during gait at the heel and first metatarsal head (MTH) of 20 subjects with diabetes, 13 with DPN, and 33 healthy controls were acquired. Multiple regression analyses were used to predict plantar pressure peaks and pressure-time integrals at both locations based on the mechanical properties of the skin and superficial soft tissues and VPTs.

Results

In the diabetes group at the MTH, skin hardness associated with 30-Hz (R2 = 0.343) and 200-Hz (R2 = 0.314) VPTs predicted peak pressure at the forefoot. In the controls at the heel, peak pressure was predicted by the skin thickness, hardness, and stiffness associated with 30-Hz (R2 = 0.269, 0.268, and 0.267, respectively) and 200-Hz (R2 = 0.214, 0.247, and 0.265, respectively) VPTs.

Conclusion

The forefoot loading of people with diabetes can be predicted by the hardness of the skin when combined with loss of vibration perception at low (30-Hz) and high (200-Hz) frequencies. Further data from larger sample sizes are needed to confirm the current findings.
Healthcare professionals’ perspectives of the management of people with palliative care needs in the emergency department of a UK hospital
Authors: Sausman Jane , Arif Azra , Young Annie , MacArtney John , Bailey Cara , Rajani Jaimini , Burt Rebecca
Published: September 2023

Background

The Emergency Department (ED) is not always the optimal place for people with palliative care needs but is the most common route for treatment when urgent care is sought. The aim of this study,’’REasons for PalLIative Care Admissions (REPLICA)’ was to explore the perspectives of ED healthcare professionals of hospital admission or discharge via ED for palliative care patients.

Methods

This is a sequential mixed methods study comprising (i) quantitative descriptive analysis of Hospital Episode Statistics (HES) of palliative care patients (code Z51.5) who were admitted through ED in a West Midlands Hospital and for the rest of England; (ii) in-depth semi-structured interviews with 17 ED staff which were analysed using thematic content analysis.

Results

Over the four years (2013–2017), 430,116 people admitted through ED were identified with a Z51.5 diagnosis code, 0.6% (n = 2736) of whom were from the West Midlands Hospital. The most common reasons for palliative care patients’ admission to hospitals across England were for care of chronic kidney disease, cancers and urinary tract infections. Five themes were elicited from the qualitative analysis: (1)Providing palliative care in ED is challenging, due to factors including lack of training in palliative care and the unsuitable environment. (2)Patients go to ED due to challenges in community managementsuch as inappropriate referrals and no care plan in place. (3)Health system influences admission and discharge decisions, including bed availability and being unable to set up community services out-of-hours. (4)Discussion with patient about treatment and end of life care needs to be outside of EDwhilst the patient is still well enough to express their wishes. (5)Improving services for patients with palliative care needs.Recommendations include short training sessions for ED staff and accessing palliative care professionals 24/7.

Conclusions

A large number of palliative care patients visit ED and are admitted to hospital for care; there is an urgent need to prevent patients attending the hospital through the establishment of a coordinated and dedicated service to support palliative care patients in the community.
The role of social accountability in changing service users’ values, attitudes, and interactions with the health services: a pre-post study
Authors: Boydell Victoria , Steyn Petrus S. , Cordero Joanna Paula , Habib Ndema , Nguyen My Huong , Nai Dela , Shamba Donat , Fuseini Kamil , Mrema Sigilbert , Kiarie James
Published: September 2023

This study evaluated the effects of community engagement through social accountability on service users’ values, attitudes and interactions. We conducted a pre–post study of the community and provider driven social accountability intervention (CaPSAI) over a 12-month period among 1,500 service users in 8 health facilites in Ghana and in Tanzania (n = 3,000).

In both countries, there were significant improvements in women’s participation in household decision-making and in how service users’ perceive their treatment by health workers. In both settings, however, there was a decline in women’s knowledge of rights, perception of service quality, awareness of accountability mechanisms and collective efficacy in the community. Though CaPSAI intervention set out to change the values, attitudes, and interactions between community members and those providing contraceptive services, there were changes in different directions that require closer examination.
Addressing non-response data for standardized post-acute functional items
Authors: Li Chih -Ying , Kim Hyunkyoung , Downer Brian , Lee Mi Jung , Ottenbacher Kenneth , Kuo Yong-Fang
Published: September 2023

Background

The post-acute patient standardized functional items (Section GG) include non-response options such as refuse, not attempt and not applicable. We examined non-response patterns and compared four methods to address non-response functional data in Section GG at nation-wide inpatient rehabilitation facilities (IRF).

