bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of action plans on perceived COPD burden
Authors: Heffner Jacqueline S.
Published: June 2024

Background:

Chronic obstructive pulmonary disease (COPD) significantly increases morbidity, mortality, and healthcare costs. Patients need enhanced resources to improve COPD symptoms, avoid exacerbations, and manage their medications. My COPD Action Plan, a worksheet developed by the American Lung Association (ALA), is designed to help patients develop a personalized self-management plan with their providers.

Methods:

This QI project, conducted at a rural primary care Federally Qualified Health Center (FQHC) as part of the author's Doctor of Nursing Practice (DNP) program requirements, included patients with COPD. Participants completed a preintervention COPD Assessment Test (CAT) and then, together with their provider, completed a personalized ALA COPD action plan. Office staff followed up with patients weekly for 8 weeks to inquire about their ability to follow their COPD action plans and forwarded patient issues to the primary care provider. Postintervention CAT scores were then obtained at a follow-up office visit. Changes in CAT scores were analyzed using descriptive statistics.

Results:

Seventeen patients met project requirements, consented to participate, and completed all the steps. Preintervention CAT scores ranged from 11 to 37, with a median score of 31. Postintervention CAT scores ranged from 3 to 28, with a median score of 17. The CAT categories that improved the most were chest tightness, activity limitation, and confidence in leaving the home.

Conclusion:

This project evaluates how use of the ALA's COPD-centered action plan improves patients' perceived COPD burden and reduces healthcare resource utilization.
Research Trends in Family-Centered Care for Children With Chronic Disease
Authors: Im YeoJin , Jung Sunyoung , Park YoungAh , Eom Jeong Hee
Published: June 2024

Family-centered care is an approach to promote the health and well-being of children with chronic diseases and their families. This study aims to explore the knowledge components, structures, and research trends related to family-centered care for children with chronic conditions. We conducted the keyword network analysis in three stages using the keywords provided by the authors of each study: (1) search and screening of relevant studies, (2) keyword extraction and refinement, and (3) data analysis and visualization. The core keywords were child, adolescence, parent, and disabled. Four cohesive subgroups were identified through degree centrality. Research trends in the three phases of a recent decade have been changed. With the systematic understanding of the context of the knowledge structure, the future research and effective strategy establishment are suggested based on family-centered care for children with chronic disease.
Dried Blood Spot Method Development and Clinical Validation for the Analysis of Elexacaftor, Elexacaftor-M23, Tezacaftor, Tezacaftor-M1, Ivacaftor, Ivacaftor Carboxylate, and Hydroxymethyl Ivacaftor Using LC-MS/MS
Authors: Vonk Steffie E. M. , van der Meer-Vos Marloes , Kos Renate , Neerincx Anne H. , Terheggen-Lagro Suzanne W. J. , Altenburg Josje , Maitland-van der Zee Anke H. , Mathôt Ron A. A. , Kemper E. Marleen ,   on behalf of the Amsterdam Mucociliary Clearance Disease (AMCD) research group
Published: June 2024

Background:

The highly effective cystic fibrosis transmembrane conductance regulator (CFTR) modulator, elexacaftor–tezacaftor–ivacaftor, is now widely being used by people with cystic fibrosis. However, few independent studies have detailed the pharmacokinetics (PK) of CFTR modulators. Blood collection by venipuncture is the gold standard for PK measurements, but it is invasive. The aim of this study was to develop and clinically validate a quantification method for elexacaftor, tezacaftor, ivacaftor, and their main metabolites in dried blood spots (DBSs) using liquid chromatography with tandem mass spectrometry.

Methods:

Linearity, accuracy, precision, stability, hematocrit (Hct), spot-to-spot carryover, spot volume, and extraction efficiency were validated in DBS for all analytes. The clinical validation of elexacaftor–tezacaftor–ivacaftor in patients was performed by comparing 21 DBS samples with matched plasma samples.

Results:

The preset requirements for linearity, within-run and between-run accuracy, precision, Hct, spot volume, and extraction efficiency were met. Puncher carryover was observed and resolved by punching 3 blanks after each sample. The samples remained stable and showed no notable degradation across the tested temperatures and time intervals. Corrected DBS values with the Passing–Bablok regression equation showed good agreement in Bland–Altman plots, and acceptance values were within 20% of the mean for a minimum of 67% of the repeats, according to the EMA guidelines.

Conclusions:

A quantification method for the analysis of elexacaftor, tezacaftor, ivacaftor, and their main metabolites was developed and clinically validated in DBS. This method could be valuable in both clinical care and research to address unanswered PK questions regarding CFTR modulators.
The Primacy of Ethics in Aesthetic Medicine: A Review
Authors: Ramirez Sylvia , Cullen Clara , Ahdoot Rodney , Scherz Gunther
Published: June 2024

Background:

The landscape of modern aesthetic medicine has witnessed a paradigm shift from traditional doctor-led care to a consumer-driven model, presenting a plethora of ethical challenges. This review discusses the ethical dimensions of medical aesthetics, exploring the implications of consumer demand, societal influences, and technological advancements on patient care and well-being.

Methods:

Drawing upon a comprehensive analysis of existing literature, this review synthesizes evidence regarding the rise of aesthetic medicine, ethical challenges encountered in practice, and the implications of social media and marketing in shaping patient perceptions and decision-making.

