bluuebunny/crossref_metadata_2025 huggingface dataset:
Overcoming Barriers to Childhood and Adolescent Vaccination: Opportunities in Precision Health Promotion
Authors: White Brianna M , Kumsa Fekede , Singh Nupur , Shaban-Nejad Arash
Published: October 2024

Background

Vaccination remains one of the greatest success stories in public health as cost-effective interventions to reduce morbidity and mortality from infectious diseases at the population level. However, the COVID-19 pandemic created unprecedented challenges to the immunization sector. Uptake of routine childhood and adolescent vaccinations was forestalled by challenges related to pandemic lockdowns/quarantine, reduced patient-provider interactions, parental reluctance to seek preventative services, poor access to health services, and loss of income and/or health insurance. Compared to pre-pandemic estimations, the pandemic era brought a consequential decline in coverage of all vaccines recommended by the Advisory Committee on Immunization Practices (ACIP). This study sought to address suboptimal adolescent vaccine delivery systems and bolster uptake in the post-pandemic era with the introduction of precision health promotion strategies centered around the use of Personal Health Libraries (PHL).

Methods

Leveraging artificial intelligence (AI), and semantic web technologies to integrate contextual knowledge (i.e., clinical, biomedical, and SDoH data) with patient preferences, proposed PHL platforms could aid in generating personalized evidence-based recommendations useful to both care provider promotion of vaccination and mitigating patient and caregiver hesitancy. The proposed application stands to provide customized digital health interventions by 1) facilitating remote knowledge acquisition, exchange, and visualization of the benefits of on-time vaccination, 2) improving health information-seeking behaviors to reduce hesitancy, 3) bolstering patient reminder and recall systems for follow-up and series completion, and 4) learning usage patterns to incorporate end-user preferences to empower patients, promote best practices, and enable them to make informed health decisions.

Results

The proposed PHL would serve as an ecosystem to manage and deliver tailored vaccine-related information to inform health decision-making regarding ACIP-recommended immunizations. Such a resource could administer health education and promotion that addresses common misconceptions regarding vaccination, alleviate safety, efficacy, and side effect concerns, and deliver evidence-based support of vaccines as primary protective measures (i.e., cancer prevention).

Conclusion

The use of PHL would enable rapid and real-time collection and interpretation of patient data beyond the traditional clinical setting, supplying care providers with tools for optimal vaccination recommendation to bolster uptake in the post-pandemic era. Moreover, the application would enable patients and caregivers to readily access vital health information and play a crucial role in addressing the obstacles encountered when seeking accurate and dependable vaccine-related information.
Short-Lived Zika Virus-Specific Antibodies in Infants: Findings from a Translational Macaque Model
Authors: Arroyo Laura , Krabbe Nicholas P , Bhattacharya Saswati , Razo Elaina , Mohr Emma
Published: October 2024

Background

In utero Zika virus (ZIKV) infection is a significant public health threat for infants as it can be vertically transmitted from mother to fetus, resulting in several health problems. Prolonged maternal viremia sometimes occurs in pregnant women with ZIKV infection. We hypothesize that mothers with prolonged viremia will be more likely to vertically transmit ZIKV to their fetuses. To evaluate this hypothesis, we developed a rhesus macaque pregnancy model of ZIKV infection, where some days have prolonged viremia (>10 days) and others have quickly cleared viremia (<10 days). Because the diagnosis of fetal ZIKV infection in newborns is challenging given the transient nature of ZIKV RNA viremia, we use infant-produced ZIKV-specific IgG as a marker of ZIKV vertical transmission. Here, we used a rhesus macaque model to define the association between longitudinal ZIKV-specific IgG antibody titers in infants and duration of maternal viremia.

Methods

Pregnant dams were inoculated in the first trimester, and their infants (n=8) were monitored for 12 months. ZIKV-specific IgG titers were measured in ZIKV-exposed infant serum samples using a whole virion ELISA at 1, 3, 6, 12, 18, 24, 30, and 36 months of age. Optical density was detected at 450nm on a SpectraMax M5e plate reader and IgG binding antibody curves were generated using R studio. Samples were below the limit of detection if they had EC90 values lower than the lowest serum dilution.

Results

One of the eight infants displayed ZIKV-specific IgG titers at 12 months of age with undetectable ZIKV-specific IgG before 12 months of age, suggesting that these infants were infected in utero and produced their own ZIKV-specific IgG. This infant was born to a dam with a short duration of plasma viremia. The remaining seven infants displayed measurable ZIKV-specific IgG in the first 3 months of life and nothing after that point, indicating the presence of maternal antibody and no infant-specific antibody. There was no apparent association between maternal viremia duration and the presence of infant-produced ZIKV-specific IgG.

