bluuebunny/crossref_metadata_2025 huggingface dataset:
Over‐ and underreporting of seizures: How big is the problem?
Authors: Hannon Timothy , Fernandes Kiran M. , Wong Victoria , Nurse Ewan S. , Cook Mark J.
Published: March 2024

Objective

Clinical decisions on managing epilepsy patients rely on patient accuracy regarding seizure reporting. Studies have noted disparities between patient‐reported seizures and electroencephalographic (EEG) findings during video‐EEG monitoring periods, chiefly highlighting underreporting of seizures, a well‐recognized phenomenon. However, seizure overreporting is a significant problem discussed within the literature, although not in such a large cohort. Our aim is to quantify the over‐ and underreporting of seizures in a large cohort of ambulatory EEG patients.

Methods

We performed a retrospective data analysis on 3407 patients referred to a diagnostic service for ambulatory video‐EEG between 2020 and 2022. Both patient‐reported events and events discovered on review of the video‐EEG were analyzed and classified as epileptic, psychogenic (typically clinical motor events, without accompanying EEG change), or noncorrelated events (NCEs; without perceivable clinical or EEG change). Events were analyzed by state of arousal and indication for referral. Subgroup analysis was performed in patients with focal and generalized epilepsies.

Results

A total of 21 024 events were recorded by 3407 patients. Fifty‐eight percent of reported events were NCEs, whereas 27% of all events were epileptic. Sixty‐four percent of epileptic seizures were not reported by the patient but discovered by the clinical service on review of the recording. NCEs were in the highest proportion in the awake and drowsy arousal states and were the most common event type for the majority of referral indications. Subgroup analysis found a significantly higher proportion of NCEs in the patients with focal epilepsy (23%) compared to generalized epilepsy (10%; p < .001, chi‐squared proportion test).

Significance

Our results reaffirm the phenomenon of underreporting and highlight the prevalence of overreporting. Overreporting likely represents irrelevant symptoms or electrographic discharges not represented on scalp electrodes, identification of which has important clinical relevance. Future studies should analyze events by risk factors to elucidate relationships clinicians can use and investigate the etiology of NCEs.
Should radiographs of the thoracolumbar spine remain part of the pre‐purchase examination?
Authors: Looijen Maty G. P. , Morgan Rhiannon E.
Published: March 2024

The inclusion of thoracolumbar radiographs in a pre‐purchase examination (PPE) is a topic of current and intense debate, subsequent to a statement from the Federation of European Equine Veterinary Associations (FEEVA) advocating the exclusion of spinous process radiography from the PPE. This review will consider the reasons behind the addition of such radiographs into PPEs, the limitations of radiography in ambulatory practice and therefore, the diagnostic limitations to the practitioner, the diagnostic benefit of a complete radiographic examination, and discussion of common and less‐frequent thoracolumbar pathologies. We will focus on laterolateral radiographs of the spinous processes as these are most commonly acquired during the PPE. The lack of consistent and repeatable grading systems highlights the subjective nature and variability in assessing this region radiographically. Coupled with the sparse scientific evidence of correlation between clinical signs of primary back pain, future performance in different levels and disciplines of equine athletes and radiographic abnormalities of the thoracolumbar spine leads us to conclude that taking radiographs of the back during PPEs should not be performed unless the clinical examination indicates otherwise.
AI‐driven IoT‐fog analytics interactive smart system with data protection
Authors: Haseeb Khalid , Saba Tanzila , Rehman Amjad , Abbas Naveed , Kim Pyoung Won
Published: March 2024

In recent decades, fog computing has contributed significantly to the expansion of smart cities. It generated numerous real‐time data and coped with time‐constraint applications. They use sensors, physical objects, and network standards to monitor health imaging, traffic surveillance, industrial management, and so forth. Interactive applications have been proposed for the Internet of Things (IoT) to control wireless channels and improve communication. However, most of the existing lack of handing network interference and a reliable monitoring process. Moreover, many solutions are vulnerable to external threats, resulting in inconsistent and untrustworthy information for end users. Thus, this article proposes a framework that considers possible shortest paths to provide the most reliable and low‐latency healthcare decision system using Q‐learning. In addition, fog devices offer a trusted transmission interference system and are kept secure. The proposed framework is specially designed for rapid real‐time medical data processing while enforcing robust security throughout the IoT‐based transmission process. To identify the health sensors in pairwise objects with the initial computing cost, the proposed framework applies graph theory. It also extracts the most effective and least loaded communication edges by examining the behaviour of devices. Moreover, the identities of devices are verified using lightweight timestamps and secret information, accordingly, it decreases the privacy threats.
The dual roles of dissimilatory iron reduction in the carbon cycle: The “iron mesh” effect can increase inorganic carbon sequestration
Authors: Zhao Cheng , Xun Fan , Li Biao , Han Xiaotong , Liu Huan , Du Yingxun , Wu Qinglong L. , Xing Peng
Published: March 2024