Results:

Aesthetic medicine confronts unique ethical challenges stemming from its elective nature and the pervasive influence of societal beauty standards. Concerns include the commodification of beauty, conflicts of interest, limited evidence-base of treatments, and the rise of nonphysician providers. Moreover, the evolving role of social media influencers and medical marketing raises ethical dilemmas regarding transparency, patient autonomy, and professional integrity.

Conclusions:

The ethical landscape of aesthetic medicine necessitates a proactive approach to address emerging challenges and safeguard patient well-being. Guided by principles of autonomy, beneficence, nonmaleficence, and justice, recommendations are proposed to enhance informed consent practices, mitigate appearance anxiety, facilitate shared decision-making, and promote responsible use of social media. Professional societies are urged to establish clear ethical guidelines and standards to uphold professionalism and patient trust in the field of aesthetic medicine.
Effects of Blast- and Impact-Related Concussion on Persistent Sleep Problems
Authors: Chung Samuel Y. , Harrison Elizabeth M. , Englert Robyn M. , Belding Jennifer N.
Published: June 2024

Objective:

Examine whether concussion mechanism of injury (high-level blast [HLB] vs impact) affects the likelihood of persistent sleep problems in a post-deployment military population.

Setting:

Post-Deployment Health Assessment and Re-Assessment survey records completed upon return from deployment and approximately 6 months later.

Participants:

Active duty enlisted US Marines who completed both assessments (N = 64 464).

Design:

This retrospective cohort study investigated US Marines deployed between 2008 and 2012. Logistic regression was used to examine persistent sleep problems 6 months after return from deployment.

Main Measures:

Self-reported sleep problems at reassessment were investigated as the outcome. Predictors included HLB-induced concussions (mbTBI vs none), impact-induced concussions (miTBI vs none), occupational risk of low-level blast, probable posttraumatic stress disorder (PTSD), depression, alcohol misuse, sleep problems upon deployment return, and relevant interactions, adjusting for sex and pay grade.

Results:

With the exception of sex, all main effects in the model were associated with greater likelihood of reporting persistent sleep problems at reassessment. Sleep problems at return from deployment showed the strongest associations with likelihood of reporting sleep problems at reassessment, followed by mbTBI. The latter was exacerbated by PTSD and depression.

Conclusion:

mbTBI (vs miTBI) may be more strongly associated with persistent sleep issues that warrant additional monitoring and treatment, particularly among those with probable PTSD and/or depression.
Outcomes of Six Specific Types of Post-Hospital Brain Injury Rehabilitation Programs
Authors: Salisbury David B. , Parrott Devan , Walters G. Joseph , McGrath Claire , Logan Daniel M. , Altman Irwin M. , Malec James F.
Published: June 2024

Objective:

Evaluate outcomes of intensive posthospital brain injury rehabilitation programs compared to supported living (SL) programs; explore variations in outcome by diagnostic category (traumatic brain injury, stroke, and other acquired brain injury [ABI]) and specific program type.

Setting:

Data were obtained from Residential Neurobehavioral, Residential Neurorehabilitation, Home and Community Neurorehabilitation, Day Treatment, Outpatient Neurorehabilitation, and SL programs serving individuals with ABI.

Participants:

A total of 2120 individuals with traumatic brain injury, stroke, or other ABI participated in this study.

Main Measures:

The main measures are sex, age, time since injury, and Mayo-Portland Adaptability Inventory (4th edition; MPAI-4).

Design:

Retrospective analyses of demographic variables and MPAI-4 Total, index, and subscale Rasch-derived T-scores on admission and discharge.

Results:

Gains on MPAI-4 Total T-scores were significantly greater for the intensive rehabilitation (IR) group in comparison to stable functioning in the SL group (F = 236.69, P < .001, partial η2 = .101) while controlling for admission/time 1 scores; similar results were found for MPAI-4 indices and subscales. For the IR cohort, discharge scores differed by diagnostic category after controlling for admission scores for the Total MPAI-4 T-score (F = 22.65, P < .001, partial η2 = .025), as well as all indices and subscales. A statistically significant interaction between program type and diagnostic group on discharge MPAI-4 Total T-scores (F = 2.55, P = .018, partial η2 = .01) after controlling for admission scores indicated that differing outcomes across diagnoses also varied by program type. Varying significant main effects and interactions were apparent for MPAI-4 indices and subscales with generally small effect sizes.

Conclusions:

Significant gains on MPAI-4 variables across IR program types compared to no change over a comparable period of time for SL programs supports the effectiveness of posthospital brain injury rehabilitation. This finding in the presence of small effect sizes on outcome variables for program type and for significant interactions between program type and diagnostic category suggests that participants generally were appropriately matched to program type and benefited from interventions provided through specific program types.
Invasive Fungal Sinusitis and Its Orbital Morbidity in Pediatric Population: A Strategic Treatment Algorithm and Outcomes
Authors: Das K. Nidhin , Sharma Vidhu , Shakrawal Jyoti , Tiwari Sarbesh , Soni Kapil , Choudhury Bikram , Goyal Amit
Published: June 2024

Background:

Invasive fungal sinusitis, particularly mucormycosis, presents a significant clinical challenge, especially in pediatric populations. This retrospective epidemiologic study aimed to investigate the clinical characteristics, risk factors and outcomes associated with this rare but severe condition, with a focus on orbital morbidity.

Methods:

Clinical data of 12 pediatric patients diagnosed with invasive fungal sinusitis between 2021 and 2023 were retrospectively analyzed. Diagnosis involved microbiological and histopathologic examinations, alongside radiologic imaging. Treatment comprised surgical intervention and antifungal therapy, with a detailed evaluation of orbital involvement. Statistical analysis included descriptive statistics and logistic regression.

