bluuebunny/crossref_metadata_2025 huggingface dataset:
Olfactory Responses of Anastrepha obliqua (Diptera: Tephritidae) to Mango Fruits as Influenced by Cultivar and Ripeness Stages
Authors: Neri Benítez-Herrera Luz , Cruz-López Leopoldo C , Malo Edi A , Romero-López Angel A , Rojas Julio C
Published: February 2023

Anastrepha obliqua Macquart (Diptera: Tephritidae) is a polyphagous species with hog plums (Spondias spp.) (Sapindales: Anacardiaceae) and mangoes (Mangifera indica L.) (Sapindales: Anacardiaceae) as primary host fruits. In this study, the olfactory preference of A. obliqua for three stages of ripeness of two mango cultivars (‘Coche’ and ‘Ataulfo’) was investigated. The female flies were more attracted to ripe ‘Coche’ fruits compared to those ripe ‘Ataulfo’. Further, they were more attracted to the ‘Coche’ half-ripe and ripe fruits than to the unripe ones, but they did not discriminate among the stages of ripeness of ‘Ataulfo’ fruits. The male flies did not show preference for any specific mango cultivars or ripeness stage tested. Four compounds from ripe ‘Coche’ mangoes, and two from ripe ‘Ataulfo’ fruits were identified using coupled gas chromatography-electroantennographic (GC-EAD) recording and gas chromatography-mass spectrometry (GC-MS) analysis. ‘Coche’ mango volatiles eliciting responses from the female antennae were ethyl butyrate, ethyl hexanoate, ethyl heptanoate, and ethyl octanoate. The two ‘Ataulfo’ mango volatiles were identified as 3-carene and ethyl octanoate. These compounds were absent in unripe mangoes of both cultivars. Synthetic blends of these compounds were attractive to females as mango extracts in field cage tests. Our results suggest that the olfactory preference of A. obliqua for attractive hosts is based on the presence or absence of the compounds associated with fruit maturity.
Clinical Laboratory Approaches for Diagnoses of Sleep-Disordered Breathing and ADHD-Like Behavior in Children
Authors: Bratton Tiffany K , Jazayeri Maryam , Senthilvel Egambaram , Mendoza Maria Romelinda , Valdes Roland
Published: February 2023

Background

Impaired breathing during sleep, as in obstructive sleep apnea (OSA), can lead to behavior symptoms like those observed in children with attention deficit hyperactivity disorder (ADHD). Obstructive sleep apnea can be effectively treated, thus avoiding problematic pharmacotherapies associated with managing ADHD. Diagnosis of OSA relies on sleep studies as the gold standard, but in children, sleep studies are inherently difficult, cumbersome, and expensive and are not practical tools in the differential diagnosis of behavior disorders. Therefore, development of clinical laboratory tests for diagnoses of sleep apnea would change the standard of care for attention deficit syndromes.

Content

We review the status of potential laboratory tests for diagnosis of OSA in children with emphasis on markers linked to intermittent hypoxia and cardiovascular responses. In the context of ADHD, we focus on preliminary evidence and rationale for urocortin 3 and erythropoietin as urinary markers with physiologic relevance for diagnosis of OSA.

Laboratory tests that correlate with both OSA and ADHD-like syndromes would be useful to diagnose root causes of behaviors and identify a subset of children who may not need psychotropic medications. The discovery of laboratory biomarkers for OSA is evolving, but several candidates show promise and provide a segue to more focused development in laboratory diagnostics.
One-carbon metabolism and related pathways in ruminal and small intestinal epithelium of lactating dairy cows
Authors: Jiang Qianming , Sherlock Danielle N , Zhang Huimin , Guyader Jessie , Pan Yuan-Xiang , Loor Juan J
Published: February 2023

Physiological and environmental stresses such as the transition into lactation and heat load contribute to gastrointestinal tract (GIT) dysfunction. The nonruminant gastrointestinal tract has mechanisms to cope with pro-oxidant and pro-inflammatory stressors arising from the gut lumen or within intestinal cells. One-carbon metabolism (OCM) contributes to anti-oxidant capacity via the production of glutathione (GSH) and taurine, and the synthesis of phospholipid, creatine, and the osmolyte glycinebetaine among others. A multipronged approach was used to assess the biological relevance of OCM and closely-related pathways on GIT function in dairy cows. Ruminal papillae (Rum) and scrapings from duodenum (Duo), jejunum (Jej), and ileum (Ile) were collected at slaughter from eight multiparous Holstein cows averaging 128 ± 12 d in milk and producing 39 ± 5 kg/d. A MIXED model ANOVA with preplanned orthogonal contrasts was used for statistical analysis. Methionine adenosyl transferase 1 activity (MAT) was ~10-fold greater (P < 0.01) and cystathionine β-synthase activity doubled in Rum vs. small intestine. Total glutathione peroxidase (GPX) activity was greatest (P = 0.03) in Ile, but similar to Rum. Activity and mRNA abundance of betaine-homocysteine S-methyltransferase were undetectable. There was a 2.5-fold greater protein abundance of GPX1 (P < 0.01) and a ~2-fold greater abundance of GPX3 (P < 0.01) in Rum vs. small intestine. Among the various amino acids (AA) with roles in OCM or closely-related pathways (e.g. creatine synthesis), concentrations of arginine, aspartate, glutamine, methionine, and serine were lower (P < 0.01) in Rum vs. small intestine. Unlike AA, concentrations of OCM-related intermediates S-5ʹ-adenosyl-homocysteine (SAH), glycinebetaine, carnitine, creatine (CRE), and cysteinesulfinic acid were greater (P < 0.01) while taurine was lower in Rum vs. small intestine. Intermediates of the folate cycle were undetectable. The fact that S-adenosylmethionine (SAM) was undetectable while MAT activity and SAH were greater in Rum suggested that availability of SAM (a methyl donor) is a key determinant of flux through the folate and methionine cycles in the GIT. Except for adenosine, concentrations of glutamate, glycine, α-ketoglutarate, hypotaurine, and GSH were lowest in Ile. Together, the data underscored unique differences in activity of one-carbon metabolism and related pathways across sections of the GIT.
High-flow nasal oxygen as an adjunct for the safe removal of impacted metallic upper airway foreign bodies
Authors: van den Berg Nadia , Aly Moustafa , Callaghan Michael , Keogh Ivan
Published: February 2023

