bluuebunny/crossref_metadata_2025 huggingface dataset:
TMOD-20. CASE REPORT: THE ODYSSEY TO THE RIGHT DIAGNOSIS. SURPRISING GLIOBLASTOMA MIMICS
Authors: Dorin Patrick , Jochum Wolfgang , Lauber Arno , Neidert Marian Christoph , Hundsberger Thomas
Published: November 2021

A 57-year-old female presented at the emergency room with acute onset aphasia but unremarkable cCT (incl. angiography and perfusion). Suspecting an ischemic stroke, she received thrombolysis with quick recovery of aphasia. Afterwards, myoclonic jerks of the face and right arm occurred leading to anticonvulsant therapy. Follow-up cMRI surprisingly demonstrated swollen T2w-hyperintense and Gd-enhancing left limbic, temporal and frontal lobes. Suspected herpes-simplex-encephalitis was treated with aciclovir despite unremarkable CSF results (no pleocytosis, no BBB disruption, negative HSV-PCR) on day 2 and follow-up (day 5). Due to persisting cognitive deficits, autoimmune limbic encephalitis was suspected, and intravenous immunoglobulin therapy was added. Three weeks later, she experienced new neurological symptoms (weakness, blurred vision, vomiting, headache). Follow-up brain MRI demonstrated a massive increase of multifocal Gd-enhancing lesions. Partial resection revealed the diagnosis of an IDH-wildtype glioblastoma (GB). Next generation oncogene panel testing demonstrated a GOPC-ROS1 fusion which is rarely found in GB. Due to the gliomatosis-like infiltration of both hemispheres, radiotherapy was deemed to be too toxic. Instead, she received two cycles of lomustine in absence of a MGMT-promotor methylation. Two months later cMRI showed a symptomatic second multilocular progression. 2nd-line therapy with a ROS-inhibitor was rejected, whereupon she died five weeks later. Our case is in several aspects peculiar: It demonstrates that rare GB-mimics (i.e. HSV- and autoimmune limbic encephalitis) can only be ruled out in a fast manner by brain biopsy. Watchful waiting may neglect fast progression of GB leading to the inability to provide optimal treatment (i.e. radiotherapy). Thrombolysis is strictly contraindicated in primary brain tumors, but was unharmful in our case most probably to the early tumor stage without relevant neoangiogenesis. Rare genetic abnormalities like ROS1-fusions which are reported mostly in childhood glioblastoma may be present and serve as a therapeutic target also in adult GB.
BRMP-02. Feasibility and evaluation of a novel language paradigm for intraoperative language testing
Authors: Rosengarth Katharina , Pain Delin , Dodoo-Schitto Frank , Hense Katharina , Tamm Teele , Ott Christian , Lürding Ralf , Bumes Elisabeth , Greenlee Mark , Schebesch Karl-Michael , Schmidt Nils Ole , Doenitz Christian
Published: November 2021

INTRODUCTION

Mapping language during direct cortical stimulation (DCS) in the stetting of awake craniotomy might be challenging without using more than one language paradigm. Applying several language tasks leads to increasing surgery times and to patient’s exhaustion. Additionally, a single language trial must be performed in less than 4 seconds to avoid DCS-induced seizures. Therefore, we aimed to design a single language paradigm which pictures highly relevant language functions and simultaneously restrains the assessment time of single language trials up to 4 seconds.

METHOD

The intraoperative language task comprised a combination of picture naming and verb generation. During DCS patients should generate correct sentences according to the language stimulus by not exceeding 4 seconds. To assess the intraoperative feasibility of the language task we included 30 healthy subjects in a pilot study to measure subjects’ speed of performing a single language task trial and to evaluate the language paradigm according to its language sensitivity by using the paradigm as a task for functional MRI. Intraoperatively, 21 patients with brain tumors in language associated brain areas were included. Patients received neuropsychological testing before and after surgery.

RESULTS

The pilot study showed in healthy subjects that by applying the novel paradigm during fMRI there is activation in a left accentuated network of inferior frontal and parietal regions and the superior and middle temporal gyrus (p<.05, FEW). It was feasible to conduct a single language trial of the novel paradigm in a time frame of 4s (performance speed 2.53 s; SD=.32s). Intraoperatively, tumor patients showed DCS-associated language errors while conducting the language task. Postoperatively, mild language but no other neuropsychological deteriorations compared to presurgical assessment were observed (p<.05).

CONCLUSION

We present a novel language paradigm which safely pictures and monitors highly relevant language functions and consequently can minimize postoperative language deficits.
FLGS-02. What is the role of intraoperative MRI when performing a high-grade glioma resection using 5-ALA? A single center series reporting extent of resection of contrast-enhancing tumor and FLAIR signal abnormality with clinical outcomes
Authors: Zakaria Rasheed , Prabhu Sujit
Published: November 2021

OBJECTIVE

Use of intraoperative MRI (iMRI) and 5-ALA together is poorly investigated although both appear individually superior to standard resection alone in meta-analyses.

METHODS

We identified 54 patients who underwent 5-ALA guided resection of an intracranial high-grade glioma. Intraoperative ultrasound and frameless stereotactic neuronavigation with tractography were used in all cases. iMRI was selectively used in 33 cases. MRI scans were used to measure extent of resection (EOR) of T1-weighted contrast enhancing (T1WCE) tumor and FLAIR signal abnormality. Clinical data were collected prospectively and survival data retrospectively.