Results:

Predominantly affecting males, the median age of the patients was 8 years. Common symptoms included orbital swelling and impaired vision. Imaging revealed characteristic features of invasive fungal sinusitis, including fat stranding and bone erosions. Orbital involvement was extensive, with poor visual outcomes observed in several cases. Surgical debridement and antifungal therapy, including transcutaneous retrobulbar Amphotericin B, were administered. Risk factors associated with poor orbital outcomes included duration of diabetes and glycated hemoglobin levels. Mortality rate stood at 22.2%.

Conclusions:

Early diagnosis, aggressive surgical intervention and combined antifungal therapy are essential for improving outcomes. Timely intervention showed stabilization of the orbital disease and better outcomes in pediatric patients. Further research with larger sample sizes is warranted to better understand and address this serious condition.
Antifungal Drug Usage in European Neonatal Units: A Multicenter Weekly Point Prevalence Study
Authors: Chorafa Elisavet , Iosifidis Elias , Oletto Andrea , Warris Adilia , Castagnola Elio , Bruggemann Roger , Groll Andreas H. , Lehrnbecher Thomas , Ferreras Antolin Laura , Mesini Alessio , Agakidou Eleni , Controzzi Tiziana , De Luca Maia , Dimitriou Gabriel , Emonts Marieke , Esposito Susanna , Fernàndez-Polo Aurora , Ghimenton-Walters Elisabetta , Gkentzi Despoina , Grasa Carlos , Hatzidaki Eleftheria , Jõgi Piia , Kildonaviciute Kornelija , Kontou Angeliki , Leibold-Aguinarte Alessa , Manzanares Angela , Mendoza-Palomar Natalia , Metsvaht Tuuli , Noni Maria , Paulus Stéphane , Perrone Serafina , Rincón-López Elena , Romani Lorenza , Sánchez Laura , Cetin Benhur Sirvan , Spoulou Vana , Strenger Volker , Vergadi Eleni , Villaverde Serena , Vuerich Marco , Zamora-Flores Elena , Roilides Emmanuel
Published: June 2024

Background:

Data on antifungal prescribing in neonatal patients are limited to either single-center or single-country studies or to 1-day recording. Therefore, we assessed antifungal longitudinal usage in neonatal units (NUs) within Europe.

Methods:

CALYPSO, a prospective weekly point prevalence study on antifungal drug usage in NUs in 18 hospitals (8 European countries), was conducted in 2020 during a 12-week period. All patients receiving systemic antifungals were included. Ward demographics were collected at the beginning; ward and patient data including indication, risk factors and antifungal regimen were weekly collected prospectively.

Results:

Among 27 participating NUs, 15 (56%) practiced antifungal prophylaxis for neonates with birth weight <1000 g or <1500 g and additional risk factors. In total, 174 patients received antifungals with a median frequency per week of 10.5% ranging from 6.9% to 12.6%. Indication for antifungal prescribing was prophylaxis in 135/174 (78%) courses and treatment in 22% [39 courses (69% empirical, 10% preemptive, 21% targeted)]. Fluconazole was the most frequent systemic agent used both for prophylaxis (133/135) and treatment (15/39, 39%). Among neonates receiving prophylaxis, the most common risk factors were prematurity (119/135, 88%), mechanical ventilation (109/135, 81%) and central vascular catheters (89/135, 66%). However, gestational age <28 weeks was only recorded in 55/135 (41%) courses and birth weight <1000 g in 48/135 (35%). Most common reason for empirical treatment was late-onset sepsis; all 8 targeted courses were prescribed for invasive candidiasis.

Conclusion:

Antifungal usage in European NUs is driven by prophylaxis and empirical treatment with fluconazole being the most prescribed agent for both indications.
The effectiveness of peer support interventions for community-dwelling adults with chronic musculoskeletal pain: a systematic review and meta-analysis of randomised trials
Authors: Wilson Monique V. , Braithwaite Felicity A. , Arnold John B. , Crouch Sophie M. , Moore Emily , Heil Alrun , Cooper Kay , Stanton Tasha R.
Published: June 2024

This systematic review and meta-analysis critically examined the evidence for peer support interventions to reduce pain and improve health outcomes in community-dwelling adults with chronic musculoskeletal pain (PROSPERO CRD42022356850). A systematic search (inception—January 2023) of electronic databases and grey literature was undertaken to identify relevant randomised controlled trials, with risk of bias and GRADE assessments performed on included studies. Meta-analyses used a generic, inverse-variance, random-effects model, calculating mean difference (MD) or standardised mean difference (SMD). Of 16,445 records identified, 29 records reporting on 24 studies (n = 6202 participants) were included. All evidence had unclear/high risk of bias and low-very low certainty. Peer support interventions resulted in small improvements in pain (medium-term: MD −3.48, 95% CI −6.61, −0.35; long-term: MD −1.97, 95% CI −3.53, −0.42), self-efficacy (medium-term: SMD 0.26, 95% CI 0.16, 0.36; long-term: SMD 0.21, 95% CI 0.07, 0.36), and function (long-term: SMD −0.10, 95% CI −0.19, −0.00) relative to usual care and greater self-efficacy (medium-term: SMD 0.36, 95% CI 0.20, 0.51) relative to waitlist control. Peer support interventions resulted in similar improvement as active (health professional led) interventions bar long-term self-efficacy (MD −0.41, 95% CI −0.77, −0.05), which favoured active interventions. No point estimates reached minimal clinically important difference thresholds. Pooled health service utilisation outcomes showed unclear estimates. Self-management, quality of life, and social support outcomes had mixed evidence. Despite low-very low evidence certainty, peer support interventions demonstrated small improvements over usual care and waitlist controls for some clinical outcomes, suggesting that peer support may be useful as an adjunct to other treatments for musculoskeletal pain.
Telehealth in Urology Beyond COVID-19
Authors: Strup Sydney , Modi Parth , Finkelstein Lisa , Kraft Kate , North Amanda , Spitz Aaron , Thatcher Jacob , Rhee Eugene , Harris Andrew
Published: June 2024

