bluuebunny/crossref_metadata_2025 huggingface dataset:
"Imagining a Better Future through Place": Geographies of Memory and Heritage
Authors: Rhodes II Mark Alan , Wuepper Emma
Published: August 2023

While the current surge of geographies of memory and heritage may appear to be a recent phenomenon, foci on questions of and work within memory and heritage follow the field of geography across the twentieth century. Heritage, in particular, while often perceived to be the realm of the anthropologist, archaeologist, or historian, also owes much of its existence today as a field and practice to geography, particularly in the British emergence of heritage studies. Both memory and heritage center around concepts geographers often find core to our discipline: place, landscape, regional and national identity, nation and state building, travel and tourism, urban planning, and development. While certainly important to the broader study of geography, the discipline does not solely bind and hold these concepts. Regardless, neither memory nor heritage studies as fully emerged fields of study in their own right rest upon geography (or any single discipline) and have increasingly transitioned from their interdisciplinary beginnings toward what many hope to see as their transdiciplinary future. Even stepping back and exploring memory and heritage as concepts leads to the inevitable branching of conflicting and pluralized definitions as we wield the terms to discuss processes of shaping, interpreting, communicating, obscuring, and reworking how the past is framed; the intersecting space-time of material culture; or the social consciousness or constructedness of past experiences. Whether studying (or shaping) these concepts as social processes, material discourses, institutionalized structures, or community values, such work spans far beyond the geographer. While we hope to center the role of geographers, particularly in recent veins of memory and heritage research along the lines of absent presence, the more-than-representational, discussions of power, and creativity in practice, it’s necessary to step back and outline the broader intersections. With this flexibility and transdisciplinarity in mind, this article lays out four primary sections of direction: theoretical and methodological framings, the move toward the more-than-representational, critical geographies, and institutionalizations.
Perspectives in Geography Internships
Authors: Huynh Niem , Asnong Hans
Published: August 2023

The discipline of geography traditionally integrates experiential ways for students to engage with practice that complements the classroom teaching of geographic skills, perspectives, and content knowledge. Examples include field trips, fieldwork, study abroad, guest speakers, and participation in special events like “GIS Days.” In the last decade, learning in higher education has shifted from a focus only on theoretical teachings to include experiential learning that enhances application to the in-class materials outside of the classroom. A spectrum of hands-on learning opportunities is available to students in geography. Of these, the internship is a common example, whether accomplished within the community or on campus. Within geography, a student might be a member of a group that surveys campus transportation (e.g., undergraduate research); collects noise data in the neighborhood (e.g., field experience); or performs remote sensing or GIS modeling (e.g., lab experience). Usually, an internship is the result of concerted effort among the department, employer, and student, whether for program credit or no credit with or without remuneration. This encyclopedia article focuses on the topic of internship within the broad discipline of geography.
Immune-Related Diarrhea and Colitis in Non-small Cell Lung Cancers: Impact of Multidisciplinary Management in a Real-World Setting
Authors: Bonanno Laura , Lorenzi Martina , Massa Davide , De Nuzzo Mattia , Angerilli Valentina , Zingone Fabiana , Barberio Brigida , Russi Alberto , Girardi Fabio , Ferro Alessandra , Dal Maso Alessandro , Frega Stefano , Pasello Giulia , Dei Tos Angelo Paolo , Coppola Marina , Fassan Matteo , Savarino Edoardo Vincenzo , Guarneri Valentina
Published: August 2023

Introduction

Immune-related adverse events (irAEs) constitute a challenge in the clinical management of solid tumors. This study aims to collect real-world data on the occurrence of immune-mediated diarrhea and colitis (IMDC) in advanced non-small cell lung cancer (aNSCLC) treated with immune checkpoint inhibitors (ICIs) and to assess the clinical impact of a multidisciplinary approach (MDA) on IMDC management.

Methods

We retrospectively collected data on patients with aNSCLC consecutively treated with ICIs, either as single agent or in combination with chemotherapy, between September 2013 and July 2022. Among patients developing IMDC, we conducted blinded revision of colonic biopsies and evaluated the clinical impact of the introduction of MDA through predefined indicators.

Results

Among the 607 patients included, 84 (13.8%) experienced IMDC. Pathological review highlighted a high prevalence of microscopic colitis (28%), with a collagenous pattern linked to longer symptoms duration (P = .01). IMDC occurred more frequently in females (P = .05) and PD-L1 expressors (P = .014) and was correlated with longer progression-free survival (17.0 vs 5.8, P < .001) and overall survival (28.3 vs 9.5, P < .001). The introduction of MDA was associated with increased employment of diagnostical tools such as fecal calprotectin test (P < .001), colonoscopy (P < .001), and gastroenterological evaluation (P = .017) and a significant decrease in both grade 3 conversion rate (P = .046) and recurrence after rechallenge (P = .016). Hospitalization rate dropped from 17.2% to 3.8% (P: ns).

Conclusion

These findings highlight the clinical relevance of IMDC and support the incorporation of a MDA to optimize the clinical management of this irAE to improve patient care. Prospective validation has been planned.
Real-world evidence for secukinumab in UK patients with psoriatic arthritis or radiographic axial spondyloarthritis: interim 2-year analysis from SERENA
Authors: Gaffney Karl , Gullick Nicola , MacKay Kirsten , Patel Yusuf , Sengupta Raj , Sheeran Tom , Hemmings Louise , Pamies Paula
Published: August 2023

Objectives

The aim was to evaluate retention rates for secukinumab in patients with active PsA or radiographic axial spondyloarthritis (r-axSpA) treated in routine UK clinical practice.

