bluuebunny/crossref_metadata_2025 huggingface dataset:
Central American Independence
Authors: Hawkins Timothy
Published: May 2023

Driven in large measure by bicentennial reflections and commemorations, as well as an explosion of interest in the Atlantic world and transatlantic revolutions, scholarship on Latin American independence has flourished in recent decades. Perhaps the most underdeveloped area of research within this field, however, concerns the former kingdom of Guatemala in Central America, a region whose unenthusiastic transition from isthmian colony to five barely viable nation-states failed to conform to the larger revolutionary narrative that developed around the collapse of the Spanish empire. In the 19th century, Latin American historians contributed to the nation-building process by constructing accounts of independence that celebrated heroic liberators and their patriotic supporters. By comparison, Central Americans looked back on the 1810s and witnessed an anemic separation from Spain, followed by a decade of confusion and hesitation that lacked any sense of national unity. Isthmian scholars applied the narrative framework established by their Latin American counterparts with limited success. By 1900, a liberal-informed consensus had solidified around a sclerotic stagnant paradigm that blamed the colony’s equivocation on extreme Spanish repression. While this narrative satisfied many Central Americans, it attracted little interest from foreign scholars. It was not until the 1960s, in fact, that the first substantive academic reevaluation and critique of the 19th-century independence historiography began. Since then, historians of Central America’s transition from colony to nation have been both prolific and creative, constructing a modern bibliography inspired by broader historiographical trends informing current research into Spanish-American independence. This new scholarship demonstrates interest in an expanded revolutionary chronology, which establishes connections and continuities between Atlantic world societies from 1750 to 1850. It has expanded beyond its traditional focus on political elites to include the roles of more marginalized social groups. It has also largely left behind the liberal depiction of independence as a Manichean battle between royalists and patriots, a shift that has encouraged consideration of the wide spectrum of political sentiment on the isthmus. While traditional studies focused on Guatemala and its capital city, a new generation of historians has explored both local and provincial responses to the imperial crisis, providing much-needed regional balance. Such work has enabled many to view the process of independence as integral to the difficult nation-building experience that followed, rather than simply the end of the colonial period. In general, the scholarship has confirmed that Central America deserves a place in any discussion of the Age of Revolutions.
Indigo in the Atlantic World
Authors: Freeser Andrea
Published: May 2023

Hundreds of plants contain the basic chemical elements of indigo, a dye used widely since prehistoric times. Prior to the sixteenth century, several species of Indigofera were grown for dye in Africa, the Americas, and Asia. In Europe and Britain, blue dye was obtained from locally grown woad. Imperial powers jettisoned woad when they grew Indigofera in their American colonies, with Spain, Britain, and France doing best with indigo. Spain did so first in Central America from the 1500s, and Britain and France followed suit from the 1600s in the Caribbean and southern continental North America. Spanish Guatemala and French Saint-Domingue produced high-demand, high-quality indigo. Inferior British South Carolina indigo succeeded once Britain dominated textile manufacturing in the Atlantic world. Colonial indigo growers fared well with good environmental conditions, plantation provisions, labor forces, and guaranteed markets—requirements destabilized by war and competition from other staples. Although indigo grown in the Americas remained viable into the nineteenth century, its manufacture declined when Britain and France invested heavily in sugar plantations, Britain suffered defeat in the American Revolutionary War, France lost Saint-Domingue during the Haitian Revolution, and Spain was invaded by Napoleon and consumed with the Peninsular War. After Britain turned to colonial India for indigo in the late eighteenth century and synthetic blue dye was invented in late-19th-century Germany, Atlantic world indigo appeared much less frequently in global markets. Spanish, French, and British indigo plantations in the Americas were built on indigenous peoples’ homelands and propelled by forced Indian labor in Spain’s colonies and African slave labor in those of France and Britain. Although the Spanish Crown ostensibly protected Indians from abuse, their lands, lives, and knowledge of indigo were taken to enrich colonizers and fill Spain’s coffers. Spain decimated indigenous populations upon colonizing the Caribbean, and when France and Britain took over Caribbean islands with gravely reduced Native populations, each imported thousands of African slaves to work indigo plantations. Many of these people made chattel, ripped from their homelands, communities, and families, had their understanding of indigo put to use for imperial gain. Such colonizer-Native-slave dynamics also played out in British and European colonies in continental North America, notably in British South Carolina, where indigo plantations fueled by African slaves fanned out into Indian country. An integral part of colonization, indigo generated wealth for planters and merchants while feeding imperial economies, doing so at huge cost to Indians and African slaves.
Critical Health Literacy
Authors: Sykes Susie , Abel Thomas
Published: May 2023

