bluuebunny/crossref_metadata_2025 huggingface dataset:
Wildfire smoke exposure and emergency department visits in Washington State
Authors: Doubleday Annie , Sheppard Lianne , Austin Elena , Busch Isaksen Tania
Published: May 2023

Wildfires are increasing in prevalence in western North America due to changing climate conditions. A growing number of studies examine the impact of wildfire smoke on morbidity; however, few evaluate these impacts using syndromic surveillance data that cover many emergency departments (EDs). We used syndromic surveillance data to explore the effect of wildfire smoke exposure on all-cause respiratory and cardiovascular ED visits in Washington state. Using a time-stratified case crossover design, we observed an increased odds of asthma visits immediately after and in all five days following initial exposure (lag 0 OR: 1.13; 95% CI: 1.10, 1.17; lag 1–5 ORs all 1.05 or greater with a lower CI of 1.02 or higher), and an increased odds of respiratory visits in all five days following initial exposure (lag 1 OR: 1.02; 95% CI: 1.00, 1.03; lag 2–5 ORs and lower CIs were all at least as large) comparing wildfire smoke to non-wildfire smoke days. We observed mixed results for cardiovascular visits, with evidence of increased odds emerging only several days following initial exposure. We also found increased odds across all visit categories for a 10 μg m−3 increase in smoke-impacted PM2.5. In stratified analyses, we observed elevated odds for respiratory visits among ages 19–64, for asthma visits among ages 5–64, and mixed risk estimates for cardiovascular visits by age group. This study provides evidence of an increased risk of respiratory ED visits immediately following initial wildfire smoke exposure, and increased risk of cardiovascular ED visits several days following initial exposure. These increased risks are seen particularly among children and younger to middle-aged adults.
Lower bounds for self-adjoint Sturm–Liouville operators
Authors: Behrndt Jussi , Gesztesy Fritz , Schmitz Philipp , Trunk Carsten
Published: May 2023

In this note we provide estimates for the lower bound of the self-adjoint operator associated with the three-coefficient Sturm–Liouville differential expression

1
r

(
−

d

d

x

p

d

d

x

+
q
)

\begin{equation*} \frac {1}{r} \left (-\frac {\mathrm d}{\mathrm dx} p \frac {\mathrm d}{\mathrm dx} + q\right ) \end{equation*}

in the weighted

L
2

L^2

-Hilbert space

L
2

(

R

;
r
d
x
)

L^2(\mathbb R; rdx)

.
On 𝑝-adic families of special elements for rank-one motives
Authors: Bullach Dominik , Burns David , Sano Takamichi
Published: May 2023

We conjecture that special elements associated with rank-one motives are obtained

p
p

-adically from Rubin–Stark elements by means of a precise higher-rank Soulé twist construction. We show this conjecture incorporates a variety of known results and existing predictions and also gives rise to a concrete strategy for proving the equivariant Tamagawa Number Conjecture for rank-one motives. We then use this approach to obtain new evidence in support of the equivariant Tamagawa Number Conjecture in the setting of CM abelian varieties.
Calcium-binding Cab45 regulates the polarized apical secretion of soluble proteins in epithelial cells
Authors: Liu Dandan , Paladino Simona , Zurzolo Chiara , Lebreton Stéphanie
Published: May 2023

Calcium levels in the trans-Golgi network, governed by SPCA1, and the calcium-binding protein Cab45 drive the polarized apical secretion of soluble proteins. The critical role of a calcium-dependent Cab45 mechanism in the regulation of exocytosis in polarized MDCK cells is highlighted.
Polychaetoid/ZO-1 strengthens cell junctions under tension while localizing differently than core adherens junction proteins
Authors: Peifer Mark , Schmidt Anja , Finegan Tara , Häring Matthias , Kong Deqing , Fletcher Alexander G. , Alam Zuhayr , Grosshans Jörg , Wolf Fred
Published: May 2023

The dramatic cell shape changes and movements of embryonic development require robust but dynamic linkage between cell-cell adherens junctions and the force-generating actomyosin cytoskeleton. Schmidt et al. combine genetic analysis and high resolution imaging to define the mechanism of action and function of Drosophila Polychaetoid, homolog of mammalian ZO-1, and reveal new insights into the complex molecular architecture of adherens junctions.
Effects of surgical specialization and surgeon resection volume on postoperative complications and mortality rate after emergent colon cancer resection
Authors: Engdahl Jenny , Öberg Astrid , Bergenfeldt Henrik , Edelhamre Marcus , Vedin Tomas , Bech-Larsen Sandra , Öberg Stefan
Published: May 2023

Background

The aim of this study was to evaluate the effect of surgical specialization and surgeon resection volume on short-term outcome after emergent colon cancer resections.

Methods

A retrospective analysis of all patients who underwent resections for colon cancer between 2011 and 2020 at Helsingborg Hospital, Sweden was performed. The senior surgeon participating in each procedure was classified as a colorectal surgeon or a non-colorectal surgeon. Non-colorectal surgeons were further divided into acute care surgeons or surgeons with other specialties. Surgeons were also divided into three groups based on median yearly resection volumes. Postoperative complications and 30- or 90-day mortality rate after emergent colon cancer resections were compared in patients operated on by surgeons with different specializations and yearly resection volumes.