Foreign body airway obstruction is considered an airway emergency and is a challenging clinical scenario for both the otolaryngologist and the anaesthetist. We present three cases of impacted upper airway metallic foreign bodies. Supra-glottic airways were obstructed and precarious. Apnoeic oxygenation utilizing high-flow nasal oxygen (HFNO), a form of tubeless anaesthetic, was used in all three cases, leading to the safe removal of the foreign bodies. Increased training, awareness and equipment availability to provide HFNO apnoeic oxygenation in the emergency setting for otolaryngology airway procedures will lead to better outcomes for patients and decreases the risk of a potential surgical airway.
Timing analysis of EXO 2030+375 during its 2021 giant outburst observed withInsight-HXMT
Authors: Fu Yu-Cong , Song L M , Ding G Q , Ge M Y , Tuo Y L , Zhang S , Zhang S N , Hou X , Qu J L , Zhang J , Zhang L , Bu Q C , Huang Y , Ma X , Zhou X , Yan W M , Yang Z X , Lu X F , Li T M , Xu Y C , Wang P J , Xiao S H , Liu H X , Ren X Q , Du Y F , Zhao Q X , Xiao Y X
Published: February 2023

We report the evolution of the X-ray pulsations of EXO 2030+375 during its 2021 outburst using the observations from Insight-HXMT. Based on the accretion torque model, we study the correlation between the spin frequency derivatives and the luminosity. Pulsations can be detected in the energy band of 1–160 keV. The pulse profile evolves significantly with luminosity during the outburst, leading to that the whole outburst can be divided into several parts with different characteristics. The evolution of the pulse profile reveals the transition between the supercritical (fan-beam dominated) and the subcritical accretion (pencil-beam dominated) mode. From the accretion torque model and the critical luminosity model, based on a distance of 7.1 kpc, the inferred magnetic fields are (0.41 − 0.74) × 1012 and (3.48 − 3.96) × 1012 G, respectively, or based on a distance of 3.6 kpc, the estimated magnetic fields are (2.4 − 4.3) × 1013 and (0.98 − 1.11) × 1012 G, respectively. Two different sets of magnetic fields both support the presence of multipole magnetic fields of the neutron star.
Characterizing the nucleus of comet 162P/Siding Spring using ground-based photometry
Authors: Donaldson A , Kokotanekova R , Rożek A , Snodgrass C , Gardener D , Green S F , Masoumzadeh N , Robinson J
Published: February 2023

Comet 162P/Siding Spring is a large Jupiter-family comet with extensive archival lightcurve data. We report new r-band nucleus light curves for this comet, acquired in 2018, 2021, and 2022. With the addition of these light curves, the phase angles, at which the nucleus has been observed, range from 0.39○ to 16.33○. We absolutely calibrate the comet light curves to r-band Pan-STARRS 1 magnitudes, and use these light curves to create a convex shape model of the nucleus by convex lightcurve inversion. The best-fitting shape model for 162P has axis ratios a/b = 1.56 and b/c = 2.33, sidereal period P = 32.864 ± 0.001 h, and a rotation pole oriented towards ecliptic longitude λE = 118○ ± 26○ and latitude βE = −50○ ± 21○. We constrain the possible nucleus elongation to lie within 1.4 < a/b < 2.0 and discuss tentative evidence that 162P may have a bilobed structure. Using the shape model to correct the light curves for rotational effects, we derive a linear phase function with slope β = 0.051 ± 0.002 mag deg−1 and intercept Hr(1, 1, 0) = 13.86 ± 0.02 for 162P. We find no evidence that the nucleus exhibited an opposition surge at phase angles down to 0.39°. The challenges associated with modelling the shapes of comet nuclei from light curves are highlighted, and we comment on the extent to which we anticipate that Legacy Survey of Space and Time will alleviate these challenges in the coming decade.
L’anxiété chez les enfants et les adolescents – partie 1 : le diagnostic
Authors: Klein Benjamin , Rajendram Rageen , Hrycko Sophia , Poynter Aven , Ortiz-Alvarez Oliva , Saunders Natasha , Andrews Debra
Published: February 2023