Dissimilatory iron reduction (DIR) can drive the release of organic carbon (OC) as carbon dioxide (CO2) by mediating electron transfer between organic compounds and microbes. However, DIR is also crucial for carbon sequestration, which can affect inorganic‐carbon redistribution via iron abiotic–phase transformation. The formation conditions of modern carbonate‐bearing iron minerals (ICFe) and their potential as a CO2 sink are still unclear. A natural environment with modern ICFe, such as karst lake sediment, could be a good analog to explore the regulation of microbial iron reduction and sequential mineral formation. We find that high porosity is conducive to electron transport and dissimilatory iron‐reducing bacteria activity, which can increase the iron reduction rate. The iron‐rich environment with high calcium and OC can form a large sediment pore structure to support rapid DIR, which is conducive to the formation and growth of ICFe. Our results further demonstrate that the minimum DIR threshold suitable for ICFe formation is 6.65 μmol g−1 dw day−1. DIR is the dominant pathway (average 66.93%) of organic anaerobic mineralization, and the abiotic‐phase transformation of Fe2+ reduces CO2 emissions by ~41.79%. Our findings indicate that as part of the carbon cycle, DIR not only drives mineralization reactions but also traps carbon, increasing the stability of carbon sinks. Considering the wide geographic distribution of DIR and ICFe, our findings suggest that the “iron mesh” effect may become an increasingly important vector of carbon sequestration.
Canopy nitrogen deposition enhances soil ecosystem multifunctionality in a temperate forest
Authors: Yang An , Zhu Dong , Zhang Weixin , Shao Yuanhu , Shi Yu , Liu Xu , Lu Ziluo , Zhu Yong‐Guan , Wang Hongtao , Fu Shenglei
Published: March 2024

Nitrogen (N) deposition affects ecosystem functions crucial to human health and well‐being. However, the consequences of this scenario for soil ecosystem multifunctionality (SMF) in forests are poorly understood. Here, we conducted a long‐term field experiment in a temperate forest in China, where N deposition was simulated by adding N above and under the canopies. We discover that canopy N addition promotes SMF expression, whereas understory N addition suppresses it. SMF was regulated by fungal diversity in canopy N addition treatments, which is largely due to the strong resistance to soil acidification and efficient resource utilization characteristics of fungi. While in understory N addition treatments, SMF is regulated by bacterial diversity, which is mainly because of the strong resilience to disturbances and fast turnover of bacteria. Furthermore, rare microbial taxa may play a more important role in the maintenance of the SMF. This study provides the first evidence that N deposition enhanced SMF in temperate forests and enriches the knowledge on enhanced N deposition affecting forest ecosystems. Given the divergent results from two N addition approaches, an innovative perspective of canopy N addition on soil microbial diversity‐multifunctionality relationships is crucial to policy‐making for the conservation of soil microbial diversity and sustainable ecosystem management under enhanced N deposition. In future research, the consideration of canopy N processes is essential for more realistic assessments of the effects of atmospheric N deposition in forests.
Positive effects of tree species diversity on productivity switch to negative after severe drought mortality in a temperate forest experiment
Authors: Shovon Tanvir Ahmed , Auge Harald , Haase Josephine , Nock Charles A.
Published: March 2024

The synthesis of a large body of evidence from field experiments suggests more diverse plant communities are more productive as well as more resistant to the effects of climatic extremes like drought. However, this view is strongly based on data from grasslands due to the limited empirical evidence from tree diversity experiments. Here we report on the relationship between tree diversity and productivity over 10 years in a field experiment established in 2005 that was then affected by the 2018 mega‐drought in central Europe. Across a number of years, tree species diversity and productivity were significantly positively related; however, the slope switched to negative in the year of the drought. Net diversity effects increased through time, with complementarity effects making greater contributions to the net diversity effect than selection effects. Complementarity effects were clearly positive in three‐ and five‐species mixtures before the drought (2012–2016) but were found to decrease in the year of the drought. Selection effects were clearly positive in 2016 and remained positive in the drought year 2018 in two‐, three‐, and five‐species mixtures. The survival of Norway spruce (Picea abies) plummeted in response to the drought, and a negative relationship between species diversity and spruce survival was found. Taken together, our findings suggest that tree diversity per se may not buffer communities against the impacts of extreme drought and that tree species composition and the drought tolerance of tree species (i.e., species identity) will be important determinants of community productivity as the prevalence of drought increases.
Hyperspectral imaging and deep learning for detection and quantification of germination in Bacillus cereus spores
Authors: Soni Aswathi , Dixit Yash , Brightwell Gale , Reis Marlon M.
Published: March 2024

Germination of Bacillus cereus spores followed by growth and replication of the vegetative cells in food can result in food poisoning and therefore significant economic and health impacts. This study explores a novel approach to detect and differentiate spores and germinated B. cereus cells using hyperspectral imaging (HSI) in combination with machine learning using three different germination triggers. HSI could successfully differentiate between dormant spores, germinated cells and structural controls (non‐spores). The spectral data in the visible‐near‐infrared range are sensitive to unique structural and chemical characteristics specific to spores, setting them apart from their vegetative counterparts and non‐biological controls. This non‐destructive and robust approach shows significant potential for detection and assessment of the physiological state (dormant or germinated). Therefore, HSI is a potential method for the detection of germination in B. cereus spores and merits further research and validation.
Potential of barley straw pretreated with a lignin inhibitor as an adjunct during beer production
Authors: Machado Filho Evandro Ribeiro , Lazzari Anderson , Saraiva Bianka Rocha , Gonzaga Diego Eduardo Romero , Gibin Mariana Sversut , dos Santos Wanderley Dantas , Sato Francielle , Matumoto Pintro Paula Toshimi
Published: March 2024

