bluuebunny/crossref_metadata_2025 huggingface dataset:
Temminck’s pangolins relax the precision of body temperature regulation when resources are scarce in a semi-arid environment
Authors: Panaino Wendy , Parrini Francesca , Kamerman Peter R , Hetem Robyn S , Meyer Leith C R , Smith Dylan , van Dyk Gus , Fuller Andrea
Published: August 2023

Climate change is impacting mammals both directly (for example, through increased heat) and indirectly (for example, through altered food resources). Understanding the physiological and behavioural responses of mammals in already hot and dry environments to fluctuations in the climate and food availability allows for a better understanding of how they will cope with a rapidly changing climate. We measured the body temperature of seven Temminck’s pangolins (Smutsia temminckii) in the semi-arid Kalahari for periods of between 4 months and 2 years. Pangolins regulated body temperature within a narrow range (34–36°C) over the 24-h cycle when food (and hence water, obtained from their prey) was abundant. When food resources were scarce, body temperature was regulated less precisely, 24-h minimum body temperatures were lower and the pangolins became more diurnally active, particularly during winter when prey was least available. The shift toward diurnal activity exposed pangolins to higher environmental heat loads, resulting in higher 24-h maximum body temperatures. Biologging of body temperature to detect heterothermy, or estimating food abundance (using pitfall trapping to monitor ant and termite availability), therefore provide tools to assess the welfare of this elusive but threatened mammal. Although the physiological and behavioural responses of pangolins buffered them against food scarcity during our study, whether this flexibility will be sufficient to allow them to cope with further reductions in food availability likely with climate change is unknown.
Association of Later-Life Weight Changes With Survival to Ages 90, 95, and 100: The Women’s Health Initiative
Authors: Shadyab Aladdin H , Manson JoAnn E , Allison Matthew A , Laddu Deepika , Wassertheil-Smoller Sylvia , Van Horn Linda , Wild Robert A , Banack Hailey R , Tabung Fred K , Haring Bernhard , Sun Yangbo , LeBlanc Erin S , Wactawski-Wende Jean , LeBoff Meryl S , Naughton Michelle J , Luo Juhua , Schnatz Peter F , Natale Ginny , Ostfeld Robert J , LaCroix Andrea Z
Published: August 2023

Background

Associations of weight changes and intentionality of weight loss with longevity are not well described.

Methods

Using longitudinal data from the Women’s Health Initiative (N = 54 437; 61–81 years), we examined associations of weight changes and intentionality of weight loss with survival to ages 90, 95, and 100. Weight was measured at baseline, year 3, and year 10, and participants were classified as having weight loss (≥5% decrease from baseline), weight gain (≥5% increase from baseline), or stable weight (<5% change from baseline). Participants reported intentionality of weight loss at year 3.

Results

A total of 30 647 (56.3%) women survived to ≥90 years. After adjustment for relevant covariates, 3-year weight loss of ≥5% vs stable weight was associated with lower odds of survival to ages 90 (OR, 0.67; 95% CI, 0.64–0.71), 95 (OR, 0.65; 95% CI, 0.60–0.71), and 100 (OR, 0.62; 95% CI, 0.49–0.78). Compared to intentional weight loss, unintentional weight loss was more strongly associated with lower odds of survival to age 90 (OR, 0.83; 95% CI, 0.74–0.94 and OR, 0.49; 95% CI, 0.44–0.55, respectively). Three-year weight gain of ≥5% vs stable weight was not associated with survival to age 90, 95, or 100. The pattern of results was similar among normal weight, overweight, and obese women in body mass index (BMI)-stratified analyses.

Conclusions

Weight loss of ≥5% vs stable weight was associated with lower odds of longevity, more strongly for unintentional weight loss than for intentional weight loss. Potential inaccuracy of self-reported intentionality of weight loss and residual confounding were limitations.
Filling In: Family Member Support for Nonrelative Residents in Long-Term Care Homes
Authors: Baumbusch Jennifer , Cooke Heather A , Sloan Yip Isabel
Published: August 2023

Background and Objectives

Past research about family involvement in long-term care (LTC) homes mainly focuses on family members’ involvement with their own relative, interactions with staff, and collective activities such as Family Councils. Our research provides novel insights into family member’s involvement in the care of residents who are not their relatives, an area that has not previously been explored.

Research Design and Methods

This critical ethnographic study examined ways that family members negotiate and navigate their roles within LTC homes. Data collection and analysis took place at 3 LTC homes in British Columbia, Canada, between 2014 and 2018. Data were collected through participant observation and semistructured interviews. Eleven family member participants shared experiences of caring for residents who were not their relatives.

Results

The umbrella theme was “filling in,” which takes place in a care environment that is understaffed and underresourced. The subthemes reflect the various ways that families are “filling in”: responding to resident’s needs, supporting staff to respond to resident needs, and filling in for residents’ families.

