bluuebunny/crossref_metadata_2025 huggingface dataset:
Approach Bias and Tobacco Craving as Mechanisms of the Effect of Approach Bias Retraining on Smoking Cessation
Authors: Garey Lorra , Rinck Mike , Rosenfield David , Nizio Pamella , Beevers Christopher G , Brown Richard A , Conroy Busch Haley E , Dutcher Christina D , McSpadden Bryan , Zvolensky Michael J , Smits Jasper A J
Published: September 2024

Introduction

Approach bias, the automatic tendency to advance toward, rather than move away from appetitive cues, has been associated with greater tobacco cravings, dependence, and likelihood of smoking relapse. Approach bias retraining (ABR) has emerged as one way to reduce approach bias and promote avoidance of smoking cues. Yet, additional research is needed to identify the mechanisms that may help explain the effect of ABR on smoking cessation.

Aims and Methods

The current study uses data collected as part of a randomized controlled trial to test two unique mechanisms of action ([1] approach bias and [2] tobacco craving) for the efficacy of standard smoking cessation treatment (ST) augmented by ABR on smoking abstinence. Participants were 96 adult daily smokers (Mage = 43.1, SD = 10.7) motivated to quit smoking.

Results

Results showed that lower approach bias and lower cravings at a treatment session were significantly related to the next session smoking abstinence (p’s < .018). Furthermore, deviations in approach bias partially mediated the effect of ABR on smoking abstinence (ab = −12.17, 95% CI: [−29.67, −0.53]). However, deviations in tobacco craving did not mediate this relation (ab = .40, 95% CI: [−0.27, 1.34]).

Conclusions

The current findings add to the extant literature by identifying approach bias as a mechanism of action of the effect of ABR on smoking abstinence during smoking cessation treatment.

Implications

The current study adds to the best of our knowledge on the effectiveness of ABR as a part of smoking cessation treatment. Results indicate that reductions in approach bias partially mediate the effect of ABR on smoking abstinence. These findings are consistent with previous research on alcohol-dependent adults and underline the potential of ABR to reduce approach bias and promote smoking cessation among smokers. Such findings could inform the development of future research exploring more targeted and effective smoking cessation interventions, ultimately improving outcomes for individuals attempting to quit smoking.
Bauxite mine and alumina refinery workers: mortality and cancer risk
Authors: Kinsman N , Del Monaco A , Dimitriadis C , Xie S , Benke G , Sim M R , Walker-Bone K
Published: September 2024

Background

Aluminium industry workers are at risk of long-term health consequences.

Aims

To investigate mortality and cancer incidence in bauxite mine and alumina refinery workers.

Methods

A pre-existing cohort of workers was re-linked with the Australian National Death Index, and the Australian Cancer Database to provide additional death (7 years) and cancer (9 years) data. Standardized mortality ratios (SMRs) and standardized incidence rates (SIRs) were estimated by job category, duration of employment and time since first employment.

Results

Linkage was performed for 6935 (6207 male) workers. Compared with the general population, there was a reduced or similar risk of death for mine/refinery workers for all causes except mesothelioma which was increased amongst male production workers [SMR 2.42, 95% CI 1.11–4.60]. Mesothelioma incidence was also increased amongst males [SIR 2.50, 95% CI 1.60–3.71]. Male office workers had a greater incidence of prostate cancer [SIR 1.30, 95% CI 1.06–1.57] and thyroid cancer [SIR 3.47, 95% CI 1.66–6.38]. Melanoma incidence was increased in female office workers [SIR 2.27, 95% CI 1.36–3.54]. Lip cancer incidence was increased in male maintenance/production workers [SIR 2.04, 95% CI 1.02–3.65]. Overall cancer incidence was otherwise similar to the general Australian population.

Conclusions

Overall risk of death and incidence of cancer for bauxite mine and alumina refinery workers was similar to the general population. Incidence and risk of death from mesothelioma were higher, likely due to historic asbestos exposure in this and other industries. The increased risk of melanoma, lip, prostate and thyroid cancers requires further investigation.
Protective Effects of 23-Valent Pneumococcal Polysaccharide Vaccination Against Mortality: The VENUS Study
Authors: Murata Fumiko , Maeda Megumi , Fukuda Haruhisa
Published: September 2024

This retrospective matched cohort study investigated the protective effects of the 23-valent pneumococcal polysaccharide vaccine (PPSV23) against pneumonia mortality and all-cause mortality in Japanese adults aged ≥65 years. We analyzed claims data, vaccination records, and death certificate records between October 2016 and December 2019 from 55 509 PPSV23-vaccinated individuals and 55 509 unvaccinated individuals. Cox proportional hazards analyses were performed to calculate the adjusted hazard ratios (HRs) of PPSV23 vaccination for mortality. The results showed that PPSV23 vaccination was significantly associated with a reduction in all-cause mortality (adjusted HR, 0.52; P < .001) but not pneumonia mortality (adjusted HR, 0.70; P = .374).
Therapeutic and restorative landscapes: including preferences for bluespaces in planning urban infrastructure
Authors: Eager Kate , McManus Phil
Published: September 2024