Les troubles anxieux sont les problèmes de santé mentale les plus courants chez les enfants et les adolescents canadiens. La Société canadienne de pédiatrie a préparé deux documents de principes qui résument les données probantes à jour sur leur diagnostic et leur prise en charge. Ces documents contiennent des conseils fondés sur des données probantes afin d’aider les professionnels de la santé à prendre des décisions à l’égard des soins aux enfants et aux adolescents atteints de ces troubles. La première partie, qui porte sur l’évaluation et le diagnostic, vise à1) passer en revue l’épidémiologie et les caractéristiques cliniques des troubles anxieux; 2) décrire un processus d’évaluation des troubles anxieux. Des thèmes précis sont abordés, y compris la prévalence, le diagnostic différentiel, les affections concomitantes et le processus d’évaluation. Des démarches sont proposées pour standardiser le dépistage, recueillir l’anamnèse et observer le patient. Des caractéristiques et indicateurs connexes, qui distinguent les troubles anxieux des peurs, inquiétudes et sentiments d’anxiété adaptés au développement, sont examinés. Il est à souligner que, dans le présent document, le terme « parent » (au singulier ou au pluriel) inclut les personnes qui s’occupent principalement de l’enfant et toutes les configurations familiales.
Anxiety in children and youth: Part 2—The management of anxiety disorders
Authors: Bobbitt Susan , Kawamura Anne , Saunders Natasha , Monga Suneeta , Penner Melanie , Andrews Debra
Published: February 2023

Anxiety disorders are the most common mental health concerns affecting Canadian children and adolescents. The Canadian Paediatric Society has developed two position statements that summarize current evidence regarding the diagnosis and management of anxiety disorders. Both statements offer evidence-informed guidance to support paediatric health care providers (HCPs) making decisions around the care of children and adolescents with these conditions. The objectives of Part 2, which focuses on management, are to: (1) review the evidence and context for a range of clinical approaches that combine behavioural and pharmacological interventions to effectively address impairment, (2) describe the roles of education and psychotherapy in the prevention and treatment of anxiety disorders, and (3) outline the use of pharmacotherapy, with side effects and risks. Recommendations for managing anxiety are based on current guidelines, review of the literature, and expert consensus. Note that when the word ‘parent’ (singular or plural) is used, it includes any primary caregiver and every configuration of family.
Arabidopsis ACT DOMAIN REPEAT9 represses glucose signaling pathways
Authors: Liao Hong-Sheng , Chen Ying-Jhu , Hsieh Wei-Yu , Li Yi-Chiou , Hsieh Ming-Hsiun
Published: February 2023

Nutrient sensing and signaling are critical for plants to coordinate growth and development in response to nutrient availability. Plant ACT DOMAIN REPEAT (ACR) proteins have been proposed to serve as nutrient sensors, but their functions remain largely unknown. Here, we showed that Arabidopsis (Arabidopsis thaliana) ACR9 might function as a repressor in glucose (Glc) signaling pathways. ACR9 was highly expressed in the leaves, and its expression was downregulated by sugars. Interestingly, the acr9-1 and acr9-2 T-DNA insertion mutants were hypersensitive to Glc during seedling growth, development, and anthocyanin accumulation. Nitrogen deficiency increased the mutants’ sensitivity to Glc. The expression of sugar-responsive genes was also significantly enhanced in the acr9 mutants. By contrast, the 35S:ACR9 and 35S:ACR9-GFP overexpression (OE) lines were insensitive to Glc during early seedling development. The Glc signaling pathway is known to interact with the plant hormone abscisic acid (ABA). Notably, the acr9 mutants were also hypersensitive to ABA during early seedling development. The Glc sensor HEXOKINASE1 (HXK1) and the energy sensor SUCROSE NON-FERMENTING1 (SNF1)-RELATED PROTEIN KINASE1 (SnRK1) are key components of the Glc signaling pathways. The acr9-1/hxk1-3 and acr9-1/snrk1 double mutants were no longer hypersensitive to Glc, indicating that functional HXK1 and SnRK1 were required for the acr9-1 mutant to be hypersensitive to Glc. Together, these results suggest that ACR9 is a repressor of the Glc signaling pathway, which may act independently or upstream of the HXK1-SnRK1 signaling module.
Predictors of COVID-19 severity and outcomes in Indian patients with rheumatic diseases: a prospective cohort study
Authors: Mathew Jithin , Jain Siddharth , Susngi Terence , Naidu Shankar , Dhir Varun , Sharma Aman , Jain Sanjay , Sharma Shefali Khanna
Published: February 2023

Objective

There is dearth of data regarding the outcomes of coronavirus disease 2019 (COVID-19) among rheumatic and musculoskeletal disease (RMD) patients from Southeast Asia. We report the clinicodemographic profile and identify predictors of COVID-19 outcomes in a large cohort of Indian RMD patients.

Methods

This prospective cohort study, carried out at the Postgraduate Institute of Medical Education and Research, Chandigarh (a tertiary care centre in India), included RMD patients affected with COVID-19 between April 2020 and October 2021. Demographic and clinical and laboratory details of COVID-19 and underlying RMD were noted. Predictors of mortality, hospitalization and severe COVID-19 were identified using stepwise multivariable logistic regression.

