bluuebunny/crossref_metadata_2025 huggingface dataset:
A case report of distal radial puncture in a patient with acute upper limb ischaemia: the last hope of the cardiologist?
Authors: Giusca Sorin , Schmidt Andrej , Korosoglou Grigorios
Published: May 2022

Background

Patients with acute limb ischaemia (ALI) present with acute symptoms, requiring prompt diagnosis and expedited treatment to preserve the viability of the affected ischaemic tissue.

Case summary

We present an 83-year-old female patient with upper ALI due to thrombotic occlusion of the left brachial artery. Concomitantly, the patient had a first diagnosis of atrial fibrillation and was not on treatment with oral anticoagulation. Transfemoral thrombectomy using a 6F Rotarex® catheter resulted in removal of the thrombus from the brachial artery. However, significant amounts of debris embolized distally, causing occlusion of both the radial and ulnar arteries. The debris was successfully removed after puncture of the distal radial artery and retrograde thrombus aspiration using a 5F Envoy catheter. This manoeuver led to flow restoration in both the radial and ulnar arteries and to complete resolution of ischaemic symptoms of the patient.

Discussion

Interventionists may consider distal radial puncture not only as an access site for coronary angiography but also as an option for the endovascular management of ALI in cases of cardiac embolism, as described herein or in cases of thrombotic complications during routine catheterization and percutaneous coronary intervention. Herein, we describe the case of an 83-year-old patient, who presented with acute upper limb ischaemia. Due to embolization of thrombotic debris during Rotarex® catheter thrombectomy, flow further diminished in the ulnar and radial arteries. The last hope for successful interventional treatment was thrombectomy from distally after retrograde puncture of the distal radial artery. This unique manoeuver led to flow restoration and complete recovery of the patient without the need for open surgery.
Bet-hedging in innate and adaptive immune systems
Authors: Tate Ann T , Van Cleve Jeremy
Published: May 2022

Immune system evolution is shaped by the fitness costs and trade-offs associated with mounting an immune response. Costs that arise mainly as a function of the magnitude of investment, including energetic and immunopathological costs, are well-represented in studies of immune system evolution. Less well considered, however, are the costs of immune cell plasticity and specialization. Hosts in nature encounter a large diversity of microbes and parasites that require different and sometimes conflicting immune mechanisms for defense, but it takes precious time to recognize and correctly integrate signals for an effective polarized response. In this perspective, we propose that bet-hedging can be a viable alternative to plasticity in immune cell effector function, discuss conditions under which bet-hedging is likely to be an advantageous strategy for different arms of the immune system, and present cases from both innate and adaptive immune systems that suggest bet-hedging at play.
Chronic unrelenting cough secondary to pericardial cyst impingement of right phrenic nerve
Authors: Mikhail John , Kennedy Gregory , Singhal Sunil , Resta Isabella Tondi , Nadeem Bilal , Azari Feredun
Published: May 2022

Located in the mediastinum, pericardial cysts are rare and benign congenital abnormalities commonly identified as incidental findings on imaging. However, some patients with abnormally enlarged cysts present with compressive symptoms, which include recurrent infections, tamponade from cardiac compression and respiratory complications. Our report highlights a challenging case of a patient with recurrent respiratory symptoms secondary to phrenic nerve compression. Misdiagnosis over the past decade resulted in ineffective interventions. After clear identification of the cyst compression of the ipsilateral phrenic nerve, the patient underwent a minimally invasive robotically assisted cyst resection with phrenic nerve preservation that alleviated respiratory symptoms.
COVID-19 vaccines: the imperfect instruments of vaccine diplomacy
Authors: Hotez Peter J
Published: May 2022

Although true vaccine diplomacy in the form of sharing vaccine development technologies and scientific cooperation with low- and middle-income countries has not been a dominant theme in the COVID-19 pandemic, this aspect is now taking off and generating some exciting new possibilities.
Optimum Urine Cotinine and NNAL Levels to Distinguish Smokers from Non-Smokers by the Changes in Tobacco Control Policy in Korea from 2008 to 2018
Authors: Park Eun Young , Lim Min Kyung , Park Eunjung , Kim Yoonjung , Lee Dohoon , Oh Kyungwon
Published: May 2022

Introduction

We examined the age- and sex-specific distributions of biomarkers of tobacco smoke exposure to determine the optimal cutoffs to distinguish smokers from non-smokers over the last 10 years in Korea, during which smoking prevalence and secondhand smoke (SHS) exposure declined due to changes in tobacco control policy.

Methods

We analyzed data from the Korea National Health and Nutrition Examination Survey on creatinine-adjusted urinary cotinine (2008–2018; 33 429 adults: 15 653 males and 17 776 females) and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL; 2016–2018; 6337 adults: 3091 males and 3246 females). We determined the optimal cutoffs and confidence intervals (CIs) to distinguish smokers from non-smokers using receiver operator characteristic curve analysis and bootstrapping (1000 resamples).

Results

The optimal cutoff values of creatinine-adjusted urine cotinine and NNAL concentration were 20.9 ng/mg (95% CI: 20.8–21.0, sensitivity: 96.6%, specificity: 93.8%) and 8.9 pg/mg (95% CI: 8.8–8.9, sensitivity: 94.0%, specificity: 94.7%), respectively, in 2016–2018. The optimal cutoffs of both biomarkers increased with age and were higher in females than in males for NNAL concentration. In both sexes, the optimal cutoff of urine cotinine continuously declined over the study period.