Methods

We characterized non-response patterns using 100% Medicare 2018 data. We applied four methods to generate imputed values for each non-response functional item of each patient: Monte Carlo Markov Chains multiple imputations (MCMC), Fully Conditional Specification multiple imputations (FCS), Pattern-mixture model (PMM) multiple imputations and the Centers for Medicare and Medicaid Services (CMS) approach. We compared changes of Spearman correlations and weighted kappa between Section GG and the site-specific functional items across impairments before and after applying four methods.

Results

One hundred fifty-nine thousand six hundred ninety-one Medicare fee-for-services beneficiaries admitted to IRFs with stroke, brain dysfunction, neurologic condition, orthopedic disorders, and debility. At discharge, 3.9% (self-care) and 61.6% (mobility) of IRF patients had at least one non-response answer in Section GG. Patients tended to have non-response data due to refused at discharge than at admission. Patients with non-response data tended to have worse function, especially in mobility; also improved less functionally compared to patients without non-response data. Overall, patients coded as ‘refused’ were more functionally independent in self-care and patients coded as ‘not applicable’ were more functionally independent in transfer and mobility, compared to other non-response answers. Four methods showed similar changes in correlations and agreements between Section GG and the site-specific functional items, but variations exist across impairments between multiple imputations and the CMS approach.

Conclusions

The different reasons for non-response answers are correlated with varied functional status. The high proportion of patients with non-response data for mobility items raised a concern of biased IRF quality reporting. Our findings have potential implications for improving patient care, outcomes, quality reporting, and payment across post-acute settings.
Social determinants of health in pregnant individuals from underrepresented, understudied, and underreported populations in the United States
Authors: Girardi Guillermina , Longo Monica , Bremer Andrew A.
Published: September 2023

Women represent the cornerstone of a family’s overall health. Therefore, supporting women’s health, particularly in pregnancy, is important to promote public health. Emerging data highlight the contribution of social determinants of health (SDOH) on pregnancy outcomes in understudied, underrepresented, and underreported (U3) populations. Importantly, women are uniquely affected by and more vulnerable to adverse outcomes associated with SDOH. The maternal mortality rate has also increased significantly in the United States, especially among U3 individuals. Factors such as access to safe food, housing and environment, access to education and emergency/health services, and stressors such as interpersonal racism, poverty, unemployment, residential segregation, and domestic violence may make women from U3 populations more vulnerable to adverse reproductive health outcomes. Despite progress in promoting women’s health, eliminating social and health disparities in pregnant individuals remains an elusive goal in U3 populations. Moreover, chronic exposure to excessive social/cultural stressors may have a physiologic cost leading to pregnancy complications such as miscarriages, preterm birth, and preeclampsia. Thus, the identification of SDOH-related factors that drive differences in pregnancy-related complications and deaths and the implementation of prevention strategies to address them could reduce disparities in pregnancy-related mortality in U3 populations.
Comparison of the diagnostic performance of twelve noninvasive scores of metabolic dysfunction-associated fatty liver disease
Authors: Zou Haoxuan , Ma Xiaopu , Zhang Fan , Xie Yan
Published: September 2023

Background

The absence of distinct symptoms in the majority of individuals with metabolic dysfunction-associated fatty liver disease (MAFLD) poses challenges in identifying those at high risk, so we need simple, efficient and cost-effective noninvasive scores to aid healthcare professionals in patient identification. While most noninvasive scores were developed for the diagnosis of nonalcoholic fatty liver disease (NAFLD), consequently, the objective of this study was to systematically assess the diagnostic ability of 12 noninvasive scores (METS-IR/TyG/TyG-WC/TyG-BMI/TyG-WtHR/VAI/HSI/FLI/ZJU/FSI/K-NAFLD) for MAFLD.

Methods

The study recruited eligible participants from two sources: the National Health and Nutrition Examination Survey (NHANES) 2017-2020.3 cycle and the database of the West China Hospital Health Management Center. The performance of the model was assessed using various metrics, including area under the receiver operating characteristic curve (AUC), net reclassification index (NRI), integrated discrimination improvement (IDI), decision curve analysis (DCA), and subgroup analysis.

Results

A total of 7398 participants from the NHANES cohort and 4880 patients from the Western China cohort were included. TyG-WC had the best predictive power for MAFLD risk in the NHANES cohort (AUC 0.863, 95% CI 0.855–0.871), while TyG-BMI had the best predictive ability in the Western China cohort (AUC 0.903, 95% CI 0.895–0.911), outperforming other models, and in terms of IDI, NRI, DCA, and subgroup analysis combined, TyG-WC remained superior in the NAHANES cohort and TyG-BMI in the Western China cohort.