Results

A total of 64 severe acute respiratory syndrome coronavirus-2-infected RMD patients [age 41.5 (19–85) years; 46 (72%) females] were included. Eighteen (28%) patients had severe COVID-19. Twenty-three (36%) required respiratory support [11 (17%) required mechanical ventilation]. Thirty-six (56%) patients required hospitalization [median duration of stay 10 (1–42) days]; 17 (27%) required intensive care unit admission. Presence of co-morbidities [odds ratio (OR) = 4.5 (95% CI: 1.4, 14.7)] was found to be an independent predictor of COVID-19 severity. Co-morbidities [OR = 10.7 (95% CI: 2.5, 45.4)] and underlying lupus [OR = 7.0 (95% CI: 1.2, 40.8)] were independently associated with COVID-19 hospitalization. Ongoing rheumatic disease activity [OR = 6.8 (95% CI: 1.3, 35.4)] and underlying diagnosis of lupus [OR = 7.1 (95% CI: 1.2, 42.4)] and SSc [OR = 9.5 (95% CI: 1.5, 61.8)] were found to be strong independent predictors of mortality. Age, sex, underlying RMD-associated interstitial lung disease and choice of immunosuppressive therapy were not associated with COVID-19 severity or adverse outcomes.

Conclusion

The presence of co-morbidities was independently associated with COVID-19 severity and hospitalization. Ongoing rheumatic disease activity and the presence of lupus or SSc independently predicted mortality. Age, sex, type of immunosuppressive therapy and presence of RMD-associated interstitial lung disease did not affect COVID-19 severity or outcomes in Indian RMD patients.
Mission-oriented innovation policy as a hybridisation process: the case of transforming a national fertilising system
Authors: Nylén Erkki-Jussi , Johanson Jan-Erik , Vakkuri Jarmo
Published: February 2023

Policymakers and researchers have discussed mission-oriented innovation policies (MIPs) as one way to tackle the grand challenges of modern societies. Our contribution to MIP research is to provide a case analysis of the unfolding of such a policy from a hybridity perspective. Hybridity refers to the amalgamation of public policies, private efforts, and voluntary activities when pursuing societal aims. In practice, hybridity integrates value propositions from governments, markets, and civil society. Our case study subject is the Finnish nutrient recycling (NR) policy. The NR policy aims to supersede the dominance of chemical fertilisers with organic fertilisers. We analysed forms of hybridity and hybrid constellations of actors that were initiated as part of the Finnish NR policy. Subsequently, we analysed how the value-creation mechanisms of legitimising, compromising, and mixing appear in the NR policy. As a result, we conceptualised what the process of hybridisation entails in the context of MIPs.
Cytotoxic and genotoxic effects of leaking chemicals from serum infusion sets: an in-vitro study
Authors: Özlü Ayşegül , Taner Gökçe
Published: February 2023

Safety concerns about medical devices playing important role in health sciences and bioengineering research are rising day by day. Although there are specific standards regarding disposable medical materials, the information is updating with the toxicological studies. In this study, cytotoxic/genotoxic effects of chemicals leaking from serum infusion sets that have an important place in the clinic were investigated. Media containing leakage chemicals were prepared from equal samples taken from the plastic line sections of 13 different brands of serum infusion sets containing phthalates and the effects on the cultured cells were compared with the untreated control groups. To obtain leaking chemicals, extracting period was selected as 72 h, a routine set-change time in the clinic as indicated in various publications. Neutral red uptake and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide tests were performed in L929 cells to determine cytotoxicity, and cytokinesis blocked micronucleus technique was performed in lymphocytes to determine genotoxicity. Cytotoxic and genotoxic damage levels were compared by evaluating cell-viability rates relative to control, micronucleus frequency, and nuclear division index values. The results showed that all sets caused a decrease in cell viability revealing the effects both on lysosomal and mitochondrial activity and increase in micronucleus frequencies in general. The number of similar studies is extremely limited, and in this study in addition to the short-term effects of using the serum infusion sets, the information about the sample tests to determine the biosecurity of disposable medical materials is given.
Research on virtual coupling technology in rail transit train collision protection
Authors: Li Gaosong , Zou Jinbai , Ma Weijie , Lan Meng
Published: February 2023

In the research on the new generation of intelligent rail transit system, the prevention of train collision accidents is still a focus. Virtual coupling technology controls the running speed and interval distance of two or more trains cooperatively through Train-to-Train (T2T) direct communication technology. The aim is to form a coordinated logical system and jointly complete the train control and dispatching. In this paper, a virtual coupling train formation control method based on the model predictive control (MPC) framework is proposed. From the establishment of the virtual coupling system, the construction of an MPC model and decoupling method, how to integrate virtual coupling technology into the rail transit train collision protection is studied. The safety and reliability of the system are calculated through fault tree and the method of constructing reliability function. The research shows that if virtual coupling technology is used for train collision protection, the overall safety and reliability of the train control system is improved.
Elucidating the Obligate Nature and Biological Capacity of an Invasive Fungal Corn Pathogen
Authors: MacCready Joshua S. , Roggenkamp Emily M. , Gdanetz Kristi , Chilvers Martin I.
Published: February 2023

Tar spot is a devasting corn disease caused by the obligate fungal pathogen Phyllachora maydis. Since its initial identification in the United States in 2015, P. maydis has become an increasing threat to corn production. Despite this, P. maydis has remained largely understudied at the molecular level, due to difficulties surrounding its obligate lifestyle. Here, we generated a significantly improved P. maydis nuclear and mitochondrial genome, using a combination of long- and short-read technologies, and also provide the first transcriptomic analysis of primary tar spot lesions. Our results show that P. maydis is deficient in inorganic nitrogen utilization, is likely heterothallic, and encodes for significantly more protein-coding genes, including secreted enzymes and effectors, than previous determined. Furthermore, our expression analysis suggests that, following primary tar spot lesion formation, P. maydis might reroute carbon flux away from DNA replication and cell division pathways and towards pathways previously implicated in having significant roles in pathogenicity, such as autophagy and secretion. Together, our results identified several highly expressed unique secreted factors that likely contribute to host recognition and subsequent infection, greatly increasing our knowledge of the biological capacity of P. maydis, which have much broader implications for mitigating tar spot of corn.