Barley straw is an agricultural residue of low added value used for alcohol production through chemical pretreatments. However, chemical pretreatments are expensive and generate residues, preventing the possible application of this product in the food. This study aims to use piperonylic acid as a lignin inhibitor applied in a barley field to obtain a pretreated straw more accessible to structural carbohydrates, releasing fermentable sugars and partially replacing malt in beer. Straws showed structural and chemical changes with SEM, FTIR and compositional analysis. These changes enabled the fermentable sugars release when inserted in wort with 2.5% of barley straw, using cellulase isolated or a xylanase and cellulase mixture in 1:2 proportion, maintaining a final enzyme concentration of 16 U mL−1. Barley straw pretreated with lignin inhibitor can be used as a brewing adjunct, increasing the release of fermentable sugars and bioactive compounds.
Impact of extraction methods on bioactive compounds and antioxidant activities of Thai jasmine rice leaf extracts
Authors: Ayuni Dwi , Neri Lilia , Pittia Paola , Sirikantaramas Supaart , Devahastin Sakamon , Borompichaichartkul Chaleeda
Published: March 2024

Studies have recently highlighted potential health benefits of young rice leaves; however, optimization of extraction process was often overlooked. The present study aimed to assess impacts of extraction methods, namely, maceration and decoction, on total phenolics content and antioxidant activities based on FRAP, DPPH, and ABTS assays of extracts from Thai cultivar of Jasmine rice leaves. The study examined influences of ethanol concentration (0–100% (v/v) for maceration), boiling time (10–30 min for decoction) and solvent‐to‐solid ratio (20–40 mL g−1 for both maceration and decoction). Results showed that under its optimal condition (50% (v/v) ethanol concentration and solvent‐to‐solid ratio of 30 mL g−1), maceration yielded significantly higher total phenolic content, 12.54 ± 0.94 mg GAE/g DW. Furthermore, mechanisms of single electron transfer responsible for antioxidant activities were explored, identifying flavonoids as potential chemical markers in rice leaf extracts. Flavonoid derivatives, specifically isoorientin (3.33 ± 0.10 mg/g DW) and isovitexin (0.98 ± 0.03 mg/g DW), were subsequently quantified. This research contributed to improved understanding of relations between bioactive compounds and their antioxidant activities. The findings also underscore potential of Thai Jasmine rice leaves as natural additives in future functional foods production.
The iodine content of raw, boiled, pan‐fried, and oven‐baked fish samples using ICP‐MS: analysis and reliability of measurements
Authors: Aslan Çin Nazlı Nur , Yüce Metehan , Özçelik Ayşe Özfer
Published: March 2024

Since there is currently a lack of scientific evidence regarding the iodine content of raw and cooked fish, this study assesses that of various raw and cooked (boiled, pan‐fried, and oven‐baked) fish samples, using inductively coupled plasma‐mass spectrometry (ICP‐MS), following alkaline extraction. The iodine content of the raw fish is found to be highest in anchovy (295.9 ± 4.2 μg/100 g) and lowest in salmon (90.1 ± 3.1 μg/100 g) in dried weight. Boiling is found to reduce the iodine content in all of the fish samples significantly, except the bonito and salmon (P < 0.05). Meanwhile, the iodine content per 100 g is found to increase significantly in the pan‐fried and oven‐baked fish. The highest percentage of one serving of cooked fish meeting recommended iodine requirement were determined in oven‐baking haddock (351.0%), while the lowest percentage of one serving (150 g) of cooked fish meeting the recommended iodine requirement were determined in boiled garfish (70.9%). The best means of meeting the recommended daily iodine requirement in all the fish species evaluated, except bluefish, is found to be oven‐baking, while boiling has the greatest effect on reducing the iodine content. As a result, fish samples from the eastern Black Sea region of Turkey are good sources of iodine and it was determined that their iodine content changes when various cooking methods are used.
Enhancing cold tolerance and quality characteristics of Carica papaya Linn through the application of 1‐methylcyclopropene, geranium and lavender oil
Authors: Loh Meng Yi , Adzahan Noranizan Mohd , Azman Ezzat Mohamad , Koh Soo Peng , Yusof Noor Liyana
Published: March 2024