The impact of urbanization on our mental health and well-being calls for urban design and infrastructure development to include accessibility to restorative spaces and therapeutic landscapes, like green and blue spaces, that can potentially improve our wellbeing. Research in the suburb of Glebe in Sydney (Australia) aimed to identify the preferences for, and use of, different types of green and blue spaces. Semi-structured interviews involving photo elicitation (12 participants) and an online survey (53 respondents) showed that bluespaces and the combination of blue and green spaces, are preferred over built and green spaces. Bluespace preferences are explained by four key themes: (i) ineffable emotions and the ‘affect’ of space; (ii) childhood memories; (iii) the separation of human and nature through language and (iv) environmental and social sustainability. The design of bluespace to improve the quality and access to urban bluespaces, such as lakes, rivers, creeks and canals, involves the provision of adequate and appropriate infrastructure. Restorative spaces and therapeutic landscapes thereby become more accessible and potentially can improve health and wellbeing for more city residents.
Unintended consequences of a night float system in Paediatric Residency
Authors: Al Maawali Ali , Puran Allan , Talarico Susanna , Bismilla Zia
Published: September 2024

Objectives

Many residency programs implement ‘night float’ (NF) systems as alternatives to a traditional 24-h call model in an attempt to comply with duty-hour regulations. Research evaluating NF systems has focused primarily on the perspective of the resident with respect to fatigue and quality of life. Understanding the broader consequences of NF models from both trainee and faculty points of view is essential to creating effective and sustainable systems to comply with duty-hour regulations while maximizing patient care, education, and quality of life (QoL).

Methods

This study used qualitative thematic analysis situated in a constructivist paradigm to explore the experience of an NF system by residents and faculty. Semi-structured interviews were conducted with 15 trainees and 3 faculty members at a large academic pediatric hospital to understand their perceptions of an NF call structure compared to the traditional 24-h call schedule.

Results

Three themes were identified: (i) Implications for resident; (ii) Implications for patient and family; and (iii) Implications for curriculum. Eight sub-themes were identified, highlighting both intended and unintended consequences of the NF system.

Conclusions

The NF system resulted in the intended outcomes of decreased fatigue and improved continuity of patient care. Unintended outcomes also occurred, however, including negative effects on assessment and feedback, lack of integration of competencies, and mixed results on resident quality of life. These areas require special attention when designing and implementing NF systems.
The 2024 British Society for Rheumatology guideline for management of systemic sclerosis
Authors: Denton Christopher P , De Lorenzis Enrico , Roblin Elen , Goldman Nina , Alcacer-Pitarch Begonya , Blamont Emma , Buch Maya H , Carulli Maresa , Cotton Caroline , Del Galdo Francesco , Derrett-Smith Emma , Douglas Karen , Farrington Sue , Fligelstone Kim , Gompels Luke , Griffiths Bridget , Herrick Ariane , Hughes Michael , Pain Clare , Pantano Georgina , Pauling John D , Prabu Athiveeraramapandian , O’Donoghue Nuala , Renzoni Elisabetta A , Royle Jeremy , Samaranayaka Muditha , Spierings Julia , Tynan Aoife , Warburton Louise , Ong Voon H
Published: September 2024

This guideline was developed according to the British Society for Rheumatology Guidelines Protocol by a Guideline Development Group comprising healthcare professionals with expertise in SSc and people with lived experience, as well as patient organization representatives. It is an update of the previous 2015 SSc guideline. The recommendations were developed and agreed by the group and are underpinned by published evidence, assessed by systematic literature review and reinforced by collective expert opinion of the group. It considers all aspects of SSc including general management, treatment of organ-based complications, including cardiopulmonary, renal and gastrointestinal tract manifestations, as well as broader impact of disease. Whilst it is focused on adults with SSc we expect that the guideline will be relevant to people of all ages and expert input and review by paediatric rheumatologists and other relevant specialists considered where the guideline was, or may not be, applicable to young people with SSc and juvenile-onset disease. In addition to providing guidance on disease assessment and management the full guideline also considers service organization within the National Health Service and future approaches to audit of the guideline. The lay summary that accompanies this abstract can be found in Supplemental information 1.
Cognitive Mechanisms of Aberrant Self-Referential Social Perception in Psychosis and Bipolar Disorder: Insights From Computational Modeling
Authors: Lasagna Carly A , Tso Ivy F , Blain Scott D , Pleskac Timothy J
Published: September 2024

Background and Hypothesis

Individuals with schizophrenia (SZ) and bipolar disorder (BD) show disruptions in self-referential gaze perception—a social perceptual process related to symptoms and functioning. However, our current mechanistic understanding of these dysfunctions and relationships is imprecise.

Study Design

The present study used mathematical modeling to uncover cognitive processes driving gaze perception abnormalities in SZ and BD, and how they relate to cognition, symptoms, and social functioning. We modeled the behavior of 28 SZ, 38 BD, and 34 controls (HC) in a self-referential gaze perception task using drift-diffusion models parameterized to index key cognitive components: drift rate (evidence accumulation efficiency), drift bias (perceptual bias), start point (expectation bias), threshold separation (response caution), and nondecision time (encoding/motor processes).

Study Results

Results revealed that aberrant gaze perception in SZ and BD was driven by less efficient evidence accumulation, perceptual biases predisposing self-referential responses, and greater caution (SZ only). Across SZ and HC, poorer social functioning was related to greater expectation biases. Within SZ, perceptual and expectancy biases were associated with hallucination and delusion severity, respectively.