[Formula: see text] Copyright © 2023 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Early Factors Predictive of Extreme High and Low Life Satisfaction 10 Years Post–Moderate to Severe Traumatic Brain Injury
Authors: O'Neil-Pirozzi Therese M. , Sevigny Mitch , Pinto Shanti M. , Hammond Flora M. , Juengst Shannon B.
Published: February 2023

Objective:

To identify demographic, injury-related, and 1-year postinjury clinical and functional predictors of high and low life satisfaction at 10 years after moderate to severe traumatic brain injury (TBI) using an extreme phenotyping approach.

Setting:

Multicenter longitudinal database study.

Participants:

A total of 3040 people from the National Institute on Disability, Independent Living, and Rehabilitation Research TBI Model Systems database with life satisfaction data at 10 years post-TBI.

Design:

Multicenter, cross-sectional, observational design.

Main Measures:

Satisfaction With Life Scale (outcome), Glasgow Coma Scale, Disability Rating Scale, Functional Independence Measure, Participation Assessment with Recombined Tools-Objective, Patient Health Questionnaire-9, and General Anxiety Disorder-7 (standardized predictors).

Results:

Greater cognitive and motor independence, more frequent community participation, and less depressive symptoms 1 year post–moderate to severe TBI predicted extreme high life satisfaction 10 years later. Non-Hispanic White and Hispanic individuals were significantly more likely than Black individuals to have extreme high life satisfaction 10 years post-TBI.

Conclusions:

Extreme phenotyping analysis complements existing knowledge regarding life satisfaction post–moderate to severe TBI. From a chronic disease management perspective, future studies are needed to examine the feasibility and impact of early postinjury medical and rehabilitative interventions targeting cognitive and motor function, community participation, and mood on the maintenance/enhancement of long-term life satisfaction post-TBI.
Neck Symptoms and Associated Clinical Outcomes in Patients Following Concussion
Authors: Oyekan Anthony A. , Eagle Shawn , Trbovich Alicia M. , Shaw Jeremy D. , Schneider Michael , Collins Michael , Lee Joon Y. , Kontos Anthony P.
Published: February 2023

Objective:

To examine the frequency and association of neck pain symptoms in patients with a concussion.

Study Setting and Participants:

Three-hundred and thirty-one consecutively enrolled patients aged 9 to 68 years with a diagnosed concussion 1 to 384 days post-injury were enrolled at a concussion clinic from a single integrated healthcare system in Western Pennsylvania between 2019 and 2021.

Design:

Retrospective cohort analysis of prospectively collected concussion screening tool intake survey responses and clinical outcomes data. The primary outcome was self-reported neck pain or difficulty with neck movement on the Concussion Clinical Profiles Screening (CP Screen) tool, recovery time, and incidence of treatment referral. Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) composite scores, Vestibular/Ocular Motor Screening (VOMS) item scores, type and severity of neck symptoms, mechanism of injury, time from injury to clinic presentation, medical history, and concussion symptom profile were secondary outcomes.

Results:

Of the 306 consecutively enrolled eligible patients in the registry, 145 (47%) reported neck pain, 68 (22.2%) reported difficulty moving their neck, and 146 (47.7%) reported either symptom. A total of 47 (15.4%) participants reported more severe neck symptoms, and this group took longer to recover (40 ± 27 days) than those not reporting neck symptoms (30 ± 28 days; U = 8316, P < .001). Stepwise logistic regression predicting more severe neck symptoms was significant (Nagelkerke R
2 = 0.174, χ2 = 9.315, P = .316) with older age (P = .019) and mechanism of injury including motor vehicle collisions (MVCs) (P = .047) and falls (P = .044) as risk factors. MVCs and falls were associated with over 4 times and 2 times greater risk, respectively, for reporting more severe neck symptoms.

Conclusion:

Neck pain and stiffness symptoms are common in patients with a concussion following high-energy mechanisms of injury including MVCs or falls from height. These symptoms are associated with prolonged recovery. Providers should evaluate neck symptoms and consider targeted treatment strategies to limit their effects in patients with a concussion.
Research Letter: Rate of BPPV in Patients Diagnosed With Concussion
Authors: McCormick Kristen , Kolar Beth
Published: February 2023

Objective:

The purpose of this study was to investigate the incidence of benign paroxysmal positional vertigo (BPPV) specifically among patients with dizziness in the rehabilitation phase of concussion recovery and to provide evidence regarding the importance of BPPV assessment in physical therapy concussion evaluations.

Setting:

Outpatient neurologic rehabilitation center at a suburban comprehensive rehabilitation hospital.

Participants:

Fifty patients diagnosed with concussion and referred to vestibular physical therapy with complaints of dizziness were tested for BPPV within their first 3 visits.

Design:

In this prospective cohort study, a positive Dix-Hallpike test or Horizontal Roll test indicated the presence of BPPV.