Inequalities in health, or the systematic difference in health status across different population groups and communities, persist globally and are, in some cases, increasing. While some inequalities are linked to behavior, the majority are attributable to social, economic, and environmental factors, often referred to as the social determinants of health. Strategies to address the determinants of health have been central to public health and health promotion (see Oxford Bibliographies in Public Health article “Health Promotion” by Lawrence Green) for several decades and are enshrined in the Ottawa Charter (see Oxford Bibliographies in Module article “Ottawa Charter” by Evelyne De Leeuw). Understanding the structure and agency processes that determine the production and distribution of health is fundamental to all levels of public health action and a requirement for active citizenship with regard to health. More recently health literacy (HL) (see Oxford Bibliographies in Module article “Health Literacy” by Rima Rudd and Lisa Schubiner) has been suggested as an approach to tackle inequalities in health and does so with a focus on empowerment through informed health behaviors of individuals and on health literacy–friendly environments such as health care settings. This focus risks neglecting issues of agency and change at the structural level required to impact on determinants of health. The current public health landscape presents new and growing challenges such as pandemics, climate change, unprecedented displacement and migration, and commercial determinants of health including unsustainable practices of production and trade. This comes at a time when people have access to a burdensome excess of information, misinformation, and disinformation (often referred to as an infodemic). There is also a growing skepticism and lack of trust in scientific and political sources, and in an evidence base that can change quickly such as during the COVID-19 pandemic. Within this context, critical health literacy (CHL) with its focus on individual and community understanding, reflection, and equitable agency for change at a structural level may offer a potential approach that provides opportunities to tackle inequalities of health. The following bibliography presents key publications which explore conceptualizations of CHL, its theoretical foundations, how it might be measured, and work done to support interventions for the development of CHL. We would like to thank Richard Benkert and Catherine Jenkins for their contribution to the literature search in the development of this article.
Studying Up
Authors: Aguilera del Castillo Pablo
Published: May 2023

Ever since her influential essay on the need to “study up,” Laura Nader has remained a critical voice in anthropology pushing scholars to examine the politics of ethnographic research. Challenging as it might be, understanding her legacy requires discussing everything from energy policy to Orientalism. Over the span of her career as an anthropologist, Nader’s work has examined power itself as an important object of study. Her critique of traditional anthropology has led to a new body of research that both invites anthropologists to study their own communities and reorients their gaze toward the power of states, bureaucratic systems, laws, economies, and sciences. Nader’s proposal to “study up” entails a change in their active scholarly examination of systems, structures, and subjects of power. Nader’s proposal also considers the ethical limitations of anthropological research done abroad, far away from the anthropologists’ homeland, and invites scholars to “repatriate anthropology” by studying the powerful in their own communities. She similarly notes an urgent need for ethnographers to better theorize power. At the heart of Nader’s call for a different kind of anthropology lies an invitation to produce anthropological knowledge that helps develop a more democratic and just society. Nader’s call to reorient anthropological research emerges in a moment of acute political awakening fueled by the end of European colonialism in many countries, the Cold War, the consolidation of a globalized capitalist world, and the consolidation of US imperialism throughout the world. In this context, Nader’s invitation to study up and down has had a lasting effect on the field, contributing to a collective reflection on how political, bureaucratic, legal, economic, and scientific knowledge is produced. Despite the many directions of anthropology today, it doesn’t seem an overstatement to say that an ever-growing number of anthropologists today are decidedly Naderian in their marked interest in understanding systems and structures of power in the making of our social worlds.
History of Intelligence in China
Authors: Castro Sara
Published: May 2023

Ancient Chinese texts document some of the first-known intelligence operations and tradecraft in history. Classic strategic texts from the Chinese canon describe state use of espionage, deception, sabotage, and other unconventional methods for achieving superiority over enemies. These texts have influenced Chinese leaders throughout history and continue to do so. However, nothing approaching the level of transparency about intelligence practices found in ancient texts still exists today. The leaders of the People’s Republic of China (PRC) hold the state’s intelligence practices as a deep secret, and they have rarely allowed or facilitated the open release of details that scholars can typically find for other countries’ intelligence regimes. Thus, this subfield of Chinese history can be difficult for scholars to explore. Moreover, bibliographies focused on Chinese intelligence can look sparse relative to the long lists of books, articles, and databases that focus on less sensitive topics such as Chinese politics, strategy, economics, or even military issues. The expansion of the Internet and social media has facilitated the development of new research and sharing of resources on Chinese intelligence, largely by scholars outside China. Scholars within China face serious limitations on what they can publish about intelligence history. The Internet has enabled new connections between scholars that have both refined and expanded understanding of how the PRC has pursued intelligence since the establishment of the country in 1949. Scholars outside China now have a consensus that the PRC defines intelligence practices differently than most Western countries, with expectations that often recall the practices for unconventional warfare described in the ancient military texts. At the same time, most scholars agree that China’s intelligence capabilities and appetite for pursuing foreign intelligence operations are greater than observers assumed in the 1990s and 2000s. From the use of cyber warfare and influence operations to economic and technical espionage, PRC intelligence activities have raised a profile that has recently allowed the subfield of Chinese intelligence studies to expand, but this subfield of historical study is not what most would consider expansive. The views expressed are those of the author and do not reflect the official policy or position of the Department of Defense, the US government, US Air Force Academy, or US Air Force.
Christianity and Warfare in the Medieval West
Authors: Nakashian Craig M.
Published: May 2023

