bluuebunny/crossref_metadata_2025 huggingface dataset:
P38 Re-assessment of the primary efficacy outcomes of cefepime/enmetazobactam versus piperacillin/tazobactam in adult patients with complicated urinary tract infections or acute pyelonephritis using updated EUCAST piperacillin/tazobactam susceptibility breakpoints
Authors: Ward Jon , Belley Adam , Quevedo Juan , Dunkel Nathalie , Velicitat Patrick
Published: August 2024

Background

In a pivotal Phase 3 clinical trial of adult patients with complicated urinary tract infections (cUTI) or acute pyelonephritis (AP), the β-lactam/β-lactamase inhibitor combination of cefepime and enmetazobactam administered by 2 h infusion demonstrated non-inferiority and met criteria for superiority compared with piperacillin/tazobactam at the primary efficacy endpoint. In this study, efficacy outcomes were reassessed when applying the updated 2021 EUCAST piperacillin/tazobactam MIC breakpoints of susceptible ≤8 mg/L and resistant ≥16 mg/L to the primary efficacy population.

Methods

The primary efficacy endpoint was the proportion of patients in the microbiological modified ITT population (m-MITT) who achieved overall success (a composite of clinical cure and microbiological eradication [urine counts <103 cfu/mL]) at test-of-cure. In the revised m-MITT population post-hoc analysis, patients were included who had a Gram-negative baseline pathogen with a cefepime/enmetazobactam MIC ≤8 mg/L and a piperacillin/tazobactam MIC ≤8 mg/L, which differed from the original analysis of including piperacillin/tazobactam MICs ≤64 mg/L. Two-sided 95% CI were computed using the stratified Newcombe method. The prespecified non-inferiority margin was −10% with superiority determined (when the lower bound of the 95% CI >0) in the event of confirmed non-inferiority.

Results

In the revised m-MITT population, 27/345 (7.8%) patients in the cefepime/enmetazobactam group and 29/333 (8.7%) patients in the piperacillin/tazobactam group were excluded due to piperacillin/tazobactam MICs that exceeded the updated EUCAST piperacillin/tazobactam MIC breakpoints of susceptible ≤8 mg/L. Overall success occurred in 78.9% (251/318) of patients receiving cefepime/enmetazobactam compared with 60.2% (183/304) receiving piperacillin/tazobactam, with an adjusted treatment difference of 19.1% (95% CI, 11.9% to 26.1%). As clinical cure rates were similar amongst the two treatment groups, overall success in the revised cefepime/enmetazobactam group was mainly due to improved microbiological eradication.

Conclusions

When applying the updated 2021 EUCAST piperacillin/tazobactam susceptibility breakpoints to primary efficacy population, cefepime/enmetazobactam was non-inferior and met criteria for superiority compared with piperacillin/tazobactam in adult patients with cUTI/AP.
Evaluation of inhibitory activity of essential oils and natural extracts on foodborne viruses
Authors: Amri Mariem , Jubinville Éric , Goulet-Beaulieu Valérie , Fliss Ismail , Jean Julie
Published: August 2024

Aims

Enteric viruses are recognized as a major concern in health care and in the food sector in Canada. Novel clean-label strategies for controlling enteric viruses are sought in the food industry. In this study, we examined the antiviral potential of plant extracts and essential oils on murine norovirus 1 (MNV-1), hepatitis A virus (HAV), and herpes simplex virus 1 (HSV-1).

Methods and results

Inactivation of the viruses by grape seed, blueberry, green tea, and cranberry extracts and by rosemary and thyme essential oils was measured using plaque formation assay. Concentrations ranging from 50 to 200 000 ppm with a contact time of 90 min were tested. Grape seed extract at 10 000 ppm was the most effective (P < 0.05) at reducing MNV-1 and HAV infectious titers, respectively, by 2.85 ± 0.44 log10 and 1.94 ± 0.17 log10. HSV-1 titer was reduced by 3.81 ± 0.40 log10 at 1000 ppm grape seed extract.

Conclusions

Among the plant products tested, grape seed extract was found the most effective at reducing the infectious titers of MNV-1, HAV, and HSV.
A window on remarkable cryptic diversity of the Merodon planifacies subgroup (Diptera: Syrphidae) in the Afrotropical Region
Authors: Vujić Ante , Djan Mihajla , Radenković Snežana , Likov Laura , Ačanski Jelena , Vujanović Dušanka , Veličković Nevena , Pérez-Bañón Celeste , Rojo Santos , Aracil Andrea , Jordaens Kurt , Ståhls Gunilla
Published: August 2024

The genus Merodon Meigen (Diptera: Syrphidae) is one of the most species-rich hoverfly genera distributed across the Palaearctic and Afrotropical regions. In the Palaearctic, the genus Merodon boasts 195 described species, while its Afrotropical region pales in comparison, with a mere 17 species documented thus far. As a result of 8 years of fieldwork conducted in the Republic of South Africa, in this paper, we present the description of 11 new species for science with a description of immature stages for 2 species, which increases the diversity of this genus in the Afrotropical region by remarkable 39%. These revelations are based on integrating morphology, molecular analysis (COI gene and 28S rRNA) and geometric morphometry. All described species belong to the Merodon planifacies subgroup, the Merodon desuturinus lineage and, within that, to the Afrotropical Merodon melanocerus group. Additionally, we provide an illustrated key to 15 species belonging to the subgroup, a detailed discussion on relevant taxonomic characters, a morphological diagnosis, a distribution map and clarification of the association between M. capi complex and host plants from the genus Merwilla.
Identifying the electromagnetic counterparts of LISA massive black hole binaries in archival LSST data
Authors: Xin Chengcheng , Haiman Zoltán
Published: August 2024

