bluuebunny/crossref_metadata_2025 huggingface dataset:
(280) Innovative Team Approach to Sexual Health Counseling; Partnership of Urology, Infectious Disease and Pelvic Floor Therapy to Increase Access to Care
Authors: Jackson C , Hakky T , Tims-Cook Z , Frank L
Published: February 2024

Introduction

Despite the prevalence and availability of HIV (Pre-exposure Prophylaxis i.e., PrEP), the number of new AIDS diagnoses continues to outpace treatment and prevention. Stigma, discrimination, lack of access continue to remain significant barriers in the prevention of new HIV infections, especially amongst vulnerable groups (i.e. LGBTQ, women, and minorities). We present a novel strategy to address a comprehensive approach to sexual health medicine through the partnership of Urology, Infectious Disease, and Pelvic Floor therapy.

Objective

Men who have sex with men (M2M) who either currently use or have an interests in use of pre-exposure prophylaxis (PrEP) continue to face barriers with respect to access to care, stigma, and or availability of effective partnerships to address and offer culturally competent care. The objective of this study is to assess attitudes and barriers to conventional and novel PrEP offerings as well as to present an innovative team approach between Urology, Infectious Disease (ID) Medicine and Pelvic Floor Therapy to offer a comprehensive multidisciplinary approach to treatment and care.

Methods

We enrolled 6 candidates (M2M) into our PrEP clinic which offers the Apretude (Cabotegivir 600 mg/3mL) injections. We conducted interviews, focused groups, and provided questionnaires to detail their experiences, beliefs, attitudes, barriers, and considerations for therapy.

Results

First, the preliminary results and findings of our study has shown that the needs, considerations, and beliefs of M2M is more varied, nuanced, and divergent with need to characterize, understand, and offer more specific culturally competent care in Sexual Health Medicine with respect to PrEP. Second, M2M designation does not exclude men from having sex with the opposite gender. These man preferred injectable PrEP option. Third, the partnership of Urology, Infectious Disease and Pelvic Floor Therapy reduced barriers, increased access to care, and decreased stigma as M2M felt more comfortable in the Urological setting.

Conclusions

M2M patients stated hesitancy, increased stigma and “shame” in going to ID for sexual health. Additionally, for M2M who have sexual partners of the opposite sex this would further increase stigma. Urology practices are accustomed to having discussions surrounding men’s sexual health with reduced stigma. The combination of Infectious Disease has presented an innovative partnership to discuss, prevent, and treat sexuallly transmited infections amongst M2M.

Disclosure

No.
(282) Longitudinal Impact of Inflatable Penile Prostheses on Patients’ Body Image and Sexual Satisfaction
Authors: Kassab J , Saffati G , Naeem T , Khera M , Lipshultz L
Published: February 2024

Introduction

Inflatable penile prostheses (IPP) are used in a multitude of urologic disorders including Peyronie’s disease and medication-refractory erectile dysfunction. The IPP procedure is performed by inserting a penile pump to help generate and maintain penile erections.

Objective

To analyze self-perceptions and body dysmorphia of patients who have had an IPP placement.

Methods

An electronic survey was delivered through REDCap to patients who had undergone an IPP placement and who were identified using diagnosis codes associated with the procedure within the 06/01/2007 - 09/01/2022 observation interval. The survey asked each patient about their comfort with their penis’s appearance and usage in sexual settings, with answer choices corresponding to a five-point Likert-Scale in addition to a free-form response section. T-tests were utilized to compare mean respondent scores before and after IPP placement using SPSS software.

Results

436 surveys were sent out, and 69 responses were received (15.83%). When asked about comfort with their penis’s appearance, the respondents had a slight, non-significant increase after IPP (T-value = -0.771, p = .221). In response to inquiring about the patient’s ease using their penis in sexual relationships, patients reported an increase due to their IPP placement (T-value = -3.00, p = .0016). When reverse coded, patients demonstrated a great decrease in concern about their penis in social situations after the IPP procedure (T-value = -3.88, p = .00008). The total score of all questions before and after IPP placement increased by an average of 15.1% (T-value = -3.21, p = .00082). 44.78% of respondents noted a positive change in how the IPP changed how they view themselves and their body; 40.30% noted neutral change and 14.93% noted a negative change. In response to how the IPP has affected sexual and romantic relations, 68.66% reported a positive difference after IPP, 16.42% were neutral, and 14.93% reported a negative difference.

Conclusions

Our data demonstrate that IPPs have a stronger impact on sexual function, as opposed to body image; however, the vast majority of patients felt a positive or neutral change of how they view themselves and their bodies post-IPP. These findings support the continued use of IPPs in patients who are non-responsive to previous erectile dysfunction treatments.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Larry Lipshultz: AbbVie (Consultant) American Medical Systems/Boston Scientific (Speaker) Augmenta LLC (Stockholder) Aytu BioScience (Consultant) Contraline, Inc. (Consultant) Endo Pharmaceuticals (Consultant/Speaker) Inherent Biosciences (Advisor) Lipocine (Consultant); Mohit Khera: Consultant- AbbVie, Halozyme, Clarus, Metuchen, Acerus, Boston Scientific, Coloplast, Endo.
(298) AUA vs AI: An Inquiry into Testosterone Guidelines
Authors: Katlowitz Y , Khurgin J , Leelani N
Published: February 2024

Introduction

ChatGPT is an artificial intelligence with an accessible user interface that allows for conversational input. It uses deep learning, a subset of machine learning based on artificial neural networks, to “speak” to the user. Patients and clinicians alike have been querying ChatGPT with medical questions, and recent publications have shown that the validity of responses vary. Limited information is available pertaining to ChatGPT’s capacity to accurately discuss testosterone management and deficiency. It is imperative for the medical community to be aware of potentially accurate or inaccurate information sources. This project is designed to assess ChatGPT’s clinical competency compared to the American Urologic Association (“AUA”) guidelines regarding the evaluation and management of testosterone deficiency.