Conclusions

The optimal cotinine cutoff declined along with smoking prevalence and levels of SHS exposure due to enforcement of tobacco control policies, including smoke-free ordinances and tax increases. Monitoring of biomarkers of tobacco exposure appears necessary for verification of smoking status and regulatory use.

Implications

Our results based on nationally representative data suggest that a large decrease in the optimal cutoff value of urine cotinine to distinguish smokers from non-smokers was caused by decreases in smoking prevalence and SHS exposure following enforcement of tobacco control policies over the last 10 years. We determined the optimal cutoff values of urine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), which were not previously reported in representative population in Asia, to enable more accurate estimation of exposure to tobacco smoke and proper assessment of disease risks. Gender- and age-specific differences in the optimal cutoffs require further study. Monitoring of biomarkers of tobacco smoke exposure seems necessary for verification of smoking status and regulatory use.
KIL1 terminates fertility in maize by controlling silk senescence
Authors: Šim�škov� M�ria , Daneva Anna , Doll Nicolas , Schilling Neeltje , Cubr�a-Rad�o Marta , Zhou Liangzi , De Winter Freya , Aesaert Stijn , De Rycke Riet , Pauwels Laurens , Dresselhaus Thomas , Brugi�re Norbert , Simmons Carl R , Habben Jeffrey E , Nowack Moritz K
Published: May 2022

Plant flowers have a functional life span during which pollination and fertilization occur to ensure seed and fruit development. Once flower senescence is initiated, the potential to set seed or fruit is irrevocably lost. In maize, silk strands are the elongated floral stigmas that emerge from the husk-enveloped inflorescence to intercept airborne pollen. Here we show that KIRA1-LIKE1 (KIL1), an ortholog of the Arabidopsis NAC (NAM (NO APICAL MERISTEM), ATAF1/2 (Arabidopsis thaliana Activation Factor1 and 2) and CUC (CUP-SHAPED COTYLEDON 2)) transcription factor KIRA1, promotes senescence and programmed cell death (PCD) in the silk strand base, ending the window of accessibility for fertilization of the ovary. Loss of KIL1 function extends silk receptivity and thus strongly increases kernel yield following late pollination. This phenotype offers new opportunities for possibly improving yield stability in cereal crops. Moreover, despite diverging flower morphologies and the substantial evolutionary distance between Arabidopsis and maize, our data indicate remarkably similar principles in terminating floral receptivity by PCD, whose modulation offers the potential to be widely used in agriculture.
Benchmarking in Academic Physical Therapy Using the PT-GQ Survey: Wave 2 Update With Application to Accreditation Reporting
Authors: Dudley-Javoroski Shauna , Shields Richard K
Published: May 2022

Objective

The Benchmarking in Academic Physical Therapy study uses the Physical Therapist-Graduation Questionnaire (PT-GQ) survey to develop comprehensive performance benchmarks for physical therapist education. These benchmarks facilitate interprofessional comparisons and have application to accreditation self-study reporting. The purpose of this study is to report updated benchmarks from enrollment Wave 2 of the study, with an emphasis on curricular areas that align with accreditation standards.

Methods

Seventy doctor of physical therapy (DPT) programs (26.5% national sample) administered the survey to graduates during 2020–2021. Where possible, respondent data were contextualized by statistical comparison with published medical student data (Welch t test, Hedges g).

Results

There were 1894 respondents who participated in the study (response rate: 63.9%). The average survey duration was 32.9 minutes. White-only, non-Hispanic/Latino/a/x individuals (78.8%) exceeded the 2020 US Census prevalence (60.1%), and only one-half of respondents perceived a benefit to their training from the diversity present in their programs. Over 94% of respondents indicated that their curricula were characterized by “problem solving/critical thinking” and “clinical reasoning,” but nearly one-half indicated “busywork” was prevalent. High curricular satisfaction ratings clustered in content areas relating to profession-specific technical skills and low ratings clustered in foundational sciences. DPT respondents reported significantly lower tolerance for ambiguity, significantly more exhaustion, and significantly less disengagement than medical students. Respondents endorsed higher levels of “adaptive” perfectionism (striving for high performance) than “maladaptive” perfectionism (concern over negative evaluations). Respondents with loans (27.7%) had debt exceeding $150,000, the benchmark above which the DPT degree loses economic power.

Conclusion

PT-GQ benchmarks revealed strengths (eg, curricula emphasizing problem solving/critical thinking and clinical reasoning) and challenges (eg, low diversity, problematic student debt) in physical therapist education.

Impact

Programs can use benchmarking for quality-improvement efforts and as a data source for accreditation self-study reports. The ongoing study will refine national benchmarks and pilot items to address new research questions.
The Occurrence Birth–Death Process for Combined-Evidence Analysis in Macroevolution and Epidemiology
Authors: Andréoletti Jérémy , Zwaans Antoine , Warnock Rachel C M , Aguirre-Fernández Gabriel , Barido-Sottani Joëlle , Gupta Ankit , Stadler Tanja , Manceau Marc
Published: May 2022