Results

Of 1121 patients resected for colon cancer, 235 (21.0 per cent) had emergent procedures. The complication rate of emergent resections was similar in patients operated on by colorectal surgeons and non-colorectal surgeons (54.1 versus 51.1 per cent respectively), and the subgroup of acute care surgeons (45.8 per cent), whereas resections performed by general surgeons were significantly associated with more frequent complications (odds ratio (OR) 2.5 (95 per cent c.i. 1.1 to 6.1)). The complication rate was numerically highest in patients operated on by surgeons with the highest resection volumes, which differed significantly from that of surgeons with intermediate resection volumes (OR 4.2 (95 per cent c.i. 1.1 to 16.0)). There was no difference in the mortality rate of patients operated on by surgeons with different specializations or yearly resection volumes.

Conclusion

This study documented similar morbidity and mortality rates after emergent colon resection performed by colorectal and acute care surgeons, but patients operated on by general surgeons had more frequent complications.
Sex-specific seasonal variations of wild boar distance traveled and home range size
Authors: Cavazza Silvia , Brogi Rudy , Apollonio Marco
Published: May 2023

Distance traveled and home range size describe how animals move in space. The seasonal variations of these parameters are important to comprehensively understand animal ecology and its connection with reproductive behavior and energy costs. Researchers usually estimate the distance traveled as the sum of the straight-line displacements between sampled positions, but this approach is sensitive to the sampling frequency and does not account for the tortuosity of the animal’s movements. By means of the continuous-time movement modeling which takes into account autocorrelation and tortuosity of movement data, we estimated the distance traveled and monthly home range size of 28 wild boar Sus scrofa and modeled their inter-sexual seasonal variability. Males traveled longer distances and used larger home ranges than females, particularly during the rut in autumn-winter, consistently with the different biological cycles of males and females. Males enlarged their home ranges during the rut but traveled constant average distances along the year, whereas females traveled shorter distances in correspondence with the peak of food resources and birth periods but exhibited constant home range size across seasons. The differences between the seasonal variation patterns of distance traveled and home range size, observed in both sexes, revealed the complex relationship between these two aspects of spatial behavior and the great opportunity of including both distance traveled and home range size in behavioral ecology investigations. We provided a detailed analysis of wild boar spatial behavior and its relationships with the reproductive cycles of males and females, promoting a deeper comprehension of their behavioral ecology.
Rotational atherectomy for calcified lesions during ST-segment elevation myocardial infarction: a case series and literature review
Authors: Brown Kristen N , Jhand Aravdeep S , Chatzizisis Yiannis , Goldsweig Andrew M
Published: May 2023

Background

ST elevation myocardial infarction (STEMI) has traditionally been a relative contraindication for the utilization of rotational atherectomy (RA). However, in severely calcified lesions, RA may be necessary to facilitate stent delivery.

Case summary

Three patients who present with STEMI are found to have severely calcified lesions on intravascular ultrasound. Equipment was unable to pass the lesions in all three cases. Rotational atherectomy was therefore performed to allow for stent passage. All three cases had achieved successful revascularization with no intraoperative or post-operative complications. The patients remained angina-free the rest of their hospitalization and at the 4 month follow-up.

Discussion

Rotational atherectomy for calcific plaque modification during STEMI when equipment will not pass is a feasible and safe therapeutic option.
The Psychologically Informed Practice Consultation Roadmap: A Clinical Implementation Strategy
Authors: Main Chris J , Simon Corey B , Beneciuk Jason M , Greco Carol M , George Steven Z , Ballengee Lindsay A
Published: May 2023

Psychologically informed practice (PiP) includes a special focus on psychosocial obstacles to recovery, but research trials have revealed significant difficulties in implementing PiP outside of research environments. Qualitative studies have identified problems of both competence and confidence in tackling the psychosocial aspects of care, with a tendency to prefer dealing with the more mechanical aspects of care. In PiP, the distinction between assessment and management is not clear-cut. Analysis of the problem is part of the intervention, and guided self-management begins with the initial detective work by the patient, who is encouraged to develop successful and relevant behavior change. This requires a different style and focus of communication that some clinicians find difficult to enact. In this Perspective, the PiP Consultation Roadmap is offered as a guide for clinical implementation to establish a therapeutic relationship, develop patient-centered communication, and guide effective pain self-management. These strategies are illustrated through the metaphor of the patient learning to drive, with the therapist as a driving instructor and the patient as a student driver. For convenience, the Roadmap is depicted in 7 stages. Each stage represents aspects of the clinical consultation in a recommended order, although the Roadmap should be viewed as a general guide with a degree of flexibility to accommodate individual differences and optimize PiP interventions. It is anticipated that the experienced PiP clinician will find it progressively easier to implement the Roadmap as the building blocks and style of consultation become more familiar.
Seasonal Susceptibility of Sweet Cherry Pruning Wounds to Calosphaeria pulchella, Cytospora sorbicola, and Eutypa lata
Authors: Li Sampson , Travadon Renaud , Trouillas Florent P.
Published: May 2023