Objective

To assess the competency of ChatGPT to answer general and clinical questions related to testosterone deficiency and replacement compared to the AUA guidelines.

Methods

The AUA guidelines for evaluation and management of testosterone deficiency include 31 main points. Each point was prompted to ChatGPT in the form of a question, accompanied by requests for validation of information, providing further information, or clinical next-step recommendations. The answers were then sorted into 3 categories all relative to the AUA guidelines, being accurate and complete, (AC), accurate but incomplete (AI), and incorrect or misleading (IM).

Results

Of the 31 guideline-based questions queried, 22/31 (71%) were AC, 4/31 (13%) were AI, and 5/31 (16%) were IM. The highest number of AI answers pertained to treatment related queries. The highest number of IM answers pertained to counseling, particularly on commonly contested topics, such as the relationship between testosterone and prostate cancer or cardiovascular health.

Conclusions

When queried about the evaluation and management of testosterone deficiency, ChatGPT offered complete and accurate answers in 71% of cases. It had increased accuracy of even up to 100% when answering regarding firmly established or more binary topics, such as diagnosis requirements or recommended adjunct testing. As such, patients and providers may consider using ChatGPT as an ancillary resource for uncomplicated or firmly established testosterone related queries. However, it did much more poorly when discussing more contested topics such as testosterone’s relationship to prostate cancer, or when approaching elements of medicine that require a more personalized human touch, such as counseling. While ChatGPT may be helpful in the base or binary matters, interpersonal and patient specific matters are best handled by experts in the field.

Disclosure

No.
(325) A Descriptive Analysis of Digital Resources for Educating Sickle Cell Patients About Priapism
Authors: Thorogood SL , Flores JM , Mulhall JP
Published: February 2024

Introduction

Men with sickle cell disease (SCD, HbSS or HbSC hemoglobinopathy) are at increased risk of priapism via increased cell surface adhesion molecule expression and blunted vasodilatory responses to nitric oxide. Previous studies have suggested that priapism knowledge is poor among men with SCD; however, studies have yet to characterize public-facing priapism educational resources.

Objective

To describe key features of online educational resources targeted to priapism patients with SCD in the US.

Methods

In March 2023, we searched the following keywords and terms using the Google search engine and search features within Facebook, YouTube, and TikTok: “painful erection”, “priapism”, “priapism patient education”, “priapism for patients”, and “priapism sickle cell patient”. Searches were performed via a computer located in Manhattan, New York and in the English language only.

Results

Google search results differed considerably when searching “painful erection” versus “priapism” and are depicted in Table 1: the former directed users to telehealth commercial websites while the latter directed users to websites hosted by healthcare and professional organizations and medical reference sites which primarily discussed etiology and need for prompt diagnosis of the condition. YouTube search results overwhelmingly focus on discussion of diagnosis, pathophysiology, and management of priapism, and most of these appear designed for a medical or medically-literate audience; however, when querying for “priapism sickle cell patient”, users are directed to patient testimonial or documentary style videos. The results of a Facebook pages search seemed intended for student education and associated with low quality media material. An equivalent search performed on Tik Tok yields videos with noticeably different characteristics, namely: starring and created by “younger” urologists and hematologists, depicting a diverse cohort of providers and patients, written/spoken in Spanish and Portuguese, informal dialogue, increased use of Q&A format. Compared to YouTube videos, TikTok posts were more recent, received more views, and were associated with more comments.

Conclusions

Our exploratory search for priapism educational resources revealed differences in content, tone, and format between online sites and mobile platforms. Based on view and comment statistics, it appears as though mobile platforms such as TikTok have an increasing role in disseminating knowledge about priapism. However, it remains unclear as to whether individual modalities are well-suited to deliver information in a specific disease phase (e.g. preventative, acute, or chronic). Importantly, the impact of word-of-mouth and private provider-to-patient interactions cannot be estimated by this methodology.

Disclosure

No.
(331) A Novel Epidemiological Approach to Geographically Mapping Selective Androgen Modulator Receptors (SARMs) in the United States Through Google Trends
Authors: Hammad MAM , Khan A , Yafi FA , Barham DW
Published: February 2024

Introduction

Selective androgen receptor modulators (SARMs) are a class of compounds known for their ability to exert agonistic and/or antagonistic effects on androgen receptors. Although there are currently no U.S. Food and Drug Agency-approved indications for SARMs, investigators are exploring the potential uses for these compounds.

Objective

This study aims to comprehensively assess the level of public interest in SARMs over the past ten years.

