bluuebunny/crossref_metadata_2025 huggingface dataset:
The Sw-5b NLR Immune Receptor Induces Early Transcriptional Changes in Response to Thrips and Mechanical Modes of Inoculation of Tomato spotted wilt orthotospovirus
Authors: Ordaz Norma A. , Nagalakshmi Ugrappa , Boiteux Leonardo S. , Atamian Hagop S. , Ullman Diane E. , Dinesh-Kumar Savithramma P.
Published: July 2023

The NLR (nucleotide-binding leucine-rich repeat) class immune receptor Sw-5b confers resistance to Tomato spotted wilt orthotospovirus (TSWV). Although Sw-5b is known to activate immunity upon recognition of the TSWV movement protein NSm, we know very little about the downstream events that lead to resistance. Here, we investigated the Sw-5b–mediated early transcriptomic changes that occur in response to mechanical and thrips-mediated inoculation of TSWV, using near-isogenic tomato lines CNPH-LAM 147 ( Sw5b+/+) and Santa Clara ( Sw-5b−/−). We observed earlier Sw-5b–mediated transcriptional changes in response to thrips-mediated inoculation compared with that in response to mechanical inoculation of TSWV. With thrips-mediated inoculation, differentially expressed genes (DEGs) were observed at 12, 24, and 72 h postinoculation (hpi). Whereas with mechanical inoculation, DEGs were observed only at 72 hpi. Although some DEGs were shared between the two methods of inoculation, many DEGs were specific to either thrips-mediated or mechanical inoculation of TSWV. In response to thrips-mediated inoculation, an NLR immune receptor, cysteine-rich receptor-like kinase, G-type lectin S-receptor-like kinases, the ethylene response factor 1, and the calmodulin-binding protein 60 were induced. Fatty acid desaturase 2-9, cell death genes, DCL2b, RIPK/PBL14-like, ERF017, and WRKY75 were differentially expressed in response to mechanical inoculation. Our findings reveal Sw-5b responses specific to the method of TSWV inoculation. Although TSWV is transmitted in nature primarily by the thrips, Sw-5b responses to thrips inoculation have not been previously studied. Therefore, the DEGs we have identified in response to thrips-mediated inoculation provide a new foundation for understanding the mechanistic roles of these genes in the Sw-5b–mediated resistance.

[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 .
Loss of PWT7, Located on a Supernumerary Chromosome, Is Associated with Parasitic Specialization of Pyricularia oryzae on Wheat
Authors: Asuke Soichiro , Horie Akiko , Komatsu Kaori , Mori Ryota , Vy Trinh Thi Phuong , Inoue Yoshihiro , Jiang Yushan , Tatematsu Yuna , Shimizu Motoki , Tosa Yukio
Published: July 2023

Pyricularia oryzae, a blast fungus of gramineous plants, is composed of various host genus–specific pathotypes. The avirulence of an Avena isolate on wheat is conditioned by PWT3 and PWT4. We isolated the third avirulence gene from the Avena isolate and designated it as PWT7. PWT7 was effective as an avirulence gene only at the seedling stage or on leaves. PWT7 homologs were widely distributed in a subpopulation of the Eleusine pathotype and the Lolium pathotype but completely absent in the Triticum pathotype (the wheat blast fungus). The PWT7 homolog found in the Eleusine pathotype was one of the five genes involved in its avirulence on wheat. A comparative analysis of distribution of PWT7 and the other two genes previously identified in the Eleusine pathotype suggested that, in the course of parasitic specialization toward the wheat blast fungus, a common ancestor of the Eleusine, Lolium, Avena, and Triticum pathotypes first lost PWT6, secondly PWT7, and, finally, the function of PWT3. PWT7 or its homologs were located on core chromosomes in Setaria and Eleusine isolates but on supernumerary chromosomes in Lolium and Avena isolates. This is an example of interchromosomal translocations of effector genes between core and supernumerary chromosomes.

[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 .
Treatment of Fourth and Fifth Carpometacarpal Fracture-Dislocations in Punching Injuries With Motion-Sparing Hamate Fixation Spring Plates: “Rabbit Ears” Plating
Authors: Smith Shelby R. , Santucci Elizabeth , Lamberti Paul M.
Published: July 2023

Punching injuries to the hand are frequent and can result in fourth and fifth carpometacarpal (CMC) fracture-dislocations. Fourth and fifth CMC fracture-dislocations are unstable, and dorsal metacarpal dislocations are most common. Operative management for maintaining reduction of the unstable fracture-dislocation was closed reduction and percutaneous pinning; however, in delayed fractures, open reduction is necessary. We report on a plating technique used for acute and delayed, unstable fourth and/or fifth CMC fracture-dislocations. This method of plating is novel and allows for physiological motion at the CMC joint through a dorsal buttressing mechanism while maintaining joint reduction. The range of motion begins within the first week postoperatively, and full composite fist formation and digital extension occur 4 to 6 weeks postoperatively. This novel technique affords an alternative effective surgical treatment option with excellent outcomes for patients presenting with fourth and fifth CMC fracture-dislocations up to 12 weeks following the injury.
Foam Sclerotherapy in the Treatment of Hemangiomas and Venous Malformations
Authors: Yang Chenzi , Li Ming , Li Xin , Zhu Jieting , Shu Chang
Published: July 2023

BACKGROUND

Sclerotherapy has achieved great success in treating most venous malformation (VM) lesions.