Conclusions

These findings indicate that diminished evidence accumulation and perceptual biases may underlie altered gaze perception in patients and that SZ may engage in compensatory cautiousness, sacrificing response speed to preserve accuracy. Moreover, biases at the belief and perceptual levels may relate to symptoms and functioning. Computational modeling can, therefore, be used to achieve a more nuanced, cognitive process-level understanding of the mechanisms of social cognitive difficulties, including gaze perception, in individuals with SZ and BD.
Glutathione S‐transferase‐Pi 1 protects cells from irradiation‐induced death by inhibiting ferroptosis in pancreatic cancer
Authors: Zhu Yan , Chen Yifan , Wang Yuling , Zhu Yuchun , Wang Hongyan , Zuo Mengzhe , Wang Jianliang , Li Yonggang , Chen Xuelian
Published: September 2024

Glutathione S‐transferase‐Pi 1 (GSTP1) is an isozyme that plays a key role in detoxification and antioxidative damage. It also confers resistance to tumor therapy. However, the specific role of GSTP1 in radiotherapy resistance in pancreatic cancer (PC) is not known. In this study, we investigated how GSTP1 imparts radioresistance in PC. The findings of previous studies and this study revealed that ionizing radiation (IR) induces ferroptosis in pancreatic cancer cells, primarily by upregulating the expression of ACSL4. Our results showed that after IR, GSTP1 prolonged the survival of pancreatic cancer cells by inhibiting ferroptosis but did not affect apoptosis. The expression of GSTP1 reduced cellular ferroptosis by decreasing the levels of ACSL4 and increasing the GSH content. These changes increase the resistance of pancreatic cancer cells and xenograft tumors to IR. Our findings indicate that ferroptosis participates in irradiation‐induced cell death and that GSTP1 prevents IR‐induced death of pancreatic cancer cells by inhibiting ferroptosis.
Updated guidelines for chronic kidney disease
Authors: Ness Becky , Mosman Amy
Published: September 2024

Chronic kidney disease (CKD) is an increasingly common condition worldwide that leads to substantial mortality. Research in the past decade has informed significant advances in preventing CKD or delaying its progression, mainly through new medications. This progress, however, requires adequate screening and identification of early CKD to truly transform patient outcomes. Revised guidelines from the Kidney Disease: Improving Global Outcomes consortium of experts aim to help clinicians incorporate these advances into practice. This article summarizes key updates from the guidelines regarding the evaluation and management of CKD that can lead to better patient outcomes.
Managing neonatal hyperbilirubinemia
Authors: Chastain Andrew P. , Geary Anne L. , Bogenschutz Kevin M.
Published: September 2024

More than 80% of newborn infants experience jaundice as a result of elevated bilirubin during the first few weeks after birth. In most cases, hyperbilirubinemia is physiologic, but persistent and extreme elevations can lead to serious long-term complications, such as kernicterus. To avoid these complications and help clinicians in the successful assessment, evaluation, and treatment of hyperbilirubinemia, the American Academy of Pediatrics updated its clinical practice guideline for neonatal hyperbilirubinemia. This article reviews the guideline and highlights significant updates, such as an elevation in the threshold for phototherapy and exchange transfusion, inclusion of gestational age, and removal of racially based norms.
Original Research: Alarm Fatigue: Exploring the Adaptive and Maladaptive Coping Strategies of Nurses
Authors: Obisesan Olawunmi , Barber Ericka , Martin Patricia , Brougham Nicole , Tymkew Heidi
Published: September 2024

Background:

To improve patient safety, hospitals use alarm notification systems to increase nurses' real-time situational awareness of a patient's condition. Such alarms are critical to nurses' clinical decision-making and prioritization, thus helping to improve patient care and care efficiency. But the frequent and often simultaneous ringing of alarms, including many that are false, nonemergent, or nonactionable, has led to overwhelm, alarm distrust, and desensitization, resulting in alarm fatigue.

Purpose:

This study aimed to explore oncology nurses' lived experiences with alarms and the adaptive and maladaptive strategies they use to cope with alarm fatigue.

Methods:

This qualitative, phenomenological study was guided by the theoretical framework of the Roy Adaptation Model. A purposive sample of nine nurses was recruited from two oncology units at a large midwestern Magnet hospital in the United States. Qualitative data were collected using a six-question, semistructured interview guide. Interviews were conducted either face-to-face in a private conference room on the unit or via the online videoconferencing platform Zoom.

Results:

Data analysis yielded five themes, the most prominent being the high volume and frequency of alarms. Nurse participants reported adopting more maladaptive than adaptive coping strategies. Overall, they felt that the high frequency of false, nonemergent, and nonactionable alarms disrupted their workflow and contributed to a general desensitization to alarms.

Conclusions:

This study's findings offer valuable insight into the problem of alarm fatigue among nurses. Practical measures are urgently needed to reduce nurses' cognitive overload; shift nonnursing responsibilities to other staff; and implement efficiency-focused process changes, such as reengineering workflows to minimize interruptions. Every effort should be made to redesign protocols to reduce alarm fatigue, including by decreasing the number of false, nonemergent, and nonactionable calls and alarms.
Functional Medicine in Nursing
Authors: Sager Brigitte
Published: September 2024

Functional medicine is a patient-centered approach that seeks to address the underlying causes of disease rather than focusing on managing the symptoms. This article explains the core principles of functional medicine and explores the potential for nurses to learn and incorporate functional medicine into their practice. By adopting a functional medicine approach, nurses can promote a more personalized and collaborative health care environment that can improve patient outcomes and empower patients to take an active role in their own health journey.
Preliminary Validation of a Clinical Reasoning Theory-Based Assessment Rubric
Authors: Deschênes Marie-France , Dionne Éric , Robert-Boluda Laura
Published: September 2024