Methods

SERENA (CAIN457A3403) is an ongoing, non-interventional, international study of patients with moderate-to-severe chronic plaque psoriasis, active PsA or active r-axSpA, who had received secukinumab for ≥16 weeks before enrolment. The primary objective of this interim analysis was to assess treatment retention rates in patients with PsA or r-axSpA who were enrolled and followed for ≥2 years at centres in the UK. The safety analysis set includes all patients who received at least one dose of secukinumab. The target population set includes all patients who fulfilled the patient selection criteria.

Results

The safety set comprised 189 patients (PsA, n = 81; r-axSpA, n = 108), and the target population set comprised 183 patients (PsA, n = 78; r-axSpA, n = 105). In the safety set, 107 patients (45 of 81 with PsA and 62 of 108 with r-axSpA) had previously received a biologic agent. Retention rates were similar between patients with PsA and r-axSpA after 1 year (PsA 91.0%, 95% CI: 84.0, 98.0; r-axSpA 89.2%, 95% CI: 82.7, 95.7) and 2 years (PsA 77.6%, 95% CI: 67.6, 87.7; r-axSpA 76.2%, 95% CI: 67.4, 85.0) of observation. Overall, 17.5% of patients (33 of 189) experienced at least one treatment-related adverse event, and 12.7% of patients (24 of 189) discontinued secukinumab because of adverse events.

Conclusion

This analysis of real-world data from the UK demonstrates high retention rates for secukinumab over 2 years in patients with PsA or r-axSpA, with a favourable safety profile.
Unilateral optogenetic stimulation of Lhx6 neurons in the zona incerta increases REM sleep
Authors: Vidal-Ortiz Aurelio , Blanco-Centurion Carlos , Shiromani Priyattam J
Published: August 2023

To determine how a waking brain falls asleep researchers have monitored and manipulated activity of neurons and glia in various brain regions. While imaging Gamma-Aminobutyric Acid (GABA) neurons in the zona incerta (ZI) we found a subgroup that anticipates onset of NREM sleep (Blanco-Centurion C, Luo S, Vidal-Ortiz A, Swank C, Shiromani PJ. Activity of a subset of vesicular GABA-transporter neurons in the ventral ZI anticipates sleep onset. Sleep. 2021;44(6):zsaa268. doi:10.1093/sleep/zsaa268.). To differentiate the GABA subtype we now image and optogenetically manipulate the ZI neurons containing the transcription factor, Lhx6. In the first study, Lhx6-cre mice (n = 5; female = 4) were given rAAV-DJ-EF1a-DIO-GCaMP6M into the ZI (isofluorane anesthesia), a GRIN lens implanted, and 21days later sleep and fluorescence in individual Lhx6 neurons were recorded for 4 hours. Calcium fluorescence was detected in 132 neurons. 45.5% of the Lhx6 neurons were REM-max; 30.3% were wake-max; 11.4% were wake + REM max; 9% were NREM-max; and 3.8% had no change. The NREM-max group of neurons fluoresced 30 seconds ahead of sleep onset. The second study tested the effects of unilateral optogenetic stimulation of the ZI Lhx6 neurons (n = 14 mice) (AAV5-Syn-FLEX-rc[ChrimsonR-tdTomato]. Stimulation at 1 and 5 Hz (1 minute on- 4 minutes off) significantly increased percent REM sleep during the 4 hours stimulation period (last half of day cycle). The typical experimental approach is to stimulate neurons in both hemispheres, but here we found that low-frequency stimulation of ZI Lhx6 neurons in one hemisphere is sufficient to shift states of consciousness. Detailed mapping combined with mechanistic testing is necessary to identify local nodes that can shift the brain between wake–sleep states.
Allogeneic Cell Therapy Applications in Neonates: A Systematic Review
Authors: Razak Abdul , Lei Donna , McDonald Courtney A , Hunt Rod W , Miller Suzanne L , Malhotra Atul
Published: August 2023

Background

Neonatal cell therapy applications are increasing; however, data on allogeneic cell therapy are limited.

Objective

To summarize evidence on allogeneic cell therapy in term and preterm neonates.

Methods

Cochrane Central Register of Controlled Trials, Embase, Ovid Medline, and various registries were searched for studies investigating the safety, feasibility, and efficacy of allogeneic cell therapy in neonates. Two authors independently selected the articles, extracted data, and assessed the risk of bias.

Results

Twelve published (153 infants) and 21 ongoing studies were included. These studies predominantly sourced allogeneic cells from umbilical cord blood (UCB). Mesenchymal stromal cells (MSCs) were the main cell type used (134 of 153 infants); others included UCB-derived total nucleated cells (TNCs) and human amnion epithelial cells (hAECs). Applications included bronchopulmonary dysplasia (BPD; 113 infants), Krabbe disease (13 infants), intraventricular haemorrhage (10 infants), perinatal arterial ischemic stroke (10 infants), hypoxic-ischaemic encephalopathy (6 infants), and necrotizing enterocolitis (1 infant). Nine out of 12 studies did not report any serious adverse events (SAEs) related to cell administration. Three studies reported SAEs, such as graft versus host disease (GVHD) in 5 infants (UCB-derived TNCs for Krabbe disease); and transient cardiorespiratory compromise in 1 infant (hAECs for BPD). Data on efficacy outcomes were limited.

Conclusion

The safety and feasibility of allogeneic cell therapy applications in neonates are available, mainly from the use of MSCs. Further safety data for other cell types are required, and the risk of GVHD in different settings needs to be determined. Efficacy studies are largely lacking for all cell types.