Postharvest application of 1‐methylcyclopropene (1‐MCP), lavender oil (LO) and geranium oil (GO) was investigated in alleviating chilling injury (CI) by regulating the cold tolerance of papaya cold stored at 4 °C for 16 days. The papaya was assessed on the attributes of CI, weight loss, firmness, colour, respiration rate, total soluble solids (TSS), soluble sugar (SS), proline and malondialdehyde content. The antagonistic effect of 1‐MCP against ethylene proved highly effective in delaying fruit ripening and metabolic processes. Notably, a 1‐h misting treatment with 600 mg L−1 1‐MCP (active ingredient, a.i.) solution significantly enhanced papaya's resistance to chilling conditions and reported a remarkable 2.08‐fold reduction in CI damage compared to the control. Furthermore, 1‐MCP‐treated papayas exhibited the highest proline concentration (61.59 μg/g FW) and the lowest malondialdehyde content (39.65 μmol/g FW). Additionally, 1‐MCP‐treated papayas displayed a 1.1‐fold reduction in oxygen consumption compared to the control. They also exhibited minimal changes in weight loss (3.6%), the least increase in TSS and SS compared to the control and better retention of fruit colour and firmness. Comparatively, GO known for its robust antioxidant and antimicrobial properties played a pivotal role in enhancing papaya's cold tolerance and providing superior protection against chilling‐induced damage when compared to the control.
Acceptability, engagement and exploratory outcomes and costs of a co‐designed intervention to support children of parents with a mental illness: Mixed‐methods evaluation and descriptive analysis
Authors: Bauer Annette , Cartagena‐Farias Javiera , Christiansen Hanna , Goodyear Melinda , Schamschula Mona , Zechmeister‐Koss Ingrid , Paul Jean
Published: March 2024

Children whose parents have a mental illness are much more likely to experience mental health problems and other adverse long‐term impacts. Child‐centred psychosocial interventions can be effective, but not much is known about how to design and implement them in different settings. A pre‐post, mixed methods, single‐arm evaluation of a co‐designed social support intervention with parents and children (4–18 years) measured parents' mental health (PHQ‐9), perceived social support (ENRICHD), parental self‐efficacy (PSAM) and children's mental health (SDQ), quality of life (Kidscreen‐27), and child service use (CAMHSRI‐EU) at baseline and 6 months. Qualitative data were gathered at 6 months to explore parents' and children's experience with the intervention. Twenty‐nine parents and 21 children completed baseline and follow‐up questionnaires; 22 parents and 17 children participated in interviews. Parents' depression (MD −1.36, SD 8.08), perceived social support (MD 1, SD 5.91), and children's mental health potentially improved, and children's service use and costs potentially reduced (€224.6 vs. €122.2, MD 112.4). Parental self‐efficacy was potentially reduced (MD −0.11, SD 3.33). The sample was too small to perform statistical analysis. Favourable themes emerged describing the high satisfaction with the intervention, parents' improved understanding of the impact of their mental health problems on children, and improvements in parent–child relationships. This study contributes to an emerging evidence base for co‐designed child‐centred interventions to prevent the transgenerational transmission of poor mental health.
Densification of low‐density boron carbide by Li doping and its microstructural characterization
Authors: Pan Chao , Wang Aiyang , Zhang Wenwen , Zhang Jinyong , Wang Weimin , Zhang Fan , Fu Zhengyi
Published: March 2024

Lithium (Li)‐doped boron carbide (B4C) has generated widespread attention for its potential to enhance mechanical properties. Nevertheless, the influence of the Li solid solution on the microstructure and mechanical properties of B4C ceramics remain unclear. In this research, the microstructure of Li‐doped B4C was investigated in meticulous detail. Through X‐ray diffraction, X‐ray photoelectron spectroscopy, and Raman spectroscopy analysis, it was confirmed that Li successfully solubilized in B4C at 1 500°C under 50 MPa for an 8 min, resulting in lattice expansion. Further insights from electron energy loss spectroscopy revealed the integration of Li into the crystal lattice and alterations in the C–B–C chains. Furthermore, the Li2O content significantly affected the densification and microstructure of B4C. Relative density increased from 91.2% (B4C) to 99.2% (9 wt.% Li2O–B4C), accompanied by a transition from a few intragranular planar defects to high‐density twins. Mechanical property tests demonstrated that 9 wt.% Li2O–B4C exhibited optimal comprehensive mechanical performance, with a flexural strength of 533 ± 27 MPa, fracture toughness of 3.71 ± 0.29 MPa∙m1/2, hardness of 33.3 ± 0.6 GPa, and a density of just 2.45 g/cm3, surpassing that of pure B4C.
Intramural needle ablation or repeated standard ablation in patients referred for repeat ablation of scar‐related ventricular tachycardia
Authors: Kurata Masaaki , Batnyam Uyanga , Tedrow Usha B. , Richardson Travis D. , Kanagasundram Arvindh N. , Hasegawa Kanae , Uetake Shunsuke , Manuelian Deborah , Pellegrini Christine , Stevenson William G.
Published: March 2024

Introduction

When ventricular tachycardia (VT) recurs after standard RF ablation (sRFA) some patients benefit from repeat sRFA, whereas others warrant advanced methods such as intramural needle ablation (INA). Our objectives are to assess the utility of repeat sRFA and to clarify the benefit of INA when repeat sRFA fails in patients with VT due to structural heart disease.

Methods

In consecutive patients who were prospectively enrolled in a study for INA for recurrent sustained monomorphic VT despite sRFA, repeat sRFA was considered first. INA was performed during the same procedure if repeat sRFA failed or no targets for sRFA were identified.