Conclusions

TyG-BMI demonstrated satisfactory diagnostic efficacy in identifying individuals at a heightened risk of MAFLD in Western China. Conversely, TyG-WC exhibited the best diagnostic performance for MAFLD risk recognition in the United States population. These findings suggest the necessity of selecting the most suitable predictive models based on regional and ethnic variations.
A systematic review and meta‐analysis of randomised controlled trials of surgical treatments for ingrown toenails part II: healing time, post‐operative complications, pain, and participant satisfaction
Authors: Exley Victoria , Jones Katherine , O'Carroll Grace , Watson Judith , Backhouse Michael
Published: September 2023

Background

When performing nail surgery, clinicians must choose from a multitude of procedures and variations within each procedure. Much has been published to guide this decision making, but there are a lack of up to date robust systematic reviews to assess the totality of this evidence.

Methods

Five databases (MEDLINE, Embase, CINAHL, Web of Science and CENTRAL) and two registers (Clinicaltrials.gov and ISRCTN) were searched to January 2022 for randomised trials evaluating the effects of a surgical intervention(s) for ingrown toenails. Two independent reviewers screened records, extracted data, assessed risk of bias and certainty of evidence. Data on co‐primary outcomes of symptom relief and symptomatic regrowth were presented in our first paper. This paper presents data for the secondary outcomes and further discussion.

Results

Of 3,928 records identified, 36 randomised trials were included in the systematic review. Healing time appears to be reduced with shorter application of phenol. A reduced healing time was also apparent was with the addition of curettage, although this may also increase the risk of post‐operative bleeding and pain. Post operative bleeding was also reportedly lower in people who received local anaesthetic with epinephrine but no tourniquet. Use of phenol with nail bed excision may decrease the risk of infection. Lower pain scores were reported when using partial matrixectomy and surgical interventions with phenol. Shorter duration of pain was reported with phenolisation and wedge resection. Participant satisfaction was high overall.

Conclusion

This second paper reports secondary outcomes from a robust systematic review of randomised trials on surgical treatment of ingrown toenails. Despite the large volume of clinical trials conducted on the topic, few clinical conclusions can be drawn due to the poor quality of these studies. Further high‐quality clinical trials are needed to answer fundamental questions in the surgical treatment of ingrown toenails.
Autistic adults benefit from and enjoy learning via social interaction as much as neurotypical adults do
Authors: De Felice S. , Hatilova A. , Trojan F. , Tsui I. , Hamilton Antonia F. de C.
Published: September 2023

Background

Autistic people show poor processing of social signals (i.e. about the social world). But how do they learn via social interaction?

Methods

68 neurotypical adults and 60 autistic adults learned about obscure items (e.g. exotic animals) over Zoom (i) in a live video-call with the teacher, (ii) from a recorded learner-teacher interaction video and (iii) from a recorded teacher-alone video. Data were analysed via analysis of variance and multi-level regression models.

Results

Live teaching provided the most optimal learning condition, with no difference between groups. Enjoyment was the strongest predictor of learning: both groups enjoyed the live interaction significantly more than other condition and reported similar anxiety levels across conditions.

Limitations

Some of the autistic participants were self-diagnosed—however, further analysis where these participants were excluded showed the same results. Recruiting participants over online platforms may have introduced bias in our sample. Future work should investigate learning in social contexts via diverse sources (e.g. schools).

Conclusions

These findings advocate for a distinction between learning about the social versus learning via the social: cognitive models of autism should be revisited to consider social interaction not just as a puzzle to decode but rather a medium through which people, including neuro-diverse groups, learn about the world around them.

Trial registration Part of this work has been pre-registered before data collection https://doi.org/10.17605/OSF.IO/5PGA3
The “real life” efficacy of dupilumab is independent of initial polyp size and concomitant steroids in CRSwNP
Authors: Campion Nicholas J. , Brugger Jonas , Tu Aldine , Stanek Victoria , Brkic Faris F. , Bartosik Tina J. , Liu David T. , Hoehl Bruna S. , Gangl Katharina , Eckl-Dorna Julia , Schneider Sven
Published: September 2023

Background

Dupilumab significantly improves symptom control in chronic rhinosinusitis with nasal polyps (CRSwNP). Patients with large polyps at the initiation of treatment (total polyp score (TPS) ≥ 5) have been the focus in published studies. Patients with significant burden of disease but small polyps (TPS ≤ 4) have not yet been evaluated for clinical response. This study set out to evaluate the benefit of dupilumab treatment on cohorts of small (TPS ≤ 4) compared to large polyps (TPS ≥ 5). Furthermore, benefit of concomitant oral and/or nasal steroid therapy has been evaluated.