Methods

Google Trends data spanning the past decade was meticulously analyzed to evaluate the public interest in specific SARMs, (Ostarine, LGD-4033, GSK2881078, PF-06260414, AC-262,356), in comparison to testosterone replacement therapy and androgen replacement therapy. As benchmarks, control search terms, such as “news," "weather," "sports," "Google," "Netflix," and "Facebook" were employed.

Results

The 10 geographical areas with the highest SARM search rate were military instillations or towns surrounding military instillations. Within these areas, the search interest accounted for a median of 4.5% of the control search interest, while the areas displaying the greatest interest reached a substantial 12%. It is noteworthy that even in the presence of an awareness campaign against the use of unapproved supplements (such as SARMs) by the Department of Defense, SARM use steadily increased in close proximity to these identified areas. In contrast, metropolitan areas unrelated to military installations accounted for less than 1% of the control search interest. Search interest for “Testosterone” was 6% nationally, however, in areas associated with high SARM interest, search interest was 6.8%.

Conclusions

Our results suggest there is a higher rate of internet searches for SARMs at or near military instillations compared to other geographic regions. Since these medications are not FDA approved and still undergoing clinical investigation, the side effect profiles are not well understood potentially leading to adverse events. Further work is needed to understand if this increased interest translates to use of SARMs among our service members.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Advisory board and speaker for Coloplast; consultant for Cynosure; advisory board and speaker for Halozyme; intellectual property with Masimo; advisory board for Promescent; consultant for Sprout; advisory board for Xialla.
(342) Glans Augmentation and Glans – Bulbospongiousus Reflex
Authors: Aglan A
Published: February 2024

Introduction

The creation of a barrier at the level of glans by the bulking agents blocking accessibility and inhibiting the tactile stimuli to reach the dorsal nerve of penis (branch of pudendal nerve) receptors is the theory behind the effect of hyaluronic acid in the field of premature ejaculation. Clinically there is a doubt about that as filler injection in frenular delta (most sensitive area in penis) and in G-spot at female accelerates time of ejaculation, some cases with history of failed dorsal neurectomy my response to hyaluronic acid injection, filler or fat injection in penis shaft doesn’t improve ejaculation time, in the opposite side implants like Elist`s implant (pneuoma) or other solid inner condoms improves premature ejaculations. The cause is that the hard implant masks pressure on the corona thus inhibits glans – bulbospongiosus reflex which delays the second phase of ejaculation, ring application at coronal sulcus delays ejaculation for the same reason, filler or fat is not solid and doesn’t resist pressure and compressed due to pressure. In glans area compression is not possible due to tight space at glans mucosa.

Objective

Explanation why glans augmentation by filler delays ejaculation.

Methods

Seven patients with history of previous glans penis augmentation (hyaluronic acid) with good response (12-14 months ago) instead of re-injection, Alaa Aglan operation was done, cutting of bulbospongiosus muscles bilaterally plus frenular delta excision 4 months post-operative all patients were injected by hyaluronic acid at glans.

Results

All patients were satisfied by the operation, 3 months post-operative the gained time was calculated for each patient (by himself) then hyaluronic acid injection was done. No change in time was reported in all patients and they reported that it was still the same time gained after surgery despite all patients reported satisfactory results after previous injection one year ago.

Conclusions

Inhibition of glans – bulbospongiosus reflex is the main cause to delay ejaculation after glans augmentation.

Disclosure

No.
(374) Comparing the Species Richness in Infectious versus Mechanical Failure Cases in Secondary Penile Prostheses Surgeries
Authors: Henry G , Henry C , Hollenbach S , Phillips C , Diaz N , Chung P
Published: February 2024

Introduction

Inflatable penile prosthesis (IPP) is a third-line treatment for treating erectile dysfunction in men. However, complications in the prostheses can cause the patient to undergo secondary penile prostheses (PP) surgery. Infection is a feared complication of IPP surgery and has a higher risk at secondary surgery. Next-generation sequencing (NGS) compares DNA to identify species and report relative abundances. NGS is an established method of microbial detection and identification in Orthopedics, Otolaryngology, wound care, and infectious disease. In prosthetic urology, NGS has been shown to provide better and more acute information than traditional cultures.

Objective

This study aims to identify species richness (i.e., number of species occurring in a sample) in penile prostheses that needed revision surgery in comparison between infectious etiology and mechanical failure cases. We hypothesize that, during secondary surgery, mechanical failure IPPs will display a greater species richness than infectious caused.

Methods

This study comprised 126 patients from 2 different centers that underwent revision PP surgery for either infectious or non-infectious issues. Upon entering the pump space (wiped pump/tubing/capsule) during surgery, 2 swabs specimens were collected and sent to the institutional laboratory for routine culture and the other to MicrogenDx for NGS testing. During the specimen evaluation, the species richness of each specimen was recorded and sorted based on the reason for revision PP surgery. ANOVA was used to test effects of ethnicity, age, diabetes status, implant duration, and year of implant removal.

Results

The demographics of the 126 patients consisted of a median age of 69 (1st quartile= 61, 3rd quartile= 76), of which 84 were White, 41 were African American, and 1 was of unknown ethnicity. 104 patients (83%) needed revision PP surgery due to mechanical failure causes, and 22 patients (17%) needed revision PP surgery due to infectious causes. From the data collected and analyzed, patients who needed revision PP surgery due to mechanical failure showed a larger species richness in the collected biofilm than patients who needed surgery due to infectious reasons (Figure 1; p= 0.04).