Phylodynamic models generally aim at jointly inferring phylogenetic relationships, model parameters, and more recently, the number of lineages through time, based on molecular sequence data. In the fields of epidemiology and macroevolution, these models can be used to estimate, respectively, the past number of infected individuals (prevalence) or the past number of species (paleodiversity) through time. Recent years have seen the development of “total-evidence” analyses, which combine molecular and morphological data from extant and past sampled individuals in a unified Bayesian inference framework. Even sampled individuals characterized only by their sampling time, that is, lacking morphological and molecular data, which we call occurrences, provide invaluable information to estimate the past number of lineages. Here, we present new methodological developments around the fossilized birth–death process enabling us to (i) incorporate occurrence data in the likelihood function; (ii) consider piecewise-constant birth, death, and sampling rates; and (iii) estimate the past number of lineages, with or without knowledge of the underlying tree. We implement our method in the RevBayes software environment, enabling its use along with a large set of models of molecular and morphological evolution, and validate the inference workflow using simulations under a wide range of conditions. We finally illustrate our new implementation using two empirical data sets stemming from the fields of epidemiology and macroevolution. In epidemiology, we infer the prevalence of the coronavirus disease 2019 outbreak on the Diamond Princess ship, by taking into account jointly the case count record (occurrences) along with viral sequences for a fraction of infected individuals. In macroevolution, we infer the diversity trajectory of cetaceans using molecular and morphological data from extant taxa, morphological data from fossils, as well as numerous fossil occurrences. The joint modeling of occurrences and trees holds the promise to further bridge the gap between traditional epidemiology and pathogen genomics, as well as paleontology and molecular phylogenetics. [Birth–death model; epidemiology; fossils; macroevolution; occurrences; phylogenetics; skyline.]
Electrodiagnostic Findings in Riboflavin Transporter Deficiency Type 2
Authors: Sanchez Jose A. , Traub Rebecca , Trau Steven P. , Howard James F.
Published: May 2022

We present the electrodiagnostic findings in a case of a 3-year-old girl presenting with sensory ataxia, gait disturbance, and visual–auditory disturbance with a genetically confirmed diagnosis of riboflavin transporter deficiency type 2 (RTD2). She carries a homozygous mutation in the SLC52A2 gene, c.1016T>C (p.Leu339Pro). Her testing demonstrates a non–length-dependent axonal sensorimotor polyneuropathy affecting predominantly the upper extremities with active denervation of the distal muscles of both arms. It is important to highlight these findings because most genetic neuropathies have a length-dependent pattern of involvement, affecting the distal legs before the arms. The electrodiagnostic findings in RTD2 have not been previously well described. These electrodiagnostic findings are in agreement with the typical clinical phenotype of RTD2, which affects the upper limbs and bulbar muscles more than the lower extremities.
Academic and Employment Status in Patients With Generalized Myasthenia Gravis Treated With Eculizumab: A Case Series
Authors: Kang Seung Ah , Sweeney Megan , Govindarajan Raghav
Published: May 2022

Objectives:

To evaluate the impact of treatment with eculizumab, a terminal complement inhibitor, on academic and employment status in patients with refractory generalized myasthenia gravis (MG).

Methods:

Case review of 7 US patients.

Results:

Six patients were aged ≤65 years; one was a full-time student and the remainder were in employment before MG diagnosis. After diagnosis, all patients gave up work (n = 3) or reduced their study/working hours (n = 4). In the 12 months after eculizumab initiation, patients who had stopped work resumed working in some capacity, whereas those who had changed their work/study hours returned to their original work/study pattern. Patients also experienced a reduction in the number of MG exacerbations, and a clinically significant improvement in MG–Activities of Daily Living scores, and were able to reduce other MG medications.

Conclusions:

These results suggest that treatment with eculizumab may help maintain education/employment activity in patients with refractory generalized MG.
Rituximab Responsive Relapsing–Remitting IgG4 Anticontactin 1 Chronic Inflammatory Demyelinating Polyradiculoneuropathy Associated With Membranous Nephropathy: A Case Description and Brief Review
Authors: Remiche Gauthier , Monteiro Marta Lamartine S. , Catalano Concetta , Hougardy Jean-Michel , Delmont Emilien , Boucraut José , Mavroudakis Nicolas
Published: May 2022

Nodal/paranodal IgG4-related chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) rarely involves anticontactin (CNTN1) subtype and exceptionally complicates with nephrotic syndrome. A 65-year-old man developed weakness, facial palsy, and balance impairment; after spontaneous recovery, he severely relapsed 1 month later. Electroneuromyography confirmed CIDP. Proteinorachy (462 mg/dL; N < 45), proteinuria (3.5 g/g creatine), and biopsy-proven membranous nephropathy were identified. Intravenous immunoglobulins, corticosteroids, and plasmaphereses did not allow recovery. Anti-CNTN1 immunoglobulin G4 (IgG4) assay was positive. Rituximab (375 mg/m2/week, 4 weeks) provided obvious improvement. Relapsing–remitting anti–CNTN1-CIDP co-occurring with nephrotic syndrome is exceptional, and its identification is essential because efficient therapies such as rituximab are available for this severe condition.
No pain management for labour: individual and organisational determinants
Authors: Merrer Jade , Chantry Anne A. , Blondel Béatrice , Le Ray Camille , Bonnet Marie-Pierre
Published: May 2022

BACKGROUND

Disparities in access to pain management have been identified in several care settings, such as emergency departments and intensive care units, but with regard to labour analgesia, it remains poorly explored.

OBJECTIVES

To determine the proportion of women without pain management during labour and its individual and organisational determinants.

DESIGN

Secondary analysis of a nationwide cross-sectional population-based study, the 2016 French National Perinatal Survey.

SETTINGS

All maternity units in France.

PARTICIPANTS

Ten thousand and eleven women who attempted vaginal delivery with a labour duration at least 15 min.

MAIN OUTCOME MEASURE

Absence of pain management, defined as absence of any pharmacological or nonpharmacological analgesic method during labour.