Discussion and Implications

Caring for residents who are not their relatives is facet of family involvement in LTC homes that has not been previously explored. Many family members have expertise in providing person-centered care and they extend this expertise to residents who are not their relatives. Policies and legislation are needed to formalize family involvement in caring for nonrelative residents as it is a component of quality of care for all residents.
Lost in Transition: Explaining Authoritarianism in Peru
Authors: Merino Roger
Published: August 2023

ABSTRACT∞

International reports by human rights organizations coincide that the government of Dina Boluarte in Peru has responded to social mobilization with disproportionate actions by public forces. Whereas recent scholarship explains the rising authoritarianism in the country to the weakness of political actors, this article provides a different interpretation by focusing on the political and economic legacies of the authoritarian government of Alberto Fujimori (1990–2000). Post-Fujimori governments have been unable to complete a double transition: a transition to consolidate democracy and a transition to advance towards a postconflict society. Rather, they have empowered economic elites and have deepened stigmatization and repression of social mobilization. To understand current authoritarianism, it is important to identify where concrete power resides and how state practices respond to the influence and needs of powerful actors.
An arbitrary-order discrete rot-rot complex on polygonal meshes with application to a quad-rot problem
Authors: Di Pietro Daniele A
Published: August 2023

In this work, following the discrete de Rham approach, we develop a discrete counterpart of a two-dimensional de Rham complex with enhanced regularity. The proposed construction supports general polygonal meshes and arbitrary approximation orders. We establish exactness on a contractible domain for both the versions of the complex with and without boundary conditions and, for the former, prove a complete set of Poincaré-type inequalities. The discrete complex is then used to derive a novel discretization method for a quad-rot problem, which, unlike other schemes in the literature, does not require the forcing term to be prepared. We carry out complete stability and convergence analyses for the proposed scheme and provide numerical validation of the results.
Homotopy Theories of (∞, ∞)-Categories as Universal Fixed Points With Respect to Weak Enrichment
Authors: Goldthorpe Zach
Published: August 2023

We show that both the $\infty $-category of $(\infty , \infty )$-categories with inductively defined equivalences, and with coinductively defined equivalences, satisfy universal properties with respect to weak enrichment in the sense of Gepner and Haugseng. In particular, we prove that $(\infty , \infty )$-categories with coinductive equivalences form a terminal object in the $\infty $-category of fixed points for enrichment, and that $(\infty , \infty )$-categories with inductive equivalences form an initial object in the subcategory of locally presentable fixed points. To do so, we develop an analogue of Adámek’s construction of free endofunctor algebras in the $\infty $-categorical setting. We prove that $(\infty , \infty )$-categories with coinductive equivalences form a terminal coalgebra with respect to weak enrichment, and $(\infty , \infty )$-categories with inductive equivalences form an initial algebra with respect to weak enrichment.
Differentiating Siegel Modular Forms and the Moving Slope of 𝒜g
Authors: Grushevsky Samuel , Ibukiyama Tomoyoshi , Mondello Gabriele , Salvati Manni Riccardo
Published: August 2023

We study the cone of moving divisors on the moduli space ${\mathcal{A}}_{g}$ of principally polarized abelian varieties. Partly motivated by the generalized Rankin–Cohen bracket, we construct a non-linear holomorphic differential operator that sends Siegel modular forms to Siegel modular forms, and we apply it to produce new modular forms. Our construction recovers the known divisors of minimal moving slope on ${\mathcal{A}}_{g}$ for $g\leq 4$, and gives an explicit upper bound for the moving slope of ${\mathcal{A}}_{5}$ and a conjectural upper bound for the moving slope of ${\mathcal{A}}_{6}$.
Crossing the Rubicon: The Strikes (Minimum Service Levels) Act 2023 as an Authoritarian Crucible
Authors: Katsaroumpas Ioannis
Published: August 2023

In the 1980s and 1990s, Conservative Governments contemplated but ultimately refused direct interventions in strikes in essential services as unenforceable and ineffective. The Strikes (Minimum Service Levels) Act 2023 crosses this Rubicon. It does so not by a participatory framework but by granting Ministers and employers virtually unrestrained powers to restrict (and effectively prohibit by neutralising the impact of) industrial action by imposing minimum service levels. This article offers a critical account of the Act based on three main claims. First, it argues that the Act is shaped by what is termed ‘coercive dual unilateralism’, an authoritarian crucible of three elements: (i) executive unilateralism, (ii) employer unilateralism and (iii) coercion (severe sanctions compounded by chilling legal uncertainty of ill-defined duties). Secondly, it challenges the Government’s claim of the Act’s compliance with ILO standards and Article 11 ECHR as a misconstruction. Thirdly, it finds that the Act satisfies all three authoritarian markers (stifling of dissent, direct state coercion, elevation of social order as an external justification for restrictions) identified in Bogg’s seminal account of the TUA 2016 as a shift away from neo-liberalism to authoritarianism. But it resists a ‘beyond neo-liberalism’ conclusion. Instead, it argues that the Act should be seen as the product of a ‘strong-weak' state (strong in power, weak in securing consent) that seeks to fortify neo-liberalism against a sharpened contestation reflected in the current strike wave.
Robust Response of the Clinical Laboratory to the COVID-19 Pandemic despite Significant Challenges
Authors: Ondracek Caitlin R , Genzen Jonathan R , Lockwood Christina M , Das Saswati , Kang Phillip , Melanson Stacy E F
Published: August 2023

Background

Clinical laboratories immediately provided rapid, reliable, and high-throughout diagnostic testing for COVID-19, which was an essential component in combating the pandemic. As the pandemic evolved, the clinical laboratory was faced with additional challenges. However, there are limited studies on the impact of the pandemic on the clinical laboratory over the past 3 years.

