bluuebunny/crossref_metadata_2025 huggingface dataset:
Mistrust and missed opportunities: BDSM practitioner experiences in healthcare
Authors: Jansen Kate L , Fried Adam L , Goetz Christianna , Kang Saleenjit
Published: September 2024

Background

Stigma and discrimination have been shown to be significant barriers to healthcare utilization and provider trust among sexual minority groups including BDSM and kink communities.

Aim

This exploratory study sought to better understand medical mistrust and experiences of discrimination in primary care settings and how these factors predict hiding kink-related injuries from healthcare providers.

Methods

A total of 301 individuals who self-identified as being a member of the BDSM community and engaged in BDSM-play activities completed an online survey.

Outcomes

Participants completed measures including experiences with BDSM-play-related injuries, disclosure of BDSM activity to healthcare providers, measures addressing mistrust in in healthcare providers (such as avoidance of questions about sexual health or STI testing), and experiences with discrimination in healthcare settings because of BDSM group membership (such as perceptions of being insulted or receiving poor care).

Results

Nearly, 40% of participants indicated at least one experience with discrimination in the healthcare system because they identified as a member of the kink community. Over 20% of participants indicated there were BDSM-related concerns they would have liked to discuss with their primary care provider but did not. Participants who hid injuries from their primary care provider had higher levels of medical mistrust and more experiences with medical discrimination than those who disclosed their injuries. A stepwise logistic regression determined that medical mistrust served as a significant predictor of hiding injuries from healthcare providers.

Clinical Implications

Patients who are members of the BDSM community are likely to have had negative healthcare experiences, and these experiences impact their communication with and trust in future medical encounters.

Strengths and Limitations

Strengths of the study include addressing diverse components of stigma in healthcare including both experiences with discrimination as well as perceptions of the medical field. Furthermore, potential direct consequences of past negative experiences such as hiding injuries from healthcare providers were examined. Given the likely impact of race, gender, and BDSM group membership on experiences with discrimination, a limitation includes the limited representations of BDSM participants from minoritized racial and ethnic groups. Furthermore, in addressing injuries, the survey did not differentiate intended or expected injuries obtained in BDSM play from unintentional or unwanted injuries.

Conclusion

Mistrust in the medical system impacts members of the BDSM community’s willingness to disclose injuries to their healthcare provider.
EU Methane Regulation and its impact on LNG imports
Authors: Talus Kim , Steck Gunnar , Atkin James
Published: September 2024

The EU Methane Regulation entered into force on 4 August 2024. It creates rules and obligations on measurement-based Monitoring, Reporting, and Verification of methane emissions of relevant activities, and on Leak Detection and Repair, and introduces limits on routine venting and flaring within the European Union (EU). In addition, and importantly for this article, it creates the first import-related requirements on methane emissions for imported fuels globally. This article will focus on the impact of the Methane Regulation on Liquified Natural Gas (LNG) imports into the EU. In this respect, the Methane Regulation creates far-reaching and difficult-to-implement obligations. The concerns for the LNG industry and imports into the EU are that (i) many of the central rules are not set out in the Methane Regulation and will be provided in the years to come and (ii) some of the key concepts and key provisions lack clarity and are open to various interpretations. As we will discuss in detail, the uncertainty created by the Methane Regulation will make contract negotiations more difficult and will negatively affect the security of gas supply within the EU.
The Interventionalist’s Perspective
Authors: Sayed Dawood
Published: September 2024

The field on interventional pain medicine (IPM) has evolved from medication management and steroid injections to performing more procedures of a surgical nature. As new therapies have developed geared toward minimally invasive and image guided techniques, physicians trained in IPM will play a larger role in bringing these therapies to real world practice. As the field of IPM continues to evolve, it will be essential that training and education continues to advocate for the safe and effective implementation of minimally invasive spine surgical procedures.
Vertebral Augmentation with Osteotome
Authors: Lam Christopher M. , Azeem Nomen
Published: September 2024

Vertebral compression fractures are common injuries sustained in the vertebral bodies of the spine and contribute up to 1 billion dollars in direct medical care costs annually. Conventional management of these fractures includes multimodal pharmacologic therapy (NSAIDs, muscle relaxants, narcotics), bracing, and surgery. Vertebral augmentation has been an emerging procedural intervention for management of these injuries whereby cement is placed in a fractured vertebral body to provide stability, resulting in decreased pain. Currently, osteotomes are mainstay instruments for safe percutaneous access to the vertebral body. This chapter reviews the evidence, procedural nuances, and criteria for vertebral augmentation with use of the osteotome.
Addressing Oneself and Patient
Authors: Bulger Jeffrey W.
Published: September 2024