OBJECTIVE

To compare the effects of foam sclerotherapy on infantile hemangioma and pyogenic granuloma (PG). In addition, we analyzed the data and outcomes of foam sclerotherapy for the VM.

MATERIALS AND METHODS

Thirty-nine patients with hemangiomas and 83 patients with VMs were treated, and clinical outcomes, resolution, and complication rates were compared. Sclerotherapy data from the VM group were also analyzed.

RESULTS

The average age of the patients and the distribution and tissue involvement of lesions among the 3 groups were significantly different (p < .001). The average amount of sclerosing foam administered per session in VMs was significantly higher than that in the other 2 groups (p < .0001) (whereas that in the PG group was lower than that in the infantile hemangioma group [p < .0001]). However, the overall therapeutic efficacy and side effects in the 3 groups were not significantly different. For VMs, the frequency of ultrasound guided foam sclerotherapy and use of 3% polidocanol increased from superficial to deep lesions, whereas the use of 1% POL decreased (p < .0001).

CONCLUSION

Infantile hemangioma and PG treatments presented good results and minor adverse reactions comparable with those of VMs.
Inferior Outcomes of EU Versus US Patients Treated With CD19 CAR-T for Relapsed/Refractory Large B-cell Lymphoma: Association With Differences in Tumor Burden, Systemic Inflammation, Bridging Therapy Utilization, and CAR-T Product Use
Authors: Bücklein Veit , Perez Ariel , Rejeski Kai , Iacoboni Gloria , Jurinovic Vindi , Holtick Udo , Penack Olaf , Kharboutli Soraya , Blumenberg Viktoria , Ackermann Josephine , Frölich Lisa , Johnson Grace , Patel Kedar , Arciola Brian , Mhaskar Rahul , Wood Anthony , Schmidt Christian , Albanyan Omar , Gödel Philipp , Hoster Eva , Bullinger Lars , Mackensen Andreas , Locke Frederick , von Bergwelt Michael , Barba Pere , Subklewe Marion , Jain Michael D.
Published: July 2023

Real-world evidence suggests a trend toward inferior survival of patients receiving CD19 chimeric antigen receptor (CAR) T-cell therapy in Europe (EU) and with tisagenlecleucel. The underlying logistic, patient- and disease-related reasons for these discrepancies remain poorly understood. In this multicenter retrospective observational study, we studied the patient-individual journey from CAR-T indication to infusion, baseline features, and survival outcomes in 374 patients treated with tisagenlecleucel (tisa-cel) or axicabtagene-ciloleucel (axi-cel) in EU and the United States (US). Compared with US patients, EU patients had prolonged indication-to-infusion intervals (66 versus 50 d; P < 0.001) and more commonly received intermediary therapies (holding and/or bridging therapy, 94% in EU versus 74% in US; P < 0.001). Baseline lactate dehydrogenase (LDH) (median 321 versus 271 U/L; P = 0.02) and ferritin levels (675 versus 425 ng/mL; P = 0.004) were significantly elevated in the EU cohort. Overall, we observed inferior survival in EU patients (median progression-free survival [PFS] 3.1 versus 9.2 months in US; P < 0.001) and with tisa-cel (3.2 versus 9.2 months with axi-cel; P < 0.001). On multivariate Lasso modeling, nonresponse to bridging, elevated ferritin, and increased C-reactive protein represented independent risks for treatment failure. Weighing these variables into a patient-individual risk balancer (high risk [HR] balancer), we found higher levels in EU versus US and tisa-cel versus axi-cel cohorts. Notably, superior PFS with axi-cel was exclusively evident in patients at low risk for progression (according to the HR balancer), but not in high-risk patients. These data demonstrate that inferior survival outcomes in EU patients are associated with longer time-to-infusion intervals, higher tumor burden/LDH levels, increased systemic inflammatory markers, and CAR-T product use.
Evaluation of paravascular inner retinal defects using en face OCT
Authors: Romero-Morales Veronica A , Bousquet Elodie , Abraham Neda , Santina Ahmad , Somisetty Swathi , Peiris Timothy , Lu Anthony , Levin Meira Fogel , Sarraf David
Published: July 2023

Purpose:

To evaluate the prevalence and risk factors for development of paravascular inner retinal defects (PIRD) using en face OCT.

Methods:

Retrospective cross-sectional study. En face and cross-sectional OCT images were reviewed (9x9 mm or 12x12 mm). PIRD were classified as either grade 1 (i.e. paravascular inner retinal cysts) when the lesion was confined within the nerve fiber layer without any communication to the vitreous cavity or grade 2 (i.e. paravascular lamellar hole) when the defects communicated to the vitreous. PIRD grading was correlated with presence of high myopia, stage of posterior vitreous detachment (PVD), and presence of epiretinal membrane (ERM) and retinoschisis.

Results:

Of 1074 patients (2148 eyes), PIRD were detected in 261 eyes with a prevalence of 261 per 2148 eyes (12.2%) and 176 per 1074 patients (16.4%). A total of 116 eyes (44.4%) displayed grade 2 PIRD while 145 eyes (55.6%) were grade 1. In the multivariate logistic regression model, the presence of partial/complete PVD, retinoschisis and ERM were significantly correlated with PIRD (OR=2.78 [1.7-4.4], p<0.001; OR=2.93 [1.7-5], p< 0.001 and OR=25.9 [2.8-242.5], p<0.001 respectively). The presence of partial/complete PVD and ERM were also significantly associated with grade 2 PIRD versus grade 1 PIRD (p=0.03 and p< 0.001).