Methods

97 patients with CRSwNP, who were begun on dupilumab between January 2020 and October 2021, were included. All patients were followed-up for 6 months. At each visit they underwent nasal endoscopy, smell identification tests and filled out validated patient questionnaires.

Results

Significant drops in TPS were seen in both patient groups after 6 months of therapy, dropping from a median score of 3 to 0 and from 6 to 2 in patients with small and large polyps respectively. Furthermore, a linear mixed model calculated a drop of 22% and 24% in TPS per month in patients with small and large polyps respectively with no significant difference in rate of decline. Finally the model showed that neither oral nor nasal steroids influenced the rate of response to dupilumab therapy.

Conclusions

Polyp size at the initiation of dupilumab therapy and whether patients continue to take steroid therapy does not appear to influence effectiveness of dupilumab treatment.
Assessing different measures of fire risk for Cultural World Heritage Sites
Authors: Falk Martin Thomas , Hagsten Eva
Published: September 2023

This study aims to assess whether two publicly available sources of fire threats to 346 Cultural World Heritage Sites across Europe substitute or complement each other. By doing so, a novel measure based on information from the UNESCO periodic report II is created and benchmarked against the European forest fire information system (EFFIS) index. The UNESCO periodic report shows that forest fires are perceived as an actual or foreseeable hazard by 40% of the management of Cultural World Heritage Sites in Europe. When the EFFIS index is linked to the UNESCO World Heritage database, it occurs that 48% of these sites are at high risk of fire, 31% at medium risk and 21% at low risk. Results based on Probit and Fractional Probit estimations reveal that the perceived fire risk relates to several site characteristics as well as location. The regressions using the EFFIS index as dependent variable show indifference to site characteristics even if location is of importance. Estimations give that the perceived fire risk is highest for sites in the East and the North of Europe, while the results for the EFFIS index lead to a dominant risk in the South. A 10° increase in latitude (corresponding to the distances between Vienna and Stockholm or Athens and Vienna) leads to a considerable decrease in the proportion of high fire risk by 28 percentage points (with a sample mean of 48%). Thus, the two measures of fire risks complement rather than substitute each other. Latitude is of no importance for the site managers, although the EFFIS gives this aspect a heavy weight, with low or zero risks in locations at higher latitudes (Iceland, Ireland, Latvia, and Norway) and larger risks in Southern Europe (Cyprus, Malta, Portugal, Albania, Spain, and Greece). In addition, the perception of (wild)-fire threat is significantly lower for cities.
Comparison of balanced and unbalanced crystalloids as resuscitation fluid in patients treated for cardiogenic shock
Authors: Gmeiner Jonas , Bulach Bernhardt , Lüsebrink Enzo , Binzenhöfer Leonhard , Kupka Danny , Stocker Thomas , Löw Kornelia , Weckbach Ludwig , Rudi Wolf-Stephan , Petzold Tobias , Kääb Stefan , Hausleiter Jörg , Hagl Christian , Massberg Steffen , Orban Martin , Scherer Clemens
Published: September 2023

Background

The efficacy and safety of saline versus balanced crystalloid solutions in ICU-patients remains complicated by exceptionally heterogenous study population in past comparative studies. This study sought to compare saline and balanced crystalloids for fluid resuscitation in patients with cardiogenic shock with or without out-of-hospital cardiac arrest (OHCA).

Methods

We retrospectively analyzed 1032 propensity score matched patients with cardiogenic shock from the Munich University Hospital from 2010 to 2022. In 2018, default resuscitation fluid was changed from 0.9% saline to balanced crystalloids. The primary endpoint was defined as 30-day mortality rate.

Results

Patients in the saline group (n = 516) had a similar 30-day mortality rate as patients treated with balanced crystalloids (n = 516) (43.1% vs. 43.0%, p = 0.833), but a higher incidence of new onset renal replacement therapy (30.2% vs 22.7%, p = 0.007) and significantly higher doses of catecholamines. However, OHCA-patients with a lactate level higher than 7.4 mmol/L had a significantly lower 30-day mortality rate when treated with saline (58.6% vs. 79.3%, p = 0.013). In addition, use of balanced crystalloids was independently associated with a higher mortality in the multivariate cox regression analysis after OHCA (hazard ratio 1.43, confidence interval: 1.05–1.96, p = 0.024).