Conclusion

ZIKV vertical transmission was confirmed in 1 of 8 pregnancies, and that case did not have a longer viremia compared to the other pregnancies. This indicates that either the rate of vertical transmission is not high in this macaque model, or that diagnostic methods for in utero infection with ZIKV are limited. We have additional pregnancies to complete antibody testing for in our cohort (10 additional pregnancies) and will learn more about this diagnostic method in these future studies.
Th2 and IL-17 responses inChlamydia pneumoniae-stimulated PBMC in asthmatic and non-asthmatic subjects
Authors: Ahmed Wefag , Shidid Sarah , Amornruk Nutchaya , Abdelmajid Haram , Norowitz Yitzchok M , Kohlhoff Stephan , Smith-Norowitz Tamar A
Published: October 2024

Background

Chlamydia pneumoniae (C. pneumoniae) is a gram-negative intracellular bacterium that causes respiratory infections in humans, including asthmatic and non-asthmatic subjects. C. pneumoniae activates cells in vitro and produces cytokines that may contribute to the inflammatory responses observed in asthma. Different asthma endotypes are described, including Th2-high and Th2-low. Th2-low endotypes are characterized by IL-17 production and neutrophilic inflammation. The aim of this study was to investigate the role of C. pneumoniae in regulating Th2 versus Th17 responses in peripheral blood mononuclear (PBMC) from subjects with or without asthma.

Methods

PBM) (1×106/mL) from asthmatic (N=6) and non-asthmatic subjects (N=14) were infected +/- C. pneumoniae TW-183 at a multiplicity of infection (MOI) = 0.1, using dose responses (1:10, 1:100), and cultured 48 hrs. Cytokine responses (Interferon (IFN)-gamma, Interleukin (IL)-2, IL-4, IL-17 A/F) were measured in supernatants (ELISA).

Results

Comparison of cytokine responses (the mean differences in non-asthmatic versus asthmatic subjects) were significant for IFN gamma (unstimulated; P<0.0001), IL-2 (unstimulated and 1:100; P<0.0001, P=0.0002, respectively), IL-4 (unstimulated, 1:10, 1:100; P=0.0001, P<0.0001, P<0.0001, respectively) and IL-17 A/F (unstimulated, P<0.0001) (Wilcoxon signed-rank test). Cytokine levels were higher in asthmatic subjects for IFN-gamma (unstimulated,1:10, 1:100), IL-2 (unstimulated), and IL-17 A/F (unstimulated) compared with non-asthmatic subjects. However, IL-4 levels were higher in non-asthmatics (unstimulated, 1:10, 1:100).

Conclusion

Differences in Th2 and IL-17 cytokines responses in PBMC from subjects with and without asthma may indicate the involvement of cell-mediated immunity, while Th17 responses, which were increased in subjects with asthma at baseline, did not increase further in response to C. pneumoniae stimulation.
Unique Pattern of Missed Opportunities for Congenital Syphilis Prevention in Alabama Compared to National Trends
Authors: Blair Isabella , Poole Claudette
Published: October 2024

Background

Missed opportunities to prevent congenital syphilis include no syphilis testing during prenatal care, late prenatal care, inadequate treatment, no prenatal care, late identification, and unidentified missed opportunities. Cases of unidentified missed opportunities are those identified as newborns with congenital syphilis born to mothers that received adequate treatment thirty days before delivery. Missed opportunities in Alabama may differ from national trends. Comparing rates of missed opportunities in Alabama to national trends may help inform Alabama physicians of the most effective intervention points for our state.

Methods

Data on congenital syphilis cases and rates of missed opportunities from 2018-2021 were collected from the Alabama Department of Public Health and CDC STI datasets. The occurrence of missed opportunity types in Alabama was determined and compared to national trends.

Results

No timely prenatal care or syphilis testing was the greatest missed opportunity nationally at 37.58%. However, the most prevalent missed opportunity in Alabama was late identification of seroconversion at 44.44% in comparison to 14.22% nationally. Second most common missed opportunity in Alabama was no timely prenatal care or syphilis testing (divided into no prenatal care at 14.81% and late prenatal care at 6.17%). Additionally, evidence of congenital syphilis despite maternal treatment was the least common missed opportunity nationally (3.75%) but made up 25% of missed opportunities in Alabama in 2021.

Conclusion

The incidence of late identification of seroconversion in Alabama is three times the national average, which emphasizes the need for targeted interventions to address this disparity. Furthermore, congenital syphilis despite maternal treatment in Alabama is six times the national rate, suggesting a need for further investigation into other missed opportunities.
Bloodstream infections in a Brazilian Pediatric Tertiary Oncology Hospital: 30-month analysis regarding the classification of the infection, distribution of microorganisms and their resistance profile
Authors: Prado Seila Israel do , Ignácio Júnior José Carlos , de Castro Paulo Tarso Oliveira e
Published: October 2024

Background

Infections are a major cause of morbidity and mortality in pediatric oncology patients during their treatment. Bloodstream infections are the main site of infection in these patients. Bacteremia in these patients can be secondary to a primary infectious focus, result from central line associated bloodstream infections (CLABSIs) or mucosal barrier injury laboratory-confirmed bloodstream infection (MBI-LCBI).

Methods

Descriptive study of bloodstream infections in pediatric patients undergoing oncological treatment and hematopoietic stem cell transplantation in a tertiary pediatric oncology hospital in Brazil from January 1st, 2021 to June 30th, 2023. Infections were classified according to the Centers for Disease Control and Prevention/ National Healthcare Safety Network (CDC/NHSN) criteria into CLABSIs, MBI-LCBIs and secondary bloodstream infections.

Among the bloodstream infections that met CDC/NHSN criteria for CLABSI, were analyzed separately those who also met the criteria of catheter-related bloodstream infection (CRBSI) according to Infectious Diseases Society of America (IDSA).