Introduction:

Implementation of telehealth (TH) accelerated during the COVID-19 pandemic and has become a vital part of health care delivery. As we move toward the post-COVID-19 era, clinical practice has demonstrated a need for updated policies and quality improvement to solidify the role of TH in the urology care setting. The AUA Census data were used to explore trends, benefits, and barriers to urology TH implementation.

Methods:

The AUA Workforce Workgroup and Telehealth Taskforce analyzed data from the 2019-2022 AUA Census. Pertinent variables included utilization, patient satisfaction, care settings, quality, and diagnoses amenable to TH.

Results:

Pre-COVID-19 TH utilization increased from 11.9% to 81% during and after the COVID-19 pandemic. TH is predominately used in metropolitan academic centers, with usage increasing from 12.8% to 83% in these areas during the pandemic. Usage also increased in non-metropolitan areas from 3.8% to 61.2%. Overall, 76.7% reported increased ease of scheduling follow-ups, 62% ease of ordering tests, and 69.5% ease of accessing patient data in favor of audio visits vs in-person visits. TH utilization increased from 42.4% to 65% for initial visits and 66.8% to 82% for follow-up visits. Over 80% of practicing urologists younger than 54 years desire the use of telemedicine for follow-up visits. TH increased patient access to care by 51.6%, and 54% of urologists expressed desire to continue using or increase utilization of TH. The top 3 barriers of patient’s ability to receive telemedicine were 67.6% noting lack of knowledge in using patient portal/software needed for telemedicine visits, 49.6% had lack of adequate conferencing tools, and 43.9% lacked high-speed internet service to enable video visits. In total, 53.4% of urologists would absolutely or probably increase usage if payment parity of TH was comparable with that of in-office E/M services.

Conclusion:

TH implementation accelerated during the COVID-19 era. In the post-COVID-19 era, TH continues to be important across multiple areas including patient and physician satisfaction and increasing access to care, particularly in rural areas. Barriers exist, especially concerning payment parity, and could be eliminated through advocacy for policy updates and standardization of technology.
TOP 100 and detection of colorectal lesions in colon capsule endoscopy: more than meets the eye
Authors: Lima Capela Tiago , Arieira Cátia , Xavier Sofia , Cúrdia Gonçalves Tiago , Boal Carvalho Pedro , Rosa Bruno , Cotter José
Published: June 2024

Colon capsule endoscopy (CCE) is a well-known method for the detection of colorectal lesions. Nevertheless, there are no studies reporting the accuracy of TOP 100, a CCE software tool, for the automatic detection of colorectal lesions in CCE. We aimed to evaluate the performance of TOP 100 in detecting colorectal lesions in patients submitted to CCE for incomplete colonoscopy compared with classic reading. A retrospective cohort study including adult patients submitted to CCE (PillCam COLON 2; Medtronic) for incomplete colonoscopy. Blinded for each other’s evaluation, one experienced reader analyzed the TOP 100 images and the other performed classic reading to identify colorectal lesions. Detection of colorectal lesions, namely polyps, angioectasia, blood, diverticula, erosions/ulcers, neoplasia, and subepithelial lesions was assessed and TOP 100 performance was evaluated compared with the gold standard (classic reading). A total of 188 CCEs were included. Prevalence of colorectal lesions, polyps, angioectasia, blood, diverticula, erosions/ulcers, neoplasia, and subepithelial lesions were 77.7, 54.3, 8.5, 1.6, 50.0, 0.5, 0.5, and 1.1%, respectively. TOP 100 had a sensitivity of 92.5%, specificity of 69.1%, negative predictive value of 72.5%, positive predictive value of 91.2%, and accuracy of 87.2% for detecting colorectal lesions. TOP 100 had a sensitivity of 89.2%, specificity of 84.9%, negative predictive value of 86.9%, positive predictive value of 87.5%, and accuracy of 87.2% in detecting polyps. All colorectal lesions other than polyps were identified with 100% accuracy by TOP 100. TOP 100 has been shown to be a simple and useful tool in assisting the reader in the prompt identification of colorectal lesions in CCE.
Learning styles, approaches and academic performance of second and third-year medical students of a medical college of Kathmandu: a descriptive cross-sectional study
Authors: Khadka Anjan , Basnet Anuj , Jaiswal Riya , Karki Sudha , Magar Sonali Shrees
Published: June 2024

Background:

The research is based on a questionnaire to study the different learning styles among medical students, and their approach to intellectual development.

Methods:

This is an observational, cross-sectional study conducted on 140 participants. Initially after the informed consent process, the second-year and third-year medical students were requested to respond to the questionnaire without consulting friends. Data were analyzed descriptively and comparison was made.