RESULTS

Among the 10 011 women included, 542 (5.4%) had no labour pain management: 318 (3.7%) of the 8526 women who initially preferred to use neuraxial analgesia and 222 (15.8%) of the 1402 who did not. Using generalised estimating equations stratified according to the maternal antenatal preference for neuraxial analgesia, the common determinants of no labour pain management in both groups were no attendance at childbirth education classes and admission to a delivery unit during the night. Among women who initially preferred to use neuraxial analgesia, those who delivered in units with <1500 annual deliveries compared with units with 2000 to 3499 annual deliveries, were more likely to do without pain management [adjusted odds ratio (OR) = 1.96; 95% confidence interval (CI), 1.39 to 2.78]; among those who did not prefer to use it, women born abroad were more likely to do without labour pain management (adjusted OR = 1.64; 95% CI, 1.12 to 2.40).

CONCLUSION

In France, 1 : 20 women had no labour pain management, and this proportion was three times higher among women who preferred not to use neuraxial analgesia. Enhancing maternal information on labour pain and its management, especially nonpharmacological methods, and rethinking care organisation, could improve access to analgesia of any kind.
Best Practices to Implement Dried Blood Spot Sampling for Therapeutic Drug Monitoring in Clinical Practice
Authors: Francke Marith I. , Peeters Laura E. J. , Hesselink Dennis A. , Kloosterboer Sanne M. , Koch Birgit C. P. , Veenhof Herman , de Winter Brenda C. M.
Published: May 2022

Background:

Sampling of blood at home to determine the concentration of drugs or other compounds can be effective in limiting hospital-based sampling. This could lower hospital visits and patient burden, improve the quality of life, and reduce health care costs. Dried blood spot (DBS) microsampling is often used for this purpose, wherein capillary blood, obtained by pricking the heel or finger, is used to measure different analytes. Although DBS has several advantages over venous blood sampling, it is not routinely implemented in clinical practice. To facilitate the bench to bedside transition, it is important to be aware of certain challenges that need to be considered and addressed.

Results:

Here, important considerations regarding the implementation of DBS in clinical practice, the choice of patients, blood sampling, transport, and laboratory analysis are discussed. In addition, we share our experience and provide suggestions on how to deal with these problems in a clinical setting.
Embryonic Origins of the Hematopoietic System: Hierarchies and Heterogeneity
Authors: Vink Chris S. , Mariani Samanta A. , Dzierzak Elaine
Published: May 2022

The hierarchical framework of the adult blood system as we know it from current medical and hematology textbooks, displays a linear branching network of dividing and differentiated cells essential for the growth and maintenance of the healthy organism. This view of the hierarchy has evolved over the last 75 years. An amazing increase in cellular complexity has been realized; however, innovative single-cell technologies continue to uncover essential cell types and functions in animal models and the human blood system. The most potent cell of the hematopoietic hierarchy is the hematopoietic stem cell. Stem cells for adult tissues are the long-lived self-renewing cellular component, which ensure that differentiated tissue-specific cells are maintained and replaced through the entire adult lifespan. Although much blood research is focused on hematopoietic tissue homeostasis, replacement and regeneration during adult life, embryological studies have widened and enriched our understanding of additional developmental hierarchies and interacting cells of this life-sustaining tissue. Here, we review the current state of knowledge of the hierarchical organization and the vast heterogeneity of the hematopoietic system from embryonic to adult stages.
Comparison of two new integrated SS-OCT tomography and biometry devices
Authors: Sorkin Nir , Achiron Asaf , Abumanhal Muhammad , Abulafia Adi , Cohen Eyal , Gutfreund Shay , Mandelblum Jorge , Varssano David , Levinger Eliya
Published: May 2022

Purpose:

To evaluate the agreement in biometry measurements and intraocular lens (IOL) power calculations between 2 integrated swept-source optical coherence tomography (SS-OCT) tomography/biometry devices: the Eyestar 900 and the Anterion.

Setting:

Tel Aviv Medical Center, Tel Aviv, Israel.

Design:

Retrospective comparative study.

Methods:

113 eyes of 66 consecutive patients who were evaluated prior to cataract surgery using both devices on the same visit were included. Measurements of axial length, anterior and posterior keratometry, anterior chamber depth, corneal diameter (CD), central corneal thickness, and lens thickness were recorded from both devices and analyzed for agreement and correlation. IOL power calculations using Barrett Universal II formula were compared between the devices in addition to prediction error (PE) and the mean absolute error (MAE).

Results:

The mean age was 71.6 ± 9.8 years. Clinically, the mean differences in measured variables were small. Measurement correlation and agreement between the devices were excellent for all variables, except for CD (Spearman r = 0.763, P < .001, and Bland-Altman 95% limits of agreement −0.21 to +0.65 mm). Good agreement was found between the devices in IOL power calculations, PE, and MAE, and the agreement was better when using the Eyestar 900 reflective keratometry measurements than the Eyestar 900 SS-OCT keratometry measurements (IOL power agreement within ±0.5 diopter (D) in 90.5% [n = 95] and 81.0% [n = 85], respectively [P = .076], and within ±0.25 D in 64.8% [n = 68] and 44.8% [n = 47], respectively [P = .005]).