Results

During this period were diagnosed 335 episodes of bloodstream infection (123 episodes in 2021, 150 in 2022 and 62 episodes in the first 6 months of 2023). There were 378 microorganisms isolated.

These infections were classified into: 35% CLABSIs, 27% MBI-LCBIs, 23% CRBSIs, and 15% secondary bloodstream infections.

Among the CLABSIs, the most common microorganisms were non-fermenting gram negative bacilli (NFGNB) 38%, enterobacteriaceae 35% and coagulase-negative staphylococcus (CoNS) 11%. Between CRBSIs, there were 31% enterobacteriaceae, 22% CoNS and 19% NFGNB.

Among the MBI-LCBIs there were 66% enterobacteriaceae and 23% group viridans streptococci (VGS). Streptococcus pneumoniae (33%) was the most common microorganism in secondary infections followed by Staphylococcus aureus (17%).

Assessing all infections together, the main enterobacteriaceae were Klebsiella spp. (40%) and only 50% of them were sensitive to cefepime while 10% were carbapenems resistant. Among NFGNB, 13% of Pseudomonas spp. and 5% of Acinetobacter spp. were carbapenems resistant.

Between the gram-positive bacteria, 77% of the S. aureus were methicillin sensitive, the same percentage of the VGS were sensitive to cefepime.

Conclusion

Among bloodstream infections, there were a predominance of CLABSI followed by MBI-LCBIs. Antimicrobial resistance between gram-positive bacteria, is of little concern in our institution. In the case of gram-negative bacteria, resistance to cefepime is becoming worrying among enterobacteriaceae.
Cytomegalovirus infection in transplant patients according to pre-transplant risk in a Hospital in Northeastern Mexico
Authors: Aparicio Denisse Vaquera , Martinez Valeria Barrientos , Antolinez Valentine Jimenez , Rodríguez Mariana Chávez , Bejarano José Iván Castillo , de Santos Abiel Mascareñas los
Published: October 2024

Background

Cytomegalovirus (CMV) is an important cause of morbidity and mortality in patients who receive a hematopoietic stem cell transplant (HSCT). It is possible to stratify the risk of developing the disease due to this agent according to the serological status of the HSCT donor and recipient. In post-transplant patients, significant T lymphocyte dysfunction occurs, so reactivation of CMV is common, which is why it should be monitored after HSCT. Our objective is to determine the association of CMV infection in post-transplant patients according to pre-transplant risk status.

Methods

Patients who received HSCT from January 2019 to June 2023 were included, they were classified according to their pre-transplant risk status and CMV infection was diagnosed by performing a viral load on day 30.

Results

70 patients with hemato-oncological diseases who received an HSCT were included, a median age of 9 years (0-16) was found, predominance of the male sex (60%), the most frequent type of transplant was haploidentical (82.9 %). Of these, 20 (28.5%) had CMV infection, with pre-transplant risk status mostly high risk (85%), of the low-risk patients (25.7%) 10% had the infection and the very high risk (4.3%) only 5% were reported infected. The period during which the infection occurred most frequently was in the early post-pregnancy stage (66.6%) and the majority received treatment with valganciclovir (95%). Of the patients infected with CMV, 15 (75%) were asymptomatic, and 5 (25%) had associated symptoms, with 2 (10%) presenting with urinary symptoms (dysuria, frequency, suprapubic pain, tenesmus), and 2 (10%) with fever, and 1 hematochezia (5%). Regarding clinical outcomes, 17 patients (85%) presented resolution of the disease, 1 (5%) presented therapeutic failure and 1 (5%) died due to multiple organ failure.

Conclusion

Due to the high prevalence of CMV infection, it is important to maintain a high index of suspicion of this pathology in this population, with the aim of achieving early diagnosis and timely initiation of treatment.
Evaluation of an intervention to decrease length of stay in children with low-risk febrile neutropenia
Authors: Rogers Molly , Morton Theodore , Cross Shane , Graetz Dylan , Hashmi Saman , Wolf Joshua
Published: October 2024

Background

Febrile neutropenia is one of the most common serious complications of myelosuppressive chemotherapy. For this reason, pediatric oncology patients with FN have traditionally been admitted to the hospital and started on empiric intravenous antibiotics. However, not all FN patients are at high risk of developing subsequent complications, and a low-risk group exists that could safely be discharged early.

Methods

A retrospective study of 194 FN episodes presenting in pediatric oncology patients at St. Jude Children’s Research Hospital. Outcomes of FN episodes were studied and compared before and after early discharge guidelines for low-risk febrile neutropenic (LRFN) were implemented at St. Jude on May 6, 2020.

Results

Total length of hospital stay was similar in the pre- and post-intervention groups (median 4 [IQR 3,6] vs. 4 [IQR 3,7] days, P = 0.443). Differences in adverse outcomes were insignificant between the pre- and post-intervention cohorts, with only two ICU admissions after the first 24 hours inpatient in the post-intervention group, one new positive blood culture (> 24 hours – 14 days of admission) in each group, and 36.2% versus 21% new fever after resolution of initial fever in pre- and post-intervention cohorts respectively. Cumulative antibiotic use between the pre- and post-intervention groups was statistically insignificant (median 13.5 [IQR 22.8,8] vs. 14 [IQR 22,9] days, P = 0.537), whereas Levofloxacin use was significantly longer in the post-intervention cohort versus the pre-intervention cohort (median 0 [IQR 0,4] vs. 0 [IQR 0,0] days, P = <0.001).