Fungal canker pathogens commonly infect trees at pruning wounds leading to branch dieback and loss of productivity in sweet cherry orchards. However, the seasonal susceptibility of sweet cherry pruning wounds to Calosphaeria pulchella, Cytospora sorbicola, and Eutypa lata is not well understood. This study compared the susceptibility of sweet cherry pruning wounds made during the dormant season (January) and the postharvest season (late May to June) to infection by main canker pathogens in California. Field trials were conducted in three cherry orchards and trees were pruned at the different periods over 2 years. Fresh pruning wounds were inoculated with spores of each pathogen, and pathogen recovery was assessed through microbiological isolations at 3 to 4 months after inoculations. Pruning wounds made in late May and June resulted in significantly higher infection by Cal. pulchella compared to pruning wounds made in January. Pruning wounds made during both seasons were generally equally susceptible to Cyt. sorbicola and E. lata infections. However, there was one orchard where dormant pruning wounds were more susceptible to infection by E. lata and there was one particularly cold winter where Cyt. sorbicola did not infect pruning wounds. Overall, our findings suggest that Cal. pulchella infections of cherry pruning wounds are more likely to occur during periods of warm temperatures such as late spring and early summer. However, infections by Cyt. sorbicola and E. lata can occur year-round if inoculum is present and if winter temperatures are not abnormally low for California. Finally, our results suggest that the emergence of Cal. pulchella as a major canker pathogen of sweet cherry in California may be the result of a shift from dormant to after-harvest pruning of sweet cherry trees.
Identification of a Novel Pm65 Allele Conferring a Wide Spectrum of Resistance to Powdery Mildew in Wheat Accession PI 351817
Authors: Xu Xiangyang , Li Genqiao , Cowger Christina , Bai Guihua , Carver Brett F. , Bian Ruolin , Bernardo Amy
Published: May 2023

Powdery mildew is caused by the highly adaptive biotrophic fungus Blumeria graminis f. sp. tritici infecting wheat worldwide. Novel powdery mildew resistance genes are urgently needed that can be used rapidly in wheat cultivar development with minimal disruption of trait advances elsewhere. PI 351817 is a German cultivar exhibiting a wide spectrum of resistance to B. graminis f. sp. tritici isolates collected from different wheat-growing regions of the United States. Evaluation of an F2 population and 237 F2:3 lines derived from OK1059060-2C14 × PI 351817 for responses to B. graminis f. sp. tritici isolate OKS(14)- B- 3- 1 identified a single dominant gene, designated Pm351817, for powdery mildew resistance in PI 351817. Using bulked segregant analysis (BSA) and simple sequence repeat (SSR) markers, Pm351817 was mapped in the terminal region of the long arm of chromosome 2A. Deep sequencing of the genotyping-by-sequencing libraries of the two parental lines identified a set of single-nucleotide polymorphism (SNP) markers in the 2AL candidate gene region. Those SNP markers was subsequently converted to Kompetitive allele-specific PCR (KASP) markers for genotyping the mapping population. Linkage analysis delimited Pm351817 to a 634-kb interval between Stars-KASP656 (771,207,512 bp) and Stars-KASP662 (771,841,609 bp) on 2AL, based on the Chinese Spring reference sequence IWGSC RefSeq v 2.1. Tests of allelism indicated that Pm351817 is located at the Pm65 locus. Pm351817 shows resistance to all B. graminis f. sp. tritici isolates used in this study and can be used to enhance powdery mildew resistance in the United States. KASP markers flanking Pm351817 can be used to select Pm351817 in wheat breeding programs after further tests for polymorphism.
Pathogenicity of Stagonosporopsis caricae, Stagonosporopsis citrulli, and Stagonosporopsis cucurbitacearum on Five Commonly Cultivated Cucurbit Species
Authors: Seblani R. , Munkvold G. P.
Published: May 2023

Gummy stem blight is a destructive fungal disease that affects all commonly cultivated cucurbit crops. One cultivar each of the five cucurbit species susceptible to gummy stem blight were inoculated with two isolates of Stagonosporopsis caricae, three isolates of Stagonosporopsis citrulli, and one isolate of Stagonosporopsis cucurbitacearum to explore the host range and relative aggressiveness of each isolate. In a series of greenhouse experiments, all isolates were pathogenic to the crops tested, but disease severity differed significantly among isolates and cucurbit cultivars. There were also significant interactions between isolate and cultivar. S. citrulli isolates caused the most severe symptoms across all five cultivars, and S. citrulli isolates C-68 and DbHD-10 were consistently among the most aggressive isolates on each cultivar. S. caricae isolates generally caused less severe symptoms, but W-1028 ( S. caricae) was among the most aggressive isolates on Tyria cucumber. These results add to the understanding of the relationships of the three Stagonosporopsis species with various cucurbit hosts, reinforcing knowledge about the pathogenicity of the three species across cucurbit crops and the potentially high aggressiveness of S. citrulli.