Methods

The American Association for Clinical Chemistry (AACC) sent 8 surveys over a 32-month time period to international clinical laboratory leadership asking questions about COVID-19 testing, supplies, staffing, and lessons learned.

Results

There were a total of 191 unique respondents: 133 laboratories in the US and 58 laboratories from 37 other countries participated. By May 2020, more than 70% of laboratories offered COVID-19 diagnostic testing with average turnaround times ranging from 1 to 24 h. Daily COVID-19 testing volumes peaked in January of 2022 at a median of 775 tests per day. Throughout the pandemic, supplies and staffing concerns increased. In most of the 8 surveys, 55% to 65% of laboratories reported they were unable to obtain supplies. Obtaining reagents and test kits was the most problematic. Staffing challenges continue to be a significant concern and most laboratories have struggled hiring testing personnel.

Conclusions

Survey results were utilized to demonstrate the impact of the pandemic on the clinical laboratory community, and importantly, findings were presented to the White House Coronavirus Taskforce. Overall, the clinical laboratories had a robust response to the COVID-19 pandemic, and despite ongoing and evolving challenges, continue to provide rapid diagnostic testing.
Determining prescriptions in electronic healthcare record data: methods for development of standardized, reproducible drug codelists
Authors: Graul Emily L , Stone Philip W , Massen Georgie M , Hatam Sara , Adamson Alexander , Denaxas Spiros , Peters Nicholas S , Quint Jennifer K
Published: August 2023

Objective

To develop a standardizable, reproducible method for creating drug codelists that incorporates clinical expertise and is adaptable to other studies and databases.

Materials and Methods

We developed methods to generate drug codelists and tested this using the Clinical Practice Research Datalink (CPRD) Aurum database, accounting for missing data in the database. We generated codelists for: (1) cardiovascular disease and (2) inhaled Chronic Obstructive Pulmonary Disease (COPD) therapies, applying them to a sample cohort of 335 931 COPD patients. We compared searching all drug dictionary variables (A) against searching only (B) chemical or (C) ontological variables.

Results

In Search A, we identified 165 150 patients prescribed cardiovascular drugs (49.2% of cohort), and 317 963 prescribed COPD inhalers (94.7% of cohort). Evaluating output per search strategy, Search C missed numerous prescriptions, including vasodilator anti-hypertensives (A and B:19 696 prescriptions; C:1145) and SAMA inhalers (A and B:35 310; C:564).

Discussion

We recommend the full search (A) for comprehensiveness. There are special considerations when generating adaptable and generalizable drug codelists, including fluctuating status, cohort-specific drug indications, underlying hierarchical ontology, and statistical analyses.

Conclusions

Methods must have end-to-end clinical input, and be standardizable, reproducible, and understandable to all researchers across data contexts.
289 The Timing of Pharmacologic Venous Thromboembolism Prophylaxis Initiation for Burn Patients with Concomitant Trauma
Authors: Castanon Lourdes , Anand Tanya , Bhogadi Sai Krishna , Colosimo Christina , Ditillo Michael , El-Qawaqzeh Khaled , Gries Lynn , Hosseinpour Hamidreza , Joseph Bellal , Nelson Adam , Spencer Audrey
Published: August 2023

Introduction

Hospitalized burn patients are at increased risk for venous thromboembolism (VTE). Clinical guidelines regarding thromboprophylaxis in burn patients with concomitant trauma are unclear. We aimed to compare the outcomes of early versus late thromboprophylaxis initiation for burn patients with concomitant trauma.

Methods

A 3-year analysis of 2017-2019 TQIP. We identified all adult burn patients with concomitant trauma who received thromboprophylaxis. We excluded patients that had severe TBI (Head AIS > 2), were transferred, those that died < 24 hours of admission and those that underwent hemorrhage control surgery. Patients were stratified based on the timing of initiation of postoperative thromboprophylaxis: Early (< 24 hours of admission) versus Late ( >24 hours). Multivariate regression analyses were performed. Outcome measures were odds of deep venous thrombosis (DVT), pulmonary embolism (PE), unplanned return to OR, unplanned ICU admission, post-prophylaxis PRBC transfusion and in-hospital mortality.

Results

9,272 trauma patients with concomitant burns who received thromboprophylaxis were identified. Overall, mean age was 41.3 ± 13.4 years, 71.5% were male, and median ISS was 3 [1-8]. 53% had second degree burns, and 39% had more than 10% of total body surface area affected. Median time to thromboprophylaxis initiation was 11 [6-20.6] hours. On multivariate regression, patients who received thromboprophylaxis after 24 hours of admission had 1.8 times higher odds of developing DVT (aOR=1.8, 95% CI=1.04-3.11, p=0.03), 4.8 times higher odds of developing PE (aOR=4.8, 95% CI=1.9-11.9, p<.001), 2 times higher odds of unplanned ICU admission (aOR=2.1, 95% CI=1.4-3.1, p<0.001), and nonsignificant increase in the odds of unplanned return to OR (aOR=2, 95% CI=0.96-4.31, p=0.06). Further, early thromboprophylaxis was not associated with increased odds of post-prophylaxis PRBC transfusion (aOR=1.1, 95% CI=0.8-1.4, p=0.4), and in-hospital mortality (aOR=0.68, 95%CI=0.4-1.1, p=0.13) compared to patients who received late thromboprophylaxis.