LSST will catalogue the light curves of up to 100 million quasars. Among these there can be $\sim$100 ultra-compact massive black hole (MBH) binaries, whose gravitational waves (GWs) can be detected 5–15 yr later by LISA. Here, we assume such a LISA detection occurred, and assess whether or not its electromagnetic (EM) counterpart can be identified as a periodic quasar in archival LSST data. We use the binary’s properties derived from the LISA waveform, including the evolution of its orbital frequency, its total mass, distance, and sky localization, to predict the redshift, magnitude, and historical periodicity of the quasar expected in the LSST data. We then use Monte Carlo simulations to compute the false alarm probability (FAP), i.e. the number of quasars in the LSST catalogue matching these properties by chance, based on the (extrapolated) quasar luminosity function, the cadence of LSST, and intrinsic ‘damped random walk’ quasar variability. We analyse four fiducial LISA binaries, with masses and redshifts of $(M_{\rm bin}/{\rm M_{\odot }},z) = (3\times 10^5,0.3)$, $(3\times 10^6,0.3)$, $(10^7,0.3)$, and $(10^7,1)$. While noise and aliasing due to LSST’s cadence produces false periodicities by chance, we find that the frequency chirp of the LISA source during the LSST observations washes out these noise peaks and allows the genuine source to stand out in appropriately scaled Lomb–Scargle periodograms. We find that all four fiducial binaries can be uniquely identified, with ${\rm FAP}\lt 10^{-5}$, a week or more before merger. This should enable follow-up EM observations targeting individual EM counterparts during their inspiral stage.
Detection and localization of the highly active FRB 20240114A with MeerKAT
Authors: Tian J , Rajwade K M , Pastor-Marazuela I , Stappers B W , Bezuidenhout M C , Caleb M , Jankowski F , Barr E D , Kramer M
Published: August 2024

We report observations of the highly active FRB 20240114A with MeerKAT using the ultra-high frequency (UHF; $544\!-\!1088$ MHz) and L band ($856\!-\!1712$ MHz) receivers. A total of 62 bursts were detected in coherent tied-array beams using the MeerTRAP real-time transient detection pipeline. We measure a structure-optimizing dispersion measure of $527.65\pm 0.01\, \text{pc}\, \text{cm}^{-3}$ using the brightest burst in the sample. We find the bursts of FRB 20240114A are generally detected in part of the broad-band of MeerKAT, $\sim 40~{{\ \rm per\ cent}}$ in the UHF and $\sim 30~{{\ \rm per\ cent}}$ in the L band, indicating the band limited nature. We analyse the fluence distribution of the 44 bursts detected at UHF, constraining the fluence completeness limit to $\sim 1$ Jy ms, above which the cumulative burst rate follows a power law $R (\gt F)\propto (F/1\, \text{Jy}\, \text{ms})^\gamma$ with $\gamma =-1.8\pm 0.2$. Using channelized telescope data captured in our transient buffer we localize FRB 20240114A in the image domain to RA = 21h27m39.86s, Dec. = +04d19m45.01s with an uncertainty of 1.4 arcsec. This localization allows us to confidently identify the host galaxy of FRB 20240114A. Also using the transient buffer data, we perform a polarimetric study and demonstrate that most of the bursts have $\sim 100~{{\ \rm per\ cent}}$ linear polarization fractions and up to $\sim 20~{{\ \rm per\ cent}}$ circular polarization fractions. Finally, we predict the flux density of a potential persistent radio source (PRS) associated with FRB 20240114A is $\backsimeq [0.6\!-\!60]\, \mu \text{Jy}$ based on the simple relation between the luminosity of the PRS and the rotation measure arising from the FRB local environment.
Leveraging electrochemical double layer structure to rationally control electrolysis
Authors: Zhang Gong , Schreier Marcel
Published: August 2024

This perspective delves into the electrochemical microenvironment, uncovering entropic effects in CO2 reduction, revealing neutral molecule electrosorption under polarization, highlighting challenges in the classical double layer model, and proposing research approaches for future interface studies.
How Machine Learning Is Reviving Sociological Theorization
Authors: Santana Jessica J. , Nelson Laura K.
Published: August 2024

As machine learning (ML) algorithms get more sophisticated, ML enhances the role of theory in sociology. ML, despite its capacity to process data in complex ways, by definition only draws on limited representations of social systems. Humans have direct observational and experiential access to these systems, along with broad worldviews and tacit knowledge that make it possible to translate models of systems into knowledge of systems. The integration of the limited representational view of ML and the expansive human worldview is transforming sociological knowledge production. ML revitalizes theory in sociology in two key ways: by shifting the focus of theorizing from a priori to a posteriori and by necessitating ongoing interpretation and theorizing by scholars at every stage of the research process, thus integrating theory throughout research design. A creole computational social science can blend knowledge from multiple disciplines to enhance the knowledge-generating process overall.
Limited content overlap between commonly used self-report instruments for central (pain) sensitization in rheumatology
Authors: ten Klooster Peter M , Simoes Jorge P , Vonkeman Harald E
Published: August 2024

Objectives

Central pain mechanisms may be prominent in a considerable subset of rheumatology patients with persistent pain. Several self-report instruments have been used in previous research to infer the presence and severity of central sensitization (CS) that stem from different definitions or approaches of CS. The current study aimed to evaluate and quantify the overlap of actual symptoms measured among self-report measures of CS in rheumatology.