Results

Of 85 patients enrolled, acute success with repeat sRFA was achieved in 30 patients (35%), and during the 6‐month follow‐up, 87% (20/23) were free of VT hospitalization, 78% were free of any VT, and 7 were lost to follow‐up. INA was performed in 55 patients (65%) after sRFA failed, or no endocardial targets were found abolished or modified inducible VT in 35/55 patients (64%). During follow‐up, 72% (39/54) were free of VT hospitalization, 41% were free of any VT, and 1 was lost to follow‐up. Overall, 59 out of 77 (77%) patients were free of hospitalization and 52% were free of any VT. Septal‐origin VTs were more likely to need INA, whereas RV and papillary muscle VTs were less likely to require INA.

Conclusions

Repeat sRFA was beneficial in 23% (18/77) of patients with recurrent sustained VT who were referred for INA. The availability of INA increased favorable outcomes to 52%.
Influencing factors of inter‐nursing lateral violence: A qualitative systematic review
Authors: Xie Qiulin , Xu Honglin , Luo Zongting , Gong Aiping , Wang Li , Zhou Jian
Published: March 2024

Background

Lateral violence is a global social problem that has attracted considerable attention in the field of public health. This has seriously affected the quality of care, the safety of patients' lives and the career development of nurses.

Objective

To systematically evaluate the factors influencing of nursing lateral violence and provide evidence for preventing and reducing inter‐nursing lateral violence.

Methods

A systematic review of qualitative study was performed in accordance with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines. We collected qualitative studies on the factors influencing of inter‐nursing lateral violence by searching PubMed, EMbase, The Cochrane Library, Web of Science, CINAHL, Science Direct, WanFang Data, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP) and Chinese Biomedical Literature Database (CBM). Data from inception to September 2023. Literature screening and data extraction were independently conducted by two reviewers. The Critical Appraisal Skills Program (CASP) scale was employed to assess the quality of the studies, including objectives, methodologies, designs, results and contributions.

Results

A total of 25 studies involving 882 participants were included. The results of the thematic analysis indicated that inter‐nursing lateral violence was influenced by hospital management, perpetrators, victims and sociodemographic factors.

Conclusion

Inter‐nursing lateral violence was influenced by multidimensional factors. To reduce the occurrence of horizontal violence among nurses, hospitals need to explore the establishment and improvement of a horizontal violence resolution mechanism, and schools should pay attention to the joint support and education of nursing students, create a good working environment and harmonious nursing culture, and promote mutual respect among nurses.

Relevance to Clinical Practice

This review emphasises the importance of the influencing factors of horizontal violence among nurses, analyses the importance of influencing factors from different perspectives, and proposes corresponding measures to reduce inter‐nursing lateral violence.

No Patient or Public Contribution

This study was mostly a literature review; neither patients nor pertinent staff were involved in either the design or conduct of the investigation.
A qualitative exploration of the use of telehealth for opioid treatment: Implications for nurse‐managed care
Authors: Heidari Omeid , Winiker Abigail K. , Pollock Sarah , Sodder Shereen , Tsui Judith I. , Tobin Karin E.
Published: March 2024

Aim

To characterise experiences with telehealth for Medications for Opioid Use Disorder (MOUD) services among patients, prescribers, nurses and substance use counsellors to inform future best practices.

Design

We engaged a qualitative descriptive study design.

Methods

Semi‐structured interviews were conducted with prescribers (nurse practitioners and physicians, n = 20), nurses and substance use counsellors (n = 7), and patients (n = 20) between June and September 2021. Interviews were verbatim transcribed. Thematic analysis was conducted using a qualitative descriptive method.

Results

Among both providers and patients, four themes were identified: (1) Difficulties with telehealth connection (2) Flexibility in follow‐up and retention, (3) Policy changes that enabled expanded care, (4) Path forward with telehealth. Two additional findings emerged from provider interviews: (1) Expansion of nurse‐managed office‐based opioid treatment, and (2) Novel methods to engage patients.

Conclusions

Patients and providers continued to view telehealth as an acceptable means for delivery and management of MOUD, particularly when utilised in a hybrid manner between in‐person visits. Nurse‐managed care for this service was evident as nurses extended the breadth of services offered and utilised novel methods such as text messages and management of ‘call‐in’ lines to engage patients.

Implications for the profession and/or patient care

Use of telehealth for MOUD should be incorporated into practice settings to reach patients in a flexible manner. Nurses in particular can use this medium to extend office‐based opioid treatment by conducting assessments and expanding capacity for other wrap‐around services.

Impact

We identify recommendations for best practices in the use of telehealth for opioid use disorder management and highlight the value of nurse‐managed care.

Reporting method

The consolidated criteria for reporting qualitative research.

Patient or Public Contribution

Patients with opioid use disorder and prescribers with experience using telehealth were interviewed for this study.
Chest wall bruising from 5‐point car seat harness as a mimicker of child abuse
Authors: Bui Jordan K. , Naing Pyae , Cathers Phillip H. , Ahmad Mizna , Cohen Bernard
Published: March 2024

Bruising rarely presents in infants younger than 9 months who are not ambulatory and is more prevalent among children beginning to walk, or “cruisers.” We present the case of a healthy 3‐month‐old infant with asymptomatic, symmetric, bilateral, large bruises on the bony chest sparing the mid‐chest/sternum with a negative non‐accidental trauma work‐up. The noted pattern of bruises matched the bilateral shoulder straps of a 5‐point harness of the car seat belt designed for infants. Awareness of this unique pattern of bruises will help elicit a better‐informed history to guide care in an appropriate setting.
The occurrence of mental health symptoms in isotretinoin‐treated adolescents
Authors: Miller Keith , McKean Alastair , Hand Jennifer , Rackley Sandra , Leung Jonathan G. , LeMahieu Allison , Geske Jennifer , Bostwick J. Michael
Published: March 2024

Background

Isotretinoin treatment for acne can reduce adverse psychiatric outcomes in adults, but there has been little investigation of the incidence of psychiatric outcomes in treated adolescents.