Protocol Registration

The protocol was registered with PROSPERO (registration number CRD42023397876), the international prospective register for systematic reviews (https://www.crd.york.ac.uk/PROSPERO).
The Direct Effects of Norepinephrine Administration on Pressure Injuries in Intensive Care Patients: A Retrospective Cohort Study
Authors: Argenti Graziela , Ishikawa Gerson , Fadel Cristina Berger
Published: August 2023

OBJECTIVE

To estimate the direct effects of norepinephrine administration on pressure injury (PI) incidence in intensive care patients.

METHODS

This is a secondary and exploratory analysis of a retrospective cohort study of intensive care patients discharged in 2017 to 2018. Observational cases only included patients who received primary PI preventive care during intensive care (N = 479). As a first-choice vasopressor drug, norepinephrine administration was approximated with days of norepinephrine. Linear path models were examined from norepinephrine administration to PI development. The identification of confounding variables and instrumental variables was grounded on directed acyclic graph theory. Direct effects were estimated with instrumental variables to overcome bias from unobserved variables. As models were re-specified with data analysis, the robustness of path identification was improved by requiring graph invariance with sample split.

RESULTS

Norepinephrine caused PI development from one stage to another after 4.0 to 6.3 days of administration in this cohort as a total effect (90% CI). The direct effect was estimated to advance the stage of PI at a rate of 0.140 per day of norepinephrine administered (standard error, 0.029; P < .001). The direct effect accounted for about 70% of the total effect on PI development.

CONCLUSIONS

Estimations with instrumental variables and structural equation modeling showed that norepinephrine administration directly and substantially affected hospital-acquired PI incidence in intensive care patients in this cohort.
Frequency and Trends of Pre-Pandemic Surge Periods in U.S. Emergency Departments, 2006–2019
Authors: Anesi George L. , Xiong Ruiying (Aria) , Delgado M. Kit
Published: August 2023

OBJECTIVES:

To quantify the frequency, outside of the pandemic setting, with which individual healthcare facilities faced surge periods due to severe increases in demand for emergency department (ED) care.

DESIGN:

Retrospective cohort study.

SETTING:

U.S. EDs.

PATIENTS:

All ED encounters in the all-payer, nationally representative Nationwide Emergency Department Sample from the Healthcare Cost and Utilization Project, 2006–2019.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Frequency of surge periods defined as ED months in which an individual facility ED saw a greater than 50% increase in ED visits per month above facility-/calendar month-specific medians. During 2006–2019, 3,317 U.S. EDs reported 354,534,229 ED visits across 142,035 ED months. Fifty-seven thousand four hundred ninety-five ED months (40.5%) during the study period had a 0% to 50% increase in ED visits that month above facility-specific medians and 1,952 ED months (1.4%) qualified as surge periods and had a greater than 50% increase in ED visits that month above facility-specific medians. These surge months were experienced by 397 unique facility EDs (12.0%). Compared with 2006, the most proximal pre-pandemic period of 2016–2019 had a notably elevated likelihood of ED-month surge periods (odds ratios [ORs], 2.36–2.84; all p < 0.0005). Compared with the calendar month of January, the winter ED months in December through March have similar likelihood of an ED-month qualifying as a surge period (ORs, 0.84–1.03; all p > 0.05), while the nonwinter ED months in April through November have a lower likelihood of an ED-month qualifying as a surge period (ORs, 0.65–0.81; all p < 0.05).

CONCLUSIONS:

Understanding the frequency of surges in demand for ED care—which appear to have increased in frequency even before the COVID-19 pandemic and are concentrated in winter months—is necessary to better understand the burden of potential and realized acute surge events and to inform cost-effectiveness preparedness strategies.
Comparison of Five-Year Graft Survival After Keratoplasty in the Veteran Population
Authors: Wendt Sydney , Gordon Abigail , Bhatnagar Anshul , Orengo-Nania Silvia , Biggerstaff Kristin , Khandelwal Sumitra
Published: August 2023

Purpose:

We investigated the corneal graft survival rate after penetrating keratoplasty (PK) and Descemet stripping endothelial keratoplasty (DSEK) in a veteran population.

Methods:

A retrospective review was conducted on patients undergoing a primary PK or DSEK at a large Veterans Affairs Medical Center between January 2005 and August 2019. Exclusion criteria included patients with a postoperative follow-up less than 5 years and patients undergoing additional ocular procedures during surgery. Patients were classified into 3 groups depending on their glaucoma status before corneal transplant: no pre-existing glaucoma, medically managed glaucoma, or surgically managed glaucoma. Graft survival was calculated using the Kaplan–Meier survival analysis.

Results:

A total of 30 eyes underwent PK, and 28 eyes underwent DSEK. There was no significant difference in graft survival rates between PK and DSEK at 1 year (83% vs. 79%, P = 0.555), 3 years (53% vs. 64%, P = 0.536), and 5 years (40% vs. 54%, P = 0.399). When combining PK and DSEK groups, Kaplan–Meier analysis showed a highly significant difference in 5-year graft survival between patients without pre-existing glaucoma (58%) and patients with either medically (50%) or surgically managed glaucoma (0%).