Results:

In this study, the students were mostly visual learners, followed by solo learners, audio learners, verbal learners, and social learners. The majority of the students in our study (84.56%) studied less than 4 h per day beyond normal lecture hours. Similarly, 45.71% of students studied continuously for 30–60 min. During break, 63.57% of students used social media, watched television, and videos, and listened to music. Most students (75%) preferred to study in a hostel room and only 12.85% used the library as their study place. The majority of the students (65.71%) of students slept between six to eight hours. The University’s suggested medical textbooks and reference materials were consulted by 94.3% of the students. The 47.85% of students favored self-directed learning with 56.42% preferring to read and write to retain the learned materials. Self-prepared notes were commonly used by the majority of students (60.7%).

Conclusions:

This research evaluates the preferred learning preferences of medical students and their relationship to academic performance, which will improve the effectiveness of teaching and learning between teachers and medical students.
Venous Thromboembolism Prevention in Rehabilitation
Authors: Geerts William H. , Jeong Eric , Robinson Lawrence R. , Khosravani Houman
Published: June 2024

Venous thromboembolism is a frequent complication of acute hospital care, and this extends to inpatient rehabilitation. The timely use of appropriate thromboprophylaxis in patients who are at risk is a strong, evidence-based patient safety priority that has reduced clinically important venous thromboembolism, associated mortality and costs of care. While there has been extensive research on optimal approaches to venous thromboembolism prophylaxis in acute care, there is a paucity of high-quality evidence specific to patients in the rehabilitation setting, and there are no clinical practice guidelines that make recommendations for (or against) thromboprophylaxis across the broad spectrum of rehabilitation patients. Herein, we provide an evidence-informed review of the topic with practice suggestions. We conducted a series of literature searches to assess the risks of venous thromboembolism and its prevention related to inpatient rehabilitation as well as in major rehabilitation subgroups. Mobilization alone does not eliminate the risk of venous thromboembolism after another thrombotic insult. Low molecular weight heparins and direct oral anticoagulants are the principal current modalities of thromboprophylaxis. Based on the literature, we make suggestions for venous thromboembolism prevention and include an approach for consideration by rehabilitation units that can be aligned with local practice.
Brief Report: Characterizing HIV Drug Resistance in Cases of Vertical Transmission in the VESTED Randomized Antiretroviral Treatment Trial
Authors: Bishop Marley D. , Korutaro Violet , Boyce Ceejay L. , Beck Ingrid A. , Styrchak Sheila M. , Knowles Kevin , Ziemba Lauren , Brummel Sean S. , Coletti Anne , Jean-Philippe Patrick , Chakhtoura Nahida , Vhembo Tichaona , Cassim Haseena , Owor Maxensia , Fairlie Lee , Moyo Sikhulile , Chinula Lameck , Lockman Shahin , Frenkel Lisa M.
Published: June 2024

Introduction:

VESTED (Virologic Efficacy and Safety of ART combinations with tenofovir alafenamide fumarate (TAF)/tenofovir disoproxil fumarate (TDF), efavirenz, and dolutegravir)(NCT03048422) compared the safety and efficacy of 3 antiretroviral treatment (ART) regimens in pregnant and postpartum women: dolutegravir + emtricitabine/TAF, dolutegravir + emtricitabine/TDF, and efavirenz/emtricitabine/TDF. Vertical HIV transmission (VT) occurred in 4 of 617 live-born infants (0.60%), who were evaluated for HIV drug resistance (HIVDR) and other risk factors.

Setting:

In 2018–2020, pregnant women (weeks 14–28) living with HIV underwent ≤14 days of ART were enrolled at 22 international sites and followed with their infants through 50 weeks postpartum.

Methods:

HIV sequences derived by single-genome amplification from longitudinally collected specimens were assessed from VT cases for HIVDR in protease, reverse transcriptase, integrase, and the nef 3′polypurine tract (3′PPT).

Results:

The 4 case mothers were prescribed efavirenz-based ART for 1–7 days before randomization to study ART. Their infants received postnatal nevirapine ± zidovudine prophylaxis and were breastfed. A total of 833 single-genome amplification sequences were derived. The “major” (Stanford HIVDR Score ≥60) non-nucleoside reverse transcriptase inhibitor (NNRTI) mutation (K103N) was detected persistently in 1 viremic mother and likely contributed to VT of HIVDR. Major NNRTI HIVDR mutations were detected in all 3 surviving infants. Neither integrase nor high frequencies of 3′PPT mutations conferring dolutegravir HIVDR were detected. The timing of HIV infant diagnosis, plasma HIV RNA levels, and HIVDR suggests 1 in utero, 1 peripartum, 1 early, and 1 late breastfeeding transmission.

Conclusions:

VT was rare. New-onset NNRTI HIVDR in case mothers was likely from efavirenz ART or dolutegravir ART prescribed before study, and in 1 case, it seemed transmitted to the infant despite nevirapine prophylaxis.

NCBI GenBank Accession Numbers:

OQ911992-OQ912874.
18F-FDG PET/CT Unveils Coexistent Myelomatous Hepatosplenic and Thyroid Cartilage Involvement
Authors: Abdlkadir Ahmed Saad , Almasri Nidal , Estrada Enrique , Fani Bozkurt Murat , Al-Ibraheem Akram
Published: June 2024

Extramedullary myelomatous disease is an aggressive condition where clonal plasma cells proliferate outside the bone marrow, allowing independent survival. This state is generally associated with negative outcomes. A 65-year-old woman presented with progressive bilateral hypochondrial pain, was initially misattributed to an inflammatory etiology, and was consequently managed with corticosteroid therapy. A bone marrow biopsy was offered after further deterioration confirming plasma cell myeloma. Afterward, 18F-FDG PET/CT revealed medullary and extramedullary hepatosplenic and thyroid cartilage involvement, concluding an overall picture of an atypical and extensive extramedullary myelomatous disease.
Patient Handoff Practices at the Epilepsy Centers in the United States: A Survey of the Medical Directors
Authors: Selioutski Olga , Herman Susan , Ritzl Eva Katharina , Garlinghouse Matthew , Taraschenko Olga
Published: June 2024

Purpose:

Communication failure is one of the most significant causes of medical errors. Providing care to patients with seizures at comprehensive epilepsy centers requires uninterrupted coverage and a multidisciplinary approach. However, handoff practices in these settings have not been comprehensively assessed, and recommendations for their standardization are currently lacking. The aim of this observational study was to define the scope of existing practices for patient handoffs across epilepsy centers in the United States and provide relevant recommendations.