Main Measures:

The primary outcome measure was the presence of BPPV. Additional demographic and injury-specific variables were also considered. Among secondary outcomes, patient characteristics and Dizziness Handicap Inventory scores were compared on the basis of presence or absence of BPPV.

Results:

Eleven participants, 22%, tested positive for BPPV. Only fall, as the mechanism of injury, was statistically significant (P < .05), with 72.7% of those who tested positive for BPPV reporting having been injured in a fall compared with 30.8% in the negative group. Nearly half, 45%, of the participants who were positive for BPPV had resolution of their BPPV within 1 visit.

Conclusion:

This study is unique in its focus on mild traumatic brain injury in the rehabilitation phase of recovery. The results provide evidence regarding the importance of BPPV assessment in physical therapy concussion evaluations.
Pediatric Hepatitis and Respiratory Viruses: A Spatiotemporal Ecologic Analysis
Authors: Sawires Rana , Osowicki Joshua , Clothier Hazel , Fahey Michael , Buttery Jim
Published: February 2023

Introduction:

Beginning in early 2022, clusters of severe pediatric hepatitis were reported in Europe and the United States. To date, no cause has been identified although human adenovirus 41 has been proposed in a proportion of cases. We examined population data >11 years for hepatitis clusters in Victoria, Australia, and whether any were spatiotemporally associated with community transmission of common respiratory viruses.

Methods:

We used SaTScan to analyze for clusters of pediatric hepatitis and respiratory adenoviruses in Victoria. Negative binomial regression analysis was performed to determine any associations between hepatitis and respiratory viruses across Victoria between July 1, 2011, and June 30, 2022.

Results:

A number of positive associations were observed in Victoria between pediatric hepatitis clusters and respiratory viruses in our spatiotemporal analysis. A positive association was not found with respiratory adenoviruses or SARS-CoV-2. Increased hepatitis clusters were observed in 2021 and 2022 as noted internationally.

Conclusion:

The current hepatitis outbreak is novel and, although respiratory viruses are broadly associated with hepatitis, SARS-CoV-2 and respiratory adenoviruses are unlikely to be related.
Reduction in Extraocular Muscle Cross-sectional Area and Correlation With Extraocular Motility and Diplopia Following Teprotumumab for Thyroid Eye Disease
Authors: Reshef Edith R. , Marsiglia Marcela , Bouhadjer Karim , Chiou Carolina A. , O’Brien-Coon Devin , Reinshagen Katherine L. , Freitag Suzanne K.
Published: February 2023

Purpose:

To quantify changes in extraocular muscle (EOM) cross-sectional areas (CSA) on orbital imaging in patients with thyroid eye disease before and after teprotumumab treatment, and assess for correlation with clinical outcomes.

Methods:

This retrospective study included thyroid eye disease patients treated with teprotumumab who had pre- and post-treatment CT imaging. Reformatted oblique coronal images were created for each orbit in a plane perpendicular to the optic nerve. EOM CSA measurements were performed by 2 radiographic reviewers and averaged. Primary outcomes included change in ratio of total EOM to orbit CSA, and of each individual muscle group to orbit CSA, before and after treatment. Secondary outcomes included subanalysis based on age (≥40, <40 years) and Clinical Activity Score (CAS) (≥4, <4), and comparison with clinical outcomes including CAS, Hertel exophthalmometry, Gorman diplopia score, and extraocular motility.

Results:

Forty-eight orbits of 24 patients (16 female, mean age 57.9 years) were included. There was a significant reduction in the total EOM to orbit CSA ratio (p < 0.01) and for each individual rectus muscle to orbit CSA ratio (p < 0.01 for all groups). Total EOM to orbit CSA ratios were reduced for 21 patients (87.5%); this was statistically significant in 13 patients (54.2%). There was significant improvement in CAS, proptosis, diplopia, and EOM motility (p < 0.01 for all categories). There was a significant correlation between reduction of EOM CSA, and reduction of diplopia (p < 0.01) and EOM motility (p < 0.01).

Conclusions:

EOM CSA is significantly reduced following treatment with teprotumumab, and correlates with clinical findings including improvement in extraocular motility and diplopia.
Chronic Lymphocytic Leukemia Presenting as Bilateral Periorbital Edema Treated With Low-dose Radiation Therapy
Authors: Spadaro Jane Z. , Chow Ryan , Sinard John H. , Watsky Kalman , Habib Larissa
Published: February 2023

Ocular manifestations in chronic lymphocytic leukemia (CLL) have been reported in 30% to 40% of patients and may be a result of direct tissue infiltration, concomitant blood dyscrasias, or a result of therapeutic intervention. Leukemia cutis, defined as infiltration of the epidermis or dermis by neoplastic lymphocytes, is rare. Herein, we present a case report of a patient with leukemia who presented with periorbital edema and ecchymosis. This is the first known case to date of periorbital CLL successfully treated with low-dose radiation therapy (4 Gy in 2 fractions). Clinicians should be aware of the possibility of ocular involvement from CLL, given the importance of prompt diagnosis and treatment.
Preliminary outcomes of accelerated partial breast irradiation by interstitial multicatheter brachytherapy with intraoperative free-hand catheter implantation in early breast cancer
Authors: Cheng Hao-Shen , Hung Chih-Chiang , Wang Kuo-Chung , Tsai I-Chen , Lin Jia-Fu , Yeh Hui-Ling
Published: February 2023

Background:

To evaluate the clinical feasibility of interstitial brachytherapy by intraoperative free-hand catheter implantation in the treatment of early breast cancer after breast-conserving surgery (BCS).