RESULTS

The mean EOR of T1WCE tumor was 93.7% (range 38 – 100%) with mean residual volume of 2.2 cc. The mean EOR of FLAIR signal abnormality was 59% (range 15–100%) with mean residual volume of 35.7 cc. Compared to using 5-ALA alone, using iMRI+5-ALA did not reduce the volume of residual T1WCE tumor (Mann-Whitney U, p = 0.557) and no more patients achieved complete resection (14/21 vs. 24/33, Chi-Square, p = 0.634). The volume of residual FLAIR signal abnormality was no different (Mann-Whitney U, p= 0.081) but more patients in the 5-ALA+iMRI group achieved resection of >53.21% of the FLAIR signal abnormality, which is known to be a predictor of improved prognosis (20/31 vs 5/21, Chi-Square, p = 0.004*). There was no difference in new neurological deficits at 30 days (Fisher’s exact test, p=0.549). Median OS was 14.3 months and median PFS was 5.2 months. There were no significant differences in OS or PFS between patients operated with iMRI in addition to 5-ALA.

CONCLUSIONS

5-ALA and iMRI both assist in safely maximizing EOR when combined with adjuncts such as awake craniotomy and cortical/subcortical mapping. The role and interaction of these two technologies needs further study to understand whether they are additive and what their influence on clinical outcomes is.
IOTG-01. Computational Neurosurgery in Brain Tumors: A paradigm shift on the use of Artificial Intelligence and Connectomics in pre- and intra-operative imaging
Authors: Di Ieva Antonio , Russo Carlo , Al Suman Abdulla , Liu Sidong
Published: November 2021

Computational Neurosurgery is a novel field where computational modeling and artificial intelligence (AI) are used to analyze diseases of neurosurgical interest. Our aim is to apply AI models to brain tumor (BT) images to a) automatically segment BTs on pre-operative MRI, b) predict the genetic subtype of glioma on intra- and post-operative histological specimens; and c) predict the extent of resection according to connectomics data. For the segmentation task, we used 510 BT images to train a deep learning (DL) model for automatic segmentation of the tumors’ edges and comparison of the AI-generated masks versus experts’ consensus (quantified by means of the dice score). For the histopathology task, we digitalized 266 hematoxylin/eosin slides of gliomas (including 130 IDH-wildtype and 136 IDH-mutant) and applied a DL architecture to predict the IDH genetic status, then validated by immunohistochemistry and genetic sequencing. The datasets were also augmented by generating synthetic glioma images by means of a Generative Adversarial Network methodology. The resection of 10 BTs was also customized according to connectomics data. In the segmentation experiment, we reached a dice score of ~0.9 (out of 1.0), while further demonstrating that only the T1, T1 after gadolinium, and FLAIR sequences are necessary for accurate automatic segmentation. In the histopathology task, we were able to predict the genetic status with accuracy between 76% and 95% using the DL model. The machine learning-based connectome analysis allowed us to perform safe supramaximal resection. We have shown the robustness of applying AI methodology or the automatic segmentation of BTs in MR imaging. Moreover, we have also shown that AI can be used to predict the genetic status, specifically, IDH, in histopathology images of gliomas. Our results support the use of AI in the clinical scenario for a fast and objective computerized characterization of patients affected by BTs.
ITVT-04. Management of intraoperative technological advances [intraoperative MRI, neuronavigation system using PET, and 5-aminolevulinic acid (5-ALA)–induced fluorescence image-guided surgery] for glioblastoma
Authors: Miyake Keisuke , Ogawa Daisuke , Hatakeyama Tetsuhiro
Published: November 2021

OBJECTIVE

The maximum resection of Glioblastoma (GBM) is the standard therapy and is expected to improve prognosis. Image-guided surgery using a neuronavigation system is the standard technique for glioma. However, due to the brain shift during surgery, intraoperative technologies, such as 5-ALA fluorescence and intraoperative MRI (IoMRI), are employed. Radiotracers are used during positron emission tomography (PET) for metabolic imaging and assist the evaluation of glioma metabolism. We compared the effectiveness of these intraoperative technologies.

METHODS

Between January 2016 and May 2021, 52 patients with gliomas underwent IoMRI. 21 patients were selected for 5-ALA fluorescence-guided resection of GBM and underwent multiple PET studies (MET, FLT, and FMISO). We graded fluorescence level as strong, vague, or none. Following tumor resection, we identified the fluorescence level and evaluated the residual volume of gadolinium-enhanced T1WI (T1-Gd) on IoMRI and at each PET study. After calculating the extent of resection (EOR) for T1-Gd, we compared the residual volume on T1-Gd for IoMRI and each PET study, between EOR ≥ 93% and EOR < 93%.

RESULTS

We detected strong 5-ALA fluorescence during induction and before tumor resection in all 21 (100%) patients with a newly-diagnosed and histopathologically-confirmed GBM. Following tumor resection, we noted an EOR ≥ 93% for T1-Gd in 12 cases (vague, 4; none, 8) and an EOR < 93% for T1-Gd in 9 cases (vague, 5; none, 4). The compared median residual volume (mL) with no fluorescence between EOR ≥ 93% and EOR < 93% for T1-Gd were T1-Gd (0.22, 0.74), MET (0.29, 3.31), FLT (0.24, 1.77), and FMISO (0.22, 1.02).