[Formula: see text] Copyright © 2023 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
P2X7 receptor of microglia in olfactory bulb mediates the pathogenesis of olfactory dysfunction in a mouse model of allergic rhinitis
Authors: Ren Chao , Mou Ya‐Kui , Song Xiao‐Yu , Wei Shi‐Zhuang , Wang Han‐Rui , Wang Yao , Zhang Wen‐Bin , Li Bing , Song Xi‐Cheng
Published: May 2023

The pathogenesis of allergic rhinitis (AR)‐related olfactory dysfunction (OD) remains unknown. Inhibiting microglial response in olfactory bulb (OB) can ameliorate AR‐related OD, but no precise targets have been available. In this study, we established a mouse model of ovalbumin (OVA)‐induced AR and combined with the application of P2X7 receptor (P2X7R)‐specific antagonists and cell culture in conditioned medium to investigate the role and mechanism of OB microglial P2X7R in AR‐related OD. Serum IgE and IL‐5 levels determined via ELISA and federated the number of nose‐scratching to affirm the success of OVA‐induced AR mouse model. Buried food pellet test was used to evaluate the olfactory function of mice. The changes of IBA1, GFAP, P2X7R, IL‐1β, IL‐1Ra, and CASPASE 1 were detected by quantitative polymerase chain reaction and western blotting. The levels of adenosine triphosphate (ATP) were determined by the commercialized kit. The morphological changes of microglia were assessed using immunofluorescence staining and Sholl analysis. Findings showed that AR‐related OD was associated with OB microglia‐mediated imbalance between IL‐1β and IL‐1Ra. Treatment with BBG improved the olfactory function in AR mice with restoring the balance between IL‐1β and IL‐1Ra. In vitro, the conditioned medium obtained after HNEpC treatment with Der p1 could activate HMC3 to arise inflammatory reaction basing on “ATP‐P2X7R‐Caspase 1” axis, while inhibition of its P2X7R suppressed the reaction. In brief, microglial P2X7R in OB is a direct effector molecule in AR‐related OD and inhibition of it may be a new strategy for the treatment of AR‐related OD.
Grit as a Predictor of Academic Success Among Associate Degree Nursing Students
Authors: Young-Brice Amber , Johnson B. Kyle , McCormack Mary Grace , Peña Maria , Leiberg Jessica , Dreifuerst Kristina Thomas
Published: May 2023

AIM

The purpose of this study was to explore whether grit is a predictor of success in associate degree nursing (ADN) programs.

BACKGROUND

A question that challenges admission decision-making in nursing programs is “Who will succeed?” This question is particularly relevant in ADN programs, which often have higher attrition rates than baccalaureate programs.

METHOD

This longitudinal, mixed-methods study was conducted with 451 ADN students across nine programs, including interviews with seven unsuccessful students and nine successful students.

RESULTS

Short Grit Scale scores were not found to be statistically significant as a predictor of academic success; however, themes that emerged from the interviews do align with the theory of grit.

CONCLUSION

Further research is needed to explore whether recognizing the level of grit in students during admission processes would help identify students who are likely to succeed.
An Online Module to Promote Self-Care and Resiliency in Nursing Students
Authors: Higgins Karen , Hawkins Janice , Tremblay Beth , Wiles Lynn
Published: May 2023

Because the demands of nursing education can impact the physical and mental health of nursing students, the American Association of Colleges of Nursing’s revised Essentials require inclusion of self-care and resilience education in nursing curricula. This article describes the development, implementation, and evaluation of a self-care module in a new online undergraduate course. Using the REST mnemonic (relationships, exercise, soul, and transformative thinking), students developed personalized self-care plans for the semester. End-of-course evaluations revealed an increase in self-care activities. The most used activities were exercise, humor, intentional rest, and healthy eating.
Associations between Patient Experience and Addiction Treatment Facility Services: Results of the Addiction Treatment Locator, Assessment, and Standards Surveys
Authors: Chen Kevin , Oldfield Benjamin J. , Joudrey Paul J. , Biegacki Emma T. , Fiellin David A.
Published: May 2023

Objectives

Patient experience and presence of evidence-based facility services are 2 dimensions of assessing quality of addiction treatment facilities. However, the relationship between these two is not well described. The objective of this study was to explore associations between patient experience measures and service offerings at addiction treatment facilities.

Methods

We used data from cross-sectional surveys of addiction treatment facilities and persons involved in treatment at corresponding facilities to identify facility services (eg, availability of medications for alcohol use disorder, assistance with obtaining social services, etc) and patient experience measures (overall facility rating, extent helped by treatment, ability to deal with daily problems after treatment), respectively. We used hierarchical multiple logistic regression to test for associations between top-box scores for each patient experience outcome and facility services.

Results

We analyzed 9191 patient experience surveys from 149 facilities. Assistance with obtaining social services (adjusted odds ratio [95% confidence interval], 0.43 [0.28–0.66]) was associated with lower overall treatment facility ratings. Childcare (2.00 [1.04–3.84]) was associated with top-box scores for extent helped. Availability of cognitive behavioral therapy (2.67 [1.25–5.73]) and childcare (1.77 [1.08–2.92]) were associated with top-box scores for ability to deal with daily problems after treatment. Assistance with obtaining social services (0.61 [0.41–0.90]) was associated with lower scores for ability to deal with problems after treatment.

Conclusions

Few addiction treatment facility services were associated with patient experience measures. Future work should explore bridging the gap between evidence-based services and positive patient experiences.
Persistent Use of Prescription Opioids Before and After Lumbar Spine Surgery
Authors: Holmberg Siril T. , Skurtveit Svetlana , Gulati Sasha , Salvesen Øyvind O. , Nygaard Øystein P. , Solberg Tore K. , Fredheim Olav M.S.
Published: May 2023

Study Design.

Prospective pharmacoepidemiologic study.