Questions persist regarding the evaluation of cognitive processes related to clinical reasoning when resolving situations in a learning by concordance tool. This Delphi technique study aimed to validate a clinical reasoning assessment rubric based on script theory. Seventeen experts participated in the study. Two rounds of consultation were conducted to obtain a consensus on the accuracy and clarity of the rubric descriptors (clarity index and content validity index ≥ 0.9). The results inform future research procedures and the intended use of the rubric to facilitate evaluator inferences, provide student feedback, and support the development of learners’ clinical reasoning.
Maternal Perception of Infant Sleep and Bonding in Opioid Use Disorder
Authors: Xu Joyce H. , Merhar Stephanie L. , Defranco Emily A. , McAllister Jennifer M. , Terplan Mishka , Nidey Nichole L.
Published: September 2024

Objective

Infant sleep problems are common in early infancy and can negatively influence maternal-infant bonding. As opioid-exposed neonates are at increased risk of sleep difficulties, we examined the association between maternal perception of infant sleep difficulties and maternal-infant bonding among dyads affected by maternal opioid use disorder (OUD), from birth through 6 months.

Methods

We enrolled 100 birthing people (participants) between 6 months and 2 years postpartum who had received medications for OUD during their pregnancy. Participants answered questions regarding maternal and infant characteristics, as well as the Postpartum Bonding Questionnaire (PBQ), on which higher scores indicate decreased maternal-infant bonding. Unadjusted and adjusted linear regression models were used to examine the association between infant sleep and bonding.

Results

Of 100 study participants, 91 completed the PBQ. Of these, 55% reported difficulties with their infant’s sleep during the first 6 months postpartum. Although bonding scores were overall strong, those who reported infant sleep difficulties scored on average 10.40 points higher on the PBQ (β = 10.40; 95% confidence interval, 5.94–14.85) than participants who did not report sleep difficulties, indicating the negative association between infant sleep problems and bonding. This effect remained after adjusting for relevant maternal-infant characteristics (β = 6.86; 95% confidence interval, 2.49–11.24).

Conclusions

In this study among postpartum individuals with OUD, maternal perception of infant sleep problems was associated with reduced maternal-infant bonding. This relationship between infant sleep and bonding offers a target for supporting dyads affected by OUD.
Synergistic combination effect of the PCA-1/ALKBH3 inhibitor HUHS015 on prostate cancer drugs in vitro and in vivo
Authors: Mabuchi Miyuki , Tsujikawa Kazutake , Tanaka Akito
Published: September 2024

Prostate cancer antigen-1/ALKBH3, a DNA/RNA demethylase of 3-methylcytosine, 1-methyladenine (1-meA), and 6-meA, was found in prostate cancer as an important prognostic factor. Additionally, 1-meA has been associated with other cancers. The ALKBH3 inhibitor HUHS015 was found to be effective against prostate cancer both in vitro and in vivo. Herein, we investigated the effect of HUHS015 in combination with drugs for prostate cancer approved in Japan (including bicalutamide, cisplatin, mitoxantrone, prednisolone, ifosfamide, tegafur/uracil, docetaxel, dacarbazine, and estramustine) by treating DU145 cells with around IC50 value concentrations of these drugs for 3 days. Additionally, the cells were observed for additional 9 days after drug removal. Combination treatment with dacarbazine, estramustine, tegafur/uracil, and HUHS015 showed a slight additive effect after 3 days. After drug washout of them and mitoxantrone, the combined effects and levels were enhanced and sustained, although the effects of each treatment alone declined. HUHS015 combined with cisplatin or docetaxel elicited synergistic and sustained effects. In vivo, combining HUHS015 and docetaxel, the first chemotherapeutic agent for castration-resistant prostate cancer, showed notable effects in the DU145 xenograft model. In conclusion, HUHS015 exhibited a synergistic effect with docetaxel and drugs acting on DNA in vitro, even after drug removal. Since cancer chemotherapy is typically administered during rest periods due to its high toxicity, combining it with an ALKBH3 inhibitor could be a promising strategy for enhancing cancer treatment, as it can elicit an additive effect during treatment, allowing dosage reduction, and synergistically sustain the effect after drug washout during rest periods.
Association of Quality of Life and Visual Function in Glaucoma With Tests of Structure and Function
Authors: Bektaş Fatma Merve , Tekeli Oya
Published: September 2024

Précis:

In addition to standard automated perimetry tests, contrast sensitivity (CS) testing and macular analyses may predict changes in the quality of life (QOL) in patients at different stages of glaucoma.

Objective:

To examine the relationship between functional and structural tests of visual function and the 25-item National Eye Institute-Visual Function Questionnaire (NEI-VFQ-25) and the 36-item Short Form (SF-36) Health Survey in patients with different stages of glaucoma.

Materials and Methods:

Standard automated perimetry tests, optical coherence tomography scans, and CS testing were prospectively performed in 160 patients with glaucoma. The Hoddap-Parrish-Anderson staging system was used for glaucoma staging. Health-related QOL questionnaires (NEI-VFQ-25, SF-36) were also administered to all patients.