Methods

We used Fried’s (2017) comprehensive systematic approach to analyse the content of five commonly used or typical self-report measures (Generalized Pain Questionnaire, Pain Sensitivity Questionnaire, Central Sensitization Inventory, Central Aspects of Pain in the Knee scale and the painDETECT) used in rheumatology research and to visualize and quantify the overlap in symptoms measured.

Results

The five instruments together measured 39 different symptoms, most of which could be grouped into nociplastic pain manifestations (7 symptoms), neuropathic pain qualities (5 symptoms), and psychosomatic symptoms and emotional distress (25 symptoms). Most symptoms (74.4%) were unique to a single instrument. Thermal allodynia was the most frequently measured symptom across the different instruments, assessed in four of the measures. Average content overlap was very low and ranged from no overlap at all to moderate overlap (Jaccard index = 0.43) between pairs of instruments.

Conclusion

There is high heterogeneity and limited overlap in the content of self-report measures used to infer central pain sensitization. This may lead to results that are specific to the particular instrument and may limit the generalizability and comparability of study findings in rheumatology research.
Enhancing tumor photodynamic synergistic therapy efficacy through generation of carbon radicals by Prussian blue nanomedicine
Authors: Zhong Jun , Zhu Mingzhi , Guo Jiaqi , Chen Xinyu , Long Ruimin , Körte Fabian , Wang Shibin , Chen Hao , Xiong Xin , Liu Yuangang
Published: August 2024

Significant progress has been achieved in tumor therapies utilizing nano-enzymes which could convert hydrogen peroxide into reactive oxygen species (ROS). However, the ROS generated by these enzymes possess a short half-life and exhibit limited diffusion within cells, making it challenging to inflict substantial damage on major organelles for effective tumor therapy. Therefore, it becomes crucial to develop a novel nanoplatform that could extend radicals half-life. Artesunate (ATS) is a Fe (II)-dependent drug, while the limited availability of iron (II), coupled with the poor aqueous solubility of ATS, limits its application. Here, Prussian blue (PB) was selected as a nano-carrier to release Fe (II), thus constructing a hollow Prussian blue/artesunate/methylene blue (HPB/ATS/MB) nanoplatform. HPB degraded and released iron(III), ATS and MB, under the combined effects of NIR irradiation and the unique tumor microenvironment. Moreover, Fe (III) exploited GSH to formation of Fe (II), disturbing the redox homeostasis of tumor cells and Fe (II) reacted with H2O2 and ATS to generate carbon radicals with a long half-life in situ. Furthermore, MB generates 1O2 under laser irradiation conditions. In vitro and in vivo experiments have demonstrated that the HPB/ATS/MB NPs exhibit a synergistic therapeutic effect through photothermal therapy, photodynamic therapy and radical therapy.
Erectile dysfunction among male patients receiving methadone maintenance treatment: focusing on anxiety-related symptoms
Authors: Changchien Te-Chang , Hsieh Tsung-Jen , Yen Yung-Chieh
Published: August 2024

Background

Erectile dysfunction (ED) in patients receiving methadone maintenance treatment (MMT) is a relatively neglected issue.

Aim

In this study we sought to determine the actual prevalence of ED and risky sexual behaviors in patients receiving MMT and identify clinically relevant risk factors for ED, particularly mental health conditions, that may contribute to achieving holistic healthcare and improving treatment adherence in this patient population.

Methods

A cross-sectional study of male Chinese MMT patients was conducted. Comprehensive demographic and clinical data regarding age, obesity, history of major mental and physical illness, HIV infection, other substance use, methadone dose/duration, and associated risky sexual behaviors were all collected. Assessment tools, including the 5-item International Index of Erectile Function, the Chinese Health Questionnaire, and the Taiwanese Depression Questionnaire were administered.

Outcomes

The relationship between mental health–related factors and ED was fully analyzed and elaborated.

Results

The prevalence of ED among male patients in a methadone maintenance therapy outpatient clinic was 55.7%. The prevalence rate of ED among the individuals treated for longer than 6 months was 56.8%, whereas that for untreated individuals was 52.0%. Additionally, methadone-treated individuals were older and had a higher proportion of condom use and drug-assisted sexual activity than untreated individuals. Pearson correlation revealed that higher Chinese Health Questionnaire and Taiwanese Depression Questionnaire scores were negatively correlated with lower scores on the 5-item International Index of Erectile Function. In the multivariate regression model, anxiety and other psychosomatic symptoms were associated with more severe ED, whereas individuals who consumed alcohol within the past month had less severe ED after adjustment for other demographic and clinical variables. The findings of the present study revealed no association between ED and methadone treatment duration or dosage.

Clinical Implications

Healthcare professionals should discuss mental health issues in patients on MMT with ED, especially anxiety symptoms and recent alcohol use.

Strengths and Limitations

This study is one of the few reports within the limited body of research highlighting a significant association of ED with anxiety-related symptoms in patients undergoing MMT. Our study had some limitations. First, the sample size of HIV-infected individuals was insufficient. Second, the cross-sectional study design could not definitively demonstrate a causal mechanism.