Abstract: The initial encounter between a patient and practitioner is crucial in establishing the patient–practitioner relationship based on confidentiality and privacy. The practitioner should introduce themself accurately and determine how the patient wants to be addressed. Titles of respect are important for setting up professional boundaries and acknowledging the patient’s autonomy in providing informed consent for healthcare treatment options. The practitioner’s role is to educate patients and help them make informed decisions using the patient’s reasonable goals, values, and priorities and avoid causing harm by only providing standards of care options for the patient to consent to or refuse. It is important that practitioners and students are transparent and honest about their current status and that the student never implies that they are a licensed practitioner.
Advance Directives—Planning
Authors: Bulger Jeffrey W.
Published: September 2024

Abstract:The Patient Self-Determination Act of 1990 mandates that all healthcare institutions receiving Medicaid or Medicare payments must inform patients of their legal rights to make decisions about their healthcare, periodically inquire about advanced directives, document patients’ healthcare wishes, and provide educational programs on patient self-determination. An advance directive (living will) and durable power of attorney for healthcare allow patients to self-determine their treatment preferences and establish a healthcare decision-making surrogate. The durable power of attorney is accompanied by professional responsibilities for both the practitioner and surrogate, with the surrogate obligated to use the patient’s reasonable goals, values, and priorities when making treatment decisions. If these are not determinable, the surrogate must maximize the patient’s best interests using the principles of beneficence (do good) and nonmaleficence (do no harm). The living will should be respected if it provides clear instructions.
The role of culture in a suicidal process
Authors: Eskin Mehmet
Published: September 2024

Culture plays a significant role in the suicidal process. Researchers attribute variations in suicidal behaviours across societies to divergences in manifestations of culture. However, scholarly work mostly fails to understand what culture is, and how to conceptualize and measure this over-encompassing and elusive phenomenon. This chapter first surveys the nature of suicidal behaviour and its intersocietal variation, and then discusses the concept of culture and its relevance to suicidology. It also outlines how culture might be involved in the suicidal process, as well as some methodological considerations. The chapter chooses three cultural manifestations that scientific work previously identified as representing cross-cultural variations. The three cultural manifestations are religion, individualism–collectivism, and self-construal. Then it surveys the scientific work on the relations of religion, individualism–collectivism, and self-construal with suicidal behaviour. The chapter ends with some conclusions and recommendations for future scientific work.
Ethnic aspects in pharmacological treatment of suicidality
Authors: Döring-Brandl Eva
Published: September 2024

Suicidal ideations, suicide attempts, and suicide are a serious risk for individuals with psychiatric disorders. Approximately 90% of suicides occur in patients with mental disorders. Therefore, suicide prevention is a key issue in psychiatric treatment. Besides psychotherapy, pharmacotherapy plays an important role and various substances are used for treatment of suicidal patients. Immigrants and members of ethnic minorities appear to be at increased risk of suicidality. Ethnic differences in tolerability and efficacy of psychiatric medication may influence treatment outcome and might often not be considered in clinical practice. This chapter reviews different types of medication used for treatment of suicidal patients, including antidepressants, mood stabilizers, antipsychotics, and benzodiazepines, and summarizes current findings on ethnic factors influencing treatment response and/or the occurrence of side effects.
Soft tissue masses
Authors: Kang Mandeep , Ward David
Published: September 2024

Soft tissue tumours are a large and heterogeneous group of neoplasms with numerous histological subtypes. Malignant soft tissue masses account for less than 1% of all malignant tumours but they are life-threatening and pose a diagnostic and therapeutic challenge. There is an association of soft tissue tumour development with exposure to certain chemicals, high-dose radiation, some viral infections, and specific genetic abnormalities. In most cases, the aetiology is unknown. They are classified according to various parameters including location, growth pattern, likelihood of recurrence, presence and distribution of metastatic disease, patient age, and prognosis. Patients initially may be asymptomatic during the early stages of tumour development. As the mass matures and grows, discomfort may ensue from pressure exerted upon surrounding structures. Diagnosis is generally confirmed via an accumulation of tests, including radiological analysis, tissue biopsy, and sentinel lymph node investigation. Benign soft tissue masses are common and can either be left untreated or treated by surgery alone. Malignant soft tissue masses require a multidisciplinary and multimodality approach for clinical evaluation and management. The mainstay of treatment is surgical excision or tumour debulking with adjuvant radiotherapy and/or chemotherapy.
Ear pain and hearing loss
Authors: Hawthorne Maurice
Published: September 2024