Results:

The study group comprised 29 patients with suspected glaucoma, 104 with mild glaucoma, 15 with moderate glaucoma, and 12 with severe glaucoma. The mean total score of the NEI-VFQ-25 was 88.8 ± 8.2. The SF-36 did not show a significant correlation with the data on functional and structural tests of visual function, whereas the NEI-VFQ-25 showed a low to moderate correlation (r = 0.212 to −0.492). Vision parameters can explain up to 18.6% of the total score of the NEI-VFQ-25. CS was the only function significantly correlated with glaucoma suspects, whereas, in the early stages, visual acuity was the strongest correlated function with the NEI-VFQ-25 total score (P = 0.003 and r = 0.551; P = 0.001 and r = 0.343, respectively). The impact of the visual field on vision-related QOL increased in the advanced stages (P = 0.013, r = 0.688). The macular retinal ganglion cell plus inner plexiform layer thickness remained associated with NEI-VFQ-25 at all stages of glaucoma (r = 0.335 to 0.802). The NEI-VFQ-25 total score and most of the subscales were correlated with the physical and mental component summary scores of the SF-36 (r = 0.159 to 0.587).

Conclusion:

Visual acuity correlated the most with QOL in patients with glaucoma, as measured with the NEI-VFQ-25 to assess QOL in glaucoma. The impact of visual functions on QOL varies at different stages of glaucoma.
A Nomogram of Predicting Healthcare-associated Infections in Burned Children
Authors: Long Tengfei , Hu Xuejiao , Liu Ting , Hu Guanfeng , Fu Jie , Fu Jing
Published: September 2024

Background:

Healthcare-associated infections (HAIs) are a common clinical concern associated with adverse prognosis and mortality in burned children. This study aimed to construct a predictive nomogram of the risk of HAIs in burned children.

Methods:

Children admitted to the burn unit of Wuhan Third Hospital between 2020 and 2022 were included. The univariate and multivariate logistic regression analyses were adopted to ascertain predictors of HAIs. A nomogram was developed to predict the HAI risk of each patient, with receiver operating characteristic curves and calibration curves being generated to assess its predictive ability. Furthermore, decision and impact curves were used to assess the clinical utility.

Results:

Of 1122 burned children, 61 (5.5%) patients experienced HAIs. The multivariate analysis indicated that total burn surface area, length of stay, surgery, central venous catheter use and urinary catheter use were the independent risk factors of HAIs. Using these variables, we developed a predictive nomogram of the occurrence of HAIs in burned children, and the internal validation results demonstrated good discrimination and calibration of the nomogram. The area under the curve values of the nomogram was 0.926 (95% CI, 0.896–0.957). The calibration curve showed high consistency between the actual and predicted HAIs. The decision and impact curve indicated that the nomogram was of good clinical utility and more credible net clinical benefits in predicting HAIs.

Conclusions:

The present study constructed a nomogram for predicting the risk of HAIs in burned children. This nomogram may strengthen the effective screening of patients at high risk of HAIs.
An Australian Single-center Cohort of Pediatric Empyema: Incidence, Pathogens and Disease Severity, and the Interaction of the COVID-19 Pandemic
Authors: Le Fevre Emily R. , Selvadurai Hiran , Haggie Stuart
Published: September 2024

Background:

Empyema is the most common complication of pediatric community-acquired pneumonia, posing a significant morbidity to children. Clinicians have observed an increase in empyema rates and acuity in the years following the COVID-19 pandemic.

Methods:

This retrospective analysis of children managed for empyema in a tertiary pediatric hospital, aimed to compare the incidence and describe the clinical characteristics prepandemic and postpandemic (2017–2023).

Results:

There were 222 empyema cases, with a median age of 3 years (0.3–15 years). The majority (87.8%) of cases were managed with a chest drain and fibrinolytics. The remaining underwent minimally invasive video-assisted thoracoscopic surgery. Admissions postpandemic were associated with significantly longer lengths of stays (14 vs 12 days, P ≤ 0.001), higher rates of pediatric intensive care unit admissions (32% vs 26%, P = 0.045), and they required higher level of care (inotropes, noninvasive and invasive ventilation). There were also significantly higher rates of Streptococcus pyogenes (28% vs 7%, P ≤ 0.001), while rates of other organisms were not significantly different. We also noted a significant reduction in immunization rates post-pandemic (95.8% vs 83.1%, P < 0.01); however, there was no significant difference in S. pneumoniae serotypes between epochs.

Conclusions:

This study demonstrates an increased rate and severity of pediatric empyemas in the post-pandemic period. We propose that the increase was secondary to the increased rates of S. pyogenes seen in the postpandemic period. This rise in infection rates may be alleviated with nonpharmacologic measures aimed at reducing transmission; however, such measures are not sustainable and should be avoided.
Lacticaseibacillus paracasei Bacteremia Associated With Probiotic Use in a Child With Hypoganglionosis: Case Report and Literature Review
Authors: Ukai Kohei , Okamoto Koh , Ichinose Akinori , Yoshida Mariko , Higurashi Yoshimi , Yoneda Ryu , Yamamoto Shuta , Asahara Takashi
Published: September 2024