Conclusions

Early VTE prophylaxis in burn patients is associated with decreased rates of DVT and PE, without increasing the risk of bleeding and mortality. VTE prophylaxis may be initiated within 24 hours of admission to reduce VTE in this high-risk patient population.

Applicability of Research to Practice

This work will guide the timing of initiation of venous thromboembolism prophylaxis in burn patients with concomitant trauma
292 Augmented Renal Clearance in Burn Patients: Incidence and Discordance with Standard Creatinine Clearance Estimation
Authors: Mueller Scott W , Blass Brittany , Davis Julia N , Deeter Lyndsay A , Gibson Cameron , Kohler Amber D , Wiktor Arek J
Published: August 2023

Introduction

Augmented renal clearance (ARC) is a phenomenon that occurs in some critically ill populations. ARC is associated with drug failure, commonly antimicrobials, due to subtherapeutic drug exposure. Patient specific factors for ARC have not been well described in the burn population. The aim of this study is to describe the incidence and patient characteristics associated with ARC in those admitted to a burn service for a mixed severity of illness.

Methods

Consecutive adult patients admitted to an ABA verified burn center were screened under an institutional collaborative practice agreement for identification of ARC via a 12-hour urine collection (UC-12). Data was collected retrospectively under an IRB approved protocol. Creatinine clearance (CrCl) was calculated directly from UC-12 whereas Cockcroft-Gault (C-G) was calculated using a standard equation with adjusted body weight when applicable. A UC-12 CrCl greater than 130 mL/min was considered ARC and all values were compared to C-G estimations. Descriptive and inferential analyses were non-parametric using a two-sided alpha value of < 0.05 as significant.

Results

A total of 53 patients over 8 months completed a UC-12 with a median 2 (range 1-9) collected during hospitalization. The population was largely male (81%), without trauma (91%), median age 43 (interquartile range [IQR] 35.5-58.5), total body surface area (TBSA) 20% (IQR 7.25-23.55), with thermal injuries (91%). Of the 53 patients, ARC was identified during hospitalization in 68%. There were no significant differences in median age, TBSA, proportion of trauma, or thermal burn between patients with ARC and those without (41 vs 48 years, 20.25 vs 13%, 11 vs 6%, and 94 vs 82%, respectively; p >0.1 for all). Of the 117 UC-12 measurements, ARC was identified in 61.5%, occurring a median 9 days (range 0-72) post injury. Overall median UC-12 CrCl was 148 mL/min (IQR 105-199) and C-G estimation was 139 mL/min (IQR 106-162) with a median discordance of 16 mL/min (IQR -14-58). Discordance of 30mL/min or more (positively or negatively) was frequent comparing actual CrCl to estimates using C-G (58%).

Conclusions

ARC, as directly measured by UC-12, is common in a mixed burn population. Additional research is required to identify patients at increased risk for ARC and subsequent drug dosing strategies to maintain efficacy without undue risk of toxicity.

Applicability of Research to Practice

Widely accepted estimations of CrCl may result in incorrect drug dosing and commonly underestimates actual CrCl which has implications for drug clearance, and therefore, dosing. Patients with ARC likely require dosing that exceeds FDA recommendations when titration to a dynamic effect or real-time pharmacokinetics are unavailable. Timed urine collection for CrCl calculation should be considered in the burn population.
Susceptibility of the adult house fly (Diptera: Muscidae) and 3 of its principal parasitoids (Hymenoptera: Pteromalidae) to the GHA strain of Beauveria bassiana and 4 isolates from field-collected muscid flies
Authors: Pagac Alexandra A , Geden Christopher J , Martin Gregory P , Patterson Paul H , Machtinger Erika T
Published: August 2023

House fly (Musca domestica L.) (Diptera: Muscidae) populations can negatively impact poultry layer facilities, posing a risk to human and animal health and egg food safety. House flies quickly develop resistance to traditional chemical control methods; therefore, improved biological control may provide opportunities for improved integrated pest management (IPM) programs. Biological control methods currently used include augmentative releases of pteromalid pupal parasitoids and application of the fungal entomopathogen Beauveria bassiana (Balsamo) Vuillemin. This study used bioassays to compare the impact of different B. bassiana strains on survival of house flies and of 3 species of filth fly parasitoids. The B. bassiana that were compared were 3 new field-collected isolates, an older field-collected isolate (L90), and a common commercially available strain (GHA). Flies and parasitoids were exposed to filter paper treated with 1.5 × 109 spores of each strain and a control. All field-isolated strains induced lower mean survival times in house flies than GHA did. The results for all species of parasitoids demonstrated less difference among the treatment groups and the control than in-house flies. Although there was some effect of B. bassiana exposure on parasitoid mortality, the expected spatial separation of parasitoids from areas of application may offer some protection. Using the most effective tested strains of B. bassiana and filth fly parasitoids jointly could be a biological component of an IPM plan for fly control in poultry facilities.
Total Bias in Income Surveys when Nonresponse and Measurement Errors are Correlated
Authors: Neri Andrea , Porreca Eleonora
Published: August 2023