Methods:

Between January 2018 and December 2019, 44 patients with early breast cancer after BCS who met the inclusion criteria ≥45 years old, invasive carcinoma ≤3 cm or ductal carcinoma in situ <2.5 cm, estrogen receptor positive, lymph node negative, surgical margin negative, no distant metastasis, and an ECOG performance score ≤1 were enrolled in this phase II single-arm study. The postoperative irradiation field includes the tumor bed plus 2-cm margin in all directions, except in the anterior–posterior direction. The total prescribed tumor dose was 3400 cGy delivered in 10 fractions twice daily at 6-hour intervals. The primary endpoints were acute side effects, late treatment-related toxicity, and cosmetic outcome. The secondary endpoints were local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), distant metastasis-free survival (DMFS), and overall survival (OS).

Results:

The median follow-up time was 33.5 months (mean, 32.9 months; range, 20-43 months). The cosmetic results were good to very good in 92.3% of the questionnaire respondents. The acute toxicities were mild, and no acute grade 3-4 toxicity was noted. Wound infection was noted in two patients (4.5%). There was only one event of regional lymph node recurrence in one patient. The 3-year LRFS, DMFS, and OS were 100%, and RRFS was 94.7%. For two patients who had a positive lymph node based on their final pathology reports, postoperative irradiation, including whole breast and regional lymph nodes, was added.

Conclusion:

Accelerated partial breast irradiation using interstitial brachytherapy with the intraoperative free-hand catheter implantation technique provides an alternative method of postoperative radiotherapy for selected patients with early breast cancer after BCS with acceptable toxicities.
Hidden behind thromboinflammation: revealing the roles of von Willebrand factor in sickle cell disease pathophysiology
Authors: Vital Eudorah F. , Lam Wilbur A.
Published: February 2023

Purpose of review

This review provides an update on the pathophysiology of sickle cell disease (SCD) with a particular focus on the dysregulation of the von Willebrand factor (VWF) - ADAMTS13 axis that contributes to its pathogenesis. In discussing recent developments, we hope to encourage new and ongoing discussions surrounding therapeutic targets for SCD.

Recent findings

Within the last 5 years, the role of VWF in the pathophysiology of SCD has been further elucidated and is now a target of study in ongoing clinical trials.

The pathophysiology of SCD is multifaceted, as it involves systemwide vascular activation, altered blood rheology, and the activation of immune responses and coagulative pathways. The presence of VWF in excess in SCD, particularly in its largest multimeric form, greatly contributes to its pathogenesis. Understanding the molecular mechanisms that underly the presence of large VWF multimers in SCD will provide further insight into the pathogenesis of SCD and provide specific targets for therapy.
Nurses' Perceptions of Infusion Therapy During the COVID-19 Pandemic
Authors: Weaver Susan H. , Steinheiser Marlene M. , McNicholas Miriam , Prinzo Deborah , Wertz Bridget
Published: February 2023

During the COVID-19 pandemic, nurses were faced with challenges when caring for patients, safely administering intravenous (IV) medications and solutions, and protecting themselves from the virus. To address these challenges, nurses moved infusion pumps outside of intensive care unit (ICU) rooms of patients with COVID-19 to minimize their exposure to the virus, conserve personal protective equipment, and efficiently administer IV medications and solutions. The purpose of this qualitative descriptive study was to explore and describe nurses' perception of managing infusion pumps outside the ICU rooms of patients with COVID-19 at 6 acute care hospitals. Eight interviews were conducted with ICU nurse managers, assistant nurse managers, clinical nurses, and vascular access team staff. From the interviews, the overarching theme was “figure out a way,” with the subtheme “no clear-cut policy.” Additional themes were: (1) limiting nurses' exposure, (2) increased risk for infection and error, (3) teamwork, and (4) roller coaster of emotions. The findings from this study revealed that, during this unprecedented pandemic, nurses were innovative and figured out a way to care for patients who were critically ill with COVID-19. Understanding this experience provides insight into creating policies and procedures to guide patient care in future pandemics or emergency care.
Development of a Multidisciplinary Professional Advancement Framework
Authors: Rakow Cara , White Eliza , Hobbie Wendy , Roberts Kathryn E.
Published: February 2023

The creation of professional advancement programs is an important goal to support development of nurses and other team members. Maintaining consistency among programs within one institution poses a challenge. The development of an overarching framework has provided this structure. Our framework is composed of core components, key elements, and best practices that can be applied to ensure consistency among all programs. This framework can be applied to existing programs or guide new eight programs.
Enteral Feeding for Moderately Premature and Low Birth Weight Infants: A Single-Center Retrospective Observational Cohort Study
Authors: Dekker Dorita M.Z. , van Brakel Monique , van den Akker Chris H.P. , Plötz Frans B.
Published: February 2023