The study of Christianity and warfare in the Middle Ages is usually focused on the following areas: the role that the church played in directing and prosecuting wars (such as holy wars and the Crusades), the development of theoretical frameworks to justify/condemn warfare in both general and specific contexts (such as just war theory and canonical legislation), the role that clergy played in regulating violence in medieval society (as in the peace and truce of God), and the role(s) that members of the clergy played in warfare. In one way or another, these topics have been debated since the days of the early church. The debate over the proper interaction between Christianity and warfare in the Middle Ages derived from a number of different factors, including the perceived pacifism of the founder of the religion, Jesus Christ. This led to an ideological argument over the appropriateness of violence by Christians. Early Christians debated whether Christians could shed blood, and once institutionalized they debated which Christians could shed blood, when, under what conditions, and what (if any) penance they needed to complete to return to communion with the church community. The writings of Saint Augustine on just war shaped the argument well into the Middle Ages. The long-standing efforts by the bishops of Rome to centralize clerical administration and ideology also fit into the discussion. As the bishops of Rome asserted their roles as the ecclesiastical heads of Christianity, they worked with and against secular rulers to establish church governance throughout Europe. This religious edifice was reinforced by the development and codification of canon law, which sought to regulate the behavior of clerics, including in warfare. Clerics also sought to regulate violence in society more broadly, especially to restrain the warfare of a fractious nobility. Holy wars, including those hearkening back to examples from the Old Testament, and Crusades further entwined Christianity and warfare. Christianity, and its church(es), was now at the forefront of directing, supporting, and endorsing warfare, often offering spiritual benefits for the participants. Crusades, members of the military orders, and ordinary knights now operated in a world where spiritual (and temporal) benefits could accrue to those fighting in licit causes endorsed clerical leaders. Despite the major divisions caused by the Reformation, something that Roman Catholic and Protestant Christians could agree on was that God was on their side in their wars against each other.
Urban Forest Ecology
Authors: Duinker Peter N. , Steenberg James W. N.
Published: May 2023

Urban forestry, as the name implies, is a branch of forestry that deals with trees and woodlands in urban areas. Practice in urban forestry may have its foundations in the nineteenth century, but the moniker of urban forestry launched in earnest in the 1970s largely through the contributions of Eric Jorgensen, a professor at the University of Guelph on Ontario, Canada. Urban forestry combines long traditions of science and management in the fields of arboriculture (management of individual trees), silviculture (management of stands of trees), and forestry (management of larger woodlands comprised of many stands). Urban forestry, according to Jorgensen (see Konijnendijk, et al. 2006, cited under Definitions) is “a specialized branch of forestry and has as its objectives the cultivation and management of trees for their present and potential contribution to the physiological, sociological and economic well-being of urban society” (p. 95). This bibliography concentrates on the ecology of urban forests. Given that ecology is the study of organisms and their relationships with the biotic and abiotic environments, one instantly recognizes the fundamental ecological nature upon which urban-forest studies must rest. No trees in the urban ecosystem—whether in the heart of downtown or in the peri-urban outskirts of the town or city, or indeed anywhere between—escape the influence of humans, especially their built infrastructure. So urban forestry as a science and practice cannot help but rest firmly on the foundation of urban forest ecology. However, scoping this domain of science is fraught with pitfalls because the boundaries are unclear, broad, and porous. Much of forest ecology in general pertains to all forests, not just hinterland forests nor timber-producing forests. Equally complicating the scoping problem are the numerous intense relationships between people and trees which justify the notion that urban forests are best understood as social-ecological systems with vital economic and technical dimensions. Hearty thanks to K. E. Turner and C. Ordóñez Barona for assistance in identifying relevant literature, and to an anonymous reviewer for revisions suggestions.
Jewish-Latino Literature
Authors: Pridgeon Stephanie
Published: May 2023

Literature from Jewish and Latinx-identifying authors shows that Latinx ethnicities are constructed differentially throughout the Americas because of the complexities of ethnonational identities stemming from countries of origin. The overlapping—and oven conflicting—experiences of Jewish Latinxs as Jews and Latinxs are recurrent themes throughout this corpus of literary production as well as in the scholarly works that have discussed them. While still a somewhat niche topic within literary studies, a growing contingent of creative and scholarly writers has emerged to grapple with the place of Jewish Latinx fiction within existing critical understandings of US Jewish fiction, global Jewish fiction, Latin American fiction, and US Latinx fiction. While many of the authors outlined below have published other works, those included here have tended to focus on the intersections of Jewish and Latinx identities, including their characters’ and authors’ relationships to their ancestors’ or their own countries of origin in Latin America. While the category of “Latino” can be somewhat ambiguous, given the importance of diasporic experiences to the definitional understanding of the term, this bibliography takes account of literature that explores diasporic and borderland experiences from Jewish Latinx perspectives, including the works of Marjorie Agosín, Ruth Behar, Ilan Stavans, Francisco Goldman, Eduardo Halfon, Alicia (“Achy”) Obejas, and Kathleen Alcalá. However there are certainly other authors who were born in Latin American nations and lived for decades or more in the United States (among them, Jacobo Sefamí, Ariel Dorfman, David Unger, Sergio Chejfec, Marjorie Agosín, Leo Spitzer, and Nora Glickman) but whose works of fiction do not focus on the experiences of the Latin American diaspora in the United States in particular. The works in this article explore the intersecting conditions of Jewishness and latinidad.
Henslow’s Sparrow shows positive response to prescribed fire rotation
Authors: Keating Meghan P , Williams Perry J , Robb Joseph R , Buderman Frances E , Lewis Jason P , Vanosdol Teresa , Harer Ryan
Published: May 2023