CONCLUSIONS

GBM cells are difficult to distinguish in cases without 5-ALA fluorescence. For cases without 5-ALA fluorescence, we were able to maximize the resection of GBM by extracting the area of MET accumulation.
Physical work exposure matrix for use in the UK Biobank
Authors: Yanik E L , Stevens M J , Harris E Clare , Walker-Bone K E , Dale A M , Ma Y , Colditz G A , Evanoff B A
Published: November 2021

Background

UK Biobank (UKB) is a large prospective cohort capturing numerous health outcomes, but limited occupational information (job title, self-reported manual work and occupational walking/standing).

Aims

To create and evaluate validity of a linkage between UKB and a job exposure matrix for physical work exposures based on the US Occupational Information Network (O*NET) database.

Methods

Job titles and UK Standard Occupational Classification (SOC) codes were collected during UKB baseline assessment visits. Using existing crosswalks, UK SOC codes were mapped to US SOC codes allowing linkage to O*NET variables capturing numerous dimensions of physical work. Job titles with the highest O*NET scores were assessed to evaluate face validity. Spearman’s correlation coefficients were calculated to compare O*NET scores to self-reported UKB measures.

Results

Among 324 114 participants reporting job titles, 323 936 were linked to O*NET. Expected relationships between scores and self-reported measures were observed. For static strength (0–7 scale), the median O*NET score was 1.0 (e.g. audiologists), with a highest score of 4.88 for stone masons and a positive correlation with self-reported heavy manual work (Spearman’s coefficient = 0.50). For time spent standing (1–5 scale), the median O*NET score was 2.72 with a highest score of 5 for cooks and a positive correlation with self-reported occupational walking/standing (Spearman’s coefficient = 0.56).

Conclusions

While most jobs were not physically demanding, a wide range of physical work values were assigned to a diverse set of jobs. This novel linkage of a job exposure matrix to UKB provides a potentially valuable tool for understanding relationships between occupational exposures and disease.
Crushing and Splitting Direct-Acting Antivirals for Hepatitis C Virus Treatment: A Case Series and Literature Review
Authors: Whelchel Kristen , Zuckerman Autumn D , Koren David E , Derrick Caroline , Bouchard Jeannette , Chastain Cody A
Published: November 2021

Limited data exist regarding the use of direct-acting antivirals (DAAs) for hepatitis C virus (HCV) in patients who are unable to swallow tablets. This case series describes HCV treatment in patients requiring tablet manipulation, providing evidence for safety and effectiveness of HCV DAA tablet manipulation.
Excess Weight Gain With Integrase Inhibitors and Tenofovir Alafenamide: What Is the Mechanism and Does It Matter?
Authors: Wood Brian R , Huhn Gregory D
Published: November 2021

Numerous studies have detected a greater likelihood of excess weight gain with specific antiretrovirals (ARVs), particularly tenofovir alafenamide and integrase inhibitors, as compared with other agents and classes. The long-term implications and potential reversibility for individuals who have experienced substantial ARV-associated weight accumulation remain poorly understood. Furthermore, the underlying mechanism remains controversial: Is the explanation mitochondrial toxicity and weight suppression from the older agents or direct effects of the newer drugs on appetite, adipocytes, or other unintended targets? This review discusses proposed mechanisms and evidence to date and argues that the question about mechanism is highly clinically relevant because it carries significant implications for ARV management. The existing literature suggests that older ARVs, such as tenofovir disoproxil fumarate and efavirenz, suppress weight gain, but also that integrase inhibitors may stimulate excess weight gain through several plausible biologic pathways. Confirming the mechanisms of ARV-associated excess weight gain should be high priority for future research.
Impact of an Electronic Medical Record Best Practice Alert on Expedited Partner Therapy for Chlamydia Infection and Reinfection
Authors: Willis Sarah J , Elder Heather , Cocoros Noelle M , Callahan Myfanwy , Hsu Katherine K , Klompas Michael
Published: November 2021

Background

Atrius Health implemented a best practice alert (BPA) to encourage clinicians to provide expedited partner therapy (EPT) in October 2014. We assessed (1) the impact of the BPA on EPT provision and chlamydial reinfection and (2) the impact of EPT on testing for chlamydia reinfection and reinfection rates.

Methods

We included patients ≥15 years with ≥1 positive chlamydia test between January 2013 and March 2019. Tests-of-reinfection were defined as chlamydia tests 28–120 days after initial infection, and corresponding positive results were considered evidence of reinfection. We used interrupted time series analyses to identify changes in (1) frequency of EPT, (2) tests-of-reinfection, and (3) reinfections after the BPA was released. Log-binomial regression models, with generalized estimating equation methods, assessed associations between (1) EPT and tests-of-reinfection and (2) EPT and reinfection.

Results

Among 7267 chlamydia infections, EPT was given to 1475 (20%) patients. Expedited partner therapy frequency increased from 15% to 22% of infections between January 2013 and September 2014 (β = 0.003, P = .03). After the BPA was released, EPT frequency declined to 19% of infections by March 2019 (β = −0.004, P = .008). On average, 35% of chlamydia infections received a test-of-reinfection and 7% were reinfected; there were no significant changes in these percentages after BPA implementation. Patients given EPT were more likely to receive tests-of-reinfection (prevalence ratio [PR] 1.09; 95% confidence interval [CI], 1.01–1.16) but without change in reinfections (PR 0.88; 95% CI, 0.66–1.17).