Conclusions:

We find approximate parity in 1-year, 3-year, and 5-year survival rates after PK and DSEK within the veteran population. However, survival rates for both procedures are lower than those previously reported within other populations. Additional studies to understand these differences in larger cohorts are warranted. Ophthalmologists must understand the increased risk of graft failure in the veteran population to provide appropriate counseling.
Update of the European Society of Anaesthesiology and Intensive Care Medicine evidence-based and consensus-based guideline on postoperative delirium in adult patients
Authors: Aldecoa César , Bettelli Gabriella , Bilotta Federico , Sanders Robert D. , Aceto Paola , Audisio Riccardo , Cherubini Antonio , Cunningham Colm , Dabrowski Wojciech , Forookhi Ali , Gitti Nicola , Immonen Kaisa , Kehlet Henrik , Koch Susanne , Kotfis Katarzyna , Latronico Nicola , MacLullich Alasdair M.J. , Mevorach Lior , Mueller Anika , Neuner Bruno , Piva Simone , Radtke Finn , Blaser Annika Reintam , Renzi Stefania , Romagnoli Stefano , Schubert Maria , Slooter Arjen J.C. , Tommasino Concezione , Vasiljewa Lisa , Weiss Bjoern , Yuerek Fatima , Spies Claudia D.
Published: August 2023

Postoperative delirium (POD) remains a common, dangerous and resource-consuming adverse event but is often preventable. The whole peri-operative team can play a key role in its management. This update to the 2017 ESAIC Guideline on the prevention of POD is evidence-based and consensus-based and considers the literature between 01 April 2015, and 28 February 2022. The search terms of the broad literature search were identical to those used in the first version of the guideline published in 2017. POD was defined in accordance with the DSM-5 criteria. POD had to be measured with a validated POD screening tool, at least once per day for at least 3 days starting in the recovery room or postanaesthesia care unit on the day of surgery or, at latest, on postoperative day 1. Recent literature confirmed the pathogenic role of surgery-induced inflammation, and this concept reinforces the positive role of multicomponent strategies aimed to reduce the surgical stress response. Although some putative precipitating risk factors are not modifiable (length of surgery, surgical site), others (such as depth of anaesthesia, appropriate analgesia and haemodynamic stability) are under the control of the anaesthesiologists. Multicomponent preoperative, intra-operative and postoperative preventive measures showed potential to reduce the incidence and duration of POD, confirming the pivotal role of a comprehensive and team-based approach to improve patients’ clinical and functional status.
Diagnostic Patterns of Age-Related Macular Degeneration among Asian Medicare Beneficiaries Macular Degeneration in Asians
Authors: Hussain Zain S. , Wu Gloria , Loya Asad , Ding Kai , Sambhav Kumar , Riaz Kamran M. , Shah Vinay A.
Published: August 2023

Purpose:

To characterize prevalence estimates by race, age, gender, and comorbidity (diabetes, hypertension) within the Medicare beneficiary demographic.

Methods:

In this US population-based retrospective cohort analysis, the Vision and Eye Health Surveillance System was analyzed for a 100% sample of Medicare Fee-For-Service beneficiary populations of Asians and non-Hispanic Whites between 2014 and 2018. Exclusionary criteria included beneficiaries less than 40 years of age. Prevalence rate ratios (PRRs), defined as prevalence rate for Asians divided by prevalence rate for non-Hispanic Whites, were calculated utilizing multivariate negative binomial regression or Pearson-scaled Poisson regression, stratified by age, gender, and comorbidity.

Results:

A total of 21,892,200 Medicare beneficiaries fulfilled the inclusionary criteria in 2018. Of the entire cohort, 3.2%(N=714,500) were Asian. For beneficiaries aged 40-64 years, Asian males (PRR 1.73,95% CI 1.64 – 1.83,p<0.0001) and females (PRR 1.34,95% CI 1.28 – 1.41,p<0.0001) had increased prevalence rate of all AMD relative to non-Hispanic Whites. Significant time-wise increases in PRR were observed within several age groups, genders, and comorbidities (race-time interaction coefficients p<0.05).

Conclusions:

This analysis highlights increased AMD prevalence estimates within the Asian American demographic relative to non-Hispanic Whites. Furthermore, specific Asian subpopulations are experiencing accelerated prevalence rates over time.
Use of Subclavian Extracorporeal Carbon Dioxide Removal for COVID-19 Acute Respiratory Distress Syndrome as a Bridge to Lung Transplantation
Authors: Dinh Kha , Akkanti Bindu , Patel Manish , Hussain Rahat , Basra Sukhdeep , Gregoric Igor D. , Kar Biswajit
Published: August 2023

Severe acute hypercapnia is independently associated with increased adverse effects and intensive care unit mortality in mechanically ventilated patients. During the severe acute respiratory syndrome coronavirus 2 (COVID-19) pandemic, some patients were placed on extracorporeal carbon dioxide removal support when extracorporeal membrane oxygenation (ECMO) support was at capacity or not offered. We present a patient with severe acute respiratory distress syndrome caused by COVID-19 pneumonia, who was supported with Hemolung Respiratory Assist System (ALung Technologies, Inc., LivaNova, Pittsburgh, PA) via the right subclavian vein as a bridge to lung transplantation after venovenous ECMO support. The patient survived and was discharged home.
Efficacy of surgical treatment and conservative treatment for cervical spinal cord injury without fracture and dislocation in adults: A meta-analysis
Authors: Chen Deyuan , Chen Huajian , Huang Fuli
Published: August 2023

Background:

The aim of this study was to investigate the efficacy of surgical treatment and conservative treatment for cervical spinal cord injury without fracture and dislocation (CSCIWFD) in adults by meta-analysis.