Methods

This retrospective cohort study using the Rochester Epidemiology Project identified 606 patients aged 12–18 prescribed isotretinoin over a 10‐year period between January 1, 2008 and December 31, 2017. Medical records were reviewed to identify psychiatric diagnoses before and during isotretinoin therapy, as well as psychiatric symptoms not captured by formal diagnoses and changes to isotretinoin dosing because of psychiatric diagnoses or symptoms.

Results

One hundred seventy‐seven (29.2%) had a psychiatric diagnosis prior to isotretinoin initiation, but 98 (16.2%) had a new psychiatric diagnosis or psychiatric symptom while taking isotretinoin. Patients with a psychiatric history were no more likely than those without to receive a new psychiatric diagnosis during treatment (4.5% vs. 3.7%; p = .650), but did experience more psychiatric symptoms, primarily low mood and mood swings (23.7% vs. 7.7%; p < .001). Only 25.5% of the 98 with a new psychiatric diagnosis or psychiatric symptom had a subsequent dose change. A dose change was more likely if patients received a new psychiatric diagnosis (41.7% vs. 20.3%; p = .037) or patients did not have a psychosocial explanation for psychiatric symptoms (34.4% vs. 10.8%; p = .009).

Conclusions

A substantial proportion of adolescent patients prescribed isotretinoin had a prior psychiatric diagnosis. This predicts more psychiatric symptoms during isotretinoin treatment. Adolescents with a psychiatric history who have worsening symptoms and those with new‐onset psychiatric symptoms would benefit from close monitoring while taking isotretinoin.
Trade‐offs between root‐secreted acid phosphatase and root morphology traits, and their contribution to phosphorus acquisition in Brassica napus
Authors: Li Hao , Wang Chuang , Zhang Bingbing , Liu Haijiang , Hammond John P. , Wang Xiaohua , Ding Guangda , Cai Hongmei , Wang Sheliang , Xu Fangsen , Shi Lei
Published: March 2024

Oilseed rape (Brassica napus) is one of the most important oil crops in the world and shows sensitivity to low phosphorus (P) availability. In many soils, organic P (Po) is the main component of the soil P pool. Po must be mineralised to Pi through phosphatases, and then taken up by plants. However, the relationship between root‐secreted acid phosphatases (APase) and root morphology traits, two important P‐acquisition strategies in response to P deficiency, is unclear among B. napus genotypes. This study aimed to understand their relationship and how they affect P acquisition, which is crucial for the sustainable utilisation of agricultural P resources. This study showed significant genotypic variations in root‐secreted APase activity per unit root fresh weight (SAP) and total root‐secreted APase activity per plant (total SAP) among 350 B. napus genotypes. Seed yield was positively correlated with total SAP but not significantly correlated with SAP. Six root traits of 18 B. napus genotypes with contrasting root biomass were compared under normal Pi, low Pi and Po. Genotypes with longer total root length (TRL) reduced SAP, but those with shorter TRL increased SAP under P deficiency. Additionally, TRL was important in P‐acquisition under three P treatments, and total SAP was also important in P‐acquisition under Po treatment. In conclusion, trade‐offs existed between the two P‐acquisition strategies among B. napus genotypes under P‐deficient conditions. Total SAP was an important root trait under Po conditions. These results might help to breed B. napus with greater P‐acquisition ability under low P availability conditions.
Mentally healthy living after pandemic social distancing: a study of older Canadians reveals helpful anxiety reduction strategies
Authors: Low Gail , Gutman Gloria , Gao Zhiwei , França Alex Bacadini , von Humboldt Sofia , Vitorino Luciano Magalhães , Wilson Donna M. , Allana Hunaina
Published: March 2024

Background

Throughout the COVID‐19 pandemic, older Canadians were the most at risk of severe physical harm, including death, and their return to post‐COVID life was expected to be especially anxiety‐provoking. A study was conducted to obtain nationally representative evidence of older Canadians' self‐perceived anxiety levels and their strategies to manage or mitigate it as public health restrictions were lifting.

Materials and Methods

This study had a cross‐sectional descriptive design. An e‐survey was used to collect data from 1327 Canadians aged 60+ stratified by age, sex, and education to resemble the larger general population. Participants completed the Geriatric Anxiety Scale (GAS‐10) and indicated which of the 16 Centre for Addictions and Mental Health's (2022) Coping with Stress and Anxiety strategies they were using to manage or mitigate their anxiety when social distancing was lifting. Descriptive statistics, Pearson correlation, and multiple regression analysis were used to explore the data.