The pitfall for the non-ear specialist is to think that ear symptoms can only be due to ear disease—this is far from the case. Due to its complex nerve supply, pain and paraesthesia often have an origin away from the ear but symptoms are referred to the ear; consequently earache in the presence of a normal eardrum is due to a malignancy until proven otherwise. In additional to referral to the ear of symptoms from regional disease, systemic disease can also present with earache, a good example of which is Wegener’s granulomatosis and the painless deafness associated with vitamin D deficiency. While unrelenting pain with aural discharge can be a presenting symptom of life-threatening condition such as osteitis of the skull base or a malignancy of the ear, unrelenting discharge without pain can also be a sign of life-threatening disease such as cholesteatoma, tuberculosis, and tertiary syphilis. Assessment of the patient with an ear problem should include a thorough history to include symptoms of systemic and regional disease as well as auditory and neural symptoms. Examination should include the ear but also the head and neck and upper respiratory mucosal surfaces as well as looking for signs of systemic disease. Investigation should include assessment of the hearing, search for systemic conditions and local imaging of the head and neck. Treatment of hearing loss is not just confined to hearing aids but advice should be given on prevention, and the use of environmental aids or surgery considered.
Putative retina metal/metalloid-binding proteins: molecular functions, biological processes and retina disease associations
Authors: Ugarte Marta , Lawless Craig
Published: September 2024

The mammalian retina contains high amounts of metals/metalloid-selenium. Their dyshomeostases are associated with certain retinal diseases. We carried out this bioinformatics study to identify the relationships between putative retinal metal/selenium binding proteins, their molecular functions, and biological processes. Identification of putative mouse metal/selenium binding proteins was based on known binding motifs, domains, patterns, and profiles. Annotations were obtained from Uniprot keywords ‘metal binding’, ‘metal ion co-factors’, ‘selenium proteins’. Protein functions were estimated by associative frequency with key words in UniProt annotations. The raw data of five mouse proteomics PRIDE datasets (available to date) were downloaded and processed with Mascot against the mouse taxa of Uniprot (SwissProt/Trembl) and MaxQuant (version 1.6.10.43) for qualitative and quantitative datasets, respectively. Clinically relevant variants were evaluated using archives and aggregated information in ClinVar. The 438 proteins common to all the retina proteomics datasets were used to identify over-represented Gene Ontology categories. The putative mouse retinal metal/metalloid binding proteins identified are mainly involved in: (1) metabolic processes (enzymes), (2) homeostasis, (3) transport (vesicle mediated, transmembrane, along microtubules), (4) cellular localization, (5) regulation of signalling and exocytosis, (6) organelle organization, (7) (de)phosphorylation, and (8) complex assembly. Twenty-one proteins were identified as involved in response to light stimulus and/or visual system development. An association of metal ion binding proteins rhodopsin, photoreceptor specific nuclear receptor, calcium binding protein 4 with disease-related mutations in inherited retinal conditions was identified, where the mutations affected an area within or in close proximity to the metal binding site or domain. These findings suggest a functional role for the putative metal/metalloid binding site in retinal proteins in certain retinal disorders.
The potato RNA metabolism machinery is targeted by the cyst nematode effector RHA1B for successful parasitism
Authors: Huang Li , Yuan Yulin , Ramirez Chloe , Xia Chao , Zhang Cankui , Kud Joanna , Kuhl Joseph C , Caplan Allan , Dandurand Louise-Marie , Xiao Fangming
Published: September 2024