Conclusion

The implementation of guidelines for early discharge of LRFN patients showed no reduction in hospital stay. Understanding the optimal strategy for effectiveness of guideline implementation is crucial to improve quality and efficiency of care.
Surveillance of fever and neutropenia episodes at Yeolyan Hematology and Oncology Center in Armenia
Authors: Grigoryan Mark , Petrosyan Mery , Minasyan Elya , Hovhannisyan Saten , Vagharshakyan Lala , Sargsyan Lilit , Tamamyan Gevorg , Licona Sergio , Faughnan Lane , Muniz-Talavera Himy , Mukkada Sheena
Published: October 2024

Background

Fever and neutropenia frequently occur as complications in pediatric patients with malignancies, significantly escalating morbidity and mortality if not appropriately addressed. We implemented a fever registry to identify patient factors and outcomes associated with fever in patients undergoing treatment at our facility.

Methods

We conducted a single-center prospective observational study at the Pediatric Cancer and Blood Disorders Center of Armenia. All patients aged 0-21 years with a malignancy diagnosis and developing fever and neutropenia between June 25 and November 20, 2023, were included. Variables collected included age, gender, date and time of fever onset, patient symptoms, time to antibiotic administration, identified microbiologic and clinical infections, and subsequent outcomes, including mortality and requirement for critical care level interventions. Data were entered in Microsoft Excel 2016 and analyzed using descriptive statistical methods.

Results

Sixty-one patient episodes in 36 patients met the inclusion criteria. Of these, 22% of episodes had fever at home. The most common malignancy was acute leukemia, specifically B-ALL (21/61), followed by T-ALL (9/61), AML (7/61), and mixed T- and B-type (1/61). Eight out of 61 fever episodes occurred in patients with relapsed disease. The median time-to-antibiotics was 100 minutes (max: 24 hours 40 minutes) in patients developing fever outside the hospital; for inpatient cases, the median time-to-antibiotics was 30 minutes (max: 6 hours 45 minutes). The time-to-antibiotics was longer for patients experiencing fever at home compared to those in inpatient settings (p=0.043). 21% of patient episodes were pretreated, however 11 out of 61 patient episodes (18%) had a positive blood culture. Of 13 total positive cultures, ten were obtained at the time of the patient’s presentation. The most common pathogens identified were Staphylococcus spp. (8/13) including coagulase-negative (3/8), and Klebsiella spp. (3/13). Polymicrobial-positive cultures were observed during two fever and neutropenia episodes.

During 35 episodes, patients presented with no complaints except for general weakness. Among the identified sources of infection (20/61), central-line-related bloodstream infections (n=6), bacteremia (n=5), and Clostridiodes difficile colitis (n=5) were the most common. One febrile neutropenia episode resulted in death (1.6%).

Conclusion

In summary, over 75% of episodes were observed among patients with hematologic malignancies, and localizing symptoms were absent in half of episodes at presentation. We have identified opportunities for quality improvement in time to administration of antibiotics in outpatient fever episodes. The adaptation of an electronic-based medical record system will simplify the tracking process for a febrile episode.
China completes world's largest ground-based network for space weather monitoring
Authors: Xin Ling
Published: October 2024

The network can continuously track space weather from the Sun's surface to interplanetary space and Earth's atmosphere.
A meta-analysis and systematic review of the use of transition tools for patients transitioning from paediatric to adult rheumatology services
Authors: Griffin Kiron , Pearce Fiona , Packham Jonathan
Published: October 2024

Objectives

Transitioning from paediatric to adult care can be challenging, but transition tools are designed to increase successful rates of transfer. We aimed to conduct a meta-analysis and systematic review of the use of transition tools in the transfer of care from paediatric to adult services for rheumatology patients.

Methods

An extensive literature search was conducted using MEDLINE, PubMed and Embase. A total of 12 papers were included in the systematic review and 8 in the meta-analysis looking at the use of transition tools in successful follow-up in adult clinics.

Results

The meta-analysis showed 86.6% (95% CI 53.3, 80.6) of patients who used a transition tool attended an adult outpatient clinic within 1 year of their last paediatric appointment, compared with 67.7% (95% CI 56.7, 99.7) of patients who successfully transferred without a transition tool.

Conclusions

The systematic review demonstrated several unique transition tools with local success, but no dominant method. This article demonstrated a general positive influence of transition tools on successful transfer, but more research is needed to strengthen the association.
The New (White) Normal: Human Anatomy and the Naturalisation of White Bodies in British University Teaching, 1860–1910
Authors: Martin Rebecca
Published: October 2024

The discipline of human anatomy has often been overlooked in histories of race science in favour of comparative anatomy, anthropology, ethnography and statistics. However, understanding the historical relationship between human anatomy and race science is particularly important because of the discipline’s central role, unlike its sister disciplines, in medical education. This article begins to redress this oversight, demonstrating that human anatomy played a key role in the development of nineteenth-century race science in Britain. This article considers three main elements of ideas about racial anatomical difference: the language of racial hierarchy, anatomists’ location of racial difference within the body and the perpetuation of these ideas over time. In so doing, I argue that research into racial difference was demonstrably anatomical during the late nineteenth century, playing a key role in British anatomists’ discipline-building processes, and that these ideas were present within the classroom, influencing generations of medical students.
Probabilistic sleep staging in MSLTs across hypersomnia disorders
Authors: Hjuler Andersen Louise , Brink-Kjaer Andreas , Sum-Ping Oliver , Pizza Fabio , Biscarini Francesco , Haubjerg Østerby Niels Christian , Mignot Emmanuel , Plazzi Giuseppe , Jennum Poul J
Published: October 2024