Methods:

With a time span from 2010 to 2022, PubMed, Web of Science, Embase, China National Knowledge Infrastructure (CNKI) and Wanfang databases were searched for all clinical randomized controlled trials on the comparison of surgical treatment and conservative treatment for CSCIWFD in adults. The Cochrane quality assessment tool was used as the standard. Stata 16.0 statistical software was used for meta-analysis.

Results:

A total of 870 articles were retrieved, and 12 studies were finally included for meta-analysis. Among them, there were 451 patients in the observation group (surgical treatment) and 346 patients in the control group (conservative treatment). The results of meta-analysis showed that the observation group was superior to the control group in the effective rate (OR = 4.737, 95% CI [2.613, 8.586], P < .001), Japanese Orthopedic Association (JOA) score at 3 months after treatment (SMD = 1.038, 95% CI [0.417, 1.659], P = .001), 6 months after treatment (SMD = 3.135, 95% CI [2.120, 4.151], P < .001) and 12 months after treatment (SMD = 2.808, 95% CI [1.880, 3.737], P < .001). In addition, the JOA scores of patients at 12 months after surgical treatment (SMD = 6.397, 95% CI [4.654, 8.14], P < .001) and conservative treatment (SMD = 3.197, 95% CI [2.144, 4.24], P < .001) were significantly higher than those before treatment.

Conclusions:

Surgical treatment can improve the effective rate and JOA score of adult patients with CSCIWFD compared to conservative treatment. This suggests that surgical treatment can significantly improve the patient’s spinal cord function.
Surveys on androgen abuse: a review of recent research
Authors: Ganson Kyle T. , Nagata Jason M.
Published: August 2023

Purpose of review

To summarize recent survey research on androgen abuse [i.e., anabolic-androgenic steroids (AAS)], including prevalence among international samples, risk factors for use, associated impairments of use, and treatment and interventions for abusers.

Recent findings

Recent research has documented the prevalence of androgens abuse remains most common among boys and men compared to girls and women, which was stable across nations. However, fewer studies have focused on population-based samples and instead focused on convenience or high-risk samples (i.e., gym goers). Androgen abusers commonly report a history of violent victimization, including adverse childhood experiences. Research continues to document many adverse biological, psychological, and social effects related to androgen abuse, including more than 50% of abusers reporting at least one side effect. Mental health problems and polysubstance use continues to be highly prevalent among androgen abusers. Despite these adverse effects from use, there remains little survey research on treatment and interventions for androgen abusers, representing an important area of future investigation.

Androgen abuse remains relatively common, particularly among boys and men, with adverse health effects regularly occurring. Healthcare professionals and systems can adapt their treatment approaches to focus on reducing harms associated with androgen abuse.
Implementing a safety huddle for fall prevention and awareness
Authors: Masters Michelle , Breda Karen Lucas , Karl Cherry
Published: August 2023

Team huddles can be used as a unifying approach to reporting, adapting, learning, and improving teamwork to prevent falls.
Diagnosing infectious mononucleosis
Authors: Day Mercedes , Toon Molly
Published: August 2023

Nurses must make informed decisions when encountering a patient with mononucleosis. This article will guide you along the way.
Innovative Strategies to Facilitate Newly Licensed Nurse Transition to Practice During the COVID-19 Pandemic
Authors: Pate Kimberly , Powers Kelly , Pagel Julie , Montegrico James
Published: August 2023

As healthcare facilities transition from initial phases of the COVID-19 pandemic, it is imperative to consider innovative strategies to overcome instructional challenges presented to nursing schools in order to maintain a competent workforce amidst nursing shortages and increasing patient volumes and complexity. Nursing professional development practitioners will play a pivotal role in revitalizing transition-to-practice programs to meet the demands of the new workforce. This article details an academia–practice initiative for newly licensed nurses who enter practice during the pandemic.
Mental health and health behaviors of parents of survivors of childhood cancer in the early COVID-19 pandemic: Exploring the role of intolerance of uncertainty
Authors: Hou Sharon H. J. , Forbes Caitlin , Cho Sara , Tran Andrew , Forster Victoria J. , Wakefield Claire E. , Heathcote Lauren C. , Wiener Lori , Michel Gisela , Patterson Pandora , Stokoe Mehak , Reynolds Kathleen , Schulte Fiona M. S.
Published: August 2023

Introduction:

Parents of survivors of childhood cancer may be particularly vulnerable to the experience of poor mental health amid the COVID-19 pandemic. This study aimed to (1) describe the mental health of parents of childhood cancer survivors; (2) explore the role of intolerance of uncertainty (IU) in mental health; and (3) explore the associations of parent mental health and health behaviors with IU.

Methods:

A cross-sectional, quantitative assessment of parents of survivors of childhood cancer (younger than 18 years) was conducted between May and June 2020. Participants completed an online questionnaire regarding their mental health (PROMIS anxiety, depression), IU (Intolerance of Uncertainty Scale), and health behaviors. Recruitment was conducted through social media and community organizations using convenience and snowball sampling.

Results:

Seventy-two participants from 6 countries completed the study (99% mothers, mean age of survivors = 11.4 years). Fifty percent of participants reported that their mental health had declined since the start of the COVID-19 pandemic, whereas 46% reported their mental health did not change. More than half of the participants (56%) reported decreased physical activity and 38% reported increased alcohol use. Exploring associations of parent mental health and health behaviors with IU, parent depression, and hours of exercise emerged as significant predictors (B = 3.62, P < .01; B = –1.58, P < .01, respectively), whereby higher depression and less exercise was associated with higher IU.