Conclusions

In patients with cardiogenic shock, use of balanced crystalloids was associated with a similar all-cause mortality at 30 days but a lower rate of new onset of renal replacement therapy. In the subgroup of patients after OHCA with severe shock, use of balanced crystalloids was associated with a higher mortality than saline.

Trial registration: LMUshock registry (WHO International Clinical Trials Registry Platform Number DRKS00015860).
Impaired parasympathetic function in long-COVID postural orthostatic tachycardia syndrome – a case-control study
Authors: Rigo Stefano , Urechie Vasile , Diedrich Andrè , Okamoto Luis E. , Biaggioni Italo , Shibao Cyndya A.
Published: September 2023

Purpose

Eighty percent of patients infected by SARS-CoV-2 report persistence of one symptom beyond the 4-week convalescent period. Those with orthostatic tachycardia and orthostatic symptoms mimicking postural tachycardia syndrome, they are defined as Long-COVID POTS [LCP]. This case-control study investigated potential differences in autonomic cardiovascular regulation between LCP patients and healthy controls.

Methods

Thirteen LCP and 16 healthy controls, all female subjects, were studied without medications. Continuous blood pressure and ECG were recorded during orthostatic stress test, respiratory sinus arrhythmia, and Valsalva maneuver. Time domain and power spectral analysis of heart rate [HR] and systolic blood pressure [SBP] variability were computed characterizing cardiac autonomic control and sympathetic peripheral vasoconstriction.

Results

LCP had higher deltaHR (+ 40 ± 6 vs. + 21 ± 3 bpm, p = 0.004) and deltaSBP (+ 8 ± 4 vs. -1 ± 2 mmHg, p = 0.04) upon standing; 47% had impaired Valsalva maneuver ratio compared with 6.2% in controls (p = 0.01). Spectral analysis revealed that LCP had lower RMSSD (32.1 ± 4.6 vs. 48.9 ± 6.8 ms, p = 0.04) and HFRRI, both in absolute (349 ± 105 vs. 851 ± 253ms2, p = 0.03) and normalized units (32 ± 4 vs. 46 ± 4 n.u., p = 0.02). LFSBP was similar between groups.

Conclusions

LCP have reduced cardiovagal modulation, but normal sympathetic cardiac and vasoconstrictive functions. Impaired parasympathetic function may contribute to the pathogenesis of Long-COVID POTS syndrome.
A protocol for the development and validation of a virtual reality-based clinical test of social cognition
Authors: Matre M , Johansen T , Olsen A , Tornås S , Martinsen AC , Lund A , Becker F , Brunborg C , Spikman J , Ponsford J , Neumann D , McDonald S , Løvstad M
Published: September 2023

Background

Impairments in social cognition are common after traumatic brain injury (TBI) and may have severe negative consequences for patients and their families. Most tests of social cognition have limited ecological validity due to simplistic and contrived social stimuli with limited relevance to everyday social functioning. There is a need for measures of social cognition that reflect the dynamic, multimodal and contextualized nature of social situations and that predict real-world functioning. Three hundred sixty–degree (360°) Virtual Reality (VR) video can increase ecological validity through enhanced social presence, or a sense of “being there”. This paper describes the development and protocol design for validation of a Norwegian VR-version of The Awareness of Social Inference Test (TASIT), which is a widely used video-based test of social cognition.

Methods

Development of VR TASIT included filming 61 short videos depicting social interactions in both VR and desktop format, using a 360° camera. Software for standardized test administration and collection of performance data was developed in Unity, for administration on both VR and desktop interface. The validation study will test the reliability and validity of VR TASIT in participants with TBI (n = 100) and healthy controls (n = 100). Half of the participants will perform the desktop version, and the other half the VR version. Analyses will include known groups validity, convergent and divergent validity, as well as test–retest reliability of VR TASIT. A comparison of the ability of TASIT VR and desktop versions to predict real-world functioning (ecological validity) will be explored using the Social Skills Questionnaire for TBI and La Trobe Communication Questionnaire. Finally, the levels of perceived social presence of the stimulus materials and prevalence of cybersickness after exposure to the virtual environment will be documented.

Discussion

It is expected that VR TASIT will have comparable or better psychometric properties than the desktop version, and that the hypothesized increased level of social presence experienced in a virtual environment will result in improved ecological validity. More broadly, benefits and limitations of using VR video as stimulus material in assessment of social cognition and considerations for future development and clinical validation are discussed.