Conclusions

Best practice alerts in electronic medical record systems may not be effective at increasing EPT prescribing and decreasing chlamydial reinfection. However, patients given EPT were more likely to receive a test of chlamydia reinfection.
Nerve Root Sparing En Bloc Resection of Sacral Chondrosarcoma: Technical Note and Review of the Literature
Authors: Pairojboriboon Sutipat , Sacino Amanda , Pennington Zach , Lubelski Daniel , Yang Robin , Morris Carol D , Suk Ian , Sciubba Daniel M , Lo Sheng-fu Larry
Published: November 2021

BACKGROUND

Total en bloc sacrectomy provides the best long-term local control for large primary bony sacral tumors, but often requires lumbosacral nerve root sacrifice leading to loss of ambulation and/or bowel, bladder, and/or sexual dysfunction. Nerve-sparing techniques may be an option for some patients that avoid these outcomes and accordingly improve postoperative quality of life.

OBJECTIVE

To describe the technique for a posterior-only en bloc hemisacrectomy with maximal nerve root preservation and to summarize the available literature.

METHODS

A 38-yr-old woman with a 7.7 × 5.4 × 4.5 cm biopsy-proven grade 2 chondrosarcoma involving the left L5-S2 posterior elements underwent a posterior-only left hemisacrectomy tri-rod L3-pelvis fusion. A systematic review of the English literature was also conducted to identify other descriptions of high sacrectomy with distal sacral nerve root preservation.

RESULTS

Computer-aided navigation facilitated an extracapsular resection that allowed preservation of the left-sided L5 and S3-Co roots. Negative margins were achieved and postoperatively the patient retained ambulation and good bowel/bladder function. Imaging at 9-mo follow-up showed no evidence of recurrence. The systematic review identified 4 prior publications describing 6 total patients who underwent nerve-sparing sacral resection. Enneking-appropriate resection was only obtained in 1 case though.

CONCLUSION

Here we describe a technique for distal sacral nerve root preservation during en bloc hemisacrectomy for a primary sacral tumor. Few prior descriptions exist, and the present technique may help to reduce the neurological morbidity of sacral tumor surgery.
Risk factors and incidence of long-COVID syndrome in hospitalized patients: does remdesivir have a protective effect?
Authors: Boglione L , Meli G , Poletti F , Rostagno R , Moglia R , Cantone M , Esposito M , Scianguetta C , Domenicale B , Di Pasquale F , Borrè S
Published: November 2021

Background

The definition of ‘long-COVID syndrome’ (LCS) is still debated and describes the persistence of symptoms after viral clearance in hospitalized or non-hospitalized patients affected by coronavirus disease 2019 (COVID-19).

Aim

In this study, we examined the prevalence and the risk factors of LCS in a cohort of patients with previous COVID-19 and followed for at least 6 months of follow-up.

Design

We conducted a prospective study including all hospitalized patients affected by COVID-19 at our center of Infectious Diseases (Vercelli, Italy) admitted between 10 March 2020 and 15 January 2021 for at least 6 months after discharge. Two follow-up visits were performed: after 1 and 6 months after hospital discharge. Clinical, laboratory and radiological data were recorded at each visit.

Results

A total of 449 patients were included in the analysis. The LCS was diagnosed in 322 subjects at Visit 1 (71.7%) and in 206 at Visit 2 (45.9); according to the post-COVID-19 functional status scale we observed 147 patients with values 2–3 and 175 with values >3 at Visit 1; at Visit 2, 133 subjects had the score between 2–3 and 73 > 3. In multivariate analysis, intensive care unit (ICU) admission (OR = 2.551; 95% CI = 1.998–6.819; P = 0.019), time of hospitalization (OR = 2.255; 95% CI = 1.018–6.992; P = 0.016) and treatment with remdesivir (OR = 0.641; 95% CI = 0.413–0.782; P < 0.001) were independent predictors of LCS.

Conclusions

Treatment with remdesivir leads to a 35.9% reduction in LCS rate in follow-up. Severity of illness, need of ICU admission and length of hospital stay were factor associated with the persistence of PCS at 6 months of follow-up.
Evolution of patient characteristics in the era of biologic treatment of psoriatic arthritis: 18-year Belgian experience from the Leuven Spondyloarthritis Biologics Cohort (BioSPAR)
Authors: Ishchenko Alla , Joly Johan , Neerinckx Barbara , Lories Rik , de Vlam Kurt
Published: November 2021

Objectives

Biologic treatments have revolutionized the management of PsA by significantly improving clinical manifestations and preventing structural damage. Both result in better quality of life and improved physical functioning. Since the introduction of the first TNF inhibitor (TNFi) in the early 2000s, therapeutic options for PsA are increasing steadily, and a new generation of biologics, including anti-IL-17 and anti-IL-23 strategies, allows distinct targeted approaches. The purpose of this study was to investigate whether the demographic, clinical and disease characteristics of PsA patients who are selected for first-line biologic treatment has changed over time since the introduction of biologics.

Methods

Patients with a clinical diagnosis of PsA were included in the KU Leuven BioSPAR registry, a prospective cohort of SpA and PsA patients treated with biologics and targeted synthetic DMARDs (tsDMARDs), such as apremilast and Janus kinase inhibitors. Demographics, prior DMARD use, disease characteristics and disease activity parameters were recorded at the initiation of biologic treatment and subsequently every 3 months for the first 2 years and later every 6 months. The patient data were compared in three treatment periods, corresponding to availability of the first and second generation of TNFi and the third generation of biologics.

Results

Analysis of 185 Caucasian patients with PsA from our prospective cohort showed longer disease duration and higher disease activity, with higher tender joint count, swollen joint count and CRP in the first period compared with the later time periods. The demographic characteristics and prior DMARD use did not change over time. Skin and nail psoriasis were more frequent in earlier compared with the later treatment periods. The bio-DMARD survival rate was similar in the early and later treatment periods.