The potato (Solanum tuberosum) cyst nematode Globodera pallida induces a multinucleate feeding site (syncytium) in potato roots as its sole source of nutrition. Here, we demonstrate that the G. pallida effector RING-H2 finger A1b (RHA1B), which is a functional ubiquitin ligase, interferes with the carbon catabolite repression 4 (CCR4)-negative on TATA-less (NOT) deadenylase-based RNA metabolism machinery that regulates syncytium development in G. pallida-infected potato. Specifically, RHA1B targets the CCR4-associated factor 1 (CAF1) and StNOT10 subunits of the CCR4-NOT complex for proteasome-mediated degradation, leading to upregulation of the cyclin gene StCycA2 involved in syncytium formation. The StCAF1 subunit of CCR4-NOT recruits the RNA binding protein StPUM5 to deadenylate StCycA2 mRNA, resulting in shortened poly-A tails of StCycA2 mRNA and subsequently reduced transcript levels. Knockdown of either subunit (StCAF1 or StNOT10) of the CCR4-NOT complex or StPUM5 in transgenic potato plants resulted in enlarged syncytia and enhanced susceptibility to G. pallida infection, which resembles the phenotypes of StCycA2 overexpression transgenic potato plants. Genetic analyses indicate that transgenic potato plants overexpressing RHA1B exhibit similar phenotypes as transgenic potato plants with knockdown of StNOT10, StCAF1, or StPUM5. Thus, our data suggest that G. pallida utilizes the RHA1B effector to manipulate RNA metabolism in host plants, thereby promoting syncytium development for parasitic success.
A glutathione S-transferase regulates lignin biosynthesis and enhances salt tolerance in tomato
Authors: Yuan Luqiao , Dang Jiao , Zhang Jiayue , Wang Linyang , Zheng Hao , Li Guobin , Li Junxiao , Zhou Fan , Khan Abid , Zhang Zhengda , Hu Xiaohui
Published: September 2024

Salt stress adversely affects the growth and yield of crops. Glutathione S-transferases (GSTs) are involved in plant growth and responses to biotic and abiotic stresses. In this study, 400 mm NaCl stress significantly induced the expression of Glutathione S-transferase U43 (SlGSTU43) in the roots of the wild-type tomato (Solanum lycopersicum L.) plants. Overexpressing SlGSTU43 enhanced the ability of scavenging reactive oxygen species in tomato leaves and roots under NaCl stress, while SlGSTU43 knock-out mutants showed the opposite performance. RNA sequencing analysis revealed that overexpressing SlGSTU43 affected the expression of genes related to lignin biosynthesis. We demonstrated that SlGSTU43 can regulate the lignin content in tomato through its interaction with SlCOMT2, a key enzyme involved in lignin biosynthesis, and promote the growth of tomato plants under NaCl stress. In addition, SlMYB71 and SlWRKY8 interact each other, and can directly bind to the promoter of SlGSTU43 to transcriptionally activate its expression separately or in combination. When SlMYB71 and SlWRKY8 were silenced in tomato plants individually or collectively, the plants were sensitive to NaCl stress, and their GST activities and lignin contents decreased. Our research indicates that SlGSTU43 can enhance salt stress tolerance in tomato by regulating lignin biosynthesis, which is regulated by interacting with SlCOMT2, as well as SlMYB71 and SlWRKY8. This finding broadens our understanding of GST functions.
Guard cell K+ channels of Kalanchoë follow the diel cycle of crassulacean acid metabolism
Authors: Lefoulon Cécile , Blatt Michael R
Published: September 2024

The activity of outward-rectifying but not inward-rectifying K + channels of Kalanchoë stomata follows the diel cycle of crassulacean acid metabolism.
Cardiovascular presentations during the COVID-19 pandemic: an interrupted time series analysis
Authors: Sritharan Hari Prakash , Nguyen Harrison , Allahwala Usaid Khalil , Bhindi Ravinay
Published: September 2024

Background

The broader implications of the Coronavirus disease 2019 pandemic on cardiovascular hospitalizations remain unclear. We aimed to assess trends in cardiovascular presentations during the Coronavirus disease 2019 pandemic.

Methods

This multicentre study examined cardiovascular presentations from March 2018 to February 2023. Patients with cardiovascular presentations were identified through administrative health records using ICD-10-AM diagnosis codes. Four key study periods were analysed: T0—pre-pandemic, T1—first lockdown, T2—easing of restrictions and T3—release of restrictions and widespread vaccination. Interrupted time series analysis was used to predict weekly cardiovascular presentations, with the mean difference between actual and predicted numbers assessed for significance.

Results

Overall, 116 518 patients were included across three major public hospitals in Australia. Cardiovascular presentations were significantly lower in T1 than predicted, with a mean decline of 13.1% (SD 16.2%; P = 0.004). There was a significant difference between the expected and actual number of most cardiovascular presentations in T2 and T3, apart from a significant reduction in cardiomyopathy and heart failure presentations during T3 (4.5% [SD 23.7%]; P = 0.007).