Conclusions:

The 2 integrated SS-OCT tomography/biometry devices had good agreement in biometry measurements and IOL power calculations. Agreement was better when the Eyestar 900 reflective anterior keratometry measurements were used rather than the Eyestar 900 SS-OCT anterior keratometry measurements. Measurements of CD had reduced agreement and were not interchangeable.
Self-Care of Chronic Illness Inventory: An Initial Psychometric Evaluation in People Living With HIV in Italy
Authors: Brito Villa Andrés , De Maria Maddalena , Caruso Rosario , Matarese Maria , Arrigoni Cristina , Dellafiore Federica
Published: May 2022

Self-care is essential to achieve positive clinical outcomes in patients with chronic diseases; however, self-care behaviors of people living with HIV (PLWH) have not been extensively studied due to the lack of validated measurements. We performed preliminary psychometric analyses of the structural validity and internal consistency of the Self-Care of Chronic Illness Inventory among 108 PLWH living in Italy and assessed self-care levels. Our findings largely replicate the instrument's original factor structure and indicated high internal consistency and reliability. Additionally, we found that PLWH performed self-care behaviors at suboptimal levels. Recommendations for clinical care and future investigations are advanced.
Validation of coronavirus-2019 phobia scale using preschool practitioners in urban and rural communities in Nigeria
Authors: Ugwu Gloria C. , Ugwuanyi Christian S. , Aye Eucharia N. , Eze Celestine O. , Ohia Nkiru Christiana , Okenyi Emmanuel C. , Oforka Theresa O. , Oraelosi Charles A. , Njoku Obiageli C. , Ezema Victor S. , Ifekoya Kelechi O. , Nwoga Chinyere Theresa , Okondugba Alexander , Onumonu Julia Amobi , Ohaneme Rosemary Chinyere , Ezeah Malachy A.
Published: May 2022

Coronavirus-2019 (COVID-19) emerged in December 2019, causing significant changes in people's social lives and other human activities. The outbreak halted educational activities throughout the world. The Nigerian experience was unique in that most people were skeptical about the pandemic's existence. This practice contributed to the Nigerian people's fear of the COVID-19 outbreak. However, in Nigeria, there has never been a validated or established Covid-19 phobia scale, necessitating this study.

This study was a pure validation study on COVID-19 phobia scale (C19PS). The study area was south-east states and a sample of 386 preschool practitioners in urban and rural communities of South East States, Nigeria participated in the study. The eligibility criteria include being a preschool teacher and demonstrating signs of COVID-19 phobia. The validation of the C19PS was done by subjecting the data gathered to principal axis factoring analysis with varimax rotation. The model fit for the data was tested using root mean square error of approximation and comparative fit index.

It was found that the Kaiser-Meyer-Olkin value of .845 for the measure of the adequacy of the sample size. There was also a significant Bartlett's test of sphericity (P < .05). This implies that the correlation matrix for the C19PS is not an identity matrix. It was revealed that C19PS had good overall reliability (α = .896) and model fit (Root mean square error of approximation = .042, comparative fit index = .943) in a sample of Nigerian preschool practitioners.

As a result, C19PS was recommended as a trustworthy tool for identifying persons who suffer from COVID-19 phobia.
Effects of a Medical Aid program on medical utilization patterns for low-income patients with affective disorder in Seoul
Authors: Shon Changwoo , Kim Jungah , You Myoungsoon
Published: May 2022

Mental illness has been increasing globally and its global burden of disease has reached a significant level, and urban dwellers have more chances of having worse mental health status due to high population density, isolated social networks. In Korea's medical security system, Medical Aid (MA) program and National Health Insurance (NHI), patients covered by MA pay much smaller out-of-pocket payments for outpatient services because of exempt from hospitalization fees. However, as a result of focusing on improving access to medical services for the urban poor due to lower out-of-pocket payment, their healthcare costs have greatly increased, while their health management has thus far been inadequate. In light of the background, this study investigated the differences in patterns of medical utilization among affective disordered patients covered by the MA program and the NHI system respectively.

Data used for this study were extracted from customized health information data from the National Health Insurance Service (NHIS). The data source used in this study, customized claims data from the NHIS, is census data, which strengthens the representativeness and reliability of the study results. A total of 6754 inpatients (MA: 3327 and NHI 20%: 3327) diagnosed with the affective disorder were retrieved by Propensity Scores Matching (PSM).

The length of stay of MA beneficiaries was found to be longer than that of NHI enrollees. However, the rate of hospital emergency room visits by NHI enrollees was higher than that of MA beneficiaries.

Overall, community-based interventions are required to prevent and treat mental health by providing primary medical care in the community, and linking with mental health centers. Such policies will ultimately improve the financial sustainability of medical security systems.
Effects of hemodialysis and reduced estimated glomerular filtration rate in nonhemodialysis on clinical outcomes after fractional flow reserve-guided deferral of revascularization
Authors: Yokoi Masashi , Ito Tsuyoshi , Nakayama Takafumi , Fujita Hiroshi , Sugiura Tomonori , Seo Yoshihiro
Published: May 2022

The effect of renal dysfunction on clinical outcomes following fractional flow reserve (FFR)-guided deferral of revascularization remains unelucidated.

We retrospectively analyzed 224 patients with atherosclerotic coronary lesions who underwent deferred revascularization based on an FFR of >0.80. The median follow-up interval was 28.1 months. Patients were divided into 2 groups: the hemodialysis (HD) and the non-HD group. The non-HD group was further classified into 2 subgroups according to their estimated glomerular filtration rate (eGFR) level: eGFR <45, equivalent to chronic kidney disease stage 3b-5 and eGFR ≥45. We evaluated major adverse cardiac events (MACE), defined as a composite of cardiac death, myocardial infarction, and any revascularization.