Objective.

To investigate clinical and sociodemographic factors associated with persistent opioid use in the years following spine surgery among patients with persistent opioid use preceding lumbar spine surgery.

Summary of Background Data.

It is unknown whether successful spine surgery leads to a cessation of preoperative persistent opioid use.

Materials and Methods.

Data from the Norwegian Registry for Spine Surgery and the Norwegian Prescription Database were linked for patients operated for degenerative lumbar spine disorders between 2007 and 2017. The primary outcome measure was persistent opioid use in the second year after surgery. Functional disability was measured with the Oswestry Disability Index (ODI). Factors associated with persistent opioid use in the year before, and two years following, surgery were identified using multivariable logistic regression analysis. The variables included in the analysis were selected based on their demonstrated role in prior studies.

Results.

The prevalence of persistent opioid use was 8.7% in the year before surgery. Approximately two-thirds of patients also met the criteria for persistent opioid use the second year after surgery. Among patients who did not meet the criteria for persistent opioid use the year before surgery, 991 (3.3%) patients developed persistent opioid use in the second year following surgery. The strongest association was exhibited by high doses of benzodiazepines in the year preceding surgery (OR 1.7, 95% CI 1.26 to 2.19, P<0.001). Among patients without persistent opioid use, the most influential factor associated with new-onset persistent opioid use in the second year after surgery was the use of high doses of benzodiazepines (OR 1.8, 95% CI 1.26 to 2.44, P<0.001), high doses of z-hypnotics (OR 2.6, 95% CI 2.10 to 3.23, P<0.001) and previous surgery at the same lumbar level (OR 1.37, 95% CI 1.11 to 1.68, P=0.003).

Conclusion.

A substantial proportion of patients reported sustained opioid use after surgery. Patients with persistent opioid use before surgery should be supported to taper off opioid treatment. Special efforts appear to be required to taper off opioid use in patients using high doses of benzodiazepines.

Level of Evidence.

2; Prospective observational study.
A Different Way to Think About Syndromes of Hereditary Colorectal Cancer
Authors: Abbass Mohammad Ali , Plesec Thomas , Church James M.
Published: May 2023

BACKGROUND:

Hereditary colorectal cancer is an increasingly complex field where the commoner syndromes are being augmented by rarer genetic presentations that contribute to familial polyposis and colorectal cancer. Coming to grips with the complexity is difficult because of the phenotypic and genotypic overlap between syndromes.

OBJECTIVE:

In this article, we describe a new way of thinking about syndromes of hereditary colorectal cancer based on their embryonic tissue of origin.

DATA SOURCES:

Articles were searched through PubMed and Medline.

STUDY SELECTION:

The terms “hereditary colorectal cancer,” “syndromes of hereditary colorectal cancer,” and “hereditary polyposis” were used to direct the search.

RESULTS:

Primarily endoderm-derived syndromes were different to mesoderm-derived syndromes in their genetics, molecular biology, histology and clinical course.

LIMITATIONS:

There is considerable phenotypic and genotypic overlap between syndromes, even when considering embryonic tissue of origin.

CONCLUSION:

Thinking about hereditary syndromes of colorectal cancer from the perspective of embryonic tissue of origin provides a fresh look at phenotype and genotype that opens new areas of exploration.
A Case of Fibula Regeneration after Below-the-knee Amputation in an Adult
Authors: Fukuba Michiko , Dogo Kyoko , Saito Koji , Ishida Tsuyoshi , Yamaoka Hisayo , Okochi Masayuki , Ogata Naoshi , Komuro Yuzo
Published: May 2023

We report the case of an adult with fibula regeneration after below-the-knee amputation. Fibula regeneration conventionally occurs at the donor site of children after autogenous fibula transplantation when the periosteum is preserved. However, the patient was an adult, and the regenerated fibula was 7-cm long and grew directly from the stump. A 47-year-old man was referred to the plastic surgery department owing to stump pain. He had an open comminuted fracture of the right fibula and tibia due to a traffic accident when he was 44 years old and underwent below-the-knee amputation and negative pressure wound therapy for skin defects. The patient recovered and was able to walk using a prosthetic limb. Upon radiography, the fibula was found to have regenerated 7 cm directly from the stump. Pathological examination revealed that the regenerated fibula contained normal bone tissue and neurovascular bundles in the cortex. The periosteum, mechanical stimuli with limb proteases, and negative pressure wound therapy were suspected to have accelerated bone regeneration. He had no inhibitory factors for bone regeneration, including diabetes mellitus, peripheral arterial disease, or active smoking status. After the resection of the regenerated fibula, the patient was ambulatory without further bone regeneration or pain. This case report suggests that bone regeneration may occur even in adults. The surgeon should not leave any part of the periosteum behind in patients undergoing amputation. In adult amputees complaining of stump pain, the possibility of bone regeneration may be considered.
Association of Hospital Readmission Rates With Discharge Disposition for Patients With Psychotic Disorders
Authors: Tucker Kariba , Zikos Dimitrios , Vick Dan J.
Published: May 2023

Goal:

We explored how readmissions may result from patients' lack of access to aftercare services, failure to adhere to psychotropic medication plans, and inability to understand and follow hospital discharge recommendations. We also investigated whether insurance status, demographics, and socioeconomic status are associated with hospital readmissions. This study is important because readmissions contribute to increased personal and hospital expenses and decreased community tenure (the ability to maintain stability between hospital admissions). Addressing hospital readmissions will promote optimal discharge practices beginning on day one of hospital admission.