We examined Henslow’s Sparrow (Centronyx henslowii) response to prescribed fire at 32 grasslands at Big Oaks National Wildlife Refuge in southeastern Indiana from 1999 to 2009. We burned grasslands in the spring between 1999 and 2007 and monitored Henslow’s Sparrows for up to 4 yr after treatment. We used linear mixed models to analyze our data. Henslow’s Sparrow counts were correlated with time since prescribed fire and grassland size. The estimated changes in mean Henslow’s Sparrow density relative to pre-burn densities were −0.19, 1.15, 0.74, and −0.68 birds ha−1 for 1–4 breeding seasons after a spring burn, respectively. We found that Henslow’s Sparrows preferred larger grasslands both during the first breeding season after prescribed fire, when vegetation was presumed to possess less litter and structural density, and during the fourth breeding season after fire, when vegetation was presumed to be a more ideal composition, but preferred smaller grasslands in the interim. Thus, grassland size shapes the magnitude of Henslow’s Sparrow population response to fire, with populations in smaller grasslands experiencing greater amplitude changes. Larger grasslands might provide more habitat diversity following prescribed fire, attenuating population change. On average, Henslow’s Sparrows responded positively to prescribed fire in a network of grasslands and cumulative net change in densities were highest three breeding seasons after a burn suggesting that maintaining this burn frequency would be beneficial to Henslow’s Sparrow abundance.
Long-term efficacy of penile rehabilitation with low-intensity extracorporeal shock wave therapy for sexual and erectile function recovery following robotic-assisted radical prostatectomy: a single-cohort pilot study
Authors: Kohada Yuki , Babasaki Takashi , Goto Keisuke , Inoue Shogo , Kurimura Yoshimasa , Tasaka Ryo , Takemoto Kenshiro , Miyamoto Shunsuke , Kobatake Kohei , Kitano Hiroyuki , Ikeda Kenichiro , Hieda Keisuke , Hayashi Tetsutaro , Hinata Nobuyuki
Published: May 2023

Background

The long-term efficacy of low-intensity extracorporeal shock wave therapy (LIESWT) for penile rehabilitation after robot-assisted radical prostatectomy (RARP) has not yet been reported.

Aim

To assess the long-term efficacy of LIESWT for penile rehabilitation after RARP by evaluating the postoperative recovery of sexual and erectile functions following RARP.

Methods

Patients who underwent RARP at our institution were categorized into 2 groups: those who received LIESWT and those who underwent penile rehabilitation with a phosphodiesterase type 5 inhibitor (PDE5i). The control group included patients who did not undergo penile rehabilitation. Potency and scores on the Expanded Prostate Cancer Index Composite for sexual function and 5-item International Index of Erectile Function (IIEF-5) were evaluated preoperatively and over 60 months after RARP.

Outcomes

The LIESWT group had significantly higher postoperative sexual function and total IIEF-5 scores and potency than the control group over the long term, and its results were not inferior to those of the PDE5i group.

Results

The LIESWT, PDE5i, and control groups comprised 16, 13, and 139 patients, respectively. As compared with the control group, the LIESWT group had significantly higher sexual function scores at 6, 12, and 60 months after surgery (P < .05) and total IIEF-5 scores at 24 and 60 months (P < .05). The LIESWT group also had a significantly higher potency rate than the control group at 60 months (P < .05). For all time points after surgery, there were no significant differences between the LIESWT and PDE5i groups in terms of sexual function and total IIEF-5 scores and potency.

Clinical Implications

LIESWT may be a new option for penile rehabilitation in patients with erectile dysfunction after RARP.

Strengths and Limitations

This pilot study was performed at a single center and involved relatively few patients, which may have led to selection bias. Furthermore, the selection of this study for penile rehabilitation was not made randomly but by the patient’s choice. Despite these limitations, our results provide evidence in support of LIESWT for penile rehabilitation after RARP because this is the first study to assess the long-term efficacy of LIESWT.