Conclusion

The population of patients selected for treatment escalation has changed over time since the introduction of biologics. Our results suggest that with years of experience, PsA patients might be considered earlier and for therapy intensification in patients with less active disease in comparison to profiles in the early days of biologic treatment.
The relationship of fear-potentiated startle and polysomnography-measured sleep in trauma-exposed men and women with and without PTSD: testing REM sleep effects and exploring the roles of an integrative measure of sleep, PTSD symptoms, and biological sex
Authors: Richards Anne , Inslicht Sabra S , Yack Leslie M , Metzler Thomas J , Russell Huie J , Straus Laura D , Dukes Cassandra , Hubachek Samantha Q , Felmingham Kim L , Mathalon Daniel H , Woodward Steven H , Neylan Thomas C
Published: November 2021

Study Objectives

Published research indicates that sleep is involved in emotional information processing. Using a fear-potentiated startle (FPS) and nap sleep protocol, we examined the relationship of emotional learning with REM sleep (REMS) in trauma-exposed participants. We also explored the roles of posttraumatic stress disorder (PTSD) symptoms, biological sex, and an integrative measure of polysomnography-measured (PSG) sleep in the learning-sleep relationship.

Methods

After an adaptation nap, participants (N = 46) completed two more visits (counterbalanced): a stress-condition visit, which included FPS conditioning procedures prior to a nap and assessment of learning retention and fear extinction training after the nap, and a control visit, which included a nap opportunity without stressful procedures. FPS conditioning included a “fear” visual stimulus paired with an air blast to the neck and a “safety” visual stimulus never paired with an air blast. Retention and extinction involved presentation of the visual stimuli without the air blast. Primary analyses examined the relationship between FPS responses pre- and post-sleep with stress-condition REMS duration, controlling for control-nap REMS duration.

Results

Higher safety learning predicted increased REMS and increased REMS predicted more rapid extinction learning. Similar relationships were observed with an integrative PSG sleep measure. They also showed unexpected effects of PTSD symptoms on learning and showed biological sex effects on learning-sleep relationships.

Conclusions

Findings support evidence of a relationship between adaptive emotional learning and REMS. They underscore the importance of examining sex effects in sleep-learning relationships. They introduce an integrative PSG sleep measure with potential relevance to studies of sleep and subjective and biological outcomes.
Generation and Application of a Versatile CRISPR Toolkit for Mammalian Cell Engineering
Authors: Dang Nghi , Lance-Byrne Alissa , Tung Angela , Guo Xiaoge , Cecchi Ryan J , Buchthal Joanna , Chavez Alejandro , Yeo Nan Cher
Published: November 2021

CRISPR/Cas9 has revolutionized the field of genome engineering. Yet, as the CRISPR toolbox has rapidly expanded, there remains a need for a comprehensive library of CRISPR/Cas9 reagents that allow users to perform complex cellular and genetic manipulations without requiring labor-intensive generation of reagents to meet each user’s unique experimental circumstances. Here we described the creation and validation of a pNAX CRISPR library consisting of 72 different Cas9 and gRNA expression plasmids to allow for efficient multiplex gene editing, activation, and repression in mammalian cells. The toolkit plasmids, which are piggyBac or lentiviral based, provide the means for reliable and rapid delivery of Cas9/gRNA through either transient transfection or stable integration. Using the toolkit, we demonstrate the ease with which users can perform single or multiplex gene editing and modulate the expression of both coding and non-coding genes. We also highlight the use of the comprehensive toolkit to perform combinatorial gene knockout to identify factors that regulate homologous recombination, along with investigating the regulatory role of a 68-kb intronic region associated with human disease.
Copper and zinc hydroxychloride cosupplementation improve growth performance and carcass and reduce diarrhea frequency in grower-finisher pigs
Authors: Mendonça Maitê Vidal , Nakasone Denis Hideki , Martinez Cristian Hernando Garcia , Gemelli Jéssica Luana , Pereira Angélica Simone Cravo , Pugine Silvana Marina Piccoli , de Melo Mariza Pires , de Andrade André Furugen Cesar , Araújo Lúcio Francelino , Augusto Karolina Von Zuben , Yanming Han , Martins Simone Maria Massami Kitamura
Published: November 2021