Results

While, on average, older Canadians were mildly anxious, nearly one‐quarter of responders rated their anxiety as severe. Age, sex, perceived health, were statistically significant correlates of anxiety. Six coping strategies were associated with significantly lower anxiety scores. Moreover, accepting some fear and anxiety as normal, challenging worries and anxious thoughts, and practising relaxation/meditation appeared to increase anxiety.

Conclusion

Older Canadians used multiple strategies to manage or mitigate their anxiety, and seemingly, with more successful than detrimental tries. Practitioners have much to learn and understand about older people's mental health promotion efforts after social distancing, now and for future pandemics.
Quantitative analysis of passive intermodulation and surface roughness
Authors: Stachura Eric , Wellander Niklas , Cherkaev Elena
Published: March 2024

We explore the relationship between rough surface conductors and the phenomenon of passive intermodulation. The underlying surface is taken to be the boundary of a Lipschitz domain, and a characteristic angle of the domain is used to track boundary dependence on the various fields. To model electro‐thermal passive intermodulation in particular, we consider a specific type of temperature‐dependent conductivity and determine conditions on the conductivity under which one can use fixed point arguments to solve an induction heating and Joule heating problem on a Lipschitz domain. In the latter problem, we also consider a time‐dependent permittivity function . Finally, weak solutions to a magneto‐quasi‐static problem are obtained when the permeability µ is temperature dependent and is allowed to degenerate in a certain way. An interesting effect of the rough surface is the inherently limited Sobolev regularity of the electric field, which can be improved if one assumes additional constraints on the boundary.
From consistent subjective assessment of skin sensitivity severity to its accurate objective scoring
Authors: Rengot Juliette , Meyer Imke , Chevrot Nathalie , Maire Marielle Le , Cherel Marie , Prestat‐Marquis Elodie , Stuhlmann Dominik
Published: March 2024

Background

Sensitive skin (SenS) is a syndrome leading to unpleasant sensations with little visible signs. Grading its severity generally relies on questionnaires or subjective ratings.

Materials and methods

The SenS status of 183 subjects was determined by trained assessors. Answers from a four‐item questionnaire were converted into numerical scores, leading to a 0–15 SenS index that was asked twice or thrice. Parameters from hyperspectral images were used as input for a multi‐layer perceptron (MLP) neural network to predict the four‐item questionnaire score of subjects. The resulting model was used to evaluate the soothing effect of a cosmetic cream applied to one hemiface, comparing it to that of a placebo applied to the other hemiface.

Results

The four‐item questionnaire score accurately predicts SenS assessors’ classification (92.7%) while providing insight into SenS severity. Most subjects providing repeatable replies are non‐SenS, but accepting some variability in answers enables identifying subjects with consistent replies encompassing a majority of SenS subjects. The MLP neural network model predicts the SenS score of subjects with consistent replies from full‐face hyperspectral images (R2Validation set = 0.969). A similar quality is obtained with hemiface images. Comparing the effect of applying a soothing cosmetic to that of a placebo revealed that subjects with the highest instrumental index (> 5) show significant SenS improvement.

Conclusion

A four‐item questionnaire enables calculating a SenS index grading its severity. Objective evaluation using hyperspectral images with an MLP neural network accurately predicts SenS severity and its favourable evolution upon the application of a soothing cream.
A corporeal conundrum: Challenges posed by remote consultation for postgraduate medical education
Authors: Campion John R. , Cantillon Peter
Published: March 2024

Background

The COVID‐19 pandemic accelerated the use of remote consultation in hospital outpatient clinics. Remote consultation alters the clinical environment and the learning environment in ways that are incompletely understood. This research sought to explore how trainees negotiate training and learning in such an environment when it is novel to them.

Methods

Purposive sampling was used to recruit eight doctors from the gastroenterology department of an academic teaching hospital. Four consultants and four trainees participated in individual, semi‐structured interviews. Interpretative phenomenological analysis of interview transcripts was employed and themes developed from the analysis, to characterise the experience of learning and teaching in remote consultation clinics, as described by participants.

Results

Participants described how they try to create mental representations of each patient they review by remote consultation. Whilst consultants found this task relatively easy, trainee physicians found remote consultation more challenging and highlighted the importance of the physical presence of the patient to help them form a holistic sense of the patient's condition. Doctors in training also struggled to develop a workable mental model of the patient's condition when physical examination was precluded by remote consultation.

Conclusions

This study highlights the place of the patient's physical presence as an essential educational stimulus to facilitate teaching and learning. Further research is needed to characterise the processes clinicians use to formulate mental models of patients who are physically absent from the consultation room.
The use of virtual patients for breaking bad news: A rapid review
Authors: Kang Woohyun
Published: March 2024

Background

Breaking bad news is an imperative skill for clinical practice that health care professionals struggle with. Virtual patients have been adopted as a new teaching aide in medical education and have shown efficacy in teaching clinical skills; however, there is limited research for use in communication skills. Virtual patients are especially well‐suited for difficult communication skills, as students can practice without risk to patients. This rapid review aimed to review literature observing the potential of virtual patients as an effective means to teach breaking bad news.

Method

A systematic search strategy was applied for papers published between November 2012 and November 2022 on Medline and Embase databases. Following the application of inclusion criteria, three studies were included. The Medical Education Research Study Quality Instrument and Critical Appraisal Skills Programme checklist were used for quality appraisal of the studies. Tabular and narrative synthesis was used to present the findings.