Methods:

The study examined the differences in hospital readmission rates for patients with a primary psychotic disorder diagnosis. Discharge data were drawn in 2017 from the Nationwide Readmissions Database. Inclusion criteria included patients aged 0–89 years who were readmitted to a hospital between less than 24 hr and up to 30 days from discharge. Exclusion criteria were principal medical diagnoses, unplanned 30-day readmissions, and discharges against medical advice. The sampling frame included 269,906 weighted number of patients diagnosed with a psychotic disorder treated at one of 2,355 U.S. community hospitals. The sample size was 148,529 unweighted numbers of patients discharged.

Principal Findings:

In a logistic regression model, weighted variables were calculated and used to determine an association between the discharge dispositions and readmissions. After controlling for hospital characteristics and patient demographics, we found that the odds for readmission for routine and short-term hospital discharge dispositions decreased for home health care discharges, which indicated that home health care can prevent readmissions. The finding was statistically significant when controlling for payer type and patient age and gender.

Practical Applications:

The findings support home health care as an effective option for patients with severe psychosis. Home health care reduces readmissions and is recommended, when appropriate, as an aftercare service following inpatient hospitalization and may enhance the quality of patient care. Improving healthcare quality involves optimizing, streamlining, and promoting standardized processes in discharge planning and direct transitions to aftercare services.
Understanding the Impact of Span of Control on Nurse Managers and Hospital Outcomes
Authors: Ruffin Asiah , Shirey Maria R. , Dick Tracey , Fazeli Pariya L. , Patrician Patricia A.
Published: May 2023

Goal:

Span of control is a multidimensional concept requiring a comprehensive definition that captures the complexities of the nurse manager's role in acute care settings. This concept analysis aimed to identify factors associated with span of control and provide a comprehensive definition outlining the breadth of this concept.

Methods:

ProQuest, PubMed, and Scopus databases were used to search peer-reviewed literature addressing the span of control in acute care nurse management. The search produced 185 articles; 177 titles and abstracts were screened for eligibility. Data from 22 articles were included in this analysis.

Principal Findings:

This analysis includes antecedents, attributes, and consequences of expanded nurse manager spans of control. Work-related factors such as staff and manager experience levels, work complexity, and patient acuity are attributes of a nurse manager's span of control. Our findings suggest that expanded spans of control can have negative consequences on nurse managers such as role overload and burnout. Low satisfaction among staff and patients can result from excessive spans of control.

Practical Implications:

An awareness of span of control can promote sustainable nursing practices by improving workplace conditions, staff satisfaction, and patient care quality. Our findings may translate across other health disciplines and thus contribute to scientific knowledge that can support changes in job designs and encourage more manageable workloads.
Preclinical simulation integrated into a nurse practitioner disease management course: Student perceptions and learning outcomes
Authors: Fitz Sarah M. , Burt Leah
Published: May 2023

Nurse practitioner (NP) educators have been tasked with incorporating simulation into preclinical curricula while pivoting to competency-based education. Despite evidence supporting simulation's role in preclinical health care education, limited scholarship has evaluated this educational method among NP students. We sought to evaluate student perceptions, learning satisfaction, and confidence after participation in an experientially designed, preclinical, simulation program and to compare levels of clinical communication self-efficacy and self-rated, clinical rotation preparedness before and after participation. The preclinical simulation program was designed, implemented, and evaluated within a disease management course. Students reported high levels of satisfaction and confidence with learning. Clinical communication self-efficacy (t[17] = 3.73, p < .01) and self-rated levels of clinical rotation preparedness (t[17] = −2.97, p < .01) were significantly higher after program participation. Simulation may be successfully implemented in preclinical disease management courses. Positive program evaluations create a foundation for further competency-based NP educational design using simulation. Faculty should consider implementing experientially designed preclinical simulation in NP programs to promote progression toward competency within the NP role and to encourage clinical readiness.
The Gender Landscape of Academic Pediatric Emergency Medicine
Authors: Levine Marla C. , Lin Timmy , Baird Janette , Constantine Erika
Published: May 2023

Objectives

Although many areas of medicine are male dominated, pediatric emergency medicine (PEM) is a female-dominated subspecialty. Despite this, executive leadership within PEM remains male dominated. The aim of this study was to describe the gender landscape of the key positions within academic PEM fellowship programs within the United States, as described by PEM fellowships' online presence.

Methods

Using the 2021–2022 Electronic Residency Application Service American Association of Medical Colleges Pediatric Fellowships (services.aamc.org/eras/erasstats/par/) application service, we were able to identify published information from 84 academic PEM fellowship programs in the United States. Each program's Web site was evaluated to determine which individuals held the position of chief or chair, medical director, and fellowship director. These individuals' genders were then cross-referenced with the National Provider Inventory database.

Results

There were 154 executive leadership roles (division chief or medical director) in total. The executive leadership role was significantly different by gender (z score: 2.54, P < 0.01), with greater male representation (n = 61; 62.9%) among identified executive leadership roles (n = 97). There were significantly more men for the medical director role (z score: 2.06, P < 0.05). Female representation was greater than male in the fellowship program director role (n = 53; 67.9%) among listed roles (z score: −3.17, P < 0.001). This gender landscape among key leadership positions was not influenced by the geographic location of the PEM fellowship program.