Probiotics are generally considered safe and used to improve intestinal function. Here, we report a Lacticaseibacillus paracasei bacteremia case in an 8-month-old girl administered probiotics containing L. paracasei after jejunostomy for hypoganglionosis. The patient had persistent bacteremia with L. paracasei and was treated with antimicrobial therapy. The isolate from the blood culture was genetically indistinguishable to the strain contained in probiotics. Bacteremia risk should be considered before probiotic use in patients with underlying compromised immune systems or intestinal integrity.
Sex, Gender, and Other Factors That Influence Infections for Men and Women
Authors: Johnson Chandler , Baldwin Amy , Bruner Lia Pierson , Rohr-Kirchgraber Theresa M. , Lin-Greenberg Alan , Rosenthal Ken S.
Published: September 2024

In this review, the anatomical, physiological, immunological, societal, and behavioral differences that influence infections for men and women will be reviewed followed by a discussion of differences in vaccine responses and the nature of infections of different organ systems. This is the third in a series of reviews that examine differences in infectious disease presentation for different demographics. Previously, infectious disease differences were compared for children and for older adults. This and the previous reviews are highly appropriate for sharing with, and educating colleagues, residents and students.
Substance Use Stigma Among Clinical and Nonclinical Staff Who Provide Care for People With HIV in the Deep South: A Pilot Training Intervention
Authors: Figgatt Mary C. , Jaiswal Jessica , Bassler John , Gagnon Kelly , Mulrain Morgan , Reed-Pickens Harriette , O'Beirne Ronan , Eaton Ellen F.
Published: September 2024

Substance use stigma is a barrier to care among people with HIV (PWH), which is exacerbated in the Deep U.S. South. Nurses and nonclinical staff serve a central role in strengthening and expanding care coordination in clinics that serve PWH. We sought to implement and evaluate a pilot training intervention that aimed to reduce substance use stigma among clinical and nonclinical staff who provide care for PWH in the Deep South. In total, 32 clinical and nonclinical staff from five clinics participated in the training, of whom 22% were nurses and 38% were linkage coordinators. We evaluated the association between the intervention and stigma by asking respondents about their agreement with varying levels of stigmatized statements both before and after the training. Overall, we observed a slight reduction in stigma scores. This training has promise as one low-burden approach to substance use stigma reduction in HIV care settings.
Effect of extracorporeal shock wave therapy on the microbial community in burn scars: retrospective case–control study
Authors: Jung Yeongyun , Kim Ryeong-Hui , Lee Eun Kyung , Seo Cheong Hoon , Joo So Young , Shin Jae-Ho , Cho Yoon Soo
Published: September 2024

Background:

The effectiveness of extracorporeal shock wave therapy (ESWT) has been demonstrated in various medical fields, including burn medicine. It promotes wound healing, improves blood flow, and modulates the inflammatory responses. The recovery speed and outcomes of skin diseases are influenced by the skin microbiome; however, studies examining the effects of specific treatments on the skin microbiome are lacking. This study investigated the impact of ESWT on the skin microbiome of burn patients, focusing on the microbial diversity and community structure within burn scars.

Materials and methods:

In the retrospective case–control study, 19 patients with burn scars were treated with ESWT, and changes in their skin microbiome were evaluated. ESWT was administered weekly for 3 months, and samples were collected from the ESWT-treated burn scars and untreated normal skin. Blood chemistry, and pain and itching scores were evaluated during sample collection. The collected samples were then subjected to 16S rRNA sequencing. Microbial community analysis was conducted using the QIIME2 and R packages.

Results:

After ESWT, changes in alpha diversity indices were observed in burn scars. Faith phylogenetic diversity (P<0.05) and observed features (P<0.01) increased, whereas the evenness index decreased (P<0.01); no marked changes were noted in untreated skin. Beta diversity analysis showed stable microbial community structures in both the treated and untreated areas. A considerable increase in Micrococcus and Staphylococcus abundance was observed. Network analysis revealed a more open microbial network structure after ESWT, indicating adaptive changes in the microbial community.

Conclusion:

ESWT enhances microbial diversity and modifies microbial community structure in burn scars, promoting a more balanced and functionally supportive microbiome. ESWT aids in scar remodeling and positively influences skin microbiome dynamics, contributing to improved skin health and recovery.
Splenic filtration of red blood cells in physiology, malaria and sickle cell disease
Authors: Sissoko Abdoulaye , Othmene Yosra Ben , Buffet Pierre
Published: September 2024

Purpose of review

The human spleen clears the blood from circulating microorganisms and red blood cells (RBCs) displaying alterations. This review analyzes how generic mechanisms by which the spleen senses RBC, such pitting, trapping and erythrophagocytosis, impact the pathogenesis of two major spleen-related diseases, malaria and sickle cell disease (SCD).

Recent findings

Scintigraphy, functional histology, comparison of circulating and splenic RBC, ex-vivo perfusion of human spleens and in-silico modeling enable relevant exploration of how the spleen retains and processes RBC in health and disease. Iterative cross-validations between medical observations, in-vitro experiments and in-silico modeling point to mechanical sensing of RBC as a central event in both conditions. Spleen congestion is a common pathogenic process explaining anemia and splenomegaly, the latter carrying a risk of severe complications such as acute splenic sequestration crisis and hypersplenism in SCD. Sickling of hemoglobin S-containing RBC may contribute to these complications without necessarily being the trigger.