Household surveys on income might suffer from quality limitations mainly due to the difficulty of enrolling households (unit nonresponse) and retrieving correct information during the interview (measurement error [ME]). These errors are likely to be correlated because of latent factors, such as the threat of disclosing personal information, the perceived sensitivity of the topic, or social desirability. For survey organizations, assessing the interplay of these errors and their impact on the accuracy and precision of inferences derived from their data is crucial. In this article, we propose to use a standard sample selection model within a total survey error framework to deal with the case of correlated nonresponse error (NR) and ME in estimating average household income. We use it to study the correlation between the two errors, quantify the ME component due to this correlation, and evaluate ME among nonrespondents. Using the Italian Survey on Income and Wealth linked with administrative income data from tax returns, we find a positive correlation between the two errors and that households at the extremes of the income distribution mainly cause this association. Our results show that ME contributes more to the total error than unit nonresponse and that it would be larger in absence of the correlation between the two errors. Finally, efforts to reduce nonresponse rates are worthwhile only for nonrespondents in the lowest estimated response propensity group. If these households participate, the bias decreases because of the reduction in NR that offsets the increase in ME.
A trait-based approach to both forestry and timber building can synchronize forest harvest and resilience
Authors: Osborne Peter , Aquilué Núria , Mina Marco , Moe Kiel , Jemtrud Michael , Messier Christian
Published: August 2023

Along with forest managers, builders are key change agents of forest ecosystems’ structure and composition through the specification and use of wood products. New forest management approaches are being advocated to increase the resilience and adaptability of forests to climate change and other natural disturbances. Such approaches call for a diversification of our forests based on species’ functional traits that will dramatically change the harvested species composition, volume, and output of our forested landscapes. This calls for the wood-building industry to adapt its ways of operating. Accordingly, we expand the evaluation of the ecological resilience of forest ecosystems based on functional diversification to include a trait-based approach to building with wood. This trait-based plant-building framework can illustrate how forecasted forest changes in the coming decades may impact and guide decisions about wood-building practices, policies, and specifications. We apply this approach using a fragmented rural landscape in temperate southeastern Canada. We link seven functional groups based on the ecological traits of tree species in the region to a similar functional grouping of building traits to characterize the push and pull of managing forests and wood buildings together. We relied on a process-based forest landscape model to simulate long-term forest dynamics and timber harvesting to evaluate how various novel management approaches will interact with the changing global environment to affect the forest-building relationships. Our results suggest that adopting a whole system, plant-building approach to forests and wood buildings, is key to enhancing forest ecological and timber construction industry resilience.
Solidarity and the Work of Moral Understanding
Authors: Dishaw Samuel
Published: August 2023

Because moral understanding involves a distinctly first-personal grasp of moral matters, there is a temptation to think of its value primarily in terms of achievements that reflect well on its possessor: the moral worth of one's action or the virtue of one's character. These explanations, I argue, do not do full justice to the importance of moral understanding in our moral lives. Of equal importance is the value of moral understanding in our relations with other moral agents. In particular, I argue that an understanding of moral matters is of central importance within relations of solidarity. In addition to highlighting an overlooked aspect of moral understanding's value, this view also has important implications for what solidarity requires of those who stand in that relationship.
Mesenchymal Stem Cell Utilization for In Vitro Donor Liver Machine Perfusion Preservation: Current Status and Future Directions
Authors: Fu Yu , Wang Yi , Liang Liwei , Gu Mingzi , Gao Yi , Feng Lei
Published: August 2023

Liver transplantation is the only effective treatment for end-stage liver disease. Currently, the shortage of high-quality donors has led to the exploration of the use of marginal organs. However, several factors limit the in vitro long-term preservation and long-distance transport of livers, which can also lead to ischemia-reperfusion injuries, resulting in poor prognosis. Therefore, an efficient and convenient strategy to improve this situation is urgently required. Normothermic machine perfusion (NMP) is expected to improve the liver environment in vitro and provide better evaluation indices for organ repair mechanisms. Mesenchymal stem cells (MSCs) can repair damaged hepatocytes or exert their protective effects via paracrine mechanisms, such as the release of extracellular vesicles (EVs). We hypothesized that combining the regenerative ability of MSCs and the significant advantages of NMP may improve the quality and utilization rate of organs, especially marginal organs. In this study, we review different strategies for liver preservation in vitro, as well as their strengths and weaknesses. We also introduce MSCs, derived EVs, and MSCs applications in liver preservation in vitro. Finally, we discuss the current challenges and future trends of MSCs applications for in vitro liver preservation. We envision novel bioreactor designs that employ 3D cell culturing and offer the possibility to reconstruct MSCs microenvironments to promote cell growth and biofunction expression. Large-scale MSCs production can be combined with normothermic machine perfusion to enhance in vitro liver preservation, thereby promoting donor organ function to benefit recipients in need of liver transplantation.
Evidence-based sexual healthcare for the LGBTQIA2+ patient across the lifespan
Authors: Shihabuddin Courtney DuBois , Lee Gabriel , Casler Kelly
Published: August 2023