Study Objectives

This study aimed to identify novel markers of narcolepsy type 1 (NT1) using between-nap opportunity periods (“lights on”) and in-nap opportunity periods (“lights off”) features of Multiple Sleep Latency Test (MSLT) recordings. We hypothesized that NT1 could be identified both from sleep–wake instability and patterns of sleepiness during wakefulness. Further, we explored if MSLTs from NT1 and narcolepsy type 2 (NT2) patients could be distinguished despite having the same diagnostic thresholds.

Methods

We analyzed “lights on” and “lights off” periods of the MSLT, extracting 163 features describing sleepiness, microsleep, and sleep stage mixing using data from 177 patients with NT1, NT2, idiopathic hypersomnia (IH), and subjective hypersomnia (sH) from three sleep centers. These features were based on automated probabilistic sleep staging, also denoted as hypnodensities, using U-Sleep. Hypersomnias were differentiated using either or both features from “lights on” and “lights off.”

Results

Patients with NT1 could be distinguished from NT2, IH, and sH using features solely from “lights on” periods with a sensitivity of 0.76 and specificity of 0.71. When using features from all periods of the MSLT, NT1 was distinguished from NT2 alone with a sensitivity of 0.77 and a specificity of 0.84.

Conclusions

The findings of this study demonstrate microsleeps and sleep stage mixing as potential markers of sleep attacks and unstable sleep–wake states common in NT1. Further, NT1 and NT2 could be frequently distinguished using “lights off” features.
Differential Transcriptome Reprogramming Induced by the Soybean Cyst Nematode Type 0 and Type 1.2.5.7 During Resistant and Susceptible Interactions
Authors: Sultana Mst Shamira , Niyikiza Daniel , Hawk Tracy E. , Coffey Nicole , Lopes-Caitar Valéria , Pfotenhauer Alexander C. , El-Messidi Hana , Wyman Chris , Pantalone Vince , Hewezi Tarek
Published: October 2024

Soybean cyst nematode (SCN, Heterodera glycines [Hg]) is a serious root parasite of soybean ( Glycine max) that induces extensive gene expression changes associated with pleiotropic biological activities in infected cells. However, the impacts of various SCN Hg types on host transcriptome reprogramming remain largely unknown. Here, we developed and used two recombinant inbred lines (RIL; RIL-72 and RIL-137) to profile transcriptome reprogramming in the infection sites during the resistant and susceptible interactions with SCN Hg Type 1.2.5.7 and Type 0. SCN bioassays indicated that RIL-72 was susceptible to Type 1.2.5.7 but resistant to Type 0, whereas RIL-137 was resistant to both types. Comparative analysis of gene expression changes induced by Type 1.2.5.7 in the resistant and susceptible lines revealed distinct transcriptome regulation with a number of similarly and oppositely regulated genes. The expression levels of similarly regulated genes in the susceptible line appeared to be insufficient to mount an effective defense against SCN. The functional importance of oppositely regulated genes was confirmed using virus-induced gene silencing (VIGS) and overexpression approaches. Further transcriptome comparisons revealed shared as well as Hg type- and genotype-specific transcriptome reprogramming. Shared transcriptome responses were mediated through common SCN-responsive genes and conserved immune signaling, whereas genotype-specific responses were derived from genetic variability, metabolic and hormonal differences, and varied regulation of protein phosphorylation and ubiquitination. The conserved defense mechanisms together with genotype-specific responses would enable plants to trigger effective and tailored immune responses to various Hg types and adapt the defense response to their genetic backgrounds.

[Formula: see text] Copyright © 2024 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Incorporating Virtual Reality Agents During a Dichotic Speech Reception Task: Insights From the Heart
Authors: Plain Bethany , Pielage Hidde , Zekveld Adriana A. , Richter Michael , Bhuiyan Tanveer A. , van de Ven Sjors R. B. , Kramer Sophia E.
Published: October 2024

Objectives:

Listening effort is moderated by not only task difficulty, but also success importance. In real communication scenarios, success importance varies based upon the social context. However, in the laboratory, it can be challenging to manipulate social context without compromising experimental control. Outside of hearing sciences, studies have applied virtual reality (VR) to incorporate social context in a controlled and repeatable manner. Several of these studies have demonstrated that social manipulations in VR can reliably elicit changes in cardiovascular measures. Here, we investigated the effect of adding VR agents to a speech reception task, while measuring from the cardiovascular system.

Design:

Twenty-eight, normally hearing participants undertook a dichotic speech reception task. Sentences in stationary noise were presented dichotically, that is, different sentences presented simultaneously to each ear. Participants were tasked to either repeat one of the sentences (single-sentence condition) or both of the sentences (dual-sentence condition). The task was conducted under two VR conditions: (1) in the presence of agents, who provided sporadic performance feedback and (2) in the presence of nonagent controls, without any feedback given. Alongside task performance, we quantified changes in cardiovascular measures, relative to pretask baselines: heart rate variability, pre-ejection period, heart rate, and blood pressure. After each condition, participants rated their subjective effort, difficulty, performance, and engagement.