Conclusions

Although PEM is a female-dominated specialty, executive leadership positions continue to be male dominated. To promote improved gender representation within leadership positions in PEM, PEM fellowship programs must provide consistent and easily accessible executive leadership descriptions within their online storefront.
Pediatric Blunt Cerebrovascular Injuries
Authors: El Tawil Chady , Nemeth Joe , Al Sawafi Muzna
Published: May 2023

The low incidence of blunt cerebrovascular injury (BCVI) reported in pediatric studies (<1%) might be related to an underreporting due to both the absence of current screening guidelines and the use of inadequate imaging techniques. This research is a review of the literature limited to the last 5 years (2017–2022) about the approach and management of BCVI in pediatrics. The strongest predictors for BCVI were the presence of basal skull fracture, cervical spine fracture, intracranial hemorrhage, Glasgow Coma Scale score less than 8, mandible fracture, and injury severity score more than 15. Vertebral artery injuries had the highest associated stroke rate of any injury type at 27.6% (vs 20.1% in carotid injury). The sensitivity of the well-established screening guidelines of BCVI varies when applied to the pediatric population (Utah score – 36%, 17%, Eastern Association for the Surgery of Trauma (EAST) guideline – 17%, and Denver criteria – 2%). A recent metaanalysis of 8 studies comparing early computed tomographic angiogram (CTA) to digital subtraction angiography for BCVI detection in adult trauma patients demonstrated high variability in the sensitivity and specificity of CTA across centers. Overall, CTA was found to have a high specificity but low sensitivity for BCVI. The role of antithrombotic as well as the type and duration of therapy remain controversial. Studies suggest that systemic heparinization and antiplatelet therapy are equally effective.
Severe Necrotizing Pancreatitis in a Pediatric Patient with COVID-19: A Case Report
Authors: Li Lucinda , Mostafavi Mojdeh , Miller John W. , Hirsch Barry , O’Connor Stephen , Sayej Wael N.
Published: May 2023

We describe a 15-year-old female diagnosed with necrotizing pancreatitis in the setting of coronavirus disease 2019 with severe complications including splenic vein and portal vein thromboses, pleural effusion requiring chest tube, acute hypoxic respiratory failure requiring noninvasive positive-pressure ventilation, and new-onset insulin-dependent diabetes mellitus, requiring over a month-long hospitalization. Following discharge, the patient experienced a prolonged loss of appetite, nausea, and extreme weight loss., During her prolonged hospitalization, she was diagnosed with necrotizing pancreatitis with walled-off collection which was ultimately treated with transgastric endoscopic ultrasound-guided drainage, multiple endoscopic necrosectomies, lumen-apposing metal stents, and double-pigtail plastic stent. Nine months after her initial presentation, patient’s clinical symptoms improved, and her weight stabilized. This case highlights the importance of recognizing acute and necrotizing pancreatitis and its morbidities as complications associated with coronavirus disease 2019.
Complications of Percutaneous and Surgical Gastrostomy Placements in Children: a Single-Centre Series
Authors: Tazi Kaoutar , Kotilea Kallirroi , Dassonville Martine , Bontems Patrick
Published: May 2023

Objectives:

Gastrostomy placement is a standard procedure for children requiring enteral feeding for more than 3–6 weeks. Various techniques have been described (percutaneous endoscopic, laparoscopy, and laparotomy), and many complications have been reported. In our center, gastrostomy placement is performed either percutaneously by pediatric gastroenterologists, by laparoscopy/laparotomy by the visceral surgery team, or jointly, that is laparoscopic-assisted percutaneous endoscopic gastrostomy. This study aims to report all complications and identify risk factors and ways to prevent them.

Methods:

This is a monocentric retrospective study including children younger than 18 years who underwent gastrostomy placement (percutaneous or surgical) between January 2012 and December 2020. Complications that occurred up to 1 year after placement were collected and classified according to their time of onset, degree of severity, and management. A univariate analysis was conducted to compare the groups and the occurrence of complications.

Results:

We established a cohort of 124 children. Sixty-three (50.8%) presented a concomitant neurological disease. Fifty-nine patients (47.6%) underwent endoscopic placement, 59 (47.6%) surgical placement, and 6 (4.8%) laparoscopic-assisted percutaneous endoscopic gastrostomy. Two hundred and two complications were described, including 29 (14.4%) major and 173 (85.6%) minor. Abdominal wall abscess and cellulitis were reported 13 times. Patients who underwent surgical placement presented more complications (major and minor combined) with a statistically significant difference compared with the endoscopic technique. Patients with a concomitant neurological disease had significantly more early complications in the percutaneous group. Patients with malnutrition had significantly more major complications requiring endoscopic or surgical management.