MACE occurred in 36 patients (16.1%). The rate of HD was significantly higher in the MACE group (19% vs 6%, P < .01). In non-HD patients, the eGFR was significantly lower in the MACE group (51.2 vs 63.2 mL/min/1.73 m2, P < .01). Overall, univariate Cox regression analysis revealed a significant relationship between HD and MACE (HR 2.91, P = .01), as did the multivariate model (HR 2.90, P = .01). Of the MACE, more deaths occurred in HD patients (15.8% vs 2.9%, P = .03). Among non-HD patients, eGFR <45 (HR 2.70, P = .02), FFR (per 0.01, HR 0.87, P < .01), and low-density lipoprotein cholesterol (per 10 mg/dL, HR 1.17, P = .02) were independent predictors of MACE. Any revascularization was more common in patients with eGFR<45 than in those with eGFR ≥45 (21.4% vs 7.3%, P = .02). Kaplan–Meier estimates revealed that the HD group showed a significantly lower MACE-free survival rate than the nonHD group (log-rank P < .01). In non-HD patients, the eGFR<45 group showed a lower MACE-free survival rate than the eGFR ≥45 group (log-rank P = .01).

HD and reduced eGFR in non-HD patients were associated with adverse cardiac events after FFR-guided deferral of revascularization.
Analyzing the Cost of Hospital Contact Isolation Practices
Authors: Saber Deborah A. , Norris Anne E. , Reinking Jeff , Trompeter Greg , Sanford Deborah
Published: May 2022

OBJECTIVES

This study aimed to determine the weekly costs of contact precaution (CP) use with medically stable patients infected/colonized with methicillin-resistant Staphylococcus aureus (MRSA) and to estimate the annual financial and environmental costs of CP.

BACKGROUND

The increasing use of disposables for infection control contributes to increasing hospital costs and amounts of solid waste at rates that are becoming unsustainable.

METHODS

A cost analysis was conducted using data from time/motion observations and previous waste audit study, along with hospital finance department values and US Department of Labor salary rates.

RESULTS

Weekly and annual costs were $521.67 and $557 463 (5% hospital multidrug-resistant organism [MDRO] rate assumed). Personal protective equipment accounted for 43% of the waste produced (approximately 1600 pounds annually).

CONCLUSIONS

Implications for nurse administrators include reevaluating activities that require personal protective equipment (PPE) and partnering with materials and human factor engineers to develop more financially and environmentally sustainable infection control practices.
Comparing the Nurse Work Environment, Job Satisfaction, and Intent to Leave Among Military, Magnet®, Magnet-Aspiring, and Non-Magnet Civilian Hospitals
Authors: Patrician Patricia A. , Olds Danielle M. , Breckenridge-Sproat Sara , Taylor-Clark Tanekkia , Swiger Pauline A. , Loan Lori A.
Published: May 2022

OBJECTIVE

This study aimed to compare the nurse work environment, job satisfaction, and intent to leave (ITL) among military, Magnet®, Magnet-aspiring, and non-Magnet civilian hospitals.

BACKGROUND

The professional nurse work environment is an important, modifiable, organizational trait associated with positive nurse and patient outcomes; creating and maintaining a favorable work environment should be imperative for nursing leaders.

METHODS

Secondary data from the Army Nurse Corps and the National Database of Nursing Quality Indicators included the Practice Environment Scale of the Nursing Work Index (PES-NWI) and single-item measures of job satisfaction and ITL.

RESULTS

Magnet and military hospitals had identical PES-NWI composite scores; however, statistically significant differences existed among the subscales. Military nurses were the most satisfied among all groups, although this difference was not statistically significant, yet their ITL was highest.

CONCLUSIONS

Favorable work environments may exist in other organizational forms besides Magnet; however, the specific components must be considered.
Assessing the Impact of HIV Preexposure Prophylaxis Scale-Up on Gonorrhea Incidence Among Gay and Bisexual Men in Sydney: A Mathematical Modeling Study
Authors: Walker Michael L. , Stiasny David , Guy Rebecca J. , Law Matthew G. , Holt Martin , Mao Limin , Donovan Basil , Grulich Andrew E. , Gray Richard T. , Regan David G.
Published: May 2022

Background

The rollout of preexposure prophylaxis (PrEP) for HIV prevention among gay and bisexual men (GBM) is associated with increases in condomless anal intercourse, potentially increasing the incidence of other sexually transmissible infections (STIs).

Methods

We developed an individual-based mathematical model to simulate the transmission of Neisseria gonorrhoeae among GBM in Sydney, accounting for changes in sexual practices, STI testing, and PrEP use. We calibrated and validated the model using reported incidence rates for HIV-positive and HIV-negative GBM from 2010 to 2019. Scenarios were run with varying PrEP uptake, PrEP-related STI testing, and PrEP-related sexual behavior and testing intervals up to 2030 to assess the impact of PrEP use on gonorrhea incidence.

Results

Preexposure prophylaxis uptake and associated 3-monthly STI testing from 2015 onward resulted in a predicted increase from 20 to 37 N. gonorrhoeae infections per 100 person-years among HIV-negative GBM by the end of 2020. This is lower than the counterfactual predictions of 45 per 100 person-years if PrEP were not scaled up and 48 per 100 person-years with nonadherence to 3-monthly STI testing. Increasing the time between STI tests for PrEP users by 1 month from 2018 results in the incidence rate among HIV-negative GBM increasing by 8% by 2030. If PrEP coverage doubles from 24% to 53%, incidence among HIV-negative GBM declines by ~25% by 2030.