People who identify as lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual, two-spirit, or other minority sexual and gender identities (LGBTQIA2+) often avoid seeking healthcare due to social discrimination and stigma. Clinical education in LGBTQIA2+-affirming care is essential but often lacking across disciplines. Provider acceptance, awareness of personal biases, and understanding of microaggressions affecting LGBTQIA2+ people can improve access, outcomes, and survival for this population. Expertise in caring for LGBTQIA2+ people in rural and suburban communities, for people who are transgender, and for people who have undergone or are in the process of undergoing gender-affirming surgeries is essential to offer best-practice healthcare.
Increasing rates of clinic no-shows during and following the COVID-19 pandemic at an academic orthopaedic multispecialty group
Authors: Hoyt Aaron K. , LeDuc Ryan C. , Castillo Hector , Miller John R.
Published: August 2023

Background:

Clinic no-shows are common throughout all medical specialties and can be used as a potential surrogate marker for access to care and have a significant impact on patients and providers. While anecdotally, orthopaedic surgeons have noticed unprecedented changes in the delivery of care as a result of the COVID-19 pandemic, the effect on no-show rates has not been quantified.

Methods:

An analysis of the rates of outpatient clinic no-shows within a multispecialty, academic orthopaedic surgery practice was completed. Encounters were sub-classified into designated periods based on a “pre-COVID-19” period, a “COVID-19” period, and a “post-COVID-19” period. A univariate analysis was performed to comment on differences amongst insurance payer status. A multivariate regression was completed to assess which variables contributed to no-show rates among this orthopaedic practice.

Results:

The overall no-show rate over the course of the study was 8.5%. These rates differed significantly between insurance groups, with the lowest no-show rate among Workers’ Compensation/Liability Insurance (WC/LI; 6.4%) and the highest among uninsured patients (21.4%). Additionally, no-show rates differed significantly by COVID period (pre-COVID=7.3%, COVID=8.6%, P<.0001). These rates further increased in the post-COVID period (9.6%, P<.0001) In response to the COVID-19 pandemic, medical practice habits have altered out of necessity.

Conclusions:

Despite a relaxation of social distancing guidelines, no-show rates have continued to increase at our institution. Our results suggest a disproportionate effect on those of lower socioeconomic status. The specific needs of the patient population should be considered when implementing strategies to improve clinic attendance.
Rett Syndrome–Associated Scoliosis
Authors: Stone Lauren E. , Kelly Michael P. , Alexander Madison , Brandel Michael , Lam Sandi K. , Ravindra Vijay M.
Published: August 2023

Study Design.

Retrospective database cohort study.

Objective.

To evaluate U.S. treatment trends and inpatient outcomes for children undergoing posterior spinal fusion (PSF) for Rett syndrome (RTT)-associated scoliosis (RAS).

Summary of Background Data.

RTT is a rare, sporadic neurodevelopmental disorder presenting in childhood with developmental regression, ataxia, and seizures. RAS occurs in 50-80% of cases of RTT, but little is known about the case volume and perioperative experience for children undergoing PSF.

Methods.

Using International Classification of Diseases (ICD)-9 and ICD-10 codes in the national Kids’ Inpatient Database, we identified children with RTT who underwent PSF in 2000-2019. Annual case volumes were analyzed. Clinical characteristics and outcomes were compared with those of a cohort of patients with neuromuscular scoliosis (NMS).

Results.

Among 220 patients with RAS, 216 (98.2%) were female (mean age at surgery 12.3±3.3 y). Surgical case incidence steadily increased over 19 years, with more RAS admissions in the South (31.4%). Overall, patients with RAS demonstrated a higher mean Elixhauser Comorbidity Index score (2 vs. 1, P<0.001) and had more perioperative complications (41.4% vs. 18%, P<0.001) than patients with NMS. RTT diagnosis independently predicted higher odds of any complications (OR 1.98, P<0.001) and increased length of stay (OR 1.18, P=0.009) for admissions for PSF.

Conclusions.

Surgical treatment for RAS is rare but increased over a 19-year period. Cases appear to be clustering by region, with the highest proportion in the South. The higher Elixhauser Comorbidity Index in RAS patients predicted higher cost, longer hospital stay, more complications (particularly respiratory), and more nonroutine discharge disposition than in other NMS patients. RTT was independently associated with higher odds of complications and longer length of stay. Because RAS cases appear to be increasing in number, future study should emphasize methods to reduce morbidity and investigate deformity-specific metrics to help better understand this population.
Risk factors and management strategies for atrial fibrillation
Authors: Durrani Duaa , Fatima Rida , Shaikh Mahnoor
Published: August 2023

Atrial fibrillation (AF) is a cardiac arrhythmia characterised by the irregular and frequently fast depolarization of the atrial myocardium resulting from a disturbance of the usual electrical conduction routes within the atria, which causes disorganised and ineffective atrial contractions. The management of AF involves a multidisciplinary approach that includes identifying and treating underlying risk factors, managing symptoms, and preventing complications. The risk factors for AF include age, hypertension, obesity, diabetes mellitus, valvular heart disease, coronary artery disease, congestive heart failure, alcohol consumption, sleep apnea, and family history. The management strategies for AF include rate control, rhythm control, anticoagulation, left atrial appendage closure, lifestyle modifications, surgical ablation, catheter ablation, cardioversion, and education and support. The choice of management strategy should be tailored to the individual patient’s risk profile, comorbidities, and other factors. Further research is needed to improve our understanding of the pathophysiology of AF and to develop more effective management strategies for this condition.
Opportunities to Improve Tobacco Control for State Agency Employees
Authors: Kava Christine M. , Strait Michelle , Treend Katie , Vu Thuy , Hannon Peggy A. , Harris Jeffrey R.
Published: August 2023

Objective

The aim of the study is to explore tobacco-related knowledge and perceptions at Washington State (WA) agencies.