Conclusions:

At the height of the COVID-19 global pandemic, some parents of survivors of childhood cancer experienced poor mental health. IU plays a significant role in mental health outcomes, but this does not translate to health behaviors.
Principal component analysis of a swine injury model identifies multiple phenotypes in trauma
Authors: Buzzard Lydia , Smith Sawyer , Dixon Alexandra , Kenny James , Appleman Ma , Subramanian Sarayu , Behrens Brandon , Rick Elizabeth , Madtson Brianne , Goodman Andrew , Murphy James , McCully Belinda , Kanlerd Amonpon , Trivedi Alpa , Pati Shibani , Schreiber Martin
Published: August 2023

BACKGROUND

Trauma is the third leading cause of death in the United States and the primary cause of death for people between the ages of 1 year and 44 years. In addition to tissue damage, trauma may also activate an inflammatory state known as trauma-induced coagulopathy (TIC) that is associated with clotting malfunctions, acidemia, and end-organ dysfunction. Prior work has also demonstrated benefit to acknowledging the type and severity of endothelial injury, coagulation derangements, and systemic inflammation in the management of trauma patients. This study builds upon prior work by combining laboratory, metabolic, and clinical metrics into an analysis of trauma phenotypes, evolution of phenotypes over time after trauma, and significance of trauma phenotype on mortality.

METHODS

Seventy 3-month-old female Yorkshire crossbred swine were randomized to injury and resuscitation groups. Principal component analysis (PCA) of longitudinal swine TEG data (Reaction time, Alpha-Angle, Maximum Amplitude, and Clot Lysis at 30 minutes), pH, lactate, and MAP was completed in R at baseline, 1 hour postinjury, 3 hours postinjury, 6 hours postinjury, and 12 hours postinjury. Subjects were compared by principal component factor scores to assess differences in survival, injury severity, and treatment group.

RESULTS

Among injured animals, three phenotypes were observed at each time point. Five phenotypes were associated with differences in survival, and of these, four were associated with differences in injury severity. Phenotype alignment was not significantly different by treatment group.

CONCLUSION

This application of PCA to a set of coagulation, hemodynamic, and organ perfusion variables has identified multiple evolving phenotypes after trauma. Some of these phenotypes may correlate with injury severity and may have implications for survival. Next steps include validating these findings over greater numbers of subjects and exploring other machine-learning techniques for phenotype identification.

LEVEL OF EVIDENCE

Level IV, Therapeutic/Care Management
A PSEUDO-DILEMMA: ARE WE OVER-DIAGNOSING AND OVER-TREATING TRAUMATIC SPLENIC INTRAPARENCHYMAL PSEUDOANEURYSMS?
Authors: Radding Sydney , Harfouche Melike N. , Dhillon Navpreet K. , Ko Ara , Hawley Kristy L. , Kundi Rishi , Maddox John S. , Radowsky Jason S. , DuBose Joseph J. , Feliciano David V. , Kozar Rosemary A. , Scalea Thomas M.
Published: August 2023

Introduction

Splenic embolization for traumatic vascular abnormalities in stable patients is a common practice. We hypothesize that modern contrast-enhanced CT over diagnoses post-traumatic splenic vascular lesions such as intraparenchymal pseudoaneurysms (PSA) that may not require embolization.

Methods

We reviewed the experience at our high-volume center with endovascular management of blunt splenic injuries from Jan 2016-Dec 2021. Multidisciplinary review was used to compared initial CT findings to subsequent angiography, analyzing management and outcomes of identified vascular lesions.

Results

Of 853 splenic injuries managed overall during the study period, 255 (29.9%) underwent angiography of the spleen at any point during hospitalization. Vascular lesions were identified on 58% of initial CTs; extravasation (12.2%) and PSA (51.0%). Angiography was performed a mean of 22 hours after admission, with 38% done within 6 hours. Embolization was performed for 90.5% (231) of patients. Among the 130 patients with PSA on initial CT, 36 (27.7%) had no visible lesion on subsequent angiogram. From the 125 individuals who did not have a PSA identified on their initial CT, 67 (54%) had a PSA seen on subsequent angiography. On post-embolization CT at 48-72 hours, persistently perfused splenic PSAs were seen in 41.0% (48/117) of those with and 22.2% (2/9) without embolization. Only one of 24 (4.1%) patients with PSA on angiography observed without embolization required delayed splenectomy, whereas 6.9% (16/231) in the embolized group had splenectomy at a mean of 5.5 + 4 days after admission.

Conclusion

There is a high rate of discordance between CT and angiographic identification of splenic PSAs. Even when identified at angiogram and embolized, close to half will remain perfused on follow-up imaging. These findings question the use of routine angioembolization for all splenic PSAs.

Level of Evidence

IV

Study Type

Therapeutic/care management
SARS-CoV-2 variants Omicron BA.4/5 and XBB.1.5 significantly escape T cell recognition in solid organ transplant recipients vaccinated against the ancestral strain
Authors: Halvorson Torin , Ivison Sabine , Huang Qing , Ladua Gale , Yotis Demitra M. , Mannar Dhiraj , Subramaniam Sriram , Ferreira Victor H. , Kumar Deepali , Belga Sara , Levings Megan K.
Published: August 2023

Background

Immune-suppressed solid organ transplant recipients (SOTRs) display impaired humoral responses to COVID-19 vaccination, but T cell responses are incompletely understood. The highly infectious SARS-CoV-2 variants Omicron BA.4/5 and XBB.1.5 escape neutralization by antibodies induced by vaccination or infection with earlier strains, but T cell recognition of these lineages in SOTRs is unclear.