Conclusions

Behavior change due to widespread PrEP use may lead to significant increases in gonorrhea incidence in GBM, but the recommended quarterly STI testing recommended for PrEP users should reduce incidence by 18% by 2030.
Yakima County Incidence Rates of Sexually Transmitted Infections From 2013 to 2018 in Urban-Rural and Area-Deprivation Continua
Authors: Pham Christine , Oluwoye Oladunni , Amiri Solmaz
Published: May 2022

Background

This study aimed to examine variations in the incidence rates of sexually transmitted infections (STIs; i.e., chlamydia, gonorrhea, and syphilis) across the urban-rural and area-deprivation continua from January of 2013 to December of 2018 in Yakima County, Washington. The rates of STIs has been increasing in the United States in the past decade. Historically, Yakima County has higher rates of STIs than state and national rates. In addition, Yakima County contains rural areas and areas with greater deprivation that face gaps in access to care.

Methods

The Washington State Department of Health Database Surveillance System was used to conduct the study. The data set included diagnosed cases of chlamydia, gonorrhea, and syphilis with positive laboratory test results for the duration of the study period. Incidence rates of STIs were calculated and statistically analyzed across the urban-rural and area-deprivation continua using rural-urban commuting area codes and the area deprivation index.

Results

The incidence rates of STIs increased from January of 2013 to December of 2018. Rates of STI did not differ in micropolitan, small town, and rural block groups compared with the metropolitan block groups. Most-deprived block groups had significantly higher STI rates compared with less deprived block groups.

Conclusions

There is a need for increased STI intervention in higher deprivation areas including STI education. Public health officials and health care providers should be aware of these risk factors and tailor interventions to the neighborhood they serve.
Summary of the Fourth Annual American Sexually Transmitted Diseases Association Workshop on Improving Sexually Transmitted Infection Control Efforts Through Cross-Sector Collaboration
Authors: Van Gerwen Olivia , Griner Stacey , Davis Alissa , Footman Alison , Pinto Casey N. , Melendez Johan H. , Tuddenham Susan , Exten Cara , Soge Olusegun O. , Chakraborty Payal , Nenninger Ashley , Marlowe Elizabeth M. , Joseph Ajith M. , McGowin Chris L. , Seña Arlene C. , Fortenberry J. Dennis , Ghanem Khalil G. , Van Der Pol Barbara
Published: May 2022

The American Sexually Transmitted Diseases Association has, for several years, been conducting a cross-sector workshop to bring together a variety of stakeholders to develop ideas for collaboratively improving the sexually transmitted infection control efforts in the United States. In this summary, we share the content of discussions and ideas of the fourth annual workshop for future research and potential changes to practice with a focus on diagnostic capacity.
Long-term HIV treatment outcomes and associated factors in sub-Saharan Africa: multi-country longitudinal cohort analysis
Authors: Inzaule Seth C. , Kroeze Stefanie , Kityo Cissy M. , Siwale Margaret , Akanmu Sulaimon , Wellington Maureen , de Jager Marleen , Ive Prudence , Mandaliya Kishor , Stevens Wendy , Steegen Kim , Nankya Immaculate , Boender T. Sonia , Ondoa Pascale , Sigaloff Kim C.E. , de Wit Tobias F. Rinke , Hamers Raph L.
Published: May 2022

Objective:

In a multicountry prospective cohort of persons with HIV from six countries between 2007 and 2015, we evaluated long-term outcomes of first-line non-nucleoside reverse-transcriptase inhibitor-based antiretroviral therapy (ART), and risk factors for loss-to-follow-up, mortality, virological failure, and incomplete CD4+ T-cell recovery.

Methods:

We calculated cumulative incidence of lost-to-follow-up, death, virological failure (VL ≥ 1000 cps/ml) and incomplete CD4+ T-cell recovery (<500 cells/μl) at successive years, using Kaplan–Meier and Cox regression.

Results:

Of 2735 participants, 58.0% were female, median age was 37 (interquartile range [IQR] 32–43) years, and median pre-ART CD4+ T-cell count was 135 (IQR 63–205)/μl. Total follow-up time was 7208 person-years (median 24.3 months, IQR 18.7–58.3). Deaths by any cause and loss to follow-up occurred mostly during the first year of ART (84%, 201/240 and 56%, 199/353, respectively). During their first 6 years of ART, 71% (95% confidence interval [CI] 69.0–73.7) were retained on first-line, and among those 90–93% sustained viral suppression (<1000 cps/ml); CD4+ T-cell recovery was incomplete in 60% (220/363) of participants. The risk factors associated with poor outcomes during long-term ART were: for loss-to-follow-up, recent VL ≥1000 cps/ml, recent CD4+ T-cell count ≤50 cells/μl, age <30 years, being underweight; for mortality, recent CD4+ T-cell count ≤50 cells/μl; and, for virological failure, age <40 years, recent CD4+ T-cell count ≤200 cells/μl, poor adherence, male sex, and low-level viremia.