Conclusions:

Our results indicate that wide field en face OCT facilitates the identification of PIRD over a large area of retina with a single capture. The presence of PIRD was significantly associated with PVD, ERM and retinoschisis, confirming the role of vitreoretinal traction in the pathogenesis of PIRD.
Association Between Indication for Descemet Stripping Automated Endothelial Keratoplasty and Rural Residency
Authors: Pollmann André S. , Pinto Ashlyn M. , Cadieux Danielle , Seamone Christopher D. , George Stanley P. , Smith Corey A. , Lewis Darrell R.
Published: July 2023

Purpose:

Residing in rural locations can be a barrier to health care access. This study investigated the impact of residing in rural and small town (RST) areas on Descemet stripping automated endothelial keratoplasty (DSAEK) indications and outcomes in Atlantic Canada.

Methods:

A retrospective cohort analysis examined consecutive DSAEKs performed in Nova Scotia between 2017 and 2020. Patient rurality was determined by the Statistical Area Classification system developed by Statistics Canada. Univariate and multivariate logistic regression models were used to assess for factors associated with DSAEK indication, including repeat keratoplasty, RST residence status, and travel time.

Results:

Of 271 DSAEKs during the study period, 87 (32.1%) were performed on the eyes of RST residents. The median postoperative follow-up time was 1.6 years. Undergoing DSAEK for a previous failed keratoplasty was not associated with a higher odds of RST residency (odds ratio [OR], 0.50; 95% confidence interval [CI], 0.19–1.16; P = 0.13) but was associated with travel time (OR, 0.78 for each increasing hour of travel; 95% CI, 0.61–0.99; P = 0.044). RST residency was not associated with the occurrence of graft failure (OR, 0.48; 95% CI, 0.17–1.17; P = 0.13).

Conclusions:

Residing in a rural area in Atlantic Canada was not associated with DSAEK graft failure. Repeat endothelial keratoplasty was associated with shorter travel time for corneal surgery but not rural residency status. Further research in this field could inform regional health strategies aimed at improving equity and accessibility to ophthalmology subspecialist care.
The impact of the social context on the development of secondary hyperalgesia: an experimental study
Authors: Jaltare Ketan Prafull , Vanderijst Laetitia , Karos Kai , Torta Diana M.
Published: July 2023

Social support has been shown to reduce pain ratings and physiological responses to acute pain stimuli. Furthermore, this relationship is moderated by adult attachment styles. However, these effects have not been characterized in experimentally induced symptoms of chronic pain, such as secondary hyperalgesia (SH) which is characterized by an increased sensitivity of the skin surrounding an injury. We aimed to examine whether social support by handholding from a romantic partner can attenuate the development of experimentally induced SH. Thirty-seven women, along with their partners, participated in 2 experimental sessions 1 week apart. In both sessions, SH was induced using an electrical stimulation protocol. In the support condition, the partner was seated across from the participant holding the participant's hand during the electrical stimulation, whereas in the alone condition, the participant went through the stimulation alone. Heart rate variability was measured for both the participant as well as the partner before, during, and after the stimulation. We found that the width of the area of hyperalgesia was significantly smaller in the support condition. Attachment styles did not moderate this effect of social support on the area width. Increasing attachment avoidance was associated with both a smaller width of hyperalgesia and a smaller increase in the sensitivity on the stimulated arm. For the first time, we show that social support can attenuate the development of secondary hyperalgesia and that attachment avoidance may be associated with an attenuated development of secondary hyperalgesia.
Analysis of a Division I Sports Medicine Program's COVID-19 Protocol: Identifying Factors that Predict Testing Demands and Positive Rates During a Pandemic
Authors: Stickler Kasey , Morrone Blass , Brown Andrew , Franks Adam M. , Johnson Paris , Lacmichanne Rajan , Rupp David
Published: July 2023

Objective:

To determine factors indicating testing frequency and positive test results in a Division I sports department intrapandemic.

Design:

Retrospective analysis.

Setting:

A single Division I collegiate sports department.

Patients:

All student-athlete (n = 437), student staff (n = 89), and adult staff (n = 202) members of the sports department. Total cohort (n = 728).

Interventions:

The authors analyzed the independent variables of local positive rates, sport characteristics, and campus events for impact on the volume of the departmental testing and positive rates.

Main Outcome Measures:

Measured dependent variables of the volume of departmental testing and positive rates were analyzed.

Results:

Positive predictive rates (PPRs) largely differed from local, off-campus rates in timing and duration (59.52%: P < 0.05). Overall, 20633 tests were administered with 201 positive results (0.97% PPR). Student-athlete numbers were highest in all categories, followed by adult then student staff. Greater proportions of contact sports became positive (53.03%: P < 0.001) and all-male sports (47.69%: P < 0.001). No comparative difference was seen for teams using fomites (19.15%: P = 0.403). Spring sports teams had the lowest percentage of the team positive (22.22%: P < 0.001). Winter sports had the highest PPR (1.15%), all occurring during team-controlled activities. Playing sports indoors did not increase inside team-controlled activity positive rates (P = 0.066).