Controversy exists in clinical practice regarding optimal initial enteral feeding (EF) for moderately premature and low birth weight (BW) infants. We included 96 infants stratified into 3 groups (I: 1600–1799 g [n = 22]; II: 1800–1999 g [n = 42]; III: 2000–2200 g [n = 32]). The protocol recommended starting with minimal EF (MEF) in infants weighing <1800 g. On the first day of life, 5% of the infants in group I did not follow the protocol mandating MEF, but started with exclusive EF instead, compared to 36% and 44% of the infants in groups II and III, respectively. The median number of days until exclusive EF was achieved was 5 days longer for infants receiving MEF than for infants who had received normal portions of EF from birth onward. We observed no significant differences in feeding-related complications. We advocate omitting MEF in moderately premature infants with a BW of 1600 g or higher.
Using a Learning System Approach to Improve Safety for Prone-Position Ventilation Patients
Authors: Thomas Anna L. , Graham Kelly , Davila Shannon , Giuffrida Patricia
Published: February 2023

Objectives

This study aimed to describe how a Patient Safety Organization, to which healthcare organizations submit patient safety event data for both protections and analysis, used a learning system approach to analyze and interpret trends in member data. The data analysis informed evidence-based practice recommendations for improvement of patient outcomes for patients receiving prone-position ventilation.

Methods

Patient safety analysts with critical care nursing backgrounds identified a need for increased support of Patient Safety Organization members who were proning patients during the COVID-19 pandemic. Patient safety events from member organizations across the United States were analyzed and aggregated. Primary and secondary taxonomies for safety events experienced by patients receiving prone-position ventilation were created, which provided insight into harm trends in this patient population.

Results

Analysis of 392 patient safety events resulted in the identification of gaps in the care of these fragile patients, including but not limited to medical device–related pressure injuries, concerns with care delivery, staffing and acuity issues, and medical device dislodgement. Event themes in prone-position ventilation safety events informed a literature search from which an evidence-based action plan was developed and disseminated to Patient Safety Organization members for use in harm reduction efforts.

Conclusions

Using a learning system approach, patient safety event data related to prone-position ventilation or any other type of patient safety event can be aggregated and analyzed to identify key areas of safety concerns and gaps in practice, allowing organizations to affect improvement efforts.
Development of a Periprocedure Trigger for Outpatient Interventional Radiology Procedures in the Veterans Health Administration
Authors: Bart Nina , Mull Hillary J. , Higgins Mikhail , Sturgeon Daniel , Hederstedt Kierstin , Lamkin Rebecca , Sullivan Brian , Branch-Elliman Westyn , Foster Marva
Published: February 2023

Objectives

Interventional radiology (IR) is the newest medical specialty. However, it lacks robust quality assurance metrics, including adverse event (AE) surveillance tools. Considering the high frequency of outpatient care provided by IR, automated electronic triggers offer a potential catalyst to support accurate retrospective AE detection.

Methods

We programmed previously validated AE triggers (admission, emergency visit, or death up to 14 days after procedure) for elective, outpatient IR procedures performed in Veterans Health Administration surgical facilities between fiscal years 2017 and 2019. We then developed a text-based algorithm to detect AEs that explicitly occurred in the periprocedure time frame: before, during, and shortly after the IR procedure. Guided by the literature and clinical expertise, we generated clinical note keywords and text strings to flag cases with high potential for periprocedure AEs. Flagged cases underwent targeted chart review to measure criterion validity (i.e., the positive predictive value), to confirm AE occurrence, and to characterize the event.

Results

Among 135,285 elective outpatient IR procedures, the periprocedure algorithm flagged 245 cases (0.18%); 138 of these had ≥1 AE, yielding a positive predictive value of 56% (95% confidence interval, 50%–62%). The previously developed triggers for admission, emergency visit, or death in 14 days flagged 119 of the 138 procedures with AEs (73%). Among the 43 AEs detected exclusively by the periprocedure trigger were allergic reactions, adverse drug events, ischemic events, bleeding events requiring blood transfusions, and cardiac arrest requiring cardiopulmonary resuscitation.

Conclusions

The periprocedure trigger performed well on IR outpatient procedures and offers a complement to other electronic triggers developed for outpatient AE surveillance.
Preventing Surgical Site Infections: Are Safety Climate Level and Its Strength Associated With Self-reported Commitment To, Subjective Norms Toward, and Knowledge About Preventive Measures?
Authors: Pfeiffer Yvonne , Atkinson Andrew , Maag Judith , Lane Michael A. , Schwappach David L. B. , Marschall Jonas
Published: February 2023

Objectives

Surgical site infections (SSIs) represent a major source of preventable patient harm. Safety climate in the operating room personnel is assumed to be an important factor, with scattered supporting evidence for the association between safety climate and infection outcome so far. This study investigated perceptions and knowledge specific to infection prevention measures and their associations with general assessments of safety climate level and strength.

Methods

We invited operating room personnel of hospitals participating in the Swiss SSI surveillance program to take a survey (response rate, 38%). A total of 2769 responses from 54 hospitals were analyzed. Two regression analyses were performed to identify associations between subjective norms toward, commitment to, as well as knowledge about prevention measures and safety climate level and strength, taking into account professional background and number of responses per hospital.

Results

Commitment to perform prevention measures even when situational pressures exist, as well as subjective norm of perceiving the expectation of others to perform prevention measures were significantly (P < 0.05) related to safety climate level, while for knowledge about preventative measures this was not the case. None of the assessed factors was significantly associated with safety climate strength.

Conclusions

While pertinent knowledge did not have a significant impact, the commitment and the social norms to maintain SSI prevention activities even in the face of other situational demands showed a strong influence on safety climate. Assessing the knowledge about measures to prevent SSIs in operating room personnel opens up opportunities for designing intervention efforts in reducing SSIs.