Methods

The study used a cross-sectional employee survey and qualitative focus groups with managers/supervisors. We produced descriptive statistics to examine differences in awareness and perceptions of tobacco-control efforts among employees and conducted a rapid thematic analysis of focus group data.

Results

Of employees, only 18% with a history of tobacco use had used their agency’s cessation benefits. Employees who did not use tobacco and who had higher education had more favorable attitudes toward tobacco-control efforts. In the focus groups, manager/supervisors described limited tobacco cessation promotion at their agency, barriers to tobacco control implementation, and concerns about the perceived effectiveness of additional tobacco-control efforts.

Conclusions

State agencies should increase promotion of tobacco control policies and programs to increase awareness and reduce disparities in tobacco use.
Multisystem inflammatory syndrome in a neonate secondary to COVID-19: a case report
Authors: Upadhyay Sristi , Devkota Sagar
Published: August 2023

Introduction and importance:

Multisystem inflammatory syndrome in children secondary to coronavirus disease 2019 (COVID-19) (MIS-C) is very common and may present with clinical features similar to Kawasaki disease but is rarely reported in neonates (MIS-N). Any history of maternal upper respiratory tract infection should raise suspicion of MIS-N secondary to COVID-19 in critically ill neonates.

Case presentation:

The authors present a term neonate with gradually progressive respiratory distress requiring mechanical ventilation with marked improvement after starting immunoglobulin and steroids after blood investigations revealed high IgG COVID-19 antibody titers.

Clinical findings and investigation:

Admitted to the Neonatal Intensive Care Unit as he received bag and mask ventilation for 30 s following delivery, he was kept under oxygen via nasal prongs; but he still had nasal flaring, subcostal retraction, and tachypnea. All the blood investigations were within normal limits except for elevated C-reactive protein.

Intervention and outcome:

With no improvement despite oxygen via nasal prongs, he was kept under bubble continuous positive airway pressure with positive end-expiratory pressure of 5 cm of H2O. With no improvement even after 24 h of noninvasive ventilation, he was kept under mechanical ventilation in assisted pressure-controlled mode with a peak inspiratory pressure of 22 cm H2O and respiratory rate of 40 breaths/minute. As the mother gave a history of on-and-off cough for almost a month, samples were sent for COVID-19 antibodies which came out to be positive with very high titers of IgG antibodies. Intravenous steroids, immunoglobulin, and subcutaneous low molecular weight heparin were started and marked improvement was noted. The peak inspiratory pressure and FiO2 were gradually tapered off, and he was extubated on the 10th day of mechanical ventilation.

Conclusion:

Multisystem inflammatory syndrome in neonates is rare but should always be considered in neonates with multisystem involvement and a history of maternal upper respiratory tract infection after excluding all other causes.
Zika virus disease: an alarming situation resurfacing on the radar – a short communication
Authors: Shariff Sanobar , Kantawala Burhan , Hamiidah Nakyanzi , Yadav Tularam , Nazir Abubakar , Uwishema Olivier
Published: August 2023

Background/introduction:

On the 13th of December 2022, a 5-year-old girl from Karnataka, India, tested positive for Zika virus. The first Zika virus was isolated from the serum of a rhesus monkey in the Zika Forest of Uganda in 1947. Zika virus was largely dormant for about 70 years before suddenly resurfacing across all of America, from Brazil to the Pacific Islands and is connected to a grouping of microcephaly phenotypes based on a complete virus genome analysis. All of the aforementioned research provides an overview of the migration of this virus from the Americas to continental Africa via mosquitoes. The current study, therefore, aims to evaluate the virologic characteristics, prophylaxis, transmitting mechanisms, diagnosis, clinical manifestations, and treatment of ZIKV infection in light of the virus’s widespread dissemination and deadly nature.

Aim:

The investigation’s findings aim to demonstrate that in order to prevent further outbreaks, there is a national requirement for active epidemiological and entomological observation of Zika.

Materials and methods:

Data were extracted from academic journals of medicine published in MEDLINE, PubMed, ScienceDirect, Ovid, and Embase inventory databases with a predetermined search strategy. Articles considering the Zika virus and its clinical manifestations, especially neurological, were included.

Results:

The Zika virus has been declared a public health emergency of global significance by the World Health Organization (WHO). It is of alarming concern that it is now one of the most prevalent infectious diseases associated with birth abnormalities discovered in the past five decades. The onset and accelerated spread of disease to other parts of the world is attributed to the migration of infected hosts and climate change. Rapid laboratory diagnosis, evaluation of serological techniques, and virus isolation are urgently needed, along with newer modalities such as mathematical modeling as prediction devices to curb this issue. Due to its grave neurological manifestations, it is mandated to engineer peptide therapies and a virus-specific vaccination to treat this neurotropic virus.