Results:

Performance and the subjective perception of performance were lower, while subjective effort and difficulty were higher, in the dual-sentence condition, compared with the single-sentence condition. Heart rate was the only cardiovascular measure that was sensitive to the experimental manipulations. Contrary to our expectations, heart rate increased in the nonagent control conditions, compared with the agent conditions. An exploratory analysis revealed heart rate fluctuations within a trial: heart rate was higher during the first 6 sec of the trial (reflecting the presentence masking noise and the sentence presentation) in the dual-sentence condition, compared with the single-sentence condition.

Conclusions:

This study was the first to incorporate VR agents who provided performance feedback during a dichotic speech reception task. Our results suggest that the VR agents did not increase success importance, which could be attributed to a lack of realism of the agents. We also demonstrated that the cardiovascular response to experimental manipulations may differ depending on the data window selected for analysis.
Psychosocial wellbeing in people with melanoma in-situ: a systematic review
Authors: Zheng Lejie , Susanto Alyssa Kathleen , Soyer H. Peter , Janda Monika , Catapan Soraia de Camargo
Published: October 2024

This systematic review aims to evaluate the prevalence of reductions in psychosocial wellbeing among patient with melanoma in situ (MIS). It also aims to identify factors associated with psychosocial reactions, the instruments used to measure psychosocial outcomes, and to evaluate existing intervention programs for supporting this population. Search strategies for different databases including PubMed, Embase, Scopus, PsycINFO, and Web of Science were designed and implemented. A total of 2378 records were identified, resulting in 22 included papers. Various aspects of psychosocial wellbeing were evaluated in the reviewed articles, with fear of cancer recurrence being the most frequently investigated among patients diagnosed with melanoma. Only 2 of the 22 studies reported data for MIS patients, indicating no significant difference in psychosocial welling between patients with MIS and those at higher stages. Regarding interventional support, there is a notable lack of interventions specifically addressing the psychosocial needs of MIS patients. Our findings highlight a significant research gap on psychosocial wellbeing following a MIS diagnosis and suggest a shortage of targeted psychosocial interventions for this growing patient population. The observed variability in measuring psychosocial aspects presents challenges in identifying the essential components of effective interventions. Future research should prioritize employing mixed methodologies and addressing the unique needs of MIS patients.
Clinical Outcomes after Cleft Palate Repair at a Major Referral Hospital in Addis Ababa, Ethiopia
Authors: Gebremariyam Zenebe Teklu , Eshete Mekonen , Baraki Atakiltie
Published: October 2024

Background:

The two most common complications after primary palatoplasty are oronasal fistula and velopharyngeal insufficiency (VPI). To the best of our knowledge, there have been no studies examining postpalatoplasty speech outcomes in Ethiopia.

Methods:

A hospital-based retrospective cross sectional study design was used. A total of 149 patient records were reviewed, and 103 patients fulfilled all the inclusion criteria. These 103 cleft lip and palate patients who had undergone cleft palate repair at Yekatit 12 Hospital Medical College and who had undergone long-term speech assessment with the speech therapy department from January 2019 to December 2021 were included in this study. The bivariate/multivariate logistic regression was used to compare between different groups of patients, with the level of significance set at a P value of less than 0.05.

Results:

Moderate and severe hypernasality was seen in 45.7% of patients. Age at time of palatal surgery has significant association with incidence of hypernasality (P = 0.01). The type of cleft, sex of the patient, and type of surgery had no significant association with incidence of hypernasality. Oronasal fistula was seen in 25% of patients, with Pittsburgh type VI being the most common (40%).

Conclusions:

There is a high rate of VPI and oronasal fistula in this cohort of patients who underwent palatoplasty at Yekatit 12 Hospital. One of the factors for higher complication rate was older age at time of surgery. Therefore, patient education and strengthening the cleft care with training are paramount to ensure better results.
The “Mosque Tower Pattern” for the Preoperative Marking of Reduction Mammaplasty
Authors: Elia Rossella , Maruccia Michele , Tedeschi Pasquale , Nacchiero Eleonora , Giudice Giuseppe
Published: October 2024

Background:

Breast reduction, the seventh most performed plastic surgery globally, has witnessed a significant increase in procedures over recent years. Various techniques exist, each with its advantages and complications, emphasizing the critical role of preoperative marking. Although existing literature focuses on different reduction mammaplasty techniques, limited attention is given to surgical preoperative marking. This study introduces a “mosque tower” pattern combined with a superomedial pedicle, aiming to minimize complications and standardize the design based on individualized factors such as patient characteristics and predicted breast reduction weight.

Methods:

The retrospective case series includes 103 women who underwent reduction mammaplasty between 2017 and 2020. Surgical marking is described, and complications are recorded. The study categorizes breasts into three groups based on key-hole dimensions, correlating them with predicted resection weight. Statistical analysis establishes a rationale formula for selecting key-hole size.