Conclusions:

Longitudinal changes in local, off-campus infection rates partially affected sports departmental positive results while testing rates were more influenced by sport and university schedule. Testing resources should be directed toward high-risk sports, which included contact sports (football, basketball, and soccer), all-male teams, both Winter and indoor sports inside team-controlled activities, and sports with long periods of time outside team-controlled activities.
Social Cognition and Functioning in Patients With Social Anxiety Disorder and/or Attention-Deficit/Hyperactivity Disorder
Authors: Uğurpala Can , Tükel Raşit , Ziylan Ege Çağın , Ertekin Erhan , Berberoğlu Ertuğ
Published: July 2023

In recent years, social cognition and one of its dimensions, the theory of mind, have been more commonly investigated in patients with social anxiety disorder (SAD) and attention-deficit/hyperactivity disorder (ADHD). In this study, SAD, ADHD, comorbid SAD-ADHD, and healthy control (HC) groups, each consisting of 30 participants, were included and compared in terms of social cognition and functionality. Mean global functioning assessment scores were found to be significantly higher in the HC group compared with the other three groups and in the ADHD group compared with the SAD and SAD-ADHD groups. Mean Dokuz Eylül Theory of Mind Index total scores were found to be significantly higher in the HC group compared with the other three groups and in the SAD and SAD-ADHD groups compared with the ADHD group. These findings suggest that SAD patients with or without ADHD show better social cognition but worse functioning compared with pure ADHD patients.
Sociodemographic and Behavioral Predictors of Recurrent Bacterial Vaginosis among Sexual Health Clinic Patients in New York City from 2014-2018
Authors: Davis Alissa , Crawley Addie , Ashmore Mary , Landers Sara E. , Pathela Preeti
Published: July 2023

Objective

Bacterial vaginosis (BV) is associated with adverse reproductive outcomes and recurrence is common. We examined factors associated with BV recurrence using electronic medical record data for patients attending New York City Department of Health and Mental Hygiene sexual health clinics (SHCs) from 2014-2018.

Methods

Clinician-diagnosed BV was defined using a clinical BV diagnosis code based on Amsel criteria. Recurrent BV was defined as any BV diagnosis occurring more than 30 days following the previous diagnosis. Adjusted hazard ratios (AHRs) for the relationship between potential risk factors and recurrent BV were estimated using conditional gap-time models.

Results

The dataset contained 14,858 patients with at least one BV diagnosis. Of these, 46.3% (n = 6,882) had at least one follow-up visit to an SHC between January 2014 and December 2018. Of those with a follow-up visit, 53.9% (n = 3,707) had ≥1 recurrent BV episode, with 33.7% (n = 2,317) experiencing recurrence within 3 months. In the multivariable model, using a hormonal IUD (AHR: 1.31; 95% CI [1.14-1.49]) or copper IUD (AHR: 1.17; 95% CI [1.01-1.37]), having a history of trichomonas (AHR: 1.23; 95% CI [1.12-1.36]), and being non-Hispanic Black (AHR: 1.11; 95% CI [1.04-1.18]) were associated with higher risk for BV recurrence, while using non-IUD hormonal contraception was associated with reduced risk (AHR: 0.88; 95% CI [0.80-0.98]).

Conclusions

Risk of BV recurrence was increased among patients using an IUD, while it was reduced in patients using non-IUD hormonal contraception.
The association between Adverse Childhood Experiences and HPV vaccination coverage in U.S. young adults: a cross-sectional study
Authors: Zhang Shengruo , Richardson Barbra A. , Lin John , Winer Rachel L.
Published: July 2023

Background

Adverse childhood experiences (ACEs) contribute to adverse health outcomes in adulthood. Access to preventive healthcare services, including HPV vaccinations, may mitigate the impact of ACEs on adverse health outcomes. Our objective was to assess associations between ACEs and HPV vaccination coverage among young adults.

Methods

We included 3415 18–29-year-old respondents to the 2019-2020 Behavioral Risk Factor Surveillance System (BRFSS) ACE and HPV vaccination modules. ACEs included emotional, physical and sexual abuse; household intimate partner violence, substance abuse, mental illness; and parental separation/divorce and incarcerated household member. We used log-binomial regression models to calculate prevalence ratios (PRs) with 95% confidence intervals for associations between ACEs and self-reported HPV vaccination and completion. Secondary outcomes included influenza vaccination uptake, time since routine checkup, HIV testing history, and HIV-related risk behavior.

Results

Several ACEs were positively associated with HPV vaccine initiation, including emotional abuse (PR:1.29, 95%CI:1.17-1.43), intimate partner violence (PR:1.14, 95%CI:1.00-1.30), substance abuse (PR:1.20, 95%CI:1.08-1.33), and mental illness (PR:1.35, 95%CI:1.22-1.50). Similar associations were observed for completion. Conversely, most ACEs were negatively associated with influenza vaccination (PRs from 0.72-1.00), and with recent checkup (PRs from 0.92-1.00). ACEs were positively associated with having had an HIV test (PRs from 1.19-1.56) and HIV-related risk behavior (PRs from 1.19-2.07).

Conclusions

The unexpected positive associations between ACEs and HPV vaccination coverage could be due to opportunities to receive HPV vaccination in late adolescence or early adulthood while accessing STI/HIV prevention or treatment services. Future studies should evaluate associations between ACEs and timely HPV vaccination in early adolescence.
Sexually transmitted infection point-of-care testing in resource-limited settings: a narrative review guided by an implementation framework
Authors: Chitneni Pooja , Owembabazi Moran , Muyindike Winnie , Asiimwe Stephen , Masete Godfrey , Mbalibulha Yona , Nakku-Joloba Edith , Manabe Yukari C. , Haberer Jessica , Matthews Lynn , Van Der Pol Barbara
Published: July 2023

Most sexually transmitted infections (STIs) are acquired in resource-limited settings (RLS) where laboratory diagnostic access is limited. Advancements in point-of-care testing (POC) technology have the potential to bring STI testing to many RLS. We define POC as performed near the patient and with results readily available to inform clinical practice. The World Health Organization Special Programme for Research and Training in Tropical Diseases further outlines desirable POC characteristics with the REASSURED criteria.