Methods:

A 79-question survey was developed to establish the patterns of transition of care for patients undergoing continuous EEG recording, including the periodicity of handoffs and specifics of the relevant workflow. With permission from the National Association of Epilepsy Centers (NAEC), the survey was distributed to the medical directors of all Level 3 and 4 NAEC-accredited epilepsy centers in the United States.

Results:

The responses were obtained from 70 institutions yielding a survey response rate of 26%. Of these, more than 77% had established weekly handoff processes for both the epilepsy monitoring unit and continuous EEG (cEEG) monitoring services. However, only 53% and 43% of centers had procedures for daily service transfers for the patients admitted to the epilepsy monitoring unit or the patients undergoing cEEG, respectively. The patterns of handoffs were complex and utilized group handoffs in <50% of institutions. In most centers (>70%), patient data transmitted through handoffs included history, clinical information, and EEG findings. However, templates were not applied to standardize this information. All participants agreed or strongly agreed that a culture of patient safety was maintained in their place of practice; however, 12% of participants felt that insufficient time was allowed to discuss these patients or carry out the handoffs without interruptions.

Conclusions:

Existing handoff practices are not uniform or fully established across epilepsy centers in the United States. This study recommends that guidelines for formal handoff procedures be developed and introduced as a quality metric for all NAEC–accredited epilepsy centers.
High-Frequency Stimulation of the Centromedian Thalamic Nucleus Aborts Seizures and Ictal Apnea
Authors: Nathan Cody L. , Gavvala Jay R. , Chaitanya Ganne , Cunningham Elizabeth , Lee Jungwha Julia , Adney Scott , Rosenow Joshua , Schuele Stephan , Gerard Elizabeth
Published: June 2024

A 32-year-old right-handed woman presented with medically and surgically refractory left temporal neocortical epilepsy secondary to focal cortical dysplasia who underwent stereoelectroencephalography involving the centromedian nucleus of the thalamus. With the use of real-time stereoelectroencephalography monitoring, four electroclinical seizures were aborted by administering high-frequency stimulation at the centromedian nucleus at seizure onset. Seizures before stimulation were all associated with ictal apnea, while those with stimulation had no ictal apnea. This case demonstrates how providing high-frequency stimulation to the centromedian nucleus of the thalamus can abort electroclinical seizures and ictal apnea.
Survey of Continuous EEG Monitoring Practices in the United States
Authors: Kayal Gina , Oliveira Kristen N. , Haneef Zulfi
Published: June 2024

Objective:

Continuous EEG (cEEG) practice has markedly changed over the last decade given its utility in improving critical care outcomes. However, there are limited data describing the current cEEG infrastructure in US hospitals.

Methods:

A web-based cEEG practice survey was sent to neurophysiologists at 123 ACGME-accredited epilepsy or clinical neurophysiology programs.

Results:

Neurophysiologists from 100 (81.3%) institutions completed the survey. Most institutions had 3 to 10 EEG faculty (80.0%), 1 to 5 fellows (74.8%), ≥6 technologists (84.9%), and provided coverage to neurology ICUs with >10 patients (71.0%) at a time. Round-the-clock EEG technologist coverage was available at most (90.0%) institutions with technologists mostly being in-house (68.0%). Most institutions without after-hours coverage (8 of 10) attributed this to insufficient technologists. The typical monitoring duration was 24 to 48 hours (23.0 and 40.0%), most commonly for subclinical seizures (68.4%) and spell characterization (11.2%). Larger neurology ICUs had more EEG technologists (p = 0.02), fellows (p = 0.001), and quantitative EEG use (p = 0.001).

Conclusions:

This survey explores current cEEG practice patterns in the United States. Larger centers had more technologists and fellows. Overall technologist numbers are stable over time, but with a move toward more in-hospital compared with home-based coverage. Reduced availability of EEG technologists was a major factor limiting cEEG availability at some centers.
Direct (D)-Wave Monitoring Enhancement With Subdural Electrode Placement: A Case Series
Authors: Shah Harshal A. , Chen Adrian , Green Ross , Ber Roee , D'Amico Randy S. , Sciubba Daniel M. , Lo Sheng-Fu Larry , Silverstein Justin W.
Published: June 2024

Purpose:

Direct-wave (D-wave) neuromonitoring is a direct measure of corticospinal tract integrity that detects potential injury during spinal cord surgery. Epidural placement of electrodes used for D-wave measurements can result in high electrical impedances resulting in substantial signal noise that can compromise signal interpretation. Subdural electrode placement may offer a solution.