Conclusion

In patients undergoing MMT, individuals who reported less severe anxiety symptoms and alcohol consumption in the past month tended to have less severe ED, regardless of the MMT duration or dosage.
The power of preferences: productivity and stress in new teleworkers during COVID-19
Authors: Blind Georg D , Lottanti von Mandach Stefania , Kotosaka Masahiro , Chiavacci David
Published: August 2024

This study of teleworking during the COVID-19 pandemic avoids a common self-selection bias by controlling for preferences and whether the introduction of teleworking was voluntary or mandatory. In a survey (n = 1,500) conducted in December 2020, we inquired about working arrangements and agent preferences in January, April, and December 2020. Productivity levels initially did not significantly differ for newly teleworking individuals after correcting for age, gender, marital status, breadwinner and management roles, childcare gap, area, job type, and general awareness, but were negatively affected by a preference mismatch (PM; around −3pp) and cognitive dissonance (not going with one’s preference in spite of having a chance to do so, adding another −5pp). By December 2020, individuals with a PM lost as much as 9pp of their productivity levels, but the net effect for those in partially remote work was only about −2pp. Similarly, stress levels initially did not differ for newly teleworking individuals using largely the same controls as before. By December 2020, stress levels for individuals newly undertaking fully remote telework were significantly lower than for the control group of individuals with unchanged working arrangements, but the PM contributed significantly to higher stress levels.
Evaluation of formaldehyde when complete feed and soybean meal were inoculated with porcine epidemic diarrhea virus, porcine reproductive and respiratory syndrome virus, and Seneca Valley virus 1
Authors: Harrison Olivia L , Bai Jianfa , Larson Martee , Pograninchniy Roman M , Domingues Francisco , Holcombe Nicole , Lopez Othmar , Jones Cassandra K
Published: August 2024

Formaldehyde has been found to decrease virus concentrations in feed and ingredient matrices. Continued research is needed to identify the appropriate inclusion levels and application time for different viruses in these matrices. The objective was to evaluate different inclusion levels of formaldehyde when applied either pre- or postinoculation of porcine epidemic diarrhea virus (PEDV), type 2 porcine reproductive and respiratory syndrome virus (PRRSV), and Seneca Valley virus 1 (SVV1) to complete feed or soybean meal. The experiment was designed in a 2 × 2 factorial with a formaldehyde-based product (Termin-8, Anitox Corporation, Lawrenceville, GA) applied either before virus inoculation (preinoculation) or after inoculation (postinoculation) at either a 2 or 3 kg/MT. On day 0, samples of the respective matrices were weighed in 50 g aliquots and added to 500 mL bottles. Formaldehyde was applied to the preinoculation samples at the respective inclusion levels and 50 µL of each virus were added to the postinoculation samples. All bottles were shaken and allowed to sit at room temperature for 24 h. On day 1, virus was added to the preinoculation samples and formaldehyde was added to the postinoculation bottles. Half of the samples were immediately processed (0 h) and the other half were incubated at room temperature for an additional 24 h. Samples were processed and aliquots were analyzed via triplex PCR. An application time × inclusion level interaction was observed for PEDV at 0 h and SVV1 and PEDV at 24 h in complete feed, where less viral RNA (P < 0.05) was detected in the postinoculation samples at either inclusion level as compared to the positive controls. In soybean meal, the same interaction was observed in PEDV and PRRSV at 0 h and SVV1 and PEDV at 24 h with less detectable RNA observed (P < 0.05) in the postinoculation samples regardless of inclusion level than the preinoculation counterparts and the controls. Overall, an application time effect was noticed in each matrix where less RNA was detected in the postinoculation samples at 0 h (P < 0.05) compared to the preinoculation samples and the control, and at 24 h, both the pre- and postinoculation samples had less detectable RNA (P < 0.05) than the control. Overall, formaldehyde can reduce detectable RNA immediately in contaminated complete feed and soybean meal, with greater decreases observed as mitigant contact time increases.
Anesthesiology Resident Knowledge of Transfusion Medicine: Results From the Anesthesiology Transfusion Education Study
Authors: Connelly NR , Adler AC , Vanderberg LE , Conlin F , Mitchell JD , Goldstein S , Haspel RL ,   ATEST Collaborators
Published: August 2024

(Anesth Analg. 2024;138(3):655–663. doi: 10.1213/ANE.0000000000006327)

Significant knowledge gaps exist in transfusion medicine across medical specialties, especially among trainees, potentially leading to unnecessary transfusion practices. Anesthesiology providers commonly administer blood products in the perioperative period, highlighting the need for resident anesthesiologists to acquire adequate transfusion knowledge, although there are limited published assessments. The Biomedical Excellence for Safer Transfusion (BEST) Collaborative developed a transfusion medicine knowledge assessment tool validated through Rasch analysis. This tool has been used internationally to assess transfusion knowledge among medical trainees, revealing deficiencies and guiding educational improvements. A modified version of this assessment was administered to anesthesiology residents, with ethical approval and participant consent.
Methemoglobinemia Outbreak in a Neonatal ICU and Maternity Ward
Authors: Takahashi S , Ishige T , Takizawa T
Published: August 2024

(N Engl J Med. 2023;389(25):2395–2397. doi: 10.1056/NEJMc2308125)