Conclusions

NGS has been shown to accurately represent the characteristics of biofilm present in secondary PP surgery, supported by similar results in Ortho and ENT literature. When the PP was clinically infected, NGS identified less species richness in biofilm from revision PP surgery than non-infectious PP biofilm which is consistent with infections being caused by a few key pathogens per case.

Disclosure

Yes, this is sponsored by industry/sponsor: MicroGenDX.

Clarification: Industry funding only - investigator initiated and executed study.

Any of the authors act as a consultant, employee or shareholder of an industry for: MicroGenDX, Irrisept.
(389) Incidence of Venous Thromboembolism and Hematoma Following Placement of Inflatable Penile Prosthetic: Safety of Perioperative Subcutaneous Heparin
Authors: Good J , Pereira TA , Crist N , Saldivar R , Bernie HL
Published: February 2024

Introduction

Patients undergoing inflatable penile prosthetic (IPP) surgery are generally at a higher risk for cardiovascular (CV) complications such as venous thromboembolism (VTE) following surgery, due to pre-existing comorbidities, such as age, obesity, smoking status, and vascular disease, which are associated with erectile dysfunction (ED). The use of perioperative subcutaneous heparin (SqH) along with a surgical drain was shown to be effective in preventing VTE in IPP patients, without increasing hematoma formation. Not all prosthetic surgeons utilize surgical drains postoperatively and this is an unaddressed area of perioperative IPP surgical management. The American Urologic Association (AUA) and European Association of Urology (EAU) perioperative VTE guidelines do not address VTE risk with IPP surgery.

Objective

In this study we aim to assess the safety and efficacy of perioperative SqH in preventing VTE in IPP patients without the use of a surgical drain.

Methods

This was a retrospective review from January 2021-July 2023 of patients who underwent IPP placement or revision and replacement at a single institution. Patient demographics, comorbidities, Caprini risk factor scores, VTE risk factors, hematoma incidence, and 90-day post-operative complications were reviewed. Statistical analyses were performed comparing these variables in men who received SqH and those who did not.

Results

We reviewed data for 240 patients. Of the 240, 53% (n=127) received perioperative SqH. The incidence of VTE was 0.9% (1/113) in the non-SqH group, no VTE was recorded in the group receiving heparin. There was no statistical difference in hematoma formation between groups (SqH 5.5% vs. non-SqH 6.2% p=.898). Hypertension prevalence was found to be higher in the SqH group (p=.045). There was no statistical significance between other comorbidities including diabetes (p=.343), average BMI (p=.078), vascular disease (p=.155), immunosuppressed status (p=.604), smoker status (p=.530), history of malignancy (p=.513), COPD (p=.084), MI (p=.820), CVA/TIA (p=.158), hyperlipidemia (p=.157), and heart failure (p=.244). Average operative time was found to be slightly higher in the non-SqH group (SqH 78.1 minutes vs. non-SqH 85.9 minutes p=.032). Caprini risk factor scores were similar (SqH 6.79 vs. non-SqH 6.82 p=.474) between groups. 94% of the patients in this study were considered high risk for VTE (≥5 Caprini Risk factor score).

Conclusions

Perioperative SqH use without placement of a surgical drain was found to be safe and effective in preventing VTE in patients undergoing IPP surgery. There was no increased risk of hematoma formation or post-operative complications between the groups. Perioperative SqH should be considered in all patients undergoing IPP surgery.

Disclosure

No.
(399) Reducing Out-of-Pocket Expenses for Peyronie’s Disease Therapy with a Novel Penile Traction Device
Authors: Dori L , Sura A , Panagis G , Welliver R
Published: February 2024

Introduction

Penile traction therapy (PTT) has gained popularity as a nonsurgical approach to penile lengthening and curvature correction in those with Peyronie's disease (PD). PD is an acquired fibrotic plaque that develops within the tunica albuginea and causes penile curvature, which can have significant physical and mental health consequences. Due to the sensitive nature of this disease presentation and the large number of unidentified or misdiagnosed people, current prevalence estimations in the US are around 11%. PD therapies aim to correct penile curvature while also addressing erectile dysfunction and pain. Common PD therapies include oral medications, intralesional penile injections, surgery, and stretching techniques. When deciding which therapies to pursue, disease severity, costs, compliance, and patient access to facilities and trained providers must be considered. Of these therapies, PTT with a penile traction device (PTD), although uncovered by insurance, has proven to be one of the most cost-effective PD treatments. While an effective treatment in some men, PTDs cost hundreds of dollars out-of-pocket.

Objective

Our project aims to address the financial and practicality concerns of penile traction therapy by creating an affordable and comfortable PTD.

Methods

Our PTD offers precise, dial-adjustable tensioning and penile holding systems with contoured penile holding plates lined with silicone cushions for improved grip and comfort. Our PTD is 3D-printed using polylactic acid (PLA) and medical-grade silicone. To assess our efforts in improving comfort, we measured holding capacity under tension at increasing amounts of penile clamping. We compared our silicone-lined clamp to an all-plastic clamp: this test served as a surrogate for comfort. By improving its grip on the penis, patients can secure their penis with minimal clamping force, thereby improving comfort.