Despite advantages related to immediate test-and-treat care, integrating POC into RLS healthcare systems can present challenges that preclude reliance on these tests. In 2018, we incorporated molecular near-POC for chlamydia, gonorrhea, and trichomoniasis and SDBioline Treponemal immunochromatographic testing confirmed by rapid plasma reagin for syphilis diagnosis at the Mbarara University of Science and Technology Research Laboratory in rural southwestern Uganda. We describe our experiences with STI POC as a case example to guide a narrative review of the field using the Consolidated Framework for Implementation Research as a conceptual framework.

Though POC and near-POC are described as easy to use, the challenges of limited person-power, healthcare processes, limited infrastructure/resources, high costs, and quality control obstacles can impede the impact of these tests. Increased investment in operators, training, and infrastructure, restructuring healthcare systems to accommodate increased POC access, and optimizing costs are all crucial to the successful implementation of STI POC in RLS. Expanded STI POC in RLS will increase access to accurate diagnoses, appropriate treatment, and engagement in partner notification, treatment, and prevention efforts.
The outcome of using zolpidem for treatment of postoperative posterior fossa syndrome in children with brain tumor
Authors: AlAzmi Aeshah , Abdullah Shaker , Abdullah Khalid , Ruediger Stendel
Published: July 2023

Introduction:

At present, there is no supporting evidence-based therapy of proven efficacy to treat posterior fossa syndrome (PFS) after surgical resection of posterior fossa tumors in children where only 22% of patients may experience a full recovery. However, zolpidem, a nonbenzodiazepine hypnotics drug, seems to be a possible treatment option for PFS symptoms.

Methods and Materials:

This was a retrospective chart review for all children with brain tumors younger than 15 years diagnosed with confirmed PFS after surgical resection at King Abdulaziz Medical City, Jeddah, and received zolpidem to alleviate the PFS symptoms between May 2016 and April 2019.

Results:

A total of 6 pediatric patients who experienced PFS symptoms (median of 4 days, range 1–7 days) were included. The most commonly observed symptoms were irritability, hypotonia, swallowing deficit, unsteady walking, and delayed speech. To alleviate the PFS symptoms, zolpidem was commenced 2–5 days postoperatively. The median duration of use was 13.5 days. During the hospital course, recovery of speech was observed after 2 weeks in most patients (50%) while 83.3% of patients recovered their normal speech in 4 months although not fully ambulated. No discontinuation of zolpidem use was reported because of adverse events.

Conclusion:

Most of our children (83.3%) who experienced PFS postresection responded to zolpidem trials which may represent a promising research field.
Using Quality Improvement to Design Early Childhood Services Navigation in Primary Care
Authors: King Amy L. , Brown Courtney M. , White Cynthia C. , Copeland Kristen A.
Published: July 2023

Introduction:

Enrollment in high-quality early childhood education (ECE) improves educational and health outcomes and can mitigate racial and economic disparities. Pediatricians are encouraged to promote ECE yet lack the time and knowledge to assist families effectively. In 2016, our academic primary care center hired an ECE Navigator to promote ECE and help families enroll. Our SMART aims were to increase the number of children with facilitated referrals to high-quality ECE programs from 0 to 15 per month and to confirm enrollment on a subset to achieve an enrollment rate of 50% by December 31, 2020.

Methods:

We used the Institute for Healthcare Improvement’s Model for Improvement. Interventions included system changes in partnership with ECE agencies (eg, interactive map of subsidized preschool options, streamlined enrollment forms), case management with families, and population-based approaches to understand families’ needs and the program’s overall impact. We plotted the number of monthly facilitated referrals and the percentage of referrals enrolled on run and control charts. We used standard probability-based rules to identify special causes.

Results:

Facilitated referrals increased from 0 to 29 per month and remained above 15. The percentage of enrolled referrals increased from 30% to 74% in 2018, then decreased to 27% in 2020 when childcare availability declined during the pandemic.

Conclusions:

Our innovative ECE partnership improved access to high-quality ECE. Interventions could be adopted in part or whole by other clinical practices or WIC offices to equitably improve early childhood experiences for low-income families and racial minorities.
Let us to the TWISST; Plan, Simulate, Study and Act
Authors: Colman Nora , Hebbar Kiran B.
Published: July 2023

Introduction:

Translational Work Integrating Simulation and Systems Testing (TWISST) is a novel application of simulation that augments how we discover, understand, and mitigate errors in our system. TWISST is a diagnostic and interventional tool that couples Simulation-based Clinical Systems Testing with simulation-based training (SbT). TWISST tests environments and work systems to identify latent safety threats (LSTs) and process inefficiencies. In SbT, improvements made to the work system are embedded in hard wire system improvements, ensuring optimal integration into clinical workflow.