This study investigated copper (Cu) and zinc (Zn) hydroxychloride cosupplementation on the growth performance, diarrhea frequency, carcass, meat quality, and antioxidant activity in grower-finisher pigs. A total of 256 pigs were used from 70 to 154 days (d) of age, distributed in four treatments, with eight pigs in each pen and eight replications per treatment. Diets were provided to grower pigs from 70 to 112 days old and in the finisher, 112 to 154 days old. Copper was considered the low level at 100 mg Cu/kg and 90 mg Cu/kg, respectively, and 150 mg Cu/kg in both periods as high in the grower and finisher periods. In the grower and finisher period, zinc was cosupplemented in the diet at 80 mg Zn/kg and 70 mg Zn/kg, respectively. In the diets, T1 and T2 groups are the traditional inorganic sources for minerals (copper sulfate, CuSO4; zinc oxide, ZnO) and T3 and T4 hydroxychloride sources (copper hydroxychloride, CHC, and zinc hydroxychloride, ZHC). The flavomycin was associated with treatments with low Cu content in the inclusion of 50 g/ton. The experimental design was in randomized blocks, the data were submitted to analysis of PROC MIXED in SAS, the PDIFF test analyzed the treatment effect. At the finisher period, pigs fed both minerals from hydroxychloride source had a higher BW 154 d, average daily gain (ADG) 70 to 154 d, the hot and cold carcass weight and frequency of normal feces than those fed 150 mg Cu/kg and Zn from a traditional inorganic source (P < 0.05). The animals fed low Cu levels of the sulfate source had a higher ADG 70 to 154 d than those fed high Cu levels of the same source (P < 0.05). Pigs fed 150 mg Cu/kg cosupplemented with Zn from a hydroxychloride source had the highest carcass length (P < 0.05). There was no difference among the treatments for meat quality (P > 0.05). Pigs fed 150 mg Cu/kg and Zn from a traditional inorganic source had a higher superoxide dismutase (SOD) activity than the other treatments (P < 0.05). Animals fed low Cu levels from hydroxychloride had a higher malondialdehyde (MDA) formation than those fed sulfate source, regardless of the Cu levels and those fed high Cu levels of hydroxychloride (P < 0.05). In conclusion, 150 mg Cu/kg as copper sulfate cosupplemented to zinc oxide in the diet of growing and finishing pigs impairs the growth performance, carcass and increases diarrhea frequency, and copper and zinc hydroxychloride cosupplementation improves these characteristics.
Impact of calcium nitrate supplementation on the oxygen-carrying capacity of lactating sows and their offspring
Authors: van de Ligt Jennifer L G , Saddoris-Clemons Kari L , Norton Sharon A , Davis Meagan M , Doepker Candace L
Published: November 2021

Calcium nitrate supplementation has recently been suggested to provide potential benefits to sows and, in particular, their offspring when administered at a level of 1,200 ppm in feed shortly before farrowing through lactation. More specifically, nitrate supplementation has been suggested as one opportunity for improved placental and/or fetal blood flow and has been hypothesized in previous work to be important to the swine industry in light of the global trend toward larger litter sizes. The benefit is likely manifested through exposure to the nitrate moiety, but interestingly, nitrate has historically been considered a compound of concern for swine. High levels of nitrate once metabolized to nitrite can interfere with the oxygen-carrying capacity of hemoglobin, resulting in increased methemoglobin and, subsequently, methemoglobinemia (MetHb) if the animal is deprived of significant amounts of oxygen; however, the level of nitrate exposure necessary to induce MetHb in sows is not clearly defined. This work was undertaken to examine methemoglobin levels in sows and piglets exposed to the potentially beneficial levels of 1,200 and 6,000 ppm nitrate added to their diets over the course of the periparturient period. Other oxygen capacity blood variables were evaluated (e.g., hemoglobin, hematocrit, and various measures of hemoglobin and red blood cell volumes and concentrations), as well as performance endpoints (weight changes and feed intake) and general observations over the 27-d period. No evidence of treatment-related toxicity manifestation was observed at these supplemental levels. Nearly all oxygen-related variables were affected by time (independent of treatment), indicating adaptive general effects of farrowing. These findings support the hypothesis that MetHb is not a concern up to at least 6,000 ppm supplemental nitrate exposure, even in combination with additional nitrate in the sow’s daily diet. This work is important to help swine producers understand that consideration of nitrate benefit should outweigh concern for risk of nitrate-induced toxicity.
Communication strategies to facilitate the implementation of new clinical practices: a qualitative study of community mental health therapists
Authors: Albright Karen , Navarro Elena I , Jarad Iman , Boyd Meredith R , Powell Byron J , Lewis Cara C
Published: November 2021

Lay Summary

There has been a great deal of attention recently to the study of implementation, or how something (e.g., a new clinical practice or initiative) is actually put into effect. Many studies have found a number of barriers to and facilitators of the implementation process. But despite this increased attention, the field of implementation science may not have paid enough attention to the role of communication. Although communication is generally acknowledged as important, precisely how it impacts implementation—and, importantly, the ways it might be improved—is typically unexplored. This study conducted focus groups with mental health therapists in 12 clinics which were about to implement a new clinical practice: measurement-based care for depressed adults receiving psychotherapy. What these therapists shared about their perspectives and experiences suggest that there are at least five ways to facilitate effective communication when introducing a new clinical practice: communicating a clear rationale for the new practice, providing necessary procedural knowledge, using multiple methods to communicate about the change, giving sufficient lead time to prepare for the change, and providing the opportunity for bidirectional engagement.
Nurses Spreading Misinformation
Authors: Grace Pamela J.
Published: November 2021

Nurses are trusted to be truthful and to provide considered, substantiated information in a neutral way. Yet the COVID-19 crisis has highlighted how some nurses engage in misinformation on social media and in other venues. This article explores the reasons why people believe they are fully informed, including the possible influence of confirmation biases. It also describes the augmented ethical responsibilities of nurses to examine in depth what they think they know and understand and to account for cognitive biases. Strategies for nurse leaders, managers, and educators are provided to facilitate good practice and help ensure nurses are held accountable for their actions and social media postings.
All Nursing Is Global Nursing
Authors: Gray Sarah , Madigan Elizabeth
Published: November 2021

Editor's note: Sigma Theta Tau International Honor Society of Nursing is a global organization focused on leadership and scholarship, with more than 135,000 members from over 100 countries. This first article in a series highlights why global nursing should matter to U.S. nurses and offers an overview of organizations within the global nursing community.
The Role of Technology in Health Professions Education During the COVID-19 Pandemic
Authors: Jeffries Pamela R. , Bushardt Reamer L. , DuBose-Morris Ragan , Hood Colton , Kardong-Edgren Suzan , Pintz Christine , Posey Laurie , Sikka Neal
Published: November 2021