Methods:

Medical records for consecutive patients with epidural and subdural D-wave monitoring were reviewed. Demographic and clinical information including preoperative and postoperative motor strength were recorded. Neuromonitoring charts were reviewed to characterize impedances and signal amplitudes of D-waves recorded epidurally (before durotomy) and subdurally (following durotomy). Nonparametric statistics were used to compare epidural and subdural D-waves.

Results:

Ten patients (50% women, median age 50.5 years) were analyzed, of which five patients (50%) were functionally independent (modified McCormick grade
≤
II) preoperatively. D-waves were successfully acquired by subdural electrodes in eight cases and by epidural electrodes in three cases. Subdural electrode placement was associated with lower impedance values (P = 0.011) and a higher baseline D-wave amplitude (P = 0.007) relative to epidural placement. No association was observed between D-wave obtainability and functional status, and no adverse events relating to subdural electrode placement were encountered.

Conclusions:

Subdural electrode placement allows successful D-wave acquisition with accurate monitoring, clearer waveforms, and a more optimal signal-to-noise ratio relative to epidural placement. For spinal surgeries where access to the subdural compartment is technically safe and feasible, surgeons should consider subdural placement when monitoring D-waves to optimize clinical interpretation.
Fall assessment and intervention among community-dwelling older people in a primary health care center in Spain: a best practice implementation project
Authors: Fernández María García , Pantiga Mónica Martínez , Fernández Carmen Pino , Muñoz Laura Albornos , Guerrero Carmen Gutierrez
Published: June 2024

Introduction:

The implementation of fall prevention programs in the community is complex. Although there is solid scientific evidence that supports the effectiveness of such programs, there are multiple barriers that should be addressed using multifaceted strategies.

Aims:

The aim of this project was to increase compliance with evidence-based recommendations regarding fall risk screening and preventive interventions among older adults in a primary health care setting.

Methods:

This project used a pre-/post-implementation clinical audit based on the JBI Evidence Implementation Framework. Eight audit criteria were derived from JBI evidence summaries. The sample size was 62 patients aged 70 years or older. Data collection methods included a review of medical records and a questionnaire. A baseline audit was conducted and five barriers to best practice were identified. Strategies were then developed to increase compliance with the evidence-based recommendations, guided by JBI's Getting Research into Practice (GRiP) analysis. A follow-up audit was conducted in July 2022 to evaluate changes in compliance with best practices.

Results:

The baseline audit showed 0% compliance with best practice recommendations for seven out of eight audit criteria. Five barriers were identified: (1) absence of fall risk screening tools, (2) lack of fall prevention intervention protocols, (3) insufficient reporting of fall episodes in the records, (4) need for staff training, and (5) high staff turnover. Following the implementation of a fall risk assessment and intervention protocol, along with staff training, seven out of eight audit criteria increased from 0% to between 22.6% and 100%.

Conclusions:

This evidence-based implementation project improved nursing practice in relation to compliance with best practice interventions to prevent falls.

Spanish abstract:

http://links.lww.com/IJEBH/A229
Fluorescent identification of axons, dendrites and soma of neuronal retinal ganglion cells with a genetic marker as a tool for facilitating the study of neurodegeneration
Authors: Sripinun Puttipong , Lu Wennan , Nikonov Sergei , Patel Suhani , Hennessy Sarah , Bell Brent A. , Mitchell Claire H.
Published: June 2024

This study characterizes a fluorescentSlc17a6-tdTomato neuronal reporter mouse line offering strong labeling in axons throughout the optic nerve, dendrites and soma in 99% of retinal ganglion cells (RGCs). The model facilitates neuronal assessmentex vivowith wholemounts quantified to show neurodegeneration following optic nerve crush or elevated IOP as related to glaucoma,in vitrowith robust Ca2+responses to P2X7 receptor stimulation in neuronal cultures, andin vivousing a confocal scanning laser ophthalmoscope (cSLO). While the tdTomato signal showed strong overlap with RGC markers, BRN3A and RBPMS, there was no cross-labeling of displaced amacrine cells in the ganglion cell layer. Controls indicated no impact ofSlc17a6-tdTomato expression on light-dependent neuronal function, as determined with a microelectrode array (MEA), or on structure, as measured with optical coherence tomography (OCT). In summary, this novel neuronal reporter mouse model offers an effective means to increase the efficiency for real-time, specific visualization of retinal ganglion cells. It holds substantial promise for enhancing our understanding of RGC pathology in glaucoma and other diseases of the optic nerve, and could facilitate the screening of targeted therapeutic interventions for neurodegeneration.

Abstract Figure

Graphical abstract.

Fluorescent identification of axons, dendrites and soma of neuronal retinal ganglion cells with a genetic marker as a tool for facilitating the study of neurodegeneration. Puttipong Sripinun, Wennan Lu, Sergei Nikonov, Suhani Patel, Sarah Hennessy, Claire H. Mitchell*. This study delves into a new mouse model, featuring a fluorescentSlc17a6-tdTomato neuronal reporter. This model effectively labels axons in the optic nerve, as well as dendrites and soma in 99% of retinal ganglion cells (RGCs). This allows for bothin vitroandin vivoassessment of neurodegeneration, offering a practical tool for real-time, precise visualization of RGCs, with potential applications in various fields of neuroscience and neurology. Created byBiorender.com.
HOS15-mediated turnover of PRR7 enhances freezing tolerance
Authors: Kim Yeon Jeong , Kim Woe Yeon , Somers David E.
Published: June 2024