Contact with specific chemicals or drugs can cause an exceptionally rare disorder called acquired methemoglobinemia, which affects the oxygen-carrying function of hemoglobin. Most instances take place in less economically developed nations where individuals consume water from wells.
The Relationship Between Maternal Anemia and Electronic Fetal Monitoring Patterns
Authors: Beermann SE , Watkins VY , Frolova AI , Raghuraman N , Cahill AG
Published: August 2024

(Am J Obstet Gynecol. 2023;229(4):449.e1–449.e6. doi: 10.1016/j.ajog.2023.04.018)

Anemia is a common co-occurring diagnosis in pregnancy that is associated with an increased risk of several adverse pregnancy outcomes, including fetal growth restriction, preterm labor, and perinatal death. Prior studies demonstrated that maternal and fetal physiology may be protective against maternal anemia and decreased oxygen delivery to the fetus. In a 2021 study, it was observed that anemic pregnant patients had increased levels of partial pressure of oxygen in both the umbilical artery and vein at delivery compared with patients without anemia. Following these results, the present study sought to investigate how maternal anemia may be connected with electronic fetal monitoring (EFM) patterns associated with fetal hypoxia.
The Analgesic Effect of Transversalis Fascia Plane Block After Caesarean Section Under Spinal Anaesthesia With Intrathecal Morphine: A Randomized Controlled Trial
Authors: Baghirzada L , Walker A , Yu HC , Endersby R
Published: August 2024

(Anaesthesia. 2024;79(1):63–70. doi: 10.1111/anae.16173)

The necessary use of anesthesia during a cesarean delivery (CD) carries side effects including nausea, sedation, itchiness, and respiratory depression. An intrathecal administration of morphine before the CD can be paired with an ultrasound-guided interfacial truncal plane block to hypothetically reduce the risk of symptoms, especially postoperative pain. During the use of a transversalis fascia block, the T12 and L1 spinal nerves are anesthetized. Researchers within this study specifically sought to understand the reducing effects on opioid dose when injections of either bupivacaine 0.25% or saline 0.9% were given in the transversalis fascia plane during the postoperative period after a CD where morphine was administered intrathecally. Inclusion characteristics for the study were as follows: singleton pregnancy, a woman aged 18 to 45 years, body mass index <40, with a CD using spinal anesthesia scheduled; exclusion characteristics included: history of substance abuse or opioid use, chronic pain, body mass index over 40, a known allergy to a drug in the designed trial, those undergoing CD without spinal anesthesia, as well as non-native English speakers.
Current approach to muscle imaging in myositis
Authors: Saygin Didem , Albayda Jemima
Published: August 2024

Purpose of review

Muscle imaging is commonly utilized in idiopathic inflammatory myopathies (IIM) for diagnostic evaluation, selection of muscle biopsy site, and differentiating between disease activity versus damage. In this review, we discuss the current state and recent developments in the use of muscle imaging modalities including muscle magnetic resonance imaging (MRI), ultrasound (US), and positron emission tomography (PET) scan.

Recent findings

Muscle MRI is a clinically useful tool in evaluation of IIM with studies showing good correlations between pattern of morphological changes on MRI and histopathological findings on muscle biopsy. The use of computer aided diagnostics to enable quantification of muscle pathology will be a welcome development for future studies and trials. New studies highlight that muscle US could be a particularly useful point of care tool in longitudinal monitoring of patients with active myositis. Muscle FDG-PET scan shows inflammatory activity in IIM muscle and can also provide additional information on extra-muscular manifestations and cancer screening. Utilization of novel tracers is an exciting development for IIM evaluation.

Muscle MRI remains the gold standard for muscle imaging in IIM. Growing literature on muscle US and PET scan highlight their promising applications in IIM.
Parent-Derived Health State Utilities for Developmental Dysplasia of the Hip
Authors: Bram Joshua T. , Ellsworth Bridget K. , Cirrincione Peter M. , Nichols Erikson T. , Levine Keza , Adhiyaman Akshitha , Scher David M. , Doyle Shevaun M. , Sink Ernest L. , Dodwell Emily R.
Published: August 2024

Background:

Developmental hip dysplasia (DDH) is a common condition associated with pain, disability and early hip osteoarthritis when untreated. Health utility scores have not previously been defined for a comprehensive set of DDH health states. The purpose of this study was to establish utility scores associated with DDH health states.

Methods:

Patients treated for DDH using either Pavlik harness or abduction bracing and closed/open hip reduction between February 2016 and March 2023 were identified. Thirteen vignettes describing health states in the DDH life cycle were developed. Parents of patients were asked to score each state from 0 to 100 using the feeling thermometer. A score of “0” represents the worst state imaginable/death and a score of “100” represents perfect health. Utility scores were calculated and compared between parents of patients treated operatively and nonoperatively.

Results:

Ninety parents of children with DDH (45 operative, 45 nonoperative) were enrolled. There were 82 (91.1%) female children (median age of 4.9 years at enrollment). Median utility scores ranged from 77.5 [interquartile range (IQR): 70.0 to 90.0] for Pavlik harness and 80.0 (IQR: 60.0 to 86.3) for abduction bracing to 40.0 (IQR: 20.0 to 60.0) for reduction/spica cast and 40.0 (IQR: 20.0 to 50.0) for end-stage hip arthritis. Utility scores were lower in the operative group for Pavlik harness (median 70.0 vs. 80.0, P<0.01), end-stage arthritis (30.0 vs. 40.0, P=0.04), and 1 year after total hip arthroplasty (85.0 vs. 90.0, P=0.03) health states compared with the nonoperative group. There were no differences in other scores.