Trial registration

The study protocol was pre-registered in ClinicalTrials (April 4th 2022, NCT05309005). The study was retrospectively registered in Open Science Framework (December 15th 2022, osf.io/2vem8).
Does Anesthesia Quality Improvement Participation Lead to Incremental Savings in a Surgical Quality Collaborative Population? A Retrospective Observational Study
Authors: Janda Allison M. , Vaughn Michelle T. , Colquhoun Douglas A. , Mentz Graciela , Buehler Kathryn , Nathan Hari , Regenbogen Scott E. , Syrjamaki John , Kheterpal Sachin , Shah Nirav
Published: September 2023

BACKGROUND:

The Anesthesiology Performance Improvement and Reporting Exchange (ASPIRE) Collaborative Quality Initiative (CQI) was launched as a partnership among hospitals to measure quality, review evidence-based practices, and improve anesthesia-related outcomes. Cost savings and improved patient outcomes have been associated with surgical CQI participation, but the impact of an anesthesia CQI on health care cost has not been thoroughly assessed. In this study, we evaluated whether participation in an anesthesia CQI led to health care savings. We hypothesized that ASPIRE participation is associated with reduced total episode payments for payers and major, high-volume procedures included in the Michigan Value Collaborative (MVC) registry.

METHODS:

In this retrospective observational study, we compared MVC episode payment data from Group 1 ASPIRE hospitals, the first cluster of 8 Michigan hospitals to join ASPIRE in January 2015, to non-ASPIRE matched control hospitals. MVC computes price-standardized, risk-adjusted payments for patients insured by Blue Cross Blue Shield of Michigan Preferred Provider Organization, Blue Care Network Health Maintenance Organization, and Medicare Fee-for-Service plans. Episodes from 2014 comprised the pre-ASPIRE time period, and episodes from June 2016 to July 2017 constituted the post-ASPIRE time period. We performed a difference-in-differences analysis to evaluate whether ASPIRE implementation was associated with greater reduction in total episode payments compared to the change in the control hospitals during the same time periods.

RESULTS:

We found a statistically significant reduction in total episode (−$719; 95% CI [−$1340 to −$97]; P = .023) payments at the 8 ASPIRE hospitals (N = 17,852 cases) compared to the change observed in 8 matched non-ASPIRE hospitals (N = 12,987 cases) for major, high-volume surgeries, including colectomy, colorectal cancer resection, gastrectomy, esophagectomy, pancreatectomy, hysterectomy, joint replacement (knee and hip), and hip fracture repair. In secondary analyses, 30-day postdischarge (−$354; 95% CI [−$582 to −$126]; P = .002) payments were also significantly reduced in ASPIRE hospitals compared to non-ASPIRE controls. Subgroup analyses revealed a significant reduction in total episode payments for joint replacements (−$860; 95% CI [−$1222 to −$499]; P < .001) at ASPIRE-participating hospitals. Sensitivity analyses including patient-level covariates also showed consistent results.

CONCLUSIONS:

Participation in an anesthesiology CQI, ASPIRE, is associated with lower total episode payments for selected major, high-volume procedures. This analysis supports that participation in an anesthesia CQI can lead to reduced health care payments.
Perioperative Anesthesia-Related Complications and Risk Factors in Children: A Cross-Sectional Observation Study in Rwanda
Authors: Nizeyimana Francoise , Skelton Teresa , Bould M. Dylan , Beach Michael , Twagirumugabe Theogene
Published: September 2023

BACKGROUND:

Despite an increasing awareness of the unmet burden of surgical conditions, information on perioperative complications in children remains limited especially in low-income countries such as Rwanda. The objective of this study was to estimate the prevalence of perioperative anesthesia-related adverse events and to explore potential risk factors associated with them among pediatric surgical patients in public referral hospitals in Rwanda.

METHODS:

Data were collected for all patients under 5 years of age undergoing surgery in 3 public referral hospitals in Rwanda from June to December 2015. Patient and family history, type of surgery, comorbidities, anesthesia technique, intraoperative adverse events and postoperative events in the postanesthesia care unit (PACU) were recorded. The incidence of perioperative adverse events was assessed and associated risk factors analyzed with univariate logistic regression.

RESULTS:

Of 354 patients enrolled in this study 11 children had a cardiac arrest. Six (1.7%) suffered an intraoperative cardiac arrest, 2 of whom (0.6%) died intraoperatively. In the PACU, 6 (1.8%) suffered a postoperative cardiac arrest, 5 of whom (1.5%) died in the PACU. One child had both an intraoperative cardiac arrest and then a cardiac arrest in PACU but survived. Eighty-nine children (25.1%) had an intraoperative adverse event, whereas 67 (20.6%) had an adverse event in PACU. A review of the cases where cardiac arrest or death occurred indicated that there were significant lapses in the expected standard of care. Age <1 week was associated with cardiac arrest or death.