Conclusion:

There is currently no vaccination against Zika virus infection. If societies are not adequately prepared, the epidemiological wave will have an impact on the workforce and could pose a serious threat. To alleviate the significant cost on health systems and manage its promotion globally, improved investigation and response activities are needed.
An unusual finding: Biliary ascariasis in a pregnant patient managed conservatively—a case report
Authors: katwal Shailendra , Oli Rabindra , Bhusal Amrit , Bhandari Sushmita , Ghimire Astha , Lama Roshani
Published: August 2023

Introduction and importance:

Biliary ascariasis, caused by Ascaris lumbricoides, is a rare condition, especially in non-endemic areas. However, it can present with complications such as biliary obstruction, requiring prompt diagnosis and management. This case report highlights the incidental detection and successful management of biliary ascariasis in a pregnant patient.

Case presentation:

A 26-year-old primigravida woman at 24 weeks gestation presented with mild icterus, anorexia, and gastrointestinal symptoms. Laboratory tests showed elevated bilirubin levels and peripheral eosinophilia. Abdominal ultrasound revealed the presence of roundworms in the gallbladder and common bile duct. The patient was managed conservatively with an anti-helminthic agent, resulting in the passing of a dead worm and the resolution of symptoms.

Clinical discussion:

Biliary ascariasis is a rare condition in non-endemic areas but should be considered in pregnant patients presenting with biliary symptoms. Prompt diagnosis is crucial, and imaging modalities such as abdominal ultrasound play a vital role. Conservative management with appropriate anti-helminthic therapy can effectively resolve symptoms and eliminate the infection.

Conclusion:

This case report emphasizes the importance of considering biliary ascariasis in pregnant patients with biliary symptoms. Timely diagnosis, utilizing imaging modalities, and initiating conservative management with anti-helminthic therapy can lead to successful treatment outcomes. Increased awareness and understanding of this condition can aid clinicians in providing optimal care to similar patients.
Strategic Planning
Authors: Welch Teresa D. , Smith Todd B.
Published: August 2023

Successful organizations depend on strategic thinkers who understand strategic planning and strategic management. These strategic leaders can proactively manage the constant environmental changes to position their organizations for a competitive advantage and avoid acting in a reactive and defensive manner. However, while organizations are often adept at developing extensive strategic plans, implementation of the plan is often poor or without a definitive strategy. This article addresses key strategies for successful implementation of changes to bring about sustainable cultural change in an organization to meet the organization's overall strategic goals, specifically through the use of implementation science.
Changed Perceptions
Authors: Machon Michelle , Maguire Stacy , Reitter Debbie , Tiangco-Alba Gertrude
Published: August 2023

Through a unique set of timings, a SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis of a nursing department was conducted with the staff nurses of a large medical center in late 2019 and again in 2022. The intent of the 2019 analysis was bifold, to obtain rich input from nursing staff to apprise the 2020 Nursing Strategic Plan and to inform the hospital-wide core councils and the nursing unit councils on focused project work identified as Weaknesses and Threats. When the pandemic hit, work on strategic planning was paused to manage the unparalleled impact that COVID-19 had on the organization. In 2022, nursing leadership realized they had an opportunity to repeat the SWOT analysis, not only to inform the 2023 Nursing Strategic Plan but also to determine whether the perceptions of staff nurses regarding the SWOT in the nursing department had changed postpandemic. A thematic analysis provided the structure to analyze the perceptions of nurses pre- and postpandemic. This article presents our reflections for nurse leaders to consider when addressing the positive (Strengths/Opportunities) and negative (Weaknesses/Threats) perceptions of nurses in a postpandemic health care environment.
Better Together
Authors: Compton-McBride Sheri , Reed Amy , McGuire Kelley , Andrews Angela , Liesveld Judy
Published: August 2023

Nursing is a demanding profession that calls for nurses to devote time, energy, advocacy, and compassion to improving clients' lives while providing safe, efficient care. Nurses make personal sacrifices to meet their clients' needs, which do not come without costs to their well-being. An increased migration of novice nurses out of the profession and the need to increase the volume of the nursing workforce by an average of 8% annually to address the projected nursing shortage presents a compelling need for immediate action. Reimagining the concept of academic-service partnerships to provide exposure to opportunities that can equip and empower novice nurses as they emerge into professional practice cannot be underestimated. Implementing approaches to assess, support, and nurture the health and well-being of nurses and health care organizations is foundational to retention.
A Protection Motivation Theory–Based Empowerment Intervention for Promoting Health Behaviors in Women With Human Papillomavirus: An Experimental Study
Authors: Vasli Parvaneh , Zahedinia Sara , Hosseini Meimanat , Nasiri Malihe
Published: August 2023

This experimental study on 70 women with human papillomavirus, referred to the specialized obstetrics and gynecology clinics of public hospitals in Iran in 2021, revealed that implementing the protection motivation theory–based empowerment intervention could promote their health behaviors.