Conclusion:

To achieve long-term ART success towards the UNAIDS targets, early ART initiation is crucial, coupled with careful monitoring and retention support, particularly in the first year of ART. Male and youth-centred care delivery models are needed to improve outcomes for those vulnerable groups.
Synthesis of a new chitosan-
p-tert
-butylcalix[4]arene polymer as adsorbent for toxic mercury ion
Authors: Hokmabadi Fahimeh , Zadmard Reza , Akbarzadeh Ali , Tafakori Vida , Jalali Mohammad Reza , Ahmadian Gholamreza
Published: May 2022

In this paper, we have synthesized a novel chitosan-
p-tert
-butylcalix[4]arene polymer (CCP) as a highly efficient adsorbent for mercury ion (Hg
2+
) removal from water. In fact, a lower rim diamine derivative of
p-tert
-butylcalix[4]arene has been cross-linked with chitosan chain by carbonyl diimidazole (CDI) as the linker. CDI forms a urea linkage between calix[4]arene diamine derivative and amine groups of the chitosan polymeric chain. The structure and properties of the new polymer were characterized by Fourier transform infrared spectroscopy, X-ray diffraction and scanning electron microscope. Also, the adsorption capacity of CCP was studied towards Hg
2+
in aqueous medium by inductively coupled plasma-optical emission spectrometry. Interestingly, the results showed a considerable adsorption capacity for CCP in comparison with chitosan. Therefore, CCP can be introduced as a promising adsorbent for the elimination of Hg
2+
from wastewaters. Moreover, because of the conformity of adsorption kinetic with pseudo-second-order kinetic models, it can be concluded that chemical adsorption has an important role between functional groups on CCP polymer and Hg
2+
ions. In addition, according to Freundlich isotherm, the CCP surface was heterogeneous with different functional groups.
Release characteristics of elemental mercury during low calorific value coal combustion
Authors: Gao Libing , Liu Kai , Guo Shaoqing , Liang Lei , Li Hongyan
Published: May 2022

The dynamic release characteristics of Hg
0
during low calorific value coal combustion were investigated in a combining laboratory-scale furnace coupled with atomic fluorescence spectroscopy. The results show that the sulfur has an inhibitory effect on the homogeneous oxidation of Hg
0
in flue gas. The instant intensity of Hg
0
release increases with increasing temperature while the amount of Hg
0
release gradually decreases with increasing temperature. Compared with that under air, the instant intensity of Hg
0
release under O
2
/CO
2
atmosphere increases to some extent with a lower decreasing rate of Hg
0
release peak. The release ratio of elemental mercury (Hg) from Yuwu (YW) and Qinxin (QX) coal increases while that from Yonghao (YH) coal decreases under O
2
/CO
2
atmosphere. In the range of 800–1100°C, the release rate of Hg reaches more than 96% under the residence time of 50 s.
Long-term repeatability of cognitive performance
Authors: Ashton Benjamin J. , Thornton Alex , Cauchoix Maxime , Ridley Amanda R.
Published: May 2022

Measures of cognitive performance, derived from psychometric tasks, have yielded important insights into the factors governing cognitive variation. However, concerns remain over the robustness of these measures, which may be susceptible to non-cognitive factors such as motivation and persistence. Efforts to quantify short-term repeatability of cognitive performance have gone some way to address this, but crucially the long-term repeatability of cognitive performance has been largely overlooked. Quantifying the long-term repeatability of cognitive performance provides the opportunity to determine the stability of cognitive phenotypes and the potential for selection to act on them. To this end, we quantified long-term repeatability of cognitive performance in wild Australian magpies over a three-year period. Cognitive performance was repeatable in two out of four cognitive tasks—associative learning and reversal-learning performance was repeatable, but spatial memory and inhibitory control performance, although trending toward significance, was not. Measures of general cognitive performance, obtained from principal components analyses carried out on each cognitive test battery, were highly repeatable. Together, these findings provide evidence that at least some cognitive phenotypes are stable, which in turn has important implications for our understanding of cognitive evolution.
Incidence of Glomerulonephritis after SARS-CoV-2 mRNA Vaccination
Authors: Diebold Matthias , Locher Eleonore , Boide Philipp , Enzler-Tschudy Annette , Faivre Anna , Fischer Ingeborg , Helmchen Birgit , Hopfer Helmut , Kim Min Jeong , Moll Solange , Nanchen Giliane , Rotman Samuel , Saganas Charalampos , Seeger Harald , Kistler Andreas D.
Published: May 2022

Numerous cases of glomerulonephritis manifesting shortly after SARS-CoV-2 vaccination have been reported, but causality remains unproven. We studied the association between mRNA-based SARS-CoV-2 vaccination and new-onset glomerulonephritis using a nationwide retrospective cohort and case-cohort design. Data from all Swiss pathology institutes processing native kidney biopsies served to calculate incidence of IgA nephropathy, pauci-immune necrotizing glomerulonephritis, minimal change disease and membranous nephropathy. The observed incidence during the vaccination campaign (Jan to Aug 2021) was not different from the expected incidence based on the years 2015 to 2019 (incidence rate ratio 0.86, 95%-credible interval 0.73–1.02) and did not cross the upper boundary of the 95% credible interval for any month. Among 111 patients aged >18 years with newly diagnosed glomerulonephritis between January and August 2021, 38.7% had received at least one vaccine dose before biopsy, compared to 39.5% of the general Swiss population matched for age and calendar-time. The estimated risk ratio for the development of new-onset biopsy-proven glomerulonephritis was 0.97 (95% CI 0.66–1.42, P=0.95) in vaccinated vs. unvaccinated individuals. Patients with glomerulonephritis manifesting within 4 weeks after vaccine did not differ clinically from the rest of the cohort. Results were consistent across all types of glomerulonephritis with the possible exception of minimal change disease. In conclusion, vaccination against SARS-CoV-2 was not associated with new-onset glomerulonephritis in these two complementary studies. Most temporal associations between SARS-CoV-2 vaccination and glomerulonephritis are likely coincidental.