Conclusion

LIESWT can improve sexual and erectile functions in patients with erectile dysfunction after RARP, and its efficacy can be maintained over a long period after surgery.
Phase separation is required for PML nuclear body biogenesis and function
Authors: Wu Wenyu , Tan Yangxia , Yin Hongxin , Jiang Minghao , Jiang Yanling , Ma Xiaodan , Yin Tong , Li Yuwen , Zhang Hao , Cai Xun , Meng Guoyu
Published: May 2023

PML nuclear body (NB) malfunction often leads to acute leukemia outbreaks and other severe diseases. PML NB rescue is the molecular basis of arsenic success in acute promyelocytic leukemia (APL) treatment. However, it is unclear how PML NBs are assembled. Here, we observed the presence of liquid–liquid phase separation (LLPS) in NB formation by fluorescence recovery after photobleaching (FRAP) experiment. Compared with the wild‐type (WT) NBs, PML A216V derived from arsenic‐resistant leukemia patients markedly crippled LLPS, but not altered the overall structure and PML RBCC oligomerization. In parallel, we also reported several Leu to Pro mutations that were critical to PML coiled‐coil domain. FRAP characterization and comparison between L268P and A216V revealed markedly different LLPS activities in these mutant NBs. Transmission electron microscopy (TEM) inspections of LLPS‐crippled and uncrippled NBs showed aggregation‐ and ring‐like PML packing in A216V and WT/L268P NBs, respectively. More importantly, the correct LLPS‐driven NB formation was the prerequisite for partner recruitment, post‐translational modifications (PTMs), and PML‐driven cellular regulations, such as ROS stress control, mitochondria production, and PML‐p53‐mediated senescence and apoptosis. Altogether, our results helped to define a critical LLPS step in PML NB biogenesis.
Designing and Building a Portfolio of Individual Support Resources for Physicians
Authors: Brazeau Chantal M.L.R. , Trockel Mickey T. , Swensen Stephen J. , Shanafelt Tait D.
Published: May 2023

As health care organizations in the United States move toward recovery from the COVID-19 pandemic, physicians and clinical faculty are experiencing occupational burnout and various manifestations of distress. To mitigate these challenges, health care organizations must optimize the work environment and provide support for individual clinicians using a variety of approaches, including mentoring, group-based peer support, individual peer support, coaching, and psychotherapy. While often conflated, each of these approaches offers distinct benefits. Mentoring is a longitudinal 1-on-1 relationship, typically focused on career development, usually with an experienced professional guiding a junior professional. Group-based peer support involves regular, longitudinal meetings of health professionals to discuss meaningful topics, provide mutual support to one another, and foster community. Individual peer support involves training peers to provide timely 1-on-1 support for a distressed colleague dealing with adverse clinical events or other professional challenges. Coaching involves a certified professional helping an individual identify their values and priorities and consider changes that would allow them to adhere to these more fully, and providing longitudinal support that fosters accountability for action. Individual psychotherapy is a longitudinal, short- or long-term professional relationship during which specific therapeutic interventions are delivered by a licensed mental health professional. When distress is severe, this is the best approach. Although some overlap exists, these approaches are distinct and complementary. Individuals may use different methods at different career stages and for different challenges. Organizations seeking to address a specific need should consider which approach is most suitable. Over time, a portfolio of offerings is typically needed to holistically address the diverse needs of clinicians. A stepped care model using a population health approach may be a cost-effective way to promote mental health and prevent occupational distress and general psychiatric symptoms.
Validating a Macrophage Marker Gene Signature (MMGS) in Lung Adenocarcinoma Prognosis and Response to Immunotherapy
Authors: Song Peng , Wusiman Dilinaer , Li Wenbin , Guo Lei , Ying Jianming , Gao Shugeng , He Jie
Published: May 2023

Lung adenocarcinoma (LUAD) is the leading cause of cancer-related death worldwide. Tumor-associated macrophages play pivotal roles in the tumor microenvironment (TME) and prognosis of LUAD. We first used single-cell RNA sequencing data to identify macrophage marker genes in LUAD. Univariate, least absolute shrinkage and selection operator and stepwise multivariate Cox regression analyses were conducted to evaluate macrophage marker genes as prognostic factors and to construct the macrophage marker genes signature (MMGS). A novel 8-gene signature was constructed to predict prognosis based on 465 macrophage marker genes identified by an analysis of single-cell RNA sequencing data of LUAD, and was also verified in 4 independent GEO cohorts. The MMGS significantly classified patients into high-risk and low-risk groups in terms of OS. A prognostic nomogram based on independent risk factors was established to predict the 2-, 3- and 5-year survival, which indicated superior accuracy in predicting prognosis. The high-risk group was correlated to higher tumor mutational burden, number of neoantigens, T-cell receptor richness, and lower TIDE, which suggested that high-risk patients were more likely to benefit from immunotherapy. The prediction of the possibility of immunotherapy efficacy was also discussed. Analysis of an immunotherapy cohort further verified that patients with high-risk scores had better immunotherapy responses than low-risk patients. The MMGS is a promising signature for predicting prognosis and effectiveness of immunotherapy in patients with LUAD, and may be helpful for clinical decision-making.
What Are the Barriers and Facilitators for Critical Care Nurse Participation in a Patient Blood Management Program?
Authors: Wabeke Danita , Tolich Deborah
Published: May 2023

BACKGROUND

Patient blood management (PBM) programs strive to implement best practices, mitigating blood loss through procedures to decrease anemia and the need for transfusion. Critical care nurses may have the greatest impact on blood preservation and anemia prevention for the most critically ill patients. Nurse perceptions of barriers and facilitators in PBM are not fully understood.