Methods

We characterized Spike-specific T cell responses to ancestral SARS-CoV-2, Omicron BA.4/5 and XBB.1.5 peptides in a prospective study of kidney, lung and liver transplant recipients (n = 42) throughout a three- or four-dose ancestral Spike mRNA vaccination schedule. Using an optimized activation-induced marker assay, we quantified circulating Spike-specific CD4+ and CD8+ T cells based on antigen-stimulated expression of CD134, CD69, CD25, CD137 and/or CD107a.

Results

Vaccination strongly induced SARS-CoV-2-specific T cells, including BA.4/5- and XBB.1.5-reactive T cells, which remained detectable over time and further increased following a fourth dose. However, responses to Omicron BA.4/5 and XBB.1.5 were significantly lower in magnitude compared to ancestral strain responses. Antigen-specific CD4+ T cell frequencies correlated with anti-receptor-binding domain (RBD) antibody titres, with post-second dose T cell responses predicting subsequent antibody responses. Patients receiving prednisone, lung transplant recipients and older adults displayed weaker responses.

Conclusions

Ancestral strain vaccination stimulates BA.4/5 and XBB.1.5-cross-reactive T cells in SOTRs, but responses to these variants are diminished. Antigen-specific T cells can predict future antibody responses and identify vaccine responses in seronegative individuals. Our data support monitoring both humoral and cellular immunity in SOTRs to track effectiveness of COVID-19 vaccines against emerging variants.
Coronary Artery anomalies in PatienTs Undergoing transcatheter aortic valve REplacement. The CAPTURE registry
Authors: Oliva Omar A. , Scalia Lorenzo , Sisinni Antonio , Poletti Enrico , Zannoni Jessica , Mazzucca Mattia , Criscione Enrico , Popolo Rubbio Antonio , Gorla Riccardo , Agnifili Mauro , Bedogni Francesco , Testa Luca
Published: August 2023

Background

The incidence and possible implications of coronary artery anomalies (CAA) in patients undergoing transcatheter aortic valve replacement (TAVR) are uncertain.

Aims

To evaluate the impact of CAA on TAVR outcomes, and to suggest possible strategies to prevent CAA related complications.

Methods

Among 2,164 consecutive patients who underwent TAVR in our center, 15 (0.69%) were identified to have a CAA, based on pre-operative Computed Tomography (CT) scans.

Results

CT-angiography revealed the following features of CAA: the majority of anomalous CAA concerned the right coronary artery (80%), followed by the left main (13.3%) and the left circumflex (6.7%). An intramural course was observed only in 26.7% patients, whereas an acute take-off was detected in more than half of the study cohort (53.3%). High-risk sudden cardiac death features were observed in 6 (40%) patients.

Technical success was 86.7%, device success was 80%. One patient experienced a cardiac arrest 15 minutes after procedure, resulting from occlusion of the anomalous right coronary artery with the ostium located at the right-to-non coronary commissure. There were no cases of ≥ moderate paravalvular leak or stroke. One non-cardiac related death was recorded 4 months after the procedure.

Conclusions

The interaction between transcatheter bioprosthesis and different CAA types could lead to ominous sequelae, if not promptly recognized and treated accordingly.
Achatina fulicaHaemocyanin-Derived Peptides as Novel Antimicrobial Agents
Authors: Pereira Andrés , Suarez Libardo , Roman Tanya , Guzmán Fanny , Rincón-Orozco Bladimiro , Sierra Leidy , Hidalgo William
Published: August 2023

Anteriorly we found Haemocyanin-derived peptides in semi-purified fractions of mucus secretion ofAchatina fulicathat showed an inhibitory effect onS. aureusstrains. Here, we appliedin silicorational design strategy to obtain new potential Antimicrobial Peptides (AMPs) fromA. fulicahaemocyanin-derived peptides (AfH). Designed peptides were chemically synthetized using the Fmoc strategy and antimicrobial activity againstE. coliandS. aureusstrains was investigated using the broth microdilution method. Cytotoxic activity on Vero, HaCat, and human erythrocytes cells was also evaluated. The results showed that 15-residue synthetic peptides, alpha-helical and cationic, were those with the highest biological activity against Gram positive strains, with Minimum Inhibitory Concentrations (MIC) in the range of 20 to 30 µM. The positive selectivity index suggests a higher selectivity mainly on the microorganisms evaluated and not on eukaryotic cells. In this study,A. fulicahemocyanin turned out to be an appropriate protein model for the rational design of AMPs against bacteria of public health importance. Additional studies are required to evaluate the activity of the peptides on Gram negative bacteria.
ReMiND: Recovery of Missing Neuroimaging using Diffusion Models with Application to Alzheimer’s Disease
Authors: Yuan Chenxi , Duan Jinhao , Tustison Nicholas J. , Xu Kaidi , Hubbard Rebecca A. , Linn Kristin A.
Published: August 2023

Objective

Missing data is a significant challenge in medical research. In longitudinal studies of Alzheimer’s disease (AD) where structural magnetic resonance imaging (MRI) is collected from individuals at multiple time points, participants may miss a study visit or drop out. Additionally, technical issues such as participant motion in the scanner may result in unusable imaging data at designated visits. Such missing data may hinder the development of high-quality imaging-based biomarkers. Furthermore, when imaging data are unavailable in clinical practice, patients may not benefit from effective application of biomarkers for disease diagnosis and monitoring.