ArabidopsisPSEUDO RESPONSE REGULATOR7(PRR7) is a core component of the circadian oscillator which also plays a crucial role in freezing tolerance. PRR7 undergoes proteasome-dependent degradation to discretely phase maximal expression in early evening. While its transcriptional repressive activity on downstream genes is integral to cold regulation, the mechanism of the conditional regulation of the PRR7 protein activity is unknown. We used double mutant analysis, protein interaction and ubiquitylation assays to establish that the ubiquitin ligase adaptor,HIGH EXPRESSION OF OSMOTICALLY RESPONSIVE GENE 15(HOS15), controls the protein accumulation pattern of PRR7 through direct protein-protein interactions. Freezing tolerance and electrolyte leakage assays show that PRR7 enhances cold temperature sensitivity, supported by ChIP-qPCR atC-REPEAT BINDING FACTOR(CBF) andCOLD REGULATED 15A(COR15A) promoters where PRR7 levels were higher in hos15 mutants. We establish that HOS15 mediates PRR7 protein turnover through enhanced ubiquitylation at low temperature in the dark. Under the same conditions, increased PRR7 association with the promoter regions ofCBFsandCOR15Ainhos15correlates with decreasedCBF1andCOR15Atranscription and enhanced freezing sensitivity. We propose a novel mechanism whereby HOS15-mediated regulation of PRR7 provides an intersection between the circadian system and other cold acclimation pathways leading to freezing tolerance through upregulation ofCBF1andCOR15A.
Insights into the metabolic consequences of type 2 diabetes
Authors: Bocher Ozvan , Singh Archit , Huang Yue , Võsa Urmo , Reimann Ene , Arruda Ana , Barysenska Andrei , Kolde Anastassia , Rayner Nigel W. ,   Estonian Biobank research team, Esko Tõnu , Mägi Reedik , Zeggini Eleftheria
Published: June 2024

Circulating metabolite levels have been associated with type 2 diabetes (T2D), but the extent to which these are affected by T2D and the involvement of genetics in mediating these relationships remain to be elucidated. In this study, we investigate the interplay between genetics, metabolomics and T2D risk in the UK Biobank dataset. We find 79 metabolites with a causal association to T2D, mostly spanning lipid-related classes, while twice as many metabolites are causally affected by T2D liability, including branched-chain amino acids. Secondly, using an interaction quantitative trait locus (QTL) analysis, we describe four metabolites, consistently replicated in an independent dataset from the Estonian Biobank, for which genetic loci in two different genomic regions show attenuated regulation in T2D cases compared to controls. The significant variants from the interaction QTL analysis are significant QTLs for the corresponding metabolites in the general population, but are not associated with T2D risk, pointing towards consequences of T2D on the genetic regulation of metabolite levels. Finally, we find 165 metabolites associated with microvascular, macrovascular, or both types of T2D complications, with only a few discriminating between complication classes. Of the 165 metabolites, 40 are not causally linked to T2D in either direction, suggesting biological mechanisms specific to the occurrence of complications. Overall, this work provides a map of the metabolic consequences of T2D and of the genetic regulation of metabolite levels and enable to better understand the trajectory of T2D leading to complications.
Individual variation in red deer responsiveness towards human disturbance: A prospect for wildlife viewing in Europe’s national parks
Authors: Böhme Björn , Peters Anne , Mitterwallner Veronika , Sommer Fabian , Heurich Marco , Hertel Anne G.
Published: June 2024

Animals adjust behavior to changes in perceived predation risk, their so called “landscape of fear”. However, individuals within populations can differ greatly in their plasticity towards perceived risk. In national parks, where animals are often protected from human hunting, wildlife may start losing their fear of humans and become more observable, a process that starts at the individual level. Here we aim to test whether ungulates in one of the only largely non-hunted populations in Europe show individual variation in behavioral plasticity towards gradients of human disturbance. We used random regression to dissolve the individual movement responses of 63 red deer (Cervus elaphus) to spatio-temporal variation in human recreation. We measured human disturbance as the number of recreationists on the closest trail on a given day. We quantified conditional repeatability, i.e., between-individual variation, along the perceived risk gradient. To avoid pseudoreplication, we fitted models to the hours of the day with peak activity or passivity. Diel activity patterns were conserved across individuals in our population, with peak activity in the early morning and late evening. When actively foraging during the morning, red deer responded to human disturbance with flight, i.e., longer hourly movement distances, while they reduced movement in response to disturbance when resting in the middle of the day. Between-individual variation increased with visitor frequentation, i.e., red deer behaved similarly when human disturbance was low, but with increasing human disturbance some deer adjusted movement while others responded little. Our results show that individuals varied greatly in their responsiveness towards human disturbance, with some resuming normal movement behavior. Flight responses are costly and may be selected against in non-hunted populations, leading to an increase in human-tolerant individuals over time. These are good news for national parks for which wildlife viewing is an effective tool to engage the public in conservation. Observing wildlife in Europe is difficult, likely due to a long persecution history and strong hunting pressure. Our results demonstrate that large non-hunting zones may, over time, successfully reduce wildlife’s extreme fear of humans.
Prediction of protein functions using Semantic Based Regularization
Authors: Dimitri Giovanna Maria
Published: June 2024

In this work, done in collaboration with Prof. Michelangelo Diligenti (department of Engineering and Mathematics, University of Siena) we present the use of Semantic Based Regularization Kernel based machine learning method to predict protein function. We initially build the protein functions ontology, given an initial list of proteins. We subsequently performed predictions, both at individual and at joint levels of functions, introducing and adding to the learning procedure ad-hoc first order logic rules. Experiments showed promising performances in using logic rules within the learning process for the sake of bioinformatics applications.