OBJECTIVES

The primary aim was to determine critical care nurses' perceptions of barriers and facilitators to participation in PBM. The secondary aim was to understand ways in which they believe the barriers can be addressed.

METHODS

A qualitative descriptive method was used following Colaizzi's process. Critical care nurses (n = 110) were recruited from 10 critical care units in 1 quaternary care hospital to participate in focus groups. Data were analyzed using qualitative methodology and NVivo software. Communication interactions were categorized into codes and themes.

RESULTS

Study findings were gathered under 5 categories: assessing need for blood transfusions, laboratory challenges, availability and appropriateness of supplies, minimizing need for laboratory draws, and communication. Three prominent themes indicated that (a) critical care nurses have a limited awareness of PBM, (b) critical nurses must be empowered to engage in interprofessional collaboration, and (c) addressing barriers is not complex.

CONCLUSION

The data provide insight into the challenges of critical care nurse participation in PBM, driving next step efforts in building on the institution's strengths and improving engagement. It is imperative that the recommendations derived from critical care nurses' experiences be further developed.
Calibration of the PREdiction of DELIRium in ICu Patients (PRE-DELIRIC) Score in a Cohort of Critically Ill Patients
Authors: Gravante Francesco , Giannarelli Diana , Pucci Antonello , Pisani Luigi , Latina Roberto
Published: May 2023

Background

To predict delirium in intensive care unit (ICU) patients, the Prediction of Delirium in ICU Patients (PRE-DELIRIC) score may be used. This model may help nurses to predict delirium in high-risk ICU patients.

Objectives

The aims of this study were to externally validate the PRE-DELIRIC model and to identify predictive factors and outcomes for ICU delirium.

Method

All patients underwent delirium risk assessment by the PRE-DELIRIC model at admission. We used the Intensive Care Delirium Screening Check List to identify patients with delirium. The receiver operating characteristic curve measured discrimination capacity among patients with or without ICU delirium. Calibration ability was determined by slope and intercept.

Results

The prevalence of ICU delirium was 55.8%. Discrimination capacity (Intensive Care Delirium Screening Check List score ≥4) expressed by the area under the receiver operating characteristic curve was 0.81 (95% confidence interval, 0.75-0.88), whereas sensitivity was 91.3% and specificity was 64.4%. The best cut-off was 27%, obtained by the max Youden index. Calibration of the model was adequate, with a slope of 1.03 and intercept of 8.14. The onset of ICU delirium was associated with an increase in ICU length of stay (P < .0001), higher ICU mortality (P = .008), increased duration of mechanical ventilation (P < .0001), and more prolonged respiratory weaning (P < .0001) compared with patients without delirium.

Discussion

The PRE-DELIRIC score is a sensitive measure that may be useful in early detection of patients at high risk for developing delirium. The baseline PRE-DELIRIC score could be useful to trigger use of standardized protocols, including nonpharmacologic interventions.
Longitudinal Assessment of Mobility and Self-care Among Critically Ill Older Adults. An Age-Friendly Health Systems Initiative Quality Improvement Study.
Authors: Rittel Carleigh M. , Borg Bryan A. , Hanessian Anelis V. , Kuhar Angela , Fain Mindy J. , Bime Christian
Published: May 2023

Background

Early mobility in the intensive care unit (ICU) is vital to maintaining an older adult patient's performance of activities of daily living, functional mobility, and overall quality of life. Prior studies have shown reduced length of inpatient stay and onset of delirium in patients with early mobilization. Despite these benefits, many ICU patients are often labeled as too sick to participate in therapy and frequently do not receive physical (PT) or occupational therapy (OT) consults until they are considered floor status. This delay in therapy can negatively affect a patient's capacity to participate in his/her self-care, add to the burden on caregivers, and limit disposition options.

Objectives

Our goals were to perform a longitudinal assessment of mobility and self-care among older patients through their medical ICU (MICU) stays and to quantify visits by therapy services to identify areas for improvement in achieving early intervention in this at-risk population.

Method

This was a retrospective quality improvement analysis of a cohort of admissions to the MICU at a large tertiary academic medical center between November 2018 and May 2019. Admission information, PT and OT consult information, Perme Intensive Care Unit Mobility Score, and Modified Barthel Index scores were entered into a quality improvement registry. Inclusion criteria consisted of age older than 65 years and at least 2 distinct visits by PT and/or OT for evaluation. Patients without consults and patients with weekend-only MICU stays were not assessed.

Results

There were 302 MICU patients 65 years or older admitted during the study period. Forty-four percent (132) of these patients received PT/OT consults, and among these, 32% (42) had at least 2 visits to allow comparison of objective scores. Seventy-five percent of patients had improved Perme scores (median, 9.4%; interquartile range, 2.3%-15.6%), and 58% of patients had improved Modified Barthel Index scores (median, 3%; interquartile range, −2% to 13.5%). However, 17% of potential therapy days were missed because of inadequate staffing/time, and 14% were missed because of being sedated or unable to participate.