Findings

The findings of the studies suggest that when teaching breaking bad news, virtual patients are valuable compared with no intervention and are not inferior compared with simulated patients. An unexpected benefit of virtual patients was videotaping. A barrier to learning was the lack of affect and interaction. More research into the design of virtual simulations and its integration into existing curricula is required.

Conclusion

Virtual patients are a valuable educational tool for breaking bad news; however, they are yet to replace existing educational approaches. There is a need for more large‐scale, homogeneous studies to inform instructional design and curriculum integration.
Thinking the Urban Impasse Beyond Lockdown: An Afterword
Authors: Hentschel Christine
Published: March 2024

How can the lens of the ‘urban impasse’ help us make sense of the relationship between inequality, institutions and contemporary urban life? And how can urban studies benefit from feminist affect theory to explore the theoretical potential of the ‘urban impasse’? An impasse is a dead end; it connotes an experience of being stuck, lacking orientation or a sense of the future. Still, an impasse also bears transformative potential as a powerful way of halting and denouncing that which does not work or is heading in the wrong direction—as was powerfully brought to stage in cities around the world by climate change, antiracist and women's rights movements in recent years.
Inspiratory muscle endurance is similarly reduced in the early and late stages of chronic Chagas heart disease
Authors: Pinto Diniz Clara , Felix Mediano Mauro Felippe , Rodrigues Junior Luiz Fernando , Mendes Fernanda de Souza Nogueira Sardinha , Magalhães Saraiva Roberto , Horta Veloso Henrique , Rodrigues da Costa Andréa , Hasslocher‐Moreno Alejandro Marcel , Borghi‐Silva Audrey , Silvestre de Sousa Andréa , Mazzoli‐Rocha Flavia
Published: March 2024

Objective

Inspiratory muscle strength (IMS) appears to be reduced in subjects with chronic Chagas heart disease (CHD), especially in the presence of heart failure (HF). However, only one study about IMS and inspiratory muscle endurance (IME) in those with CHD without heart failure is available. This study aimed to compare IMS and IME in subjects with CHD in the presence and absence of HF.

Methods

This is a cross‐sectional study in which 30 CHD adult patients were divided into CHD‐CC group (initial phase of CHD, without HF; n = 15) and CHD‐HF group (advanced phase of CHD, with HF; n = 15). We assessed IMS by maximum inspiratory pressure (MIP) and IME by incremental (Pthmax) and constant load (TLim) tests. Reduced IMS and IME were considered by predicted MIP values <70% and Pthmax/MIP <75%, respectively.

Results

Inspiratory muscle weakness (IMW) was more frequent in CHD‐HF than in CHD‐CC (46.7% vs. 13.3%; p = 0.05), and both groups had high frequencies of reduced IME (93.3% CHD‐CC vs. 100.0% CHD‐HF; p = 0.95). Age‐adjusted logistic regression analysis using HF as a dependent variable showed that HF was associated with an increased chance of IMW compared with the CHD‐CC group (OR = 7.47; p = 0.03; 95% CI 1.20–46.19).

Conclusion

This study suggests that, in patients with CHD, HF is associated with IMW, and that reduction of IME is already present in the initial phase, similar to the advanced phase with HF.
Survey of policies at US hospitals on the selection of RhD type of low‐titer O whole blood for use in trauma resuscitation
Authors: Clayton Skye , Leeper Christine M. , Yazer Mark H. , Spinella Philip C.
Published: March 2024

Background

Low‐titer group O whole blood (LTOWB) use is increasing due to data suggesting improved outcomes and safety. One barrier to use is low availability of RhD‐negative LTOWB. This survey examined US hospital policies regarding the selection of RhD type of blood products in bleeding emergencies.

Study Design and Methods

A web‐based survey of blood bank directors was conducted to determine their hospital's RhD‐type selection policies for blood issued for massive bleeding.

Results

There was a 61% response rate (101/157) and of those responses, 95 were complete.

Respondents indicated that 40% (38/95) use only red blood cells (RBCs) and 60% (57/95) use LTOWB. For hospitals that issue LTOWB (N = 57), 67% are supplied only with RhD‐positive, 2% only with RhD‐negative, and 32% with both RhD‐positive and RhD‐negative LTOWB. At sites using LTOWB, RhD‐negative LTOWB is used exclusively or preferentially more commonly in adult females of childbearing potential (FCP) (46%) and pediatric FCP (55%) than in men (4%) and boys (24%). RhD‐positive LTOWB is used exclusively or preferentially more commonly in men (94%) and boys (54%) than in adult FCP (40%) or pediatric FCP (21%). At sites using LTOWB, it is not permitted for adult FCPs at 12%, pediatric FCP at 21.4%, and boys at 17.1%.

Conclusion

Hospitals prefer issuing RhD‐negative LTOWB for females although they are often ineligible to receive RhD‐negative LTOWB due to supply constraints. The risk and benefits of LTOWB compared to the rare occurrence of hemolytic disease of the fetus/newborn (HDFN) need further examination in the context of withholding a therapy for females that has the potential for improved outcomes.