Results

Our literature search revealed that the average cost for PTDs recommended by urologists for patients with PD was approximately $883. Our PTD currently costs $6.38 to manufacture and assemble. We found a statistically significant (p=0.000276) increase in the tension-holding capacity of the silicone-lined clamp compared to that of the all-plastic clamp. This demonstrates that our silicone-lined clamp may exert less clamping force on the penis, thereby providing patients with the same stretching and a more comfortable grip.

Conclusions

Future directions include exploring urologists' perception of PTT for PD and their PTD recommendation patterns, refining our current PTD model, and clinically testing our device compared to those currently available.

Disclosure

No.
Saffron-cowled Blackbirds’ reduced nest success in Argentina’s agricultural land highlights the importance of non-agricultural habitat for its conservation
Authors: Pucheta Florencia M , Pereda Inés M , Di Giacomo Adrián S
Published: February 2024

The Saffron-cowled Blackbird (Xanthopsar flavus) is a globally endangered icterid endemic to the southern South American grasslands. Temperate grasslands are among the most threatened ecosystems in South America due to their high rate of land use change. In northeastern Argentina, over the last century, the conversion of natural grasslands to livestock farming, croplands, and afforestation has resulted in significant losses of breeding habitat for the Saffron-cowled Blackbird. Consequently, it has suffered severe populational declines, and its remaining populations are fragmented. In order to understand the impact of agricultural systems on the Saffron-cowled Blackbird populations, we studied its breeding biology (clutch size, hatching success, nestling production, and fledgling success) and the main parameters that influence nest survival rate in five breeding habitat types. During the breeding seasons of 2015 to 2019, we located nests and monitored their fate. We found that the cumulative probability of nest survival over the entire nesting cycle (i.e. laying, incubation, and chick rearing) was 0.06, and was lower for nests situated in grazed land covers. Conversely, nest survival was greater in breeding sites without agricultural use, particularly in marshes. Predation was the main cause of nest failure (76%), followed by brood parasitism (10%), and trampling by cattle and agricultural machinery (6%). Brood parasitism rates were higher in grazed paddocks, contributing together with predation to the failure of nests in this habitat. Our findings indicate a negative impact of livestock ranching on Saffron-cowled Blackbird reproduction. Non-agriculture habitats, such as wetlands and flooded areas, are important as refuges for nesting. Thus, the creation of breeding refuges (non-productive sites) within agricultural matrices, in association with biodiversity-friendly agricultural practices, is crucial to ensure the Saffron-cowled Blackbird’s maintenance.
Sigmoidal relationship between liver fat content and nonalcoholic fatty liver disease in Chinese adults
Authors: Yu Pingping , Yang Huachao , Li Hu , Mei Ying , Wu Yuanyuan , Cheng Hongfeng , Su Huiru , Deng Yueling , Jiang Tao , He Zhongxiang , Hu Peng
Published: February 2024

Purpose

To explore the relationship between liver fat content (LFC) and nonalcoholic fatty liver disease (NAFLD) and determine the new threshold of LFC to diagnose NAFLD.

Methods

The data from questionnaire survey, general physical examination, laboratory examination, and image examination were collected. Multivariate regression analysis, receiver operating characteristic curve analysis, smooth curve fitting, and threshold effect analysis were performed using the R software to investigate the relationship between LFC and NAFLD and to identify the new threshold of LFC to diagnose NAFLD.

Results

The prevalence of NAFLD was 30.42%, with a significantly higher prevalence in men than in women. Regression analyses demonstrated that LFC odds ratio [95% confidence interval (CI)] was 1.28 (95% CI: 1.24–1.31) in fully-adjust model. Analysis of the LFC quartile, with Q1 as a reference, revealed that the odds ratios of NAFLD were 1.47 (95% CI: 1.08–1.99), 2.29 (95% CI: 1.72–3.06), and 10.02 (95% CI: 7.45–13.47) for Q2, Q3, and Q4 groups, respectively. Smooth curve fitting and threshold effect analysis displayed a nonlinear relationship between LFC and NAFLD, and the threshold was 4.5%. The receiver operating characteristic curve indicated that when LFC was 4.5%, the area under curve (95% CI) was 0.80 (0.79–0.82), and the sensitivity and specificity of LFC in diagnosing NAFLD were 0.64% and 0.82%, respectively.

Conclusion

The relationship between LFC and NAFLD was sigmoidal, with an inflection point of 4.5%.
The evaluation of cEEGrids for fatigue detection in aviation
Authors: van Klaren Carmen , Maij Anneloes , Marsman Laurie , van Drongelen Alwin
Published: February 2024