Conclusions

In our cohort of patients older than 65 years, receipt of therapy in the MICU led to modest improvements in score-assessed mobility and self-care before transfer to floor. Staffing, time constraints, and patient sedation or encephalopathy appeared to interfere most with further potential benefits. In the next phase, we plan to implement strategies to increase PT/OT availability in the MICU and implement a protocol to increase identification and referral of candidates for whom early therapy can prevent loss of mobility and ability to perform self-care.
Multidisciplinary teams, efficient communication, procedure services, and telehealth improve cirrhosis care: A qualitative study
Authors: Serper Marina , Agha Aneeza , Garren Patrik A. , Taddei Tamar H. , Kaplan David E. , Groeneveld Peter W. , Werner Rachel M. , Shea Judy A.
Published: May 2023

Background:

Cirrhosis care and outcomes are improved with access to subspecialty gastroenterology and hepatology care. In qualitative interviews, we investigated clinicians’ perceptions of factors that optimize or impede cirrhosis care.

Methods:

We conducted 24 telephone interviews with subspecialty clinicians at 7 Veterans Affairs medical centers with high- and low-complexity services. Purposive sampling stratified Veterans Affairs medical centers on timely post-hospitalization follow-up, a quality measure. We asked open-ended questions about facilitators and barriers of care coordination, access to appointments, procedures, transplantation, management of complications, keeping up to date with medical knowledge, and telehealth use.

Results:

Key themes that facilitated care were structural: multidisciplinary teams, clinical dashboards, mechanisms for appointment tracking and reminders, and local or virtual access to transplant and liver cancer specialists through the “specialty care access network extension for community health care outcomes” program. Coordination and efficient communication between transplant and non-transplant specialists and between transplant and primary care facilitated timely care. Same-day access to laboratory, procedural, and clinical services is an indicator of high-quality care. Barriers included lack of on-site procedural services, clinician turnover, patient social needs related to transportation, costs, and patient forgetfulness due to HE. Telehealth enabled lower complexity sites to obtain recommendations for complex patient cases. Barriers to telehealth included lack of credit (eg, VA billing equivalent), inadequate staff, lack of audiovisual technology support, and patient and staff discomfort with technology. Telehealth was optimal for return visits, cases where physical examination was nonessential, and where distance and transportation precluded in-person care. Rapid telehealth uptake during the COVID-19 pandemic was a positive disruptor and facilitated use.

Conclusions:

We identify multi-level factors related to structure, staffing, technology, and care organization to optimize cirrhosis care delivery.
Adipose tissue insulin resistance exacerbates liver inflammation and fibrosis in a diet-induced NASH model
Authors: Hosokawa Yusei , Hosooka Tetsuya , Imamori Makoto , Yamaguchi Kanji , Itoh Yoshito , Ogawa Wataru
Published: May 2023

Background:

Insulin regulates various biological processes in adipocytes, and adipose tissue dysfunction due to insulin resistance in this tissue plays a central role in the development of metabolic diseases, including NAFLD and NASH. However, the combined impact of adipose tissue insulin resistance and dietary factors on the pathogenesis of NAFLD-NASH has remained unknown.

Methods and Results:

3′-phosphoinositide–dependent kinase 1 (PDK1) is a serine-threonine protein kinase that mediates the metabolic actions of insulin. We recently showed that adipocyte-specific PDK1 knockout (A-PDK1KO) mice maintained on normal chow exhibit metabolic disorders, including progressive liver disease leading to NASH, in addition to reduced adipose tissue mass. We here show that maintenance of A-PDK1KO mice on the Gubra amylin NASH (GAN) diet rich in saturated fat, cholesterol, and fructose exacerbates inflammation and fibrosis in the liver. Consistent with these histological findings, RNA-sequencing analysis of the liver showed that the expression of genes related to inflammation and fibrosis was additively upregulated by adipocyte-specific PDK1 ablation and the GAN diet. Of note, the reduced adipose tissue mass of A-PDK1KO mice was not affected by the GAN diet. Our results thus indicate that adipose tissue insulin resistance and the GAN diet additively promote inflammation and fibrosis in the liver of mice.

Conclusions:

A-PDK1KO mice fed with the GAN diet, constitute a new mouse model for studies of the pathogenesis of NAFLD-NASH, especially that in lean individuals, as well as for the development of potential therapeutic strategies for this disease.
A Question of Frame: The Role of the Bone Marrow Stromal Niche in Myeloid Malignancies
Authors: Tomasoni Chiara , Pievani Alice , Rambaldi Benedetta , Biondi Andrea , Serafini Marta
Published: May 2023