Conclusions:

Thirteen health states related to the life cycle of DDH were collected. Nonoperative interventions for DDH were viewed by parents slightly more favorably than operative treatments or long-term sequelae of untreated DDH. Future studies can assess other potential treatment experiences for patients with DDH or use these scores to perform cost-effectiveness analysis of different screening techniques for DDH.

Level of Evidence:

Level III.
Impact of Hemoglobin Levels on Composite Cardiac Arrest or Stroke Outcome in Patients With Respiratory Failure Due to COVID-19
Authors: Feng Shi Nan , Kelly Thu-Lan , Fraser John F. , Li Bassi Gianluigi , Suen Jacky , Zaaqoq Akram , Griffee Matthew J. , Arora Rakesh C. , White Nicole , Whitman Glenn , Robba Chiara , Battaglini Denise , Cho Sung-Min ,   on behalf of COVID-19 Critical Care Consortium (CCCC)
Published: August 2024

OBJECTIVES:

Anemia has been associated with an increased risk of both cardiac arrest and stroke, frequent complications of COVID-19. The effect of hemoglobin level at ICU admission on a composite outcome of cardiac arrest or stroke in an international cohort of COVID-19 patients was investigated.

DESIGN:

Retrospective analysis of prospectively collected database.

SETTING:

A registry of COVID-19 patients admitted to ICUs at over 370 international sites was reviewed for patients diagnosed with cardiac arrest or stroke up to 30 days after ICU admission. Anemia was defined as: normal (hemoglobin ≥ 12.0 g/dL for women, ≥ 13.5 g/dL for men), mild (hemoglobin 10.0–11.9 g/dL for women, 10.0–13.4 g/dL for men), moderate (hemoglobin ≥ 8.0 and < 10.0 g/dL for women and men), and severe (hemoglobin < 8.0 g/dL for women and men).

PATIENTS:

Patients older than 18 years with acute COVID-19 infection in the ICU.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Of 6926 patients (median age = 59 yr, male = 65%), 760 patients (11.0%) experienced stroke (2.0%) and/or cardiac arrest (9.4%). Cardiac arrest or stroke was more common in patients with low hemoglobin, occurring in 12.8% of patients with normal hemoglobin, 13.3% of patients with mild anemia, and 16.7% of patients with moderate/severe anemia. Time to stroke or cardiac arrest by anemia status was analyzed using Cox proportional hazards regression with death as a competing risk. Covariates selected through clinical knowledge were age, sex, comorbidities (diabetes, hypertension, obesity, and cardiac or neurologic conditions), pandemic era, country income, mechanical ventilation, and extracorporeal membrane oxygenation. Moderate/severe anemia was associated with a higher risk of cardiac arrest or stroke (hazard ratio, 1.32; 95% CI, 1.05–1.67).

CONCLUSIONS:

In an international registry of ICU patients with COVID-19, moderate/severe anemia was associated with increased hazard of cardiac arrest or stroke.
Malignant Hyperthermia
Authors: Pinyavat Teeda , Riazi Sheila , Deng Jiawen , Slessarev Marat , Cuthbertson Brian H. , Ibarra Moreno Carlos A. , Jerath Angela
Published: August 2024

OBJECTIVES:

A narrative expert review aiming to summarize the clinical epidemiology and management of critically ill patients with malignant hyperthermia (MH).

DATA SOURCES:

Medline searches were conducted to identify relevant articles describing the epidemiology, pathophysiology, and management of MH. Guidelines from key MH organizations were also incorporated into this review.

STUDY SELECTION:

Relevant studies regarding MH in both ICU and perioperative settings were reviewed.

DATA EXTRACTION:

Data from relevant studies were summarized and qualitatively assessed.

DATA SYNTHESIS:

MH is a severe reaction triggered by inhalational volatile anesthetics and succinylcholine in genetically susceptible patients. The condition is characterized by an early onset (min to hr) rise in temperature, hypercarbia, and muscular rigidity following exposure to triggering medications with potential complications of coagulopathy, rhabdomyolysis, and acute kidney injury. Acute management necessitates a coordinated multidisciplinary team approach with specific management using dantrolene, active cooling, and hyperventilation. A suspected MH reaction has important implications for future anesthetic exposure for both the patient and their family. All suspected reactions should be followed up at a specialized MH testing center using muscle contracture and genetic testing.

CONCLUSIONS:

Increasing use of inhalational anesthetics in the ICU underscores the need for enhanced education on the diagnosis and management of MH to ensure optimal patient sedation care and safety.
Gene and Protein Expression of MAGE and Associated Immune Landscape Elements in Non–Small-Cell Lung Carcinoma and Urothelial Carcinomas
Authors: Faiena Izak , Adhikary Sabina , Schweitzer Colleen , Astrow Stephanie H. , Grogan Tristan , Funt Samuel A. , Bot Adrian , Dorff Tanya , Rosenberg Jonathan E. , Elashoff David A. , Pantuck Allan J. , Drakaki Alexandra
Published: August 2024