Methods

To address the problem of missing MRI data in studies of AD, we introduced a novel 3D diffusion model specifically designed for imputing missing structural MRI (Recovery ofMissingNeuroimaging usingDiffusion models (ReMiND)). The model generates a whole-brain image conditional on a single structural MRI observed at a past visit or conditional on one past and one future observed structural MRI relative to the missing observation.

Results

Experimental results show that our method can generate highquality individual 3D structural MRI with high similarity to ground truth, observed images. Additionally, images generated using ReMiND exhibit relatively lower error rates and more accurately estimated rates of atrophy over time in important anatomical brain regions compared with two alternative imputation approaches: forward filling and image generation using variational autoencoders.

Conclusion

Our 3D diffusion model can impute missing structural MRI data at a single designated visit and outperforms alternative methods for imputing whole-brain images that are missing from longitudinal trajectories.
A school-based randomized clinical trial of silver diamine fluoride for dental caries incidence
Authors: Ruff Ryan Richard , Godín Tamarinda Barry , Niederman Richard
Published: August 2023

Importance

Dental caries is the world’s most prevalent noncommunicable disease and a source of severe health inequity. To prevent and reduce this burden, the Centers for Disease Control and Prevention recommends school dental sealant programs.

Objective

To determine whether silver diamine fluoride (SDF) is non-inferior to dental sealants and atraumatic restorative treatment (ART) for dental caries when used in a school-based program.

Design

The CariedAway study was a cluster-randomized, single-blind, pragmatic non-inferiority trial conducted from 2018-2023. Four years of follow-up were included.

Setting

Primary schools in New York City with at least 55% of the student population reporting as Black or Hispanic/Latino and at least 80% receiving free or reduced lunch.

Participants

Any child between the ages of 5 and 13 was eligible. There were 17741 eligible children across 48 schools.

Interventions

Participants were cluster-randomized at the school level to receive either a 38% concentration SDF solution or glass ionomer sealants and ART. Each participant also received fluoride varnish.

Main Outcomes

Primary study outcomes were the prevalence and incidence of dental caries. Our a priori hypothesis was that SDF was non-inferior to sealants and ART in reducing caries prevalence.

Results

A total of 7418 children were enrolled and treated, of which 4100 completed at least one follow-up observation (55%). The overall baseline prevalence of dental caries was approximately 27% (95% CI = 25.7, 28.6). Following treatment, the odds of decay prevalence decreased longitudinally (OR = 0.79, 95% CI = 0.75, 0.83) and SDF was non-inferior compared to sealants and ART (OR = 0.94, 95% CI = 0.80, 1.11). The crude incidence of dental caries in children treated with SDF was 10.2 per 1,000 tooth-years, versus 9.8 per 1,000 tooth-years in children treated with sealants and ART, for a rate ratio of 1.046 (95% CI = 0.97, 1.12).

Conclusions and Relevance

In a pragmatic trial, application of silver diamine fluoride resulted in nearly identical caries incidence compared to dental sealants and ART and was non-inferior in the longitudinal prevalence of caries. SDF is an effective alternative for use in school caries prevention, increasing access and reducing costs for oral healthcare.

Trial Registration

ClinicalTrials.gov, #NCT03442309
Hemodynamics with Mechanical Circulatory Support Devices Using a Cardiogenic Shock Model
Authors: Yahagi Kazuyuki , Nishimura Gohki , Kuramoto Kei , Tsuboko Yusuke , Iwasaki Kiyotaka
Published: August 2023

Background

Mechanical circulatory support (MCS) devices, including veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and Impella, have been widely used for patients with cardiogenic shock (CS). However, hemodynamics with each device and combination therapy is not thoroughly understood. We aimed to elucidate the hemodynamics with MCS using a CS pulsatile flow model.

Methods and Results

A pulsatile flow circulation system comprising a ventricle, aortic valve, mitral valve, elastic artery, and venous reservoir was developed. Hemodynamics with Impella CP, VA-ECMO, and a combination of Impella CP and VA-ECMO were assessed based on the pressure and flow under support with each device and the pressure-volume loop of the ventricle model. The self-recirculation with Impella was assessed using particle image velocimetry. The Impella CP device with CS status resulted in increased afterload, leading to an increase in aortic pressure and a decrease in end-diastolic volume and end-diastolic pressure (EDP). VA-ECMO support resulted in increased afterload, leading to a significant increase in aortic pressure with an increase in end-systolic volume and EDP and decreasing venous reservoir pressure. The combination of Impella CP and VA-ECMO led to left ventricular unloading, regardless of increase in afterload. Self-recirculation with Impella CP was observed in a patient with significant aortic insufficiency, leading to reduced hemodynamic support.

Conclusions

The Impella system improved hemodynamics with ventricular unloading. Hemodynamic support with Impella and VA-ECMO should be a promising combination for patients with severe CS. Physicians should be alert to the presence of significant aortic insufficiency, leading to self-recirculation with Impella.

Clinical Perspective

What is new?

This is a non-clinical study using a novel experimental pulsatile flow system with venous function that can be used to assess MCS, including Impella and VA-ECMO.

The self-recirculation phenomenon of the Impella device was assessed by a flow visualization method using particle imaging velocimetry.

What are the clinical implications?

The combination of Impella and VA-ECMO led to left ventricular unloading, regardless of the increase in afterload.

VA-ECMO could increase arterial pressure owing to increased LV afterload and alter the direction of the aortic flow (antegrade or retrograde) depending on the flow level with VA-ECMO.

Effective Impella flow was reduced during ventricular diastole when aortic insufficiency was present owing to self-recirculation with the Impella device.