Methods:

Simulation-based Clinical Systems Testing approach includes simulated scenarios, Summarize, Anchor, Facilitate, Explore, Elicit debriefing, and Failure Mode and Effect Analysis. In iterative Plan-Simulate-Study-Act cycles, frontline teams explored work system inefficiencies, identified LSTs, and tested potential solutions. As a result, system improvements were hardwired through SbT. Finally, we present a case study example of the TWISST application in the Pediatric Emergency Department.

Results:

TWISST identified 41 latent conditions. LSTs were related to resource/equipment/supplies (n = 18, 44%), patient safety (n = 14, 34%), and policies/procedures (n = 9, 22%). Work system improvements addressed 27 latent conditions. System changes that eliminated waste or modified the environment to support best practices mitigated 16 latent conditions. System improvements that addressed 44% of LSTs cost the department $11,000 per trauma bay.

Conclusions:

TWISST is an innovative and novel strategy that effectively diagnoses and remediates LSTs in a working system. This approach couples highly reliable work system improvements and training into 1 framework.
Quasi-experimental, Nonrandomized Initiative to Minimize Sleep Disruptions among Hospitalized Children
Authors: Glover Brianna , Bederman Leonid , Orenstein Evan , Kandaswamy Swaminathan , Cooley Anthony , Bryant Christy , Thompson Sarah , Thomas Sindhu , Graham Sarah , Yamasaki Selena , Thornton Michelle , Perry Linda , Hames Nicole
Published: July 2023

Introduction:

Hospitalized children experience frequent sleep disruptions. We aimed to reduce caregiver-reported sleep disruptions of children hospitalized on the pediatric hospital medicine service by 10% over 12 months.

Methods:

In family surveys, caregivers cited overnight vital signs (VS) as a primary contributor to sleep disruption. We created a new VS frequency order of “every 4 hours (unless asleep between 2300 and 0500)” as well as a patient list column in the electronic health record indicating patients with this active VS order. The outcome measure was caregiver-reported sleep disruptions. The process measure was adherence to the new VS frequency. The balancing measure was rapid responses called on patients with the new VS frequency.

Results:

Physician teams ordered the new VS frequency for 11% (1,633/14,772) of patient nights on the pediatric hospital medicine service. Recorded VS between 2300 and 0500 was 89% (1,447/1,633) of patient nights with the new frequency ordered compared to 91% (11,895/13,139) of patient nights without the new frequency ordered (P = 0.01). By contrast, recorded blood pressure between 2300 and 0500 was only 36% (588/1,633) of patient nights with the new frequency but 87% (11,478/13,139) of patient nights without the new frequency (P < 0.001). Overall, caregivers reported sleep disruptions on 24% (99/419) of reported nights preintervention, which decreased to 8% (195/2,313) postintervention (P < 0.001). Importantly, there were no adverse safety issues related to this initiative.

Conclusion:

This study safely implemented a new VS frequency with reduced overnight blood pressure readings and caregiver-reported sleep disruptions.
A Quality Improvement Initiative to Improve Pediatric Discharge Medication Safety and Efficiency
Authors: Ring Lisa M. , Cinotti Jamie , Hom Lisa A. , Mullenholz Mary , Mangum Jordan , Ahmed-Winston Sameeya , Cheng Jenhao Jacob , Randolph Ellie , Harahsheh Ashraf S.
Published: July 2023

Introduction:

Medication errors are a leading safety concern, especially for families with limited English proficiency and health literacy, and patients discharged on multiple medications with complex schedules. Integration of a multilanguage electronic discharge medication platform may help decrease medication errors. This quality improvement (QI) project’s primary aim (process measure) was to increase utilization in the electronic health record (EHR) of the integrated MedActionPlanPro (MAP) for cardiovascular surgery and blood and marrow transplant patients at hospital discharge and for the first clinic follow-up visit to 80% by July 2021.

Methods:

This QI project occurred between August 2020 and July 2021 on 2 subspecialty pediatric acute care inpatient units and respective outpatient clinics. An interdisciplinary team developed and implemented interventions, including integration of MAP within EHR; the team tracked and analyzed outcomes for discharge medication matching, and efficacy and safety MAP integration occurred with a go-live date of February 1, 2021. Statistical process control charts tracked progress.

Results:

Following the implementation of the QI interventions, there was an increase from 0% to 73% in the utilization of the integrated MAP in the EHR across the acute care cardiology unit-cardiovascular surgery/blood and marrow transplant units. The average user hours per patient (outcome measure) decreased 70% from the centerline of 0.89 hours during the baseline period to 0.27 hours. In addition, the medication matching between Cerner inpatient and MAP inpatient increased significantly from baseline to postintervention by 25.6% (P < 0.001).

Conclusion:

MAP integration into the EHR was associated with improved inpatient discharge medication reconciliation safety and provider efficiency.
Quantitative Magnetic Resonance Imaging for the Pancreas
Authors: Fukukura Yoshihiko , Kanki Akihiko
Published: July 2023

Magnetic resonance imaging (MRI) is important for evaluating pancreatic disorders, and anatomical landmarks play a major role in the interpretation of results. Quantitative MRI is an effective diagnostic modality for various pathologic conditions, as it allows the investigation of various physical parameters. Recent advancements in quantitative MRI techniques have significantly improved the accuracy of pancreatic MRI. Consequently, this method has become an essential tool for the diagnosis, treatment, and monitoring of pancreatic diseases. This comprehensive review article presents the currently available evidence on the clinical utility of quantitative MRI of the pancreas.
A Novel Phenotype of Calvarial Thickening and Increased Rates of Premature Calvarial Suture Closure in Children With Chronic Lung Disease
Authors: Zapatero Zachary D. , Zhang Huayan , Zandifar Alireza , Nilan Kathleen A. , Calabria Andrew C. , Swanson Jordan W. , Vossough Arastoo , Taylor Jesse A. , Lang Shih-Shan , Bartlett Scott P.
Published: July 2023

Purpose:

The purpose of this study was to characterize a novel type of calvarial thickening and provide objective measurements of skull thickness and calvarial suture morphology in patients with bronchopulmonary dysplasia.