The COVID-19 pandemic has sparked radical shifts in the ways that both health care and health professions education are delivered. Before the pandemic, some degree programs were offered fully online or in a hybrid format, but in-person learning was considered essential to the education and training of health professionals. Similarly, even as the use of telehealth was slowly expanding, most health care visits were conducted in-person. The need to maintain a safe physical distance during the pandemic rapidly increased the online provision of health care and health professions education, accelerating technology adoption in both academic and professional health care settings. Many health care professionals, educators, and patients have had to adapt to new communication modalities, often with little or no preparation. Before the pandemic, the need for cost-effective, robust methodologies to enable teaching across distances electronically was recognized. During the pandemic, online learning and simulation became essential and were often the only means available for continuity of education and clinical training. This paper reviews the transition to online health professions education and delivery during the COVID-19 pandemic and provides recommendations for moving forward.
The Prevalence and Work-Related Factors of Burnout Among Public Health Workforce During the COVID-19 Pandemic
Authors: Ibrahim Farha , Samsudin Ely Zarina , Chen Xin Wee , Toha Haidar Rizal
Published: November 2021

Objective:

To examine the prevalence of burnout and its work-related factors among public health providers (PHP) during the COVID-19 pandemic.

Methods:

We surveyed 366 PHP in May 2021 on their burnout, demographic, and work-related characteristics. Logistic regression analyses were conducted to identify associated factors.

Results:

45% PHP reported burnout. Higher PHP burnout was associated with younger age (AOR 0.96, 95% CI 0.93–0.99), prolonged COVID-19 involvement (AOR 2.35, 95% CI 1.16–4.72), as well as perceiving medium (AOR 2.10, 95% CI 1.27–3.48) and high emotional demand (AOR 4.45, 95% CI 1.67–11.77), low (AOR 2.10, 95% CI 1.27–3.48) and medium (AOR 4.18, 95% CI 1.64–10.59) role clarity, medium job satisfaction (AOR 3.21, 95% CI: 1.11–9.29), and low organisational justice (AOR 3.32, 95% CI 1.51–7.27).

Conclusions:

Improving job content and organisational characteristics may be key to reducing PHP burnout.
Expression of Protein SOX9 in Biliary Atresia
Authors: Arboleda‐Bustan Jenny E. , Ribalta Teresa , Albert Asteria , Cuadras Daniel , Martín‐Solé Oriol
Published: November 2021

Objectives:

Biliary atresia (BA) is still an enigmatic disease. Deeper knowledge of its pathophysiology could help develop better treatments. SOX9 regulates bile duct development, liver regeneration and fibrosis; therefore, it could be determinant in characterizing BA liver damage. Aim: To study if there is a SOX9 expression pattern in liver biopsies from BA patients.

Methods:

Liver biopsies from BA patients (group BA), from age‐matched infants without primary hepatic disease (group Control), and from patients with other liver conditions (group OLC) were compared. Expression of SOX9 was checked for: amount, intensity of immunoreaction, localization within ductular structures, perifibrotic epithelial cells, and lobular cells. The scores were added to create a scale from 0 to 11 that allowed group comparison. SOX9 Scale and liver survival were also looked for a correlation.

Results:

All BA cases had a score >4, while all controls scored <4. OLC livers scored 1 to 8 (3.5 ± 2.0) (P < 0.001 between all groups). A cut‐off at 4 had 100% sensitivity and 88.24% specificity to differentiate BA from Controls and from OLC (area under receiver operating characteristic curve: 0.9989 (95% confidence interval: 0.9964–1.000). Strong expression of SOX9 was observed mainly in the nuclei of proliferated ductules of portal spaces and fibrotic bridges. SOX9 Scale score could not be related to liver survival in this study.

Conclusion:

In BA livers, SOX9 is mainly expressed in reactive ductular epithelium, following a pattern significantly different from that seen in non‐BA patients; thus, SOX9 Scale may have a role in the diagnosis of BA.
Factors Influencing Role Ambiguity and Role Conflict Among Intensive Care Unit Nurses Providing End of Life Care
Authors: Wells Celia M.
Published: November 2021

AIM

The aim of this study was to determine the relationship of compassion satisfaction, compassion fatigue, and death anxiety with role ambiguity and role conflict in intensive care unit (ICU) nurses providing care at end of life.

BACKGROUND

Understanding the factors that impact care for patients and families at the end of life is important for nursing practice and nursing leaders.

METHODS

A quantitative nonexperimental correlation design was used, with 216 critical care nurses recruited using an Internet-based website. Data were analyzed using, Pearson product-moment correlation, χ
2 test of independence, and the independent-samples t test or analysis of variance as appropriate.

RESULTS

Role ambiguity and role conflict were negatively related to compassion satisfaction and were positively related to compassion fatigue and death anxiety. There was no relationship between increased years of ICU experience and role ambiguity and role conflict.

CONCLUSION

Compassion satisfaction is a significant predictor for role ambiguity, whereas burnout is best predicted by role conflict for ICU nurses providing end of life care.
Qualifications of Executive Nurses for Service on Hospital Boards
Authors: Foxx Michelle , Garner Catherine
Published: November 2021

Objective

The purpose of this qualitative survey was to document executive nurse leaders' perception of their own leadership qualities in the context of the American Hospital Association (AHA) recommended membership requirements for executive hospital board appointment.