Conclusion:

This study highlights a significant number of major complications or complications requiring additional management under general anesthesia. Children with a concomitant neurological disease or malnutrition are at greater risk of severe and early complications. Infections remain a frequent complication, and prevention strategies should be reviewed.
Technical Precision with Autologous Fat Grafting for Facial Rejuvenation: A Review of the Evolving Science
Authors: Strong Amy L. , Rohrich Rod J. , Tonnard Patrick L. , Vargo James D. , Cederna Paul S.
Published: May 2023

The scientific study of facial aging has transformed modern facial rejuvenation. As we age, fat loss in specific fat compartments is a major contributor to the structural aging of the face. Autologous fat grafting is safe, abundant, readily available, and completely biocompatible, which makes it the preferred soft tissue filler in the correction of facial atrophy. The addition of volume through fat grafting gives an aged face a more youthful, healthy, and aesthetic appearance. Harvesting and preparation with different cannula size and filter cartridge techniques have allowed for fat grafts to be divided based on parcel size and cell type into three major subtypes - macrofat, microfat, and nanofat. Macrofat and microfat has the benefit of providing volume to restore areas of facial deflation and atrophy in addition to improving skin quality, while nanofat has been shown to improve skin texture and pigmentation. In this article, the current opinions regarding fat grafting and how the evolving science of fat grafting has led to the clinical utility of each type of fat to optimize facial rejuvenation will be discussed. We now have the opportunity to individualize the use of autologous fat grafting with the various subtypes of fat for the targeted correction of aging in different anatomic areas of the face. Fat grafting has become a very powerful tool that has revolutionized facial rejuvenation, and developing precise, individualized plans for autologous fat grafting for each patient is a vertical advancement in the evolution in facial rejuvenation.
DRESS syndrome: quetiapine associated case report and literature review
Authors: Mallaro Hannah L. , Rosenthal Lisa J.
Published: May 2023

Drug rash with eosinophilia and systemic symptoms (DRESS syndrome) is a rare systemic adverse drug reaction with a high mortality rate. Cases of DRESS syndrome have been reported with almost all classes of psychiatric medications, but data remains limited. We describe the case of a 33-year-old woman who presented with acute respiratory distress syndrome secondary to severe pulmonary blastomycosis. Her hospital course was complicated by severe agitation for which the psychiatry consult team was involved and several medications were trialed including quetiapine. She developed a diffuse erythematous rash during her hospital stay and later eosinophilia and transaminitis consistent with DRESS syndrome due to either quetiapine or lansoprazole based on the timeline. Both medications were discontinued, and she was started on a prednisone taper leading to resolution of the rash, eosinophilia, and transaminitis. Her HHV-6 IgG titer later returned elevated at 1:1280. DRESS syndrome along with many other cutaneous drug reactions can be associated with psychiatric medications and familiarity and recognition are imperative. There are limited reports of quetiapine-associated DRESS syndrome in the literature; however, rash and eosinophilia should alert psychiatrists to the potential for quetiapine to be a precipitant for DRESS syndrome.
Sensitivity of endemic behaviour of COVID-19 under a multi-dose vaccination regime, to various biological parameters and control variables
Authors: Dagpunar John , Wu Chenchen
Published: May 2023

For an infectious disease such as COVID-19, we present a new four-stage vaccination model (unvaccinated, dose 1 + 2, booster, repeated boosters), which examines the impact of vaccination coverage, vaccination rate, generation interval, control reproduction number, vaccine efficacies and rates of waning immunity upon the dynamics of infection. We derive a single equation that allows computation of equilibrium prevalence and incidence of infection, given knowledge about these parameters and variable values. Based upon a 20-compartment model, we develop a numerical simulation of the associated differential equations. The model is not a forecasting or even predictive one, given the uncertainty about several biological parameter values. Rather, it is intended to aid a qualitative understanding of how equilibrium levels of infection may be impacted upon, by the parameters of the system. We examine one-at-a-time sensitivity analysis around a base case scenario. The key finding which should be of interest to policymakers is that while factors such as improved vaccine efficacy, increased vaccination rates, lower waning rates and more stringent non-pharmaceutical interventions might be thought to improve equilibrium levels of infection, this might only be done to good effect if vaccination coverage on a recurrent basis is sufficiently high.
Female–female aggression in the Gila monster (
Heloderma suspectum
)
Authors: Schuett Gordon W. , Peterson Karl H. , Powell Anthony R. , Taylor John D. , Alexander Jennifer R. , Lappin A. Kristopher
Published: May 2023

Historically, the role of aggression in the social lives of animals overwhelmingly focused on males. In recent years, however, female–female aggression in vertebrates, particularly lizards, has received increasing attention. This growing body of literature shows both similarities and differences to aggressive behaviours between males. Here, we document female–female aggression in captive Gila monsters (
Heloderma suspectum
). Based on four unique dyadic trials (eight adult female subjects), we developed a qualitative ethogram. Unexpected and most intriguing were the prevalence and intensity of aggressive acts that included brief and sustained biting, envenomation, and lateral rotation (i.e. rolling of body while holding onto opponent with closed jaws). Given specific behavioural acts (i.e. biting) and the results of bite-force experiments, we postulate that osteoderms (bony deposits in the skin) offer some degree of protection and reduce the likelihood of serious injury during female–female fights. Male–male contests in
H. suspectum,
in contrast, are more ritualized, and biting is rarely reported. Female–female aggression in other lizards has a role in territoriality, courtship tactics, and nest and offspring guarding. Future behavioural research on aggression in female Gila monsters is warranted to test these and other hypotheses in the laboratory and field.