Methods:

Infants with severe bronchopulmonary dysplasia who also had undergone computed tomography (CT) scans were identified from the neonatal chronic lung disease program database. Thickness analysis was performed using Materialise Mimics.

Results:

The chronic lung disease team treated 319 patients during the study interval of which, 58 patients (18.2%) had head CT available. Twenty-eight (48.3%) were found to have calvarial thickening. The rate of premature suture closure in the study population was 36.2% (21 of 58 patients), with 50.0% of affected cohort having evidence of premature suture closure on the first CT scan. Multivariate logistic regression identified 2 risk factors, requiring invasive ventilation at 6 months of age and fraction of inspired oxygen requirement at 6 months of age. Increased head circumference at birth protected against the development of calvarial thickening.

Conclusions:

We have described a novel subset of patients with chronic lung disease of prematurity who have calvarial thickening with remarkably high rates of premature closure of cranial sutures. The exact etiology of the association is unknown. In this patient population with radiographic evidence of premature suture closure, operative decision should be made after considering unequivocal evidence of elevated intracranial pressure or dysmorphology and balanced against the risk of the procedure.
A SYSTEMATIC RE-ANALYSIS OF COPY NUMBER LOSSES OF UNCERTAIN CLINICAL SIGNIFICANCE
Authors: Burghel George J , Ellingford Jamie M , Wright Ronnie , Bradford Lauren , Miller Jake , Watt Christopher , Edgerley Jonathan , Naeem Farah , Banka Siddharth
Published: July 2023

Background

Re-analysis of whole exome/genome data improves diagnostic yield. However, the value of re-analysis of clinical array comparative genomic hybridisation (aCGH) data has never been investigated. Case-by-case re-analysis is impractical in busy diagnostic laboratories.

Methods and Results

We harmonised historical post-natal clinical aCGH results from ∼16,000 patients tested via our diagnostic laboratory over ∼7 years with current clinical guidance. This led to identification of 33,857 benign, 2,173 class 3, and 979 pathogenic copy number losses (CNLs). We found benign CNLs to be significantly less likely to encompass haploinsufficient genes compared to the pathogenic or class 3 CNLs in our database. Using this observation, we developed a re-analysis pipeline (using up-to-date disease association data and haploinsufficiency scores) and shortlisted 207 class 3 CNLs encompassing at least one autosomal dominant disease-gene associated with haploinsufficiency or loss-of-function mechanism. Clinical scientist review led to reclassification of 7.2% shortlisted class 3 CNLs as pathogenic or likely pathogenic. This included first cases of CNV-mediated disease for some genes where all previously described cases involved only point variants. Interestingly, some CNLs could not be re-classified because the phenotypes of patients with CNLs seemed distinct from the known clinical features resulting from point variants, thus raising questions about accepted underlying disease mechanisms. Several potential novel disease-genes were identified that would need further validation.

Conclusions

Re-analysis of clinical aCGH data increases diagnostic yield and demonstrates their research value. In future, the aCGH reanalysis program should be expanded to include other copy number variant types.
Extracellular lactate as an alternative energy source for retinal bipolar cells
Authors: Garcia Victor Calbiague , Chen Yiyi , Cádiz Bárbara , Paquet-Durand François , Schmachtenberg Oliver
Published: July 2023

Retinal bipolar and amacrine cells receive visual information from photoreceptors and participate in the first steps of image processing in the retina. Several studies have suggested the operation of aerobic glycolysis and a lactate shuttle system in the retina due to the high production of this metabolite under aerobic conditions. However, whether bipolar cells form part of this metabolic circuit remains unclear. Here, we show that the lactate transporter MCT2 is functionally expressed in inner retinal neurons and demonstrate their ability to consume extracellular lactate as an alternative to glucose. In rod bipolar cells, lactate is used to maintain homeostasis of various ions and electrical responses. Overall, our data contribute to a better understanding of inner retinal metabolism.
XENTURION, a multidimensional resource of xenografts and tumoroids from metastatic colorectal cancer patients for population-level translational oncology
Authors: Leto Simonetta M. , Grassi Elena , Avolio Marco , Vurchio Valentina , Cottino Francesca , Ferri Martina , Zanella Eugenia R. , Blasio Laura di , Somale Desiana , Vara-Messler Marianela , Galimi Francesco , Sassi Francesco , Lupo Barbara , Catalano Irene , Pinnelli Marika , Viviani Marco , Sperti Luca , Mellano Alfredo , Ferrero Alessandro , Zingaretti Caterina C. , Puliafito Alberto , Primo Luca , Bertotti Andrea , Trusolino Livio
Published: July 2023