Background

Hospital boards of trustees are increasingly responsible for the quality of care and its impact on financial performance. High-performing boards are focused on the accountability of chief executive officer for quality metrics. Nurse leaders have valuable insight into key shared governance issues such as quality of care, financial performance, legal requirements, and regulatory oversight.

Methods

Fifty senior-level nurse executive members polled from the American Organization of Nurse Leaders, the Texas Organization of Nurse Leaders, and the Texas Nurse Practitioners Association completed an online quantitative survey using The Center for Healthcare Governance (CHG) Assessment Tool© of the AHA, which details a list of skills, experience, and personal qualities for executive hospital board placement. Respondents ranked their individual knowledge and skills on a 4-point Likert scale.

Results

Participant responses indicated that senior-level nurse executives have significant expertise in the key areas of quality, patient safety and performance, healthcare administration and policy, and business management. Areas ranking lower are those associated with organizational specialties: legal, construction project management, and finance.

Conclusion

This information can be used to educate executive hospital boards regarding the qualifications of nurse leaders members. Nursing leaders, professional organizations, and academia can use this information to assess the skills of senior nursing leaders as it relates to potential board appointments.
Impact of Evidence-Based Charge Nurse Education on Charge Nurse Skills and Nurse-Specific Metrics
Authors: Dols Jean Dowling , Ramirez Monica N. , Hernandez Ashley D. , Allen David , Kloewer Theresa , Aguillon Virginia
Published: November 2021

OBJECTIVE

This research study was designed to analyze the impact of an evidence-based charge nurse (CN) education program on novice and experienced CNs' self-confidence and satisfaction with the role, skill competencies, and nursing metrics.

BACKGROUND

Charge nurses are critical to effective daily unit operations. However, executive nursing leadership found that unit performance varied by CN despite experience.

METHODS

University faculty partnering with nurse leaders developed an evidence-based CN education program including a series of classes, coaching in skills and role responsibilities by nurse leaders, and evaluation of skills competencies before and after the CN education program.

RESULTS

The CN program was associated with significant positive changes in CN performance, nurse-specific metrics, hospital-acquired events, and patient satisfaction.

CONCLUSIONS

Interventions targeting frontline leaders positively impact CN performance.
Application of a myoelectric elbow flexion assist orthosis in adult traumatic brachial plexus injury: patient perspectives
Authors: Webber Christina M. , Egginton Jason S. , Shin Alexander Y. , Kaufman Kenton R.
Published: November 2021

Background:

Individuals with brachial plexus injuries (BPIs) can be prescribed assistive devices, including myoelectric elbow orthoses (MEOs), for rehabilitation or functional use after failed treatment for elbow flexion restoration. Although recent case studies indicate potential for clinical improvements after using an MEO after BPI, the patients' perspectives on such use are still unknown.

Objective:

To explore patient perspectives on the use of an MEO after surgical treatment for a traumatic BPI.

Study design:

Qualitative using both a focus group and semistructured interviews.

Methods:

Patients with BPI that used an MEO were recruited. Five patients participated in an in-person focus group, whereas three patients participated in individual phone interviews. Themes that emerged from the focus group were compared against those that emerged from the personal interviews.

Results:

Feedback was grouped into three themes: device usage, hardware performance, and device design. Within each theme, positive elements, areas for improvement, and additional considerations emerged. Patients indicated a positive attitude toward using an MEO as a rehabilitation tool. They desired a streamlined, stronger device to support them and assist during activities of daily living.

Conclusions:

For patients with BPI, a well-designed MEO that meets their needs could assist with rehabilitation and increase independence in daily activities. Continued patient engagement in the evaluation and development of both medical devices and treatment plans offers the best opportunity for improved outcomes that are important to the patient.
Prosthesis satisfaction and quality of life in US service members with combat-related major lower-limb amputation
Authors: Eskridge Susan L. , Dougherty Amber L. , Watrous Jessica R. , McCabe Cameron T. , Cancio Jill M. , Mazzone Brittney N. , Galarneau Michael R.
Published: November 2021

Background:

Military amputee patient care programs offer extensive services, including advanced prosthetic devices, to restore function and improve quality of life (QOL) among veterans and service members with combat-related limb loss, but research on satisfaction with these devices is limited.

Objective:

To assess prosthesis satisfaction and QOL in US service members and veterans with combat-related major lower-limb amputation.

Study design:

Cross-sectional study.

Methods:

Eighty-six participants with combat-related major lower-limb amputation completed the Orthotics and Prosthetics Users' Survey (OPUS) Satisfaction with Device scale and Quality of Well-Being Scale, Self-Administered, for the Wounded Warrior Recovery Project.

Results:

Most participants (62%–88%) responded Agree or Strongly Agree to OPUS Satisfaction with Device items on the fit, weight, comfort, ease of donning, appearance, and durability of their prosthesis. By contrast, the majority of participants (55%–79%) responded Disagree or Strongly Disagree to items on clothes being free of wear and tear, skin free of abrasions and irritations, and the affordability of their prosthesis. In linear regression analysis, total OPUS Satisfaction with Device score was positively associated with Quality of Well-Being Scale, Self-Administered score (β = 0.0058; P = 0.004).

Conclusions:

Findings indicate the majority of participants were satisfied with the overall functionality of their prosthesis, but dissatisfied with the effect of their prosthesis on clothing and skin, as well as expenses related to their prosthesis. Additionally, prosthesis satisfaction was positively associated with QOL.