CONCLUSIONS:

The rate of perioperative complications, including death, for children undergoing surgery in tertiary care hospitals in Rwanda was high. Quality improvement measures are needed to decrease this rate among surgical pediatric patients in this low resource setting.
Expression and function of four AAV-based constructs for dystrophin restoration in the mdx mouse model of Duchenne muscular dystrophy
Authors: Potter Rachael A. , Griffin Danielle A. , Heller Kristin N. , Mendell Jerry R. , Rodino-Klapac Louise R.
Published: September 2023

Robust expression of shortened, functional dystrophin provided impetus to develop adeno-associated virus (AAV)–based constructs for clinical application. Because several cassettes are being tested in clinical trials, this study compared the efficacies of four shortened dystrophin-promoter combinations with implications for outcomes in clinical trials: MHCK7 or MCK promoter with a shortened dystrophin transgene containing the N-terminus and spectrin repeats R1, R2, R3 and R24 (rAAVrh74.MHCK7.micro-dystrophin and rAAVrh74.MCK.micro-dystrophin, respectively); shortened dystrophin construct containing the neuronal nitric oxide (nNOS) binding site (rAAVrh74.MHCK7.DV.mini-dystrophin); and shortened dystrophin containing the C-terminus (rAAVrh74.MHCK7.micro-dystrophin.Cterm). Functional and histological benefit were examined at 4 weeks following intramuscular delivery in mdx mice. rAAVrh74.MHCK7.micro-dystrophin provided the most robust transgene expression and significantly increased specific force output in the tibialis anterior muscle. Muscle environment was normalized (i.e. reductions in central nucleation), indicating functional and histological advantages of rAAVrh74.MHCK7.micro-dystrophin. Thus, promoter choice and transgene design are critical for optimal dystrophin expression/distribution for maximal functional improvement.
Metabolic FRET sensors in intact organs: Applying spectral unmixing to acquire reliable signals
Authors: Gándara Lautaro , Durrieu Lucía , Wappner Pablo
Published: September 2023

In multicellular organisms, metabolic coordination across multiple tissues and cell types is essential to satisfy regionalized energetic requirements and respond coherently to changing environmental conditions. However, most metabolic assays require the destruction of the biological sample, with a concomitant loss of spatial information. Fluorescent metabolic sensors and probes are among the most user-friendly techniques for collecting metabolic information with spatial resolution. In a previous work, we have adapted to an animal system, Drosophila melanogaster, genetically encoded metabolic FRET-based sensors that had been previously developed in single-cell systems. These sensors provide semi-quantitative data on the stationary concentrations of key metabolites of the bioenergetic metabolism: lactate, pyruvate, and 2-oxoglutarate. The use of these sensors in intact organs required the development of an image processing method that minimizes the contribution of spatially complex autofluorescence patterns, that would obscure the FRET signals. In this article, we show step by step how to design FRET-based sensor experiments and how to process the fluorescence signal to obtain reliable FRET values.
The Role of Ultrasound in the Management of Ankle Sprains and a Clinically Relevant Geisinger Ankle Sprain Sports Ultrasound Protocol
Authors: Meyer Ryan , Loncar Laryssa Richards , Jensen Elyse , Raja Altamash , Tunis Brandon , Moreland Michael L. , Tunis Justin
Published: September 2023

Ankle sprains are the most common lower extremity injury in physically active individuals. These injuries are classified as lateral, medial, and/or syndesmotic. Treatment may include functional rehabilitation, bracing, weight-bearing restriction, medications, injections, and surgery. While most sprains heal rapidly, permanent disability and pain may arise. Diagnostic ultrasound has been demonstrated to be accurate in diagnosing ligamentous injuries, but it is often excluded from management algorithms that rely on physical examination alone to diagnose significant injuries. This article proposes a comprehensive, evidence-based diagnostic ankle ultrasound protocol to implement in conjunction with thorough history and physical examination. We also review the current literature to describe where this protocol most improves diagnostic accuracy compared with physical examination alone.
Individualism-Collectivism (I-C) indices do not mediate the negative association between non-referent downward counterfactual thinking and prevention pride in Australian university students
Authors: Broomhall Anne Gene
Published: September 2023