Melanoma-associated antigen-A (MAGE-A) is expressed in multiple cancers with restricted expression in normal tissue. We sought to assess the MAGE-A3/A6 expression profile as well as immune landscape in urothelial (UC) and non–small cell lung carcinoma (NSCLC). We also assessed co-expression of immune-associated markers, including programmed cell death ligand 1 (PD-L1) in tumor and/or immune cells, and assessed the effect of checkpoint inhibitor treatment on these markers in the context of urothelial carcinoma. We used formalin-fixed paraffin-embedded (FFPE) tissue sections from a variety of tumor types were screened by IHC for MAGE-A and PD-L1 expression. Gene expression analyses by RNA sequencing were performed on RNA extracted from serial tissue sections. UC tumor samples from patients treated with checkpoint inhibitors were assessed by IHC and NanoString gene expression analysis for MAGE-A and immune marker expression before and after treatment. Overall, 84 samples (57%) had any detectable MAGE-A expression. Detectable MAGE-A expression was present at similar frequencies in both tumor tissue types, with 41 (50%) NSCLC and 43 (64%) UC. MAGE-A expression was not significantly changed before and after checkpoint inhibitor therapy by both IHC and NanoString mRNA sequencing. Other immune markers were similarly unchanged post immune checkpoint inhibitor therapy. Stable expression of MAGE-A3/A6 pre and post checkpoint inhibitor treatment indicates that archival specimens harvested after checkpoint therapy are applicable to screening potential candidates for MAGE therapies.
Topical Tranexamic Acid on Donor Wounds in Burn Patients: A Randomized Placebo-controlled Trial
Authors: Colclough Robert N. , Almeland Stian K. , Brekke Ragnvald L. , Spigset Olav , Nordgaard Håvard , Pleym Hilde , Ausen Kjersti
Published: August 2024

Background:

Patients with major burn injuries are prone to massive blood loss owing to tangential excision of burn wounds and donor skin harvesting. In general, topical application of the antifibrinolytic drug tranexamic acid (TXA) to surgical wounds reduces bleeding; however, its effect on bleeding and re-epithelialization in superficial wounds of burns has not been explored.

Methods:

This study aimed to investigate the therapeutic potential of topical TXA in reducing blood loss and its effect on wound re-epithelialization in burn surgery. Split-thickness skin graft donor wounds in burn patients were paired and randomized to topical application of either TXA (25 mg/mL) or placebo. Endpoints were postoperative bleeding as measured by dressing weight gain per cm2 wound area, blood stain area per wound area, and visual evaluation of bleeding in the dressings. Healing time was recorded to analyze the effect on wound re-epithelialization.

Results:

There was no significant difference in bleeding or time to re-epithelialization between the TXA and placebo wounds. A post hoc subanalysis of wounds with dressing weight gain above the median, showed a significant difference in favor of TXA. However, use of tumescence may have influenced end points. No significant adverse events related to the study drugs were observed.

Conclusions:

This study demonstrates that topical application of TXA (25 mg/mL) to split-thickness skin graft donor wounds does not delay re-epithelialization. Although a reduction in bleeding is suggested, further studies are needed to determine the role of topical TXA in reducing bleeding in burn surgery.
Machine Learning–Based Identification of Risk Factors of Keratoconus Progression Using Raw Corneal Tomography Data
Authors: Cohen-Tayar Yamit , Cohen Hadar , Key Dor , Tiosano Alon , Rozanes Eliane , Livny Eitan , Bahar Irit , Nahum Yoav
Published: August 2024

Purpose:

The purpose of this study was to identify early indicators of keratoconus progression in Pentacam data using machine learning (ML) techniques.

Methods:

A retrospective Pentacam tabular data set was created by retrieving 11,760 tomography tests performed in patients with keratoconus. Data for eyes labeled unstable based on their referral for cross-linking were differentiated from data for eyes labeled stable and not referred for follow-up procedures. A boosted decision tree was trained on the final data set using a cross-validation method.

Results:

The final labeled data set included 1218 tomography tests. Training a ML model on a single test for each eye did not accurately predict disease progression, as indicated by the mean receiver-operating characteristic area under the curve of 0.59 ± 0.1, with precision of 0.27, recall of 0.3, and F1 score of 0.28. Training on serial tests for each eye included 819 tomography scans and yielded good prognostic abilities: a receiver-operating characteristic area under the curve of 0.75 ± 0.07, precision of 0.32, recall of 0.67, and F1 score of 0.43. In addition, 4 of the 55 Pentacam raw data parameters predominantly used the algorithm decision: age, central keratoconus index, Rs B, and D10 mm pachy.

Conclusions:

This study revealed specific dominant parameters attributing to the classification of stability, which are not routinely assessed in determining progression in common practice. Using ML techniques, keratoconus deterioration was evaluated algorithmically with training on multiple tests, yet was not predicted by a single tomography test. Hence, our study highlights novel factors to the current consideration of cross-linking referral and may serve as a supportive tool for clinicians.
A Tuberculous Case of Pseudo-Meigs Syndrome
Authors: Aradhya Abhay , Bedi Angad , Cox Andrew , Khattak Ridda , Al Hennawi Hussam , Pirolli Gregory , Fallis Rebecca
Published: August 2024