Ongoing progress in the exploration and understanding of spleen-related complications in malaria and SCD open the way to optimized prognosis evaluation and therapeutic applications.
Individualized Pain Treatment in Chronic Pancreatitis (INPAIN)
Authors: Hagn-Meincke Rasmus , Dugic Ana , Agarwal Ankit , Phillips Anna Evans , Waage Anna , Yadav Dhiraj , Pillai Divya , Vivian Elaina , de-Madaria Enrique , Niazi Imran Khan , Easler Jeffrey , Frøkjær Jens Brøndum , McNabb-Baltar Julia , Asferg Louise Kuhlmann , Faghih Mahya , Montiel Maria Belen Garay , Cook Mathias , Unnisa Misbah , Tarnasky Paul , Hegyi Peter , Garg Pramod , Nedergaard Rasmus Bach , Edwards Robert , Talukdar Rupjyoti , Farheen Shagufta , Olesen Søren Schou , Jagannath Soumya , Schmidt Suzette , Singh Vikesh , Hajnády Zoltán , Drewes Asbjørn Mohr ,   on behalf of the International Pancreatic Pain Consortium
Published: September 2024

Objectives

Pain is the foremost complication of chronic pancreatitis (CP), affecting about 70% of patients. However, the pathophysiological understanding and management of CP-related pain are complex, likely as patients have diverse “pain phenotypes” responding differently to treatment. This study aims to develop a bedside test panel to identify distinct pain phenotypes, investigate the temporal evolution, and determine whether they can be used to predict treatment response.

Methods

The INPAIN study is an international, multicenter, observational, longitudinal cohort study consisted of 4 substudies. The studies will prospectively enroll 400 CP patients (50 without pain and 350 with pain) and 50 control subjects, conducting biannual observations for 4 years. The test panel is consisted of comprehensive subjective and objective assessment parameters. Statistical analysis strategies differ across the substudies. A model to predict treatment efficacy will be developed using various machine learning techniques, including an artificial intelligence approach, with internal cross-validation. Trajectories in pain parameters will be characterized by graphical analysis and mixed effect models.

Discussion

The INPAIN study aims to comprehensively understand pain in CP through a test panel developed for routine clinical use. This tool has the potential to personalize treatments, improve clinical practice, enhance patient care, improve quality of life, and minimize treatment side effects.
Unveiling post-COVID-19 Rasmussen’s encephalitis: a case report of rare neurological complication
Authors: Naisr Zaira , Ahmed Abdullah Munir , Arooj Hajira , Abdullah Lava , Naeem Zunaira , Hashmi Muhammad Usman
Published: September 2024

Introduction and importance:

Rasmussen encephalitis (RE) is a rare autoimmune disorder that causes unilateral inflammation of the cerebral cortex and can lead to drug-resistant epilepsy and progressive neurological decline. Although the emergence of RE following COVID-19 has not been well documented, it emphasizes the need to understand the impact of COVID-19 on neurological health. This case emphasizes the importance of early recognition and intervention to prevent adverse outcomes related to post-COVID-19 neurological complications.

Case presentation:

A 30-year-old woman, recently diagnosed with COVID-19, experienced recurrent seizures that primarily affected the left side of her body. Despite medical management, signs of progressive weakness and altered consciousness were observed. Neurological examination, imaging, and electroencephalography confirmed a diagnosis of post-COVID-19 RE. Despite conservative management, the patient’s condition continued to deteriorate, ultimately resulting in fatal outcomes.

Clinical discussion:

The relationship between COVID-19 and autoimmune responses, which can lead to neurological complications, such as RE, is a matter of concern. Accurate diagnosis of RE depends on imaging and EEG studies; however, a definitive diagnosis often requires histopathological examination. The management of RE involves the use of anti-seizure medications and surgical interventions to control symptoms and improve outcomes. However, the unusual presentation of this case, along with challenges in diagnosis and treatment, underscores the need for increased awareness and extensive research on the neurological consequences of COVID-19.

Conclusion:

This case underscores the severe neurological consequences that can emerge after COVID-19, emphasizing the need for prompt identification and intervention. Additional research is essential to improve the comprehension and management of the neurological aftermath of COVID-19 with the ultimate goal of enhancing patient outcomes.
Male breast cancer: a 32-year retrospective analysis in radiation therapy referral center in northern Iran
Authors: Asgharian Mahboobeh , Moslemi Dariush , Nikbakht Hossein-Ali , Jahani Mohammad-Ali , Bijani Ali , Mehdizadeh Hakimeh
Published: September 2024

Background:

Breast cancer commonly occurs in women, and male breast cancer makes up less than 1% of all cases of breast cancer. The limited prevalence of male breast cancer has led to decreased attention being paid to this condition, resulting in its diagnosis occurring at later ages and at more severe disease stages.

Objectives:

This study evaluates the demographic and clinicopathological characteristics of male patients diagnosed with breast cancer who visited the northern region of Iran from 1992 to 2023.

Methods:

This descriptive study reviewed data from 58 cases of male breast cancer between 1992 and 2023. The study aimed to examine and describe the information connected to these patients. The data were analyzed with SPSS.22 set at P value less than 0.05.

Results:

The mean age of the patients examined was 62.10±13.40 years, while their mean BMI was 27.08±4.95. The study found no statistically significant correlation between BMI with stage and kinds of recurrence, including metastasis and local recurrence (P>0.05). The right and left breast involvement rates were equal (48.28%) in 28 cases, and 2 cases (3.40%) had bilateral involvement. The bone was the predominant site of metastasis, accounting for 69.23% of cases. The analysis revealed no significant correlation between stage and metastasis (P=1.000) or local recurrence (P=0.543). Most metastasis and all the local recurrence were observed in stages 3 and 4.