Results:

A total of 175 breasts were reduced in 103 women with an average follow-up of 29.8 months. The mean resection weight was 883 g per breast (range: 490–2531). A complication rate of 8% was observed, with only 2.8% experiencing wound breakdown, notably lower than reported rates in other studies. Key-hole dimension as a predicting variable was correlated significantly with resection weight.

Conclusions:

The mosque tower pattern proves to be an effective, safe, and reproducible method for preoperative marking in reduction mammaplasty. The study emphasizes the importance of individualized planning to achieve satisfactory results, particularly for surgeons in their early practice.
Zinc supplementation to improve prognosis in patients with compensated advanced chronic liver disease: a multicenter, randomized, double-blind, placebo-controlled clinical trial
Authors: Bañares Juan , Aceituno Laia , Ruiz-Ortega Lourdes , Pons Mònica , Abraldes Juan G. , Genescà Joan
Published: October 2024

Zinc homeostasis could play a role in compensated advanced chronic liver disease, and its supplementation has been linked to improvement in liver function, a decrease of hepatic complications, and reduction in HCC incidence. Compensated advanced chronic liver disease encompasses a heterogeneous group of patients with variable risks of clinically significant portal hypertension and clinical events. The ANTICIPATE model is a validated model for stratifying these risks. Our aim is to demonstrate that zinc administration can reduce the rate and risk of presenting clinical events (first decompensation, HCC, death, and liver transplantation). This study protocol describes an ongoing phase III, national, multicenter, randomized, double-blind clinical trial that will enroll 300 patients to receive either the trial treatment (zinc acexamate) or placebo. An inclusion period of 42 months is planned, with a minimum follow-up of 2 years. Our principal hypothesis is that zinc could modify the natural history of patients with compensated advanced chronic liver disease, with an overall improvement in prognosis.
Impact of Neurostimulation, Immunomodulation, Topical Medication Application, and Surgical Reconstruction on Corneal Nerve Function and Regeneration
Authors: Drake Taylor N. , Sheppard John D.
Published: October 2024

The corneal epithelium, supplied by thousands of nerve endings, plays a substantial role in absorbing and distributing nutrients along the ocular surface. Many studies have explored the influence of various modalities in regulating tear production to manage corneal disorders and dry eye disease. These findings have highlighted the advantages of enhancing corneal nerve function and regeneration through neurostimulation, neural signaling, immunomodulation, topical medication application, and surgical reconstruction. The purpose of this narrative review article was to provide an overview of the current state of knowledge on this topic based on a PubMed database literature search for relevant animal and human studies investigating the modification of the trigeminal pathway to restore corneal nerve function and improve overall ocular health. Further investigation into this area of research is important to help guide new therapeutic targets for the prevention and development of treatments of corneal degeneration.
Delayed onset Spontaneous Hyphema after OMNI® Surgical System
Authors: Gautam Natasha , Sit Arthur J.
Published: October 2024

Minimally invasive glaucoma surgery (MIGS) offers options for glaucoma treatment that have generally improved safety profiles compared with filtering surgery. MIGS vary in design and procedure, but all angle-based MIGS function by bypassing or removing aqueous humor outflow resistance at the level of the trabecular meshwork. This can lower intraocular pressure but also remove the blood-aqueous barrier. Most studies of MIGS report on relatively short-term safety, but awareness of potential long-term complications is critical for optimal patient management. This case report describes a patient with recurrent and refractory delayed onset spontaneous hyphema after OMNI procedure. To the best of our knowledge, this is the first case report describing this complication of the OMNI surgical system.
Haves and have-nots: socioeconomic position improves accuracy of machine learning algorithms for predicting high-impact chronic pain
Authors: Morris Matthew C. , Moradi Hamidreza , Aslani Maryam , Sun Sicong , Karlson Cynthia , Bartley Emily J. , Bruehl Stephen , Archer Kristin R. , Bergin Patrick F. , Kinney Kerry , Watts Ashley L. , Huber Felicitas A. , Funches Gaarmel , Nag Subodh , Goodin Burel R.
Published: October 2024

Lower socioeconomic position (SEP) is associated with increased risk of developing chronic pain, experiencing more severe pain, and suffering greater pain-related disability. However, SEP is a multidimensional construct; there is a dearth of research on which SEP features are most strongly associated with high-impact chronic pain, the relative importance of SEP predictive features compared to established chronic pain correlates, and whether the relative importance of SEP predictive features differs by race and sex. This study used 3 machine learning algorithms to address these questions among adults in the 2019 National Health Interview Survey. Gradient boosting decision trees achieved the highest accuracy and discriminatory power for high-impact chronic pain. Results suggest that distinct SEP dimensions, including material resources (eg, ratio of family income to poverty threshold) and employment (ie, working in the past week, number of working adults in the family), are highly relevant predictors of high-impact chronic pain. Subgroup analyses compared the relative importance of predictive features of high-impact chronic pain in non-Hispanic Black vs White adults and men vs women. Whereas the relative importance of body mass index and owning/renting a residence was higher for non-Hispanic Black adults, the relative importance of working adults in the family and housing stability was higher for non-Hispanic White adults. Anxiety symptom severity, body mass index, and cigarette smoking had higher relevance for women, while housing stability and frequency of anxiety and depression had higher relevance for men. Results highlight the potential for machine learning algorithms to advance health equity research.
The Effect of Peer-Mentor Support for Older Vulnerable Patients With Ischemic Heart Disease—A 24-Week Randomized Controlled Trial
Authors: Pedersen Maria , Overgaard Dorthe , Boateng Takyiwa , Bennich Birgitte , Beck Anne Marie , Andersen Ingelise , Sibilitz Kirstine Lærum , Mairey Isabelle Pascale , Thygesen Lau Caspar , Petersen Rikke Agnete
Published: October 2024

Background

The positive effects of cardiac rehabilitation (CR) are well established; however, among older and vulnerable patients, nonattendance and dropout are prevalent problems.