Peritoneal tuberculosis is a rare infection that can often mimic other pathologies. A lack of shared symptoms with pulmonary tuberculosis and its mimicry of other pathologies make it a tough disease to accurately diagnose. In young women, peritoneal tuberculosis can present with signs and symptoms suggestive of ovarian cancer-associated Meigs syndrome. A broad differential is required for accurate diagnosis when a patient seems to have peritoneal carcinomatosis with serum CA-125 elevations.
What has brain diffusion magnetic resonance imaging taught us about chronic primary pain: a narrative review
Authors: Bautin Paul , Fortier Marc-Antoine , Sean Monica , Little Graham , Martel Marylie , Descoteaux Maxime , Léonard Guillaume , Tétreault Pascal
Published: August 2024

Chronic pain is a pervasive and debilitating condition with increasing implications for public health, affecting millions of individuals worldwide. Despite its high prevalence, the underlying neural mechanisms and pathophysiology remain only partly understood. Since its introduction 35 years ago, brain diffusion magnetic resonance imaging (MRI) has emerged as a powerful tool to investigate changes in white matter microstructure and connectivity associated with chronic pain. This review synthesizes findings from 58 articles that constitute the current research landscape, covering methods and key discoveries. We discuss the evidence supporting the role of altered white matter microstructure and connectivity in chronic primary pain conditions, highlighting the importance of studying multiple chronic pain syndromes to identify common neurobiological pathways. We also explore the prospective clinical utility of diffusion MRI, such as its role in identifying diagnostic, prognostic, and therapeutic biomarkers. Furthermore, we address shortcomings and challenges associated with brain diffusion MRI in chronic primary pain studies, emphasizing the need for the harmonization of data acquisition and analysis methods. We conclude by highlighting emerging approaches and prospective avenues in the field that may provide new insights into the pathophysiology of chronic pain and potential new therapeutic targets. Because of the limited current body of research and unidentified targeted therapeutic strategies, we are forced to conclude that further research is required. However, we believe that brain diffusion MRI presents a promising opportunity for enhancing our understanding of chronic pain and improving clinical outcomes.
Bidirectional relationships between pain and patterns of cannabis and tobacco use in a US nationally representative sample
Authors: Rubenstein Dana , Green Michael J. , Sweitzer Maggie M. , Keefe Francis J. , McClernon F. Joseph
Published: August 2024

One-fifth of US adults experience chronic pain, which is associated with increased tobacco and cannabis use. Although bidirectional relationships between tobacco and pain have been demonstrated, pathways between pain, cannabis use, and co-use of cannabis and tobacco are understudied. We aimed to estimate the effects of (1) substance use (exclusive and co-use of cannabis and tobacco) on later pain intensity, and (2) pain intensity on later substance use. Data were from 31,983 adults in biennial surveys (2015-2021) of the US nationally representative longitudinal Population Assessment of Tobacco and Health Study (n = 71,055 pairs of consecutive surveys; T1 and T2). Past-week pain intensity was dichotomized (≤4/10 no/low pain; >4/10 moderate/severe pain). Mutually exclusive substance use categories (past 30 days) were no cannabis/tobacco use; exclusive cannabis/tobacco use; and co-use. Logistic regression assessed whether T1 substance use affected moderate/severe pain at T2. Multinomial models assessed whether pain status at T1 affected substance use at T2. Compared with no cannabis/tobacco use at T1, co-use (OR: 2.29 [95% CI: 2.09-2.51]), exclusive tobacco use (2.00 [1.86-2.14]), and exclusive cannabis use (1.35 [1.13-1.61]) were all associated with moderate/severe pain at T2. Moderate/severe pain at T1 increased odds of co-use (2.43 [2.22-2.66]), exclusive tobacco (2.12 [1.98-2.28]), and exclusive cannabis use (1.46 [1.29-1.65]) compared with no cannabis/tobacco use at T2, and increased odds of co-use at T2 compared with exclusive cannabis/tobacco use. Findings demonstrated bidirectional relationships between pain and the exclusive use and co-use of cannabis and tobacco and indicate potential synergy in the co-use of cannabis and tobacco with respect to pain.
Neuroleadership: A Concept Analysis and Implications for Nursing
Authors: Abou Hashish Ebtsam Aly
Published: August 2024

BACKGROUND:Neuroleadership in nursing is a specialized leadership approach that integrates insights from social neuroscience with nursing leadership practices, aiming to proficiently lead healthcare teams to enhance patient care, staff productivity, and organizational outcomes. Yet, the exploration of neuroleadership in nursing remains limited.AIM:The aim of this study was to provide an analysis of the concept of neuroleadership and its implications in the nursing context.METHODS:Walker and Avant's 8-step methodology was used for this concept analysis, including identifying the concept, clarifying the purpose of the analysis, exploring the uses of the concept, and defining its attributes, model and contrary cases, antecedents and consequences, and its empirical referents. A comprehensive search included PubMed, CINAHL, and ERIC, between 2000 and 2023.RESULTS:This concept analysis significantly contributes to the literature by providing a comprehensive overview of neuroleadership as a distinct form of nursing leadership. It covers key aspects such as definition, attributes, uses, cases, antecedents, consequences, and empirical evidence, and highlights the importance of specialized education, practical experience, and leadership attributes in this domain. The findings could serve as determinants for establishing a neuroleadership framework and developing a structured questionnaire to measure neuroleadership among nurses and nurse leaders, thereby addressing existing empirical reference gaps.CONCLUSION:Nurse leaders adopting a neuroleadership approach can gain insights into how cognitive processes shape nurses' behaviors and motivation, which directly impact patient outcomes and care quality. Further research is needed to assess the practical impact of neuroleadership and validate its factors and model case in clinical nursing practice.