Conclusion:

Male breast cancer mainly occurs in older age and is diagnosed in the advanced stages of the disease. Therefore, it is recommended to inform men and develop suitable screening programs, especially in high-risk families.
Longitudinal refractive errors over 36 months in Hispanic and Black children
Authors: Pang Yi , Li Qiong , Block Sandra S. , Wang Jingyun
Published: September 2024

SIGNIFICANCE

This study brings awareness of racial/ethnic difference of refractive error characteristics in clinics.

PURPOSE

This study aimed to assess longitudinal change in refractive errors over a 36-month period in Hispanic and Black children.

METHODS

Children (2.4 to 15 years old) were studied. Cycloplegic refraction was measured annually. Spherical equivalent was calculated. Astigmatism was evaluated by magnitude of cylinder and power vector (J0 and J45). Absolute value of interocular spherical equivalent difference was used to calculate anisometropia. Mixed-linear model was used to analyze longitudinal annual change in spherical equivalent, cylinder, J0, and J45 over 36 months.

RESULTS

A total of 485 participants (310 Black, 175 Hispanic) met the criteria. At the baseline examination, prevalence of myopia, emmetropia, and hyperopia was 39% (n = 187), 31% (n = 150), and 30% (n = 148), respectively. Spherical equivalent of Black children was not significantly different from that in Hispanic children (0.10 ± 2.92 vs. −0.37 ± 2.05 D, p=0.06); however, the Hispanic children had a significantly higher cylinder compared with Black children (Hispanic: 1.46 ± 1.57 D vs. Black: 0.92 ± 1.07 D; p<0.001). Both J0 (p<0.001) and J45 (p=0.01) were significantly different between two groups; the Hispanic children had more with-the-rule astigmatism and oblique astigmatism than the Black children. Prevalence of anisometropia (≥1 D) was higher in Black children (14%) compared with Hispanic children (5%, p=0.006). Over 36 months, spherical equivalent significantly decreased an average of 0.69 D (0.23 D/y, p<0.001) for both groups; neither astigmatism nor anisometropia changed significantly (p>0.05).

CONCLUSIONS

Astigmatism in the Hispanic children was significantly higher than in Black children. However, the Black children had a higher prevalence and degree of anisometropia than the Hispanic children.
Exploring the Impact of Race on Addressing Intimate Partner Violence in the Emergency Department
Authors: Kasa Leena , Alexander Kristine , Obenschain Katherine , Joshi Priyanka , Murray Ashlee
Published: September 2024

Objectives

Research highlights racial disparities among those experiencing intimate partner violence (IPV), yet little is known about disparities in addressing IPV in the emergency department (ED). This study was designed to examine variability in offering IPV universal education to adult caregivers across patient race within an urban pediatric ED and to explore provider attitudes regarding the role of race in this process.

Methods

We conducted a mixed-methods study using quantitative data on rates of offering adult caregivers IPV universal education and rates of missing documentation for when IPV universal education was not offered to adult caregivers from January 2016 to December 2020. Analyses compared both rates by patient race listed in the electronic health record. We also conducted semistructured interviews with ED providers, which were qualitatively analyzed for common themes.

Results

Caregivers of Black patients were both more likely to have received IPV universal education compared with caregivers of White patients (31.1% vs 27.3%, P < 0.05) and more likely to lack a documented reason for not offering than caregivers of White patients (70.4% vs 53.9%, P < 0.05). Our semistructured interviews with nurses, nurse practitioners, and physicians in the pediatric ED were able to ascertain specific racial biases that may influence these disparities.

Conclusions

Our study showed that racial disparities exist in both offering IPV universal education and documentation deferral in our pediatric ED. Combined analysis of our quantitative and qualitative data shows the importance of identifying biases that cause health disparities and increasing diversity among healthcare providers. The results of this study can be used to inform new methodologies for healthcare providers to address their personal biases and ensure that all caregivers visiting the ED are offered IPV support resources.
Ultrasound Imaging of Various Ingested Foreign Bodies in an Ex Vivo Intestinal Model
Authors: Wong Brandon M. , Wong Sterling R. , Nesiri Cem , Udayasankar Unni , Larson Michael C.
Published: September 2024

Objective

Foreign body ingestion is an increasingly prevalent issue for children who are in the preverbal to early verbal stages of life. Foreign bodies lodged in the gastrointestinal tract can cause issues such as obstruction, perforation, and fistulae. Radiographic imaging can often locate most foreign bodies; however, radiolucent objects may be missed. Ultrasound is an alternative imaging modality that can be used to locate and track foreign objects as they pass through the bowel. The objective of this study was to characterize the sonographic appearance of various ingested foreign bodies of varying characteristics in an ex vivo gastrointestinal tract segment.

Methods

A GE Logiq 9 ultrasound machine with a linear transducer at a frequency of 15 MHz was used to examine various ingested foreign bodies placed in a segment of pig intestinal tract.

Results

Imaged objects varied in visual appearance from echogenicity, texture, size, and shape; acoustic shadows and reverberation artifacts cast were particularly distinguishing characteristics.

Conclusions

Ultrasound evaluation to assess foreign body ingestion in the pediatric population may provide a useful alternative or supportive imaging modality in confirming the location and real-time tracking of the ingested item. This may be especially useful for objects of varying radiodensities that cannot always be reliably seen in traditional radiographs.