Operator fatigue poses a major concern in safety-critical industries such as aviation, potentially increasing the chances of errors and accidents. To better understand this risk, there is a need for noninvasive objective measures of fatigue. This study aimed to evaluate the performance of cEEGrids, a type of ear-EEG, for fatigue detection by analyzing the alpha and theta power before and after sleep restriction in four sessions on two separate days, employing a within-participants design. Results were compared to traditional, highly validated methods: the Karolinska Sleepiness Scale (KSS) and Psychomotor Vigilance Task (PVT). After sleep restriction and an office workday, 12 participants showed increased alpha band power in multiple electrode channels, but no channels correlated with KSS scores and PVT response speed. These findings indicate that cEEGrids can detect differences in alpha power following mild sleep loss. However, it should be noted that this capability was limited to specific channels, and no difference in theta power was observed. The study shows the potential and limitations of ear-EEG for fatigue detection as a less invasive alternative to cap-EEG. Further design and electrode configuration adjustments are necessary before ear-EEG can be implemented for fatigue detection in the field.
Persistence of Fungicides Applied to Control Snow Mold of Turfgrass as Influenced by Snow Cover and Antitranspirants
Authors: Hockemeyer Kurt , Gonzalez Vazquez Amarilys , Koch Paul L.
Published: February 2024

Turfgrass managers rely on fungicides to suppress snow mold diseases in areas with persistent snow cover, which are commonly applied once or twice in late fall prior to snow cover. Fungicide applications targeting snow mold are expected to control snow mold diseases for the duration of winter; however, climate change is increasing the frequency of winter rainfall and snowmelts and may alter the duration of snow mold control. A 3-year study was conducted in Madison, WI, to assess the impact of snow cover and antitranspirants on the persistence of the commonly used fungicides chlorothalonil and propiconazole. Snow cover, fungicide treatment, and the use of antitranspirants had minimal impacts on fungicide persistence and disease control. The most important factors influencing persistence of the fungicides were snowmelt and winter rainfall events, yet antitranspirants demonstrated modest evidence of extending chlorothalonil persistence in certain years. These results demonstrate that increasing snowmelt and winter rainfall events associated with climate change will increase dissipation of fungicides used for snow mold suppression, which will likely impact disease control.

[Formula: see text] Copyright © 2024 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
MSE FINDR: A Shiny R Application to Estimate Mean Square Error Using Treatment Means and Post Hoc Test Results
Authors: Garnica Vinicius C. , Shah Denis A. , Esker Paul D. , Ojiambo Peter S.
Published: February 2024

Research synthesis methods such as meta-analysis rely primarily on appropriate summary statistics (i.e., means and variance) of a response of interest for implementation to draw general conclusions from a body of research. A commonly encountered problem arises when a measure of variability of a response across a study is not explicitly provided in the summary statistics of primary studies. Typically, these otherwise credible studies are omitted in research synthesis, leading to potential small-study effects and loss of statistical power. We present MSE FINDR, a user-friendly Shiny R application for estimating the mean square error (i.e., within-study residual variance, [Formula: see text]) for continuous outcomes from analysis of variance (ANOVA)-type studies, with specific experimental designs and treatment structures (Latin square, completely randomized, randomized complete block, two-way factorial, and split-plot designs). MSE FINDR accomplishes this by using commonly reported information on treatment means, significance level (α), number of replicates, and post hoc mean separation tests (Fisher’s least significant difference [LSD], Tukey’s honest significant difference [HSD], Bonferroni, Šidák, and Scheffé). Users upload a CSV file containing the relevant information reported in the study and specify the experimental design and post hoc test that was applied in the analysis of the underlying data. MSE FINDR then proceeds to recover [Formula: see text] based on user-provided study information. The recovered within-study variance can be downloaded and exported as a CSV file. Simulations of trials with a variable number of treatments and treatment effects showed that the MSE FINDR-recovered [Formula: see text] was an accurate predictor of the actual ANOVA [Formula: see text] for one-way experimental designs when summary statistics (i.e., means, variance, and post hoc results) were available for the single factor. Similarly, [Formula: see text] recovered by the application accurately predicted the actual [Formula: see text] for two-way experimental designs when summary statistics were available for both factors and the sub-plot factor in split-plot designs, irrespective of the post hoc mean separation test. The MSE FINDR Shiny application, documentation, and an accompanying tutorial are hosted at https://garnica.shinyapps.io/MSE_FindR/ and https://github.com/vcgarnica/MSE_FindR/ . With this tool, researchers can now easily estimate the within-study variance absent in published reports that nonetheless provide appropriate summary statistics, thus enabling the inclusion of such studies that would have otherwise been excluded in meta-analyses involving estimates of effect sizes based on a continuous response.
Self-Blame Attribution
Authors: Minchew Leigh Anne
Published: February 2024

The attribution of self-blame for a negative physical health outcome can lead to further deterioration of one's mental and spiritual state. Using Walker and Avant's eight-step model for concept analysis, self-blame attribution is explored following the diagnosis of a human papillomavirus-related cancer in women. Conceptual case examples provide application of the concept to patient situations. Spiritual assessment tools for nurses caring for those who evidence self-blame are provided.
Local Recurrence-Free Survival After TaTME: A Canadian Institutional Experience
Authors: Hershorn Olivia , Ghuman Amandeep , Karimuddin Ahmer A. , Raval Manoj J. , Phang P. Terry , Brown Carl J.
Published: February 2024

BACKGROUND:

Transanal total mesorectal excision is a novel surgical treatment for mid to low rectal cancers. Norwegian population data has raised concerns about local recurrence in patients treated with transanal total mesorectal excision.

OBJECTIVE:

Our objective was to analyze local recurrence and disease-free survival in patients treated by transanal total mesorectal excision for rectal cancer at a high-volume tertiary center.