Until a few years ago, the onset of acute myeloid leukemia (AML) was entirely ascribed to genetic lesions in hematopoietic stem cells. These mutations generate leukemic stem cells, which are known to be the main ones responsible for chemoresistance and relapse. However, in the last years, increasing evidence demonstrated that dynamic interplay between leukemic cells and bone marrow (BM) niche is of paramount relevance in the pathogenesis of myeloid malignancies, including AML. Specifically, BM stromal niche components, such as mesenchymal stromal cells (MSCs) and their osteoblastic cell derivatives, play a key role not only in supporting normal hematopoiesis but also in the manifestation and progression of myeloid malignancies. Here, we reviewed recent clinical and experimental findings about how genetic and functional alterations in MSCs and osteolineage progeny can contribute to leukemogenesis and how leukemic cells in turn generate a corrupted niche able to support myeloid neoplasms. Moreover, we discussed how the newest single-cell technologies may help dissect the interactions between BM stromal cells and malignant hematopoiesis. The deep comprehension of the tangled relationship between stroma and AML blasts and their modulation during disease progression may have a valuable impact on the development of new microenvironment-directed therapeutic strategies, potentially useful for a wide cohort of patients.
An Educational Intervention to Enhance the Performance of Peer Feedback
Authors: Haverhals Amanda
Published: May 2023

OBJECTIVE

Offering peer feedback on a routine basis may improve nursing, patient, and organizational outcomes by addressing potentially problematic issues before they occur.

BACKGROUND

There is limited literature of specific feedback processes, although national agencies support peer feedback as a professional responsibility.

METHODS

An educational tool was used to train nurses on defining what constitutes professional peer review, reviewing ethical and professional standards, and evaluating the types of peer feedback supported by the literature along with suggestions to use when giving and receiving peer feedback.

RESULTS

The Beliefs about Peer Feedback Questionnaire was used to evaluate the nurses' perceived value and confidence when giving and receiving peer feedback before and after the implementation of the educational tool. The nonparametric Wilcoxon signed rank test demonstrated overall improvement.

CONCLUSIONS

When peer feedback educational tools were available to nurses and the environment supports professional peer review, there was a significant improvement in the level of comfort when giving and receiving peer feedback, along with increased perceived value of peer feedback given and received.
Assessing the Impact of a New Pediatric Healthcare Facility on Medication Administration
Authors: Godin Margaret R. , Nasr Annette S.
Published: May 2023

OBJECTIVE

This observational descriptive study was designed to measure the effect a new evidence-based design (EBD) hospital has on pediatric medication safety.

BACKGROUND

Medication safety is a priority for nurse leaders. Controlling system design by increasing the understanding of the impact human factors have could improve medication delivery.

METHODS

Medication administration data from 2 studies conducted at the same hospital, 1 at an older facility in 2015 and the other at a new EBD facility in 2019, were compared using a similar research design.

RESULTS

Results indicate that rates of distractions per 100 drug administrations were all statistically significant, favoring the 2015 data regardless of the EBD. No statistically significant differences were observed in error rates of any type when comparing the data collected in the older facility versus the newer EBD facility.

CONCLUSION

This study demonstrated that EBD alone does not ensure the absence of medication errors. By comparing 2 data sets, unanticipated associations were found that could impact safety. Despite the new facility's contemporary design, distractions persisted that could inform nurse leaders in developing interventions to support a safer patient care environment using a human factors approach.
Clinically Important Pharmacologic Considerations for Wide-Awake Local Anesthesia No Tourniquet Hand Surgery
Authors: Janes Lindsay , Sepehripour Sarvnaz , Lalonde Donald
Published: May 2023

Understanding the clinically important pharmacokinetics (what the body does to the drug) and pharmacodynamics (what the drug does to the body) of medications used in surgery will help surgeons use them more safely and effectively. The goal of this article is to provide an overview of these considerations for the 2 medications used in wide-awake local anesthesia with no tourniquet upper extremity surgery (ie, lidocaine and epinephrine) to establish a better understanding of lidocaine and epinephrine in tumescent local anesthesia, as well as adverse reactions and how to manage them.
The 10-7 Facial Analysis Method for Face Lifting and Facial Rejuvenation
Authors: Jalalabadi Faryan , Rohrich Rod J.
Published: May 2023

Proper facial analysis is the first step toward delivering an excellent result in any face lifting or facial rejuvenating operation or procedure. Every case should be approached in a systematic and comprehensive manner, ensuring proper assessment of specific anatomic regions contributing to facial aging as well as the global facial aesthetic. Failure to do so may result in an unnatural or partially rejuvenated face. The senior author’s (R.J.R.) approach entails 10 key anatomic regions on the frontal view and 7 on the lateral view. The 10-7 facial analysis method allows the surgeon to reliably assess every patient in a detailed, top-down, structural approach when considering face lifting or facial rejuvenation.
Myocardial Perfusion Scintigraphy in a Patient With Transposition of Great Arteries Post–Atrial Switch Surgery
Authors: Mohd Radzi Aliaa , Boey Ching Yeen , Amir Hassan Siti Zarina
Published: May 2023

We report a case of a 33-year-old woman who underwent stress and rest myocardial perfusion scintigraphy (MPS) to exclude coronary artery disease. MPS images showed an apparent dextrocardia with a right-sided septal wall uptake. The electrocardiograph showed a right axis deviation with dominant R waves at leads aVR and V1. Upon retrieval of the patient’s medical records, she had an underlying transposition of great arteries and underwent a Senning atrial switch surgery. Hence, the MPS images demonstrated a prominent right ventricular wall due to its function as the “systemic” ventricle with minimal uptake in the “pulmonary” left ventricle.