Aim

The objective of this study is to explore if a 24-week peer-mentor intervention increases initial and long-term CR attendance. Secondary aims are whether peer-mentor intervention improves lifestyle (diet and physical activity) and psychological outcomes (self-efficacy, anxiety, depression, and quality of life) among older vulnerable patients with ischemic heart disease.

Methods

The study was designed as a 2-arm, single-center, parallel, 24-week, randomized controlled trial (RCT) with follow-up at 12 and 24 weeks. Patients were randomized at a ratio of 1:1 to receive either the peer-mentor intervention (in addition to standard CR) or standard CR along (control arm).

Results

Between August 2021 and March 2023, 117 older, vulnerable patients were enrolled and randomized (59 randomized to peer-mentor intervention and 58 to usual care). The peer-mentor intervention significantly increased CR attendance. This applies to both initial participation in 1 CR session of physical training or dietary advice (78.0% vs 58.6%; P = .03), and long-term attendance in ≥50% dietary advice sessions (50.8% vs 27.6%; P = .01) and completed ≥50% (64.4% vs 41.4% P = .01) or ≥75% of the physical training sessions (59.3% vs 37.9%; P = .02). The study found no statistically significant effect on secondary outcomes.

Conclusions

Low CR attendance is a well-known problem, especially among older, vulnerable patients; however, we tested a low-cost, peer-mentor intervention that significantly increased both initial CR participation and long-term attendance in CR sessions in this group of patients.
A Curricular Review of Radiology Education in a Master of Physician Assistant Studies Program
Authors: Herzog Rachel , Li Terry , Hryniuk Alexa
Published: October 2024

Introduction

Physician assistants/associates (PAs) are expected to be competent in ordering and interpreting diagnostic imaging. However, there are no further details outlining the educational expectations of PAs as it relates to radiology upon graduation. This can result in significant variability in the radiology curricula that PA students are taught and, consequently, hinder PAs' ability to work within their full scope of practice. Therefore, the purpose of this study was to map the radiology curriculum in a Master of Physician Assistant Studies (MPAS) program to elucidate radiological educational training before graduation.

Methods

Quantitative curricular mapping was used to assess the 2021 to 2022 MPAS program for radiological involvement. Relevant course and session objectives related to radiology education were identified. In addition, educational learning material was reviewed for diagnostic imaging content.

Results

Formal radiological training was observed in 8 of 27 courses in the preclinical curriculum, with 4.35% of the total session objectives directed to radiological education. This formal exposure comprises 18.9 hours (1.71%) of curricular time. Informal diagnostic imaging exposure increased radiology education to approximately 29.5 hours (2.67%) of curricular time. One course (Diagnostic Imaging) focuses exclusively on radiology teaching and accounts for approximately 50% of the total radiologic teaching. X-ray ordering and interpretation received the greatest emphasis throughout the curriculum, while ultrasound received the least attention.

Discussion

Further integration of formal radiological education into PA programs should be considered with specific attention directed toward point-of-care ultrasound exposure and ordering/interpretation skills.
“I never thought of it as payment”: Qualitative evaluation of workshops with advanced practice registered nurses on pharmaceutical industry payment reporting
Authors: Grundy Quinn , Rudner Nancy , Klein Tracy , Ladd Elissa , Hart Dana , MacIsaac Meghan , Bero Lisa
Published: October 2024

Background:

With the expansion of professional autonomy and prescriptive authority of advanced practice registered nurses (APRNs), interactions with industry are under greater scrutiny. As of July 1, 2021, pharmaceutical and medical device companies must publicly report all payments to APRNs through the Centers for Medicare and Medicaid Services' Open Payments website.

Purpose:

To gauge APRNs' familiarity with, and perceptions of the Open Payments database and discuss whether and how APRNs should respond.

Methodology:

Virtual workshops consisting of a didactic presentation and interactive exercises with APRNs recruited through professional networks, associations, and conferences. Transcripts were analyzed using a qualitative interpretive approach, grounded in an everyday ethics theoretical framework.

Results:

Thirty-six APRN clinicians, students, and faculty participated in nine workshops. Seeing sponsored meals reported in Open Payments as “payments” prompted participants to see familiar interactions in a new way. Participants valued the enhanced transparency as a way to identify risks of bias but were concerned that reporting might undermine public trust in APRNs. Emphasizing awareness as a precursor to action, participants desired greater preparation for ensuring independence in practice.

Conclusions:

The importance of tackling the ethical issues associated with industry interactions is heightened within the context of an existing climate of distrust within health care. However, many participants were concerned about the effects of transparency on public trust rather than how APRNs individually or collectively can be more trustworthy.

Implications:

Open Payments can serve as a useful tool to catalyze broader conversations about ethics, integrity in decision making, and health policy advocacy.