DESIGN:

This is a retrospective study utilizing a prospectively maintained institutional transanal total mesorectal excision database. Patient demographics, treatment and outcomes data were analyzed. Local recurrence, disease-free, and overall survival were analyzed using Kaplan-Meier analysis.

SETTINGS:

The study was conducted at a single academic institution in Vancouver, Canada.

PARTICIPANTS:

All patients treated by transanal total mesorectal excision for rectal adenocarcinoma between 2014-2022 were included.

MAIN OUTCOME MEASURES:

The primary outcome was local recurrence-free survival.

RESULTS:

Between 2014 and 2022, 306 patients were treated by transanal total mesorectal excision at St. Paul’s Hospital. Of these, 279 patients met inclusion criteria. Mean age was 62 years (SD ± 12.3) and 66.7% of patients were male. Restorative resection was achieved in 97.5% of patients with a conversion rate from laparoscopic to open of 6.8%. Composite optimal pathological outcome was 93.9%. The median follow-up was 26 months (interquartile range 12 – 47) and 82.8% achieved reestablishment of gastrointestinal continuity to date. The overall local recurrence rate was 4.7% (n = 13). The estimated 2-year local recurrence-free survival was 95.0% (95% CI: 92 - 98) and 94.5% at 5 years (95% CI: 91 – 98).

LIMITATIONS:

Limitations include retrospective nature of the study and generalizability of a Canadian population.

CONCLUSIONS:

Recent European data has challenged the presumed oncologic safety of transanal total mesorectal excision. While the learning curve for this procedure is challenging and poor outcomes are associated with low volume, this high volume single-center study confirms acceptable oncologic outcomes consistent with the current standard. See Video
Incidence of Bacteremia, Infective Endocarditis, or Prosthetic Joint Infection in Dermatologic Surgery: A Systematic Review
Authors: McKesey Jacqueline , Mazhar Momina , Alam Murad , Srivastava Divya , Nijhawan Rajiv I.
Published: February 2024

BACKGROUND

Prophylactic antibiotic therapy is widely used in dermatologic surgery to prevent surgical site infections and bacteremia, which can lead to prosthetic joint infections (PJI) and infective endocarditis (IE) in high-risk populations.

OBJECTIVE

To evaluate the incidence of bacteremia, PJI, and IE after dermatologic surgery and assess the current evidence for antibiotic prophylaxis.

MATERIALS AND METHODS

A search of the computerized bibliographic databases was performed using key terms from the date of inception to March 21, 2021. Data extraction was performed independently by 2 data extractors.

RESULTS

The review resulted in 9 publications that met inclusion criteria, including 5 prospective cohort studies and 4 case reports or case series. The prospective studies reported a wide range of bacteremia incidence (0%–7%) after dermatologic surgery. No cases of PJI resulting directly from cutaneous surgery were identified, and only 1 case series reported IE after various skin procedures.

CONCLUSION

These findings suggest a low rate of bacteremia and a lack of direct evidence linking dermatologic surgery to PJI or IE. The scarcity of published data on this topic is a limitation, highlighting the need for further research, particularly randomized controlled trials, to guide antibiotic prophylaxis recommendations.
Symptomatology and Quality of Life of Older People With HIV and Comorbid Chronic Obstructive Pulmonary Diseases From an HIV Clinic in Birmingham, Alabama
Authors: Byun Jun Y. , Chapman Lambert Crystal , Fazeli Pariya L. , Iyer Anand S. , Batey D. Scott , Vance David E.
Published: February 2024

Psychological symptomatology and quality of life (QoL) have been studied in older people with HIV (PWH) and those with chronic obstructive pulmonary disease (COPD), respectively, but there is a dearth of studies in older PWH with COPD. Our study compared depressive symptoms, anxiety, and QoL between older PWH with and without COPD using data from an HIV clinic in Birmingham, Alabama, from January 2018 to February 2020. Data on depressive symptoms (Patient Health Questionnaire-9), anxiety (Patient Health Questionnaire-5 Anxiety), and QoL (EuroQoL-5 Dimension) were analyzed. Among 690 PWH aged 50 years or older, 102 individuals (14.8%) had COPD. Significant differences were found between the two groups in depressive symptoms and components of QoL (e.g., mobility, self-care, usual activities, and pain/discomfort), but not in anxiety and general health. Experiencing COPD may worsen depressive symptomatology and QoL in older PWH, highlighting the need for tailored health care and research for this population.
Navigating the pathway to advanced practice: A grounded theory of nurse practitioner role transition in a fellowship
Authors: Hande Karen , Jackson Heather
Published: February 2024

Background:

Greater attention to the transitional period for advanced practice nurses has urged health care organizations and employers to implement fellowships. Currently, the theoretical process of nurse practitioner (NP) role transition from the essential perspectives of NP fellows does not exist.

Purpose:

The purpose of this study was to construct a middle-range theory grounded in reality of an NP fellowship environment that explains how NPs transition to their new role.

Methodology:

Following Charmaz's constructivist methodology, 11 NPs who transitioned to practice in a fellowship were interviewed.