The breadth and depth at which cancer models are interrogated contribute to successful translation of drug discovery efforts to the clinic. In colorectal cancer (CRC), model availability is limited by a dearth of large-scale collections of patient-derived xenografts (PDXs) and paired tumoroids from metastatic disease, the setting where experimental therapies are typically tested. XENTURION is a unique open-science resource that combines a platform of 129 PDX models and a sister platform of 129 matched PDX-derived tumoroids (PDXTs) from patients with metastatic CRC, with accompanying multidimensional molecular and therapeutic characterization. A PDXT-based population trial with the anti-EGFR antibody cetuximab revealed variable sensitivities that were consistent with clinical response biomarkers, mirrored tumor growth changes in matched PDXs, and recapitulated the outcome of EGFR genetic deletion. Adaptive signals upregulated by EGFR blockade were computationally and functionally prioritized, and inhibition of top candidates increased the magnitude of response to cetuximab. These findings illustrate the probative value and accuracy of largeex vivoandin vivoliving biobanks, highlight the importance of cross-platform and cross-methodology systematic validation, and offer avenues for molecularly informed preclinical research.
Integrated single-cell multiomics uncovers foundational regulatory mechanisms of lens development and pathology
Authors: Tangeman Jared A , Rebull Sofia M , Grajales-Esquivel Erika , Weaver Jacob M , Bendezu-Sayas Stacy , Robinson Michael L , Lachke Salil A , Rio-Tsonis Katia Del
Published: July 2023

Ocular lens development entails epithelial to fiber cell differentiation, defects in which cause congenital cataract. We report the first single-cell multiomic atlas of lens development, leveraging snRNA-seq, snATAC-seq, and CUT&RUN-seq to discover novel mechanisms of cell fate determination and cataract-linked regulatory networks. A comprehensive profile ofcis- andtrans-regulatory interactions, including for the cataract-linked transcription factor MAF, is established across a temporal trajectory of fiber cell differentiation. Further, we divulge a conserved epigenetic paradigm of cellular differentiation, defined by progressive loss of H3K27 methylation writer Polycomb repressive complex 2 (PRC2). PRC2 localizes to heterochromatin domains across master-regulator transcription factor gene bodies, suggesting it safeguards epithelial cell fate. Moreover, we demonstrate that FGF hyper-stimulationin vivoleads to MAF network activation and the emergence of novel lens cell states. Collectively, these data depict a comprehensive portrait of lens fiber cell differentiation, while defining regulatory effectors of cell identity and cataract formation.
4-(3-Chloroanilino)benzoic acid
Authors: Liu Xiaoting , Long Sihui
Published: July 2023

The title compound, C13H10ClNO2, was synthesized by a Buchwald–Hartwig reaction and its crystal structure was investigated for the first time. Crystallization in a variety of solvents led to the discovery of one crystal form. High-quality single crystals were obtained by slow evaporation and the crystal structure was determined by single-crystal X-ray diffraction. The molecules in the crystal structures are highly twisted [the dihedral angle between the aromatic rings is 34.66 (6)°] and pair up to form acid–acid dimers.
Understanding the challenges of 5G deployment in India
Authors: Gupta Kriti Priya
Published: July 2023

Purpose

This study aims to understand the challenges of 5G deployment in India from the perspectives of telecom operators. These challenges are also mapped to different contexts within the technological-organizational-environmental (TOE) framework.

Design/methodology/approach

The study uses a qualitative approach comprising in-depth semi-structured interviews of employees working in telecom companies in India. Thematic analysis is used to analyse the qualitative data.

Findings

The author has identified nine challenges that are categorized under three dimensions of the TOE framework. Specifically, the findings indicate three technological challenges: hardware/device challenges, security concerns and limited use cases; two organization challenges: financial challenges and lack of skilled workforce; and four environmental challenges: inadequate infrastructure, regulatory and administrative challenges, consumers’ attitudes and competitive market conditions.

Practical implications

The results of this study would help understand the key factors that can act as barriers to the 5G rollout in India. Based on the findings of the study, the government and regulatory bodies could design conducive policies and regulatory frameworks to successfully deploy 5G in India.

Originality/value

The study is one of the very few studies to empirically examine the telecom operators’ perspectives on the challenges of 5G deployment in India. The study contributes to the TOE framework as its application in the context of identifying barriers to 5G deployment is probably for the first time.
A dynamic model considering the time-varying friction moment of a flexible rotor system
Authors: Liu Jing , An Yuchen , Fancheng Wanli , Tang Changke , Xu Lixin
Published: July 2023

Purpose

Bearing friction moments are important factors that affect the vibrations of rotor systems. The bearing friction moments are related to the dimension parameters, lubrication conditions and manufacturing errors of support bearings. This work studies the effects of the bearing friction moments on the vibrations of rotor systems.

Design/methodology/approach

The rotor is separated into several shaft elements for formulating a flexible rotor. The time-varying friction moment (TFM) is affected by the time-varying contact loads. The vibrations of FRS from the TFM and Palmgren's friction moment (PFM) calculation methods are compared. Moreover, the effects of the rotor offset and radial clearance on the frequency-amplitude characteristics of FRS are studied.

Findings

The TFM method is more consistent with the actual operation mechanisms. The rotor offset and radial clearance can significantly affect the nonlinear vibrations of FRS. This work provides a new reference and research method for the vibration analysis of rotor systems considering the friction effects.

Originality/value

The elastohydrodynamic lubrication (EHL), elastic hysteresis and differential sliding are considered. A flexible rotor system (FRS) dynamic model considering the TFM is proposed. The vibrations of FRS from the TFM calculation method and empirical calculation formula are compared. The effects of the rotor offset and radial clearance on the frequency–amplitude characteristics of FRS are studied.