Non-referent downward counterfactual thinking pertains to visualising how life events could have turned out for the worse without identifying who is blameworthy for the negative outcome. A key question is whether its link to prevention pride corresponds to the direction articulated in the Functional Theory – that is, in general, downward counterfactual thinking is positively associated with prevention goal-attainment, and this could be facilitated by greater adherence to social norms that maintain the status quo. This research question was investigated in a cross-sectional study using a sample of Australian university students (N = 209, Mage = 24.48, SD = 8.23; Range = 18-56). Contrary to the Functional Theory of Counterfactual Thinking, it was found that more frequent non-referent downward counterfactual thinking was associated with lower prevention pride. Non-referent downward counterfactuals did not significantly predict Individualism-Collectivism indices (i.e., social harmony, self-control, social identification, and social sharing of recognition). Amongst the I-C indices, only social identification and social sharing of recognition were found to be significantly positively and negatively associated with prevention pride, respectively. However, the I-C indices did not mediate the negative association between non-referent downward counterfactual thinking and prevention pride. Therapeutic implications were discussed in relation to the “wake-up call” principle to help individuals take preventative actions in the future.
Appreciative Inquiry at a Hospital: A Long Way to Move the Lines
Authors: Cayré Christine
Published: September 2023

Although the world of healthcare has shown a great interest in Appreciative Inquiry, structural rigidities that hold back its development persist. A healthcare manager shares her experience: an interview with Isabelle Djabri, Healthcare Manager at University Hospital of Montpellier, conducted by Christine Cayré.
A Transformative Appreciative Inquiry Experience
Authors: Sauzet Dominique
Published: September 2023

Author and consultant Dominque Sauzet returns to talk with three teachers at a facility in Switzerland dedicated to training young people with learning difficulties.
The Massira 2010 Project at Lyonnaise des Eaux of Casablanca (Lydec)
Authors: Benabdejlil Zineb
Published: September 2023

In 1997, Morocco’s authorities chose professional service provider Lyonnaise des Eaux to resolve the problems with the provision of water and electricity in Casablanca. Ten years later, faced with a review, they found that projects hadn’t been documented. In preparing for a difficult review, the management neglected internal communications. Faced with a demoralized team, Jaouad Benhaddou turned to Zineb Benabdejlil who proposed using Appreciative Inquiry to find a positive way forward for the organisation. Zineb asked Jaouad to recount the experience for this article.
Using Appreciative Inquiry at a Very Touchy Time: An Interview with Craig Walker, Food Company Managing Director
Authors: Pagès Jean
Published: September 2023

Craig Walker’s career as a managing director has included such food companies as MerAlliance (Thai Union Group PCL), after Labeyrie Fine Foods (CEO UK) and, before that, NUMICO INFANT NUTRITION (brands: Milupa Nutricia). Craig recounts for author Jean Pagès a positive experience resulting from a company sale which used Appreciative Inquiry to ensure that the company was fully engaged.
Fragmented Securities Regulation, Information-Processing Costs, and Insider Trading
Authors: Kim Sehwa , Kim Seil
Published: September 2023

Using a unique setting where stand-alone banks submit filings to bank regulators instead of the U.S. Securities and Exchange Commission (SEC), we examine the consequences of fragmented securities regulation for information-processing costs and opportunistic insider trading. We find the market reaction to insider-trading filings on FDICconnect is less timely than to those on SEC’s Electronic Data Gathering, Analysis, and Retrieval (EDGAR) system, suggesting FDICconnect generates higher information-processing costs. We also find only large investors trade more on insider-trading filings on FDICconnect than on insider-trading filings on SEC EDGAR, thus extracting benefits from the delayed market reaction to insider-trading filings on FDICconnect. Finally, we find increased insider selling in stand-alone banks prior to negative earnings news, suggesting insiders’ opportunistic use of private information. These findings collectively suggest regulatory fragmentation undermines market efficiency and distorts the level playing field.

This paper was accepted by Suraj Srinivasan, accounting.

Funding: This work was supported by the Eugene Lang Junior Faculty Fellowship.

Supplemental Material: The data files and online appendix are available at https://doi.org/10.1287/mnsc.2023.4903 .
Project To Focus On Process For EV Battery Recycling And Use In ‘Second Life’
Authors: Ford Jason
Published: September 2023

European REBELION project will develop ways to recycle and repurpose batteries
Tie Up For Tevva And Ecobat
Authors: Wade Andrew
Published: September 2023

Tevva has entered a partnership with battery recycling specialist Ecobat for the repair, repurposing and recycling of its lithium-ion batteries.
Revved Up In Luton
Authors: Ford Jason
Published: September 2023

New extensions to Vauxhall Motors’ Luton plant revealed a world of testing innovations