Results:

“Navigating the Pathway to Advanced Practice: A Grounded Theory of Nurse Practitioner Role Transition in a Fellowship” emerged from the data and is composed of through five phases: (1) mapping a path, (2) stepping onto the trailhead, (3) navigating the trailway, (4) gaining traction, and (5) summiting.

Conclusions:

The resulting middle-range theory is the first in the nursing literature that conceptualizes meaning about NP role transition in a fellowship. This process occurs in the contextual factor of a realm of support that includes growth, value, lifelong learning, and readiness. Throughout this process, NPs build competence and confidence that advances them to summit, or transition, to their NP role at the completion of an NP fellowship.

Implications:

This discovery will fill the research gap pertaining to best practice interventions in support of NPs during role transition in fellowships. Understanding how NPs transition to their new advanced practice roles may inform organizations on how to structure fellowships that support learning, encourage confidence, and enhance competence.
Second Malignant Neoplasms Following Treatment for Hepatoblastoma: An International Report and Review of the Literature
Authors: Trobaugh-Lotrario Angela , Watanabe Kenichiro , O’Neill Allison F. , Dembowska-Bagińska Bozenna , Häberle Beate , Murphy Andrew , Hiyama Eiso , Czauderna Piotr , Meyers Rebecka L. , Langham Max , Feusner James
Published: February 2024

Treatment intensification has improved survival in patients with hepatoblastoma (HB); however, these treatments are associated with an increased risk of late effects, including second malignant neoplasms (SMNs). Data is limited regarding SMNs following HB treatment. Cases of SMNs following treatment for HB reported in the literature and from personal communication were analyzed to further assess this late effect. Thirty-eight patients were identified. The median age at diagnosis of HB was 16 months (range: 3 to 168 mo). All patients had received a platinum agent, and almost all had anthracycline exposure. The SMNs reported were hematopoietic malignancies (n=19), solid tumors (n=12), and post-transplant lymphoproliferative disorder (n=7). Of the 36 patients with outcome data, 19 survived. SMNs following HB treatment were primarily seen in patients with chemotherapy exposure, a history of liver transplantation, hereditary tumor predisposition syndromes, and/or a history of radiation treatment. Hematopoietic malignancies were the most common SMN reported in this cohort and were diagnosed earlier than other SMNs. Prospective collection of data through a companion late effects study or international registry could be used to further evaluate the rates and risks of SMNs as well as tumor predisposition syndromes in patients treated for HB.
SIMULATED AEROMEDICAL EVACUATION EXACERBATES ACUTE LUNG INJURY VIA HYPOXIA-INDUCIBLE FACTOR-1α-MEDIATED BNIP3/NIX-DEPENDENT MITOPHAGY
Authors: Yin Chunli , Liu Xinyang , Ma Yujie , Tang Zibo , Guo Wenmin , Sun Bingbing , He Jingmei
Published: February 2024

Background

With the advancement of medicine and the development of technology, the limiting factors of aeromedical evacuation are gradually decreasing, and the scope of indications is expanding. However, the hypobaric and hypoxic environments experienced by critically ill patients in flight can cause lung injury, leading to inflammation and hypoxemia, which remains one of the few limiting factors for air medical evacuation. This study aimed to examine the mechanism of secondary lung injury in rat models of acute lung injury that simulate aeromedical evacuation.

Methods

An acute lung injury model was induced in SD rats by the administration of lipopolysaccharide (LPS) followed by exposure to a simulated aeromedical evacuation environment (equivalent to 8,000 feet above sea level) or a normobaric normoxic environment for 4 hours. The expression of hypoxia-inducible transcription-1 α (HIF-1α) was stabilized by pretreatment with dimethyloxalylglycine (DMOG). The reactive oxygen species (ROS) levels and the protein expression levels of HIF-1α, BNIP3 and NIX in lung tissue were measured.

Results

Simulated aeromedical evacuation exacerbated pathological damage to lung tissue and increased the release of inflammatory cytokines in serum as well as the ROS levels and the protein levels of HIF-1α, BNIP3, and NIX in lung tissue. Pretreatment with DMOG resulted in increases in the protein expression of HIF-1α, BNIP3 and NIX.

Conclusion

Simulated aeromedical evacuation leads to secondary lung injury through mitophagy.
Multiple systemic infections caused by Rhodococcus equi: a case report
Authors: Li Ning , Wu Changsheng , Cao Pengju , Chen Dongjie , Chen Falin , shen Xiuqing
Published: February 2024

Background.

Rhodococcus equi

is one of the most important causes of zoonotic infections from grazing animals. It poses a particular risk to immunocompromised individuals, including those who are undergoing long-term immunosuppressive therapy.

Case presentation. We report a case of

Rhodococcus equi

infection in a 65-year-old man with a medical history of diabetes, hypertension, and Adult Still’s Disease, currently taking long-term hormone therapy. The non-human immunodeficiency virus (HIV)-infected patient had blood, lung tissue, and sputum samples infected with

Rhodococcus equi

. His condition initially failed to improve despite multiple therapies, including vancomycin and meropenem. Although his symptoms improved after shifting his antibiotics to cover for the causative agent, he did not completely recover upon hospital discharge.

Conclusions. In recent years, the number of

Rhodococcus equi

cases has increased. This report describes a lethal case of

Rhodococcus equi

infection in a patient without HIV.