Conclusions

Cardiovascular presentations were significantly lower during the initial lockdown phase of the COVID-19 pandemic; this attenuated with easing of social restrictions and widespread vaccination, except for persistent reduction in cardiomyopathy and heart failure presentations.
Measuring and Mitigating Racial Disparities in Tax Audits
Authors: Elzayn Hadi , Smith Evelyn , Hertz Thomas , Guage Cameron , Ramesh Arun , Fisher Robin , Ho Daniel E , Goldin Jacob
Published: September 2024

Tax authorities around the world rely on audits to detect underreported tax liabilities and to verify that taxpayers qualify for the benefits they claim. We study differences in Internal Revenue Service audit rates between Black and non-Black taxpayers. Because neither we nor the IRS observe taxpayer race, we propose and use a novel partial identification strategy to estimate these differences. Despite race-blind audit selection, we find that Black taxpayers are audited at 2.9 to 4.7 times the rate of non-Black taxpayers. An important driver of the disparity is differing audit rates by race among taxpayers claiming the Earned Income Tax Credit (EITC). Using counterfactual audit selection models to explore why the disparity arises, we find that maximizing the detection of underreported taxes would not lead to Black EITC claimants being audited at higher rates. Rather, the audit disparity among EITC claimants stems largely from a policy decision to prioritize detecting overclaims of refundable credits over other forms of noncompliance. Modifying the audit selection algorithm to target total underreported taxes while holding fixed the number of audited EITC claimants would reduce the share of audited taxpayers who are Black and would lead to more audits focused on accurate reporting of business income and deductions, fewer audits focused on the eligibility of claimed dependents, higher per audit costs, and more detected noncompliance.
Managing Postembolization Syndrome Through a Machine Learning–Based Clinical Decision Support System
Authors: Kang Minkyeong , Kim Myoung Soo
Published: September 2024

Although transarterial chemoembolization has improved as an interventional method for hepatocellular carcinoma, subsequent postembolization syndrome is a threat to the patients' quality of life. This study aimed to evaluate the effectiveness of a clinical decision support system in postembolization syndrome management across nurses and patient outcomes. This study is a randomized controlled trial. We included 40 RNs and 51 hospitalized patients in the study. For nurses in the experimental group, a clinical decision support system and a handbook were provided for 6 weeks, and for nurses in the control group, only a handbook was provided. Notably, the experimental group exhibited statistically significant improvements in patient-centered caring attitude, pain management barrier identification, and comfort care competence after clinical decision support system implementation. Moreover, patients' symptom interference during the experimental period significantly decreased compared with before the intervention. This study offers insights into the potential of clinical decision support system in refining nursing practices and nurturing patient well-being, presenting prospects for advancing patient-centered care and nursing competence. The clinical decision support system contents, encompassing postembolization syndrome risk prediction and care recommendations, should underscore its role in fostering a patient-centered care attitude and bolster nurses' comfort care competence.
Germline Variants of Uncertain Significance in Gynecologic Oncology Patients
Authors: Cooper Julia , Senter Leigha
Published: September 2024

Germline and somatic genetic/genomic testing are commonly ordered for gynecologic oncology patients. Genetic tests can inform disease etiology, prognosis, treatment decisions, and risk to the patient’s relatives. Variants of uncertain significance (VUSs) are frequently encountered and have a more nuanced interpretation than straightforward pathogenic or benign variant classifications. Clinical care providers should be familiar with why and how VUSs are reported, their clinical significance, variant reclassification practices, and patient perceptions of VUSs.
Viral antibody response predicts morbidity and mortality in alcohol-associated hepatitis
Authors: Hsu Cynthia L. , Wang Limin , Maestri Evan , Jacob Aleesha R. , Do Whitney L. , Mayo Susan , Bosques-Padilla Francisco , Verna Elizabeth C. , Abraldes Juan G. , Brown Jr. Robert S. , Vargas Victor , Altamirano Jose , Caballería Juan , Shawcross Debbie L. , Louvet Alexandre , Lucey Michael R. , Mathurin Philippe , Garcia-Tsao Guadalupe , Stärkel Peter , Bataller Ramon , Investigators AlcHepNet , Wang Xin W. , Schnabl Bernd
Published: September 2024

Background and Aims:

Alcohol-associated hepatitis (AH) is associated with very high mortality despite abstinence from alcohol; up to 40% of patients die within 6 months of diagnosis. Patients with AH are especially prone to infections, which can lead to multiorgan dysfunction and poorer prognosis.

Approach and Results:

We performed comprehensive serological profiling of the viral and bacterial infection history of 36 healthy controls, 48 patients with alcohol use disorder, and 224 patients with AH from 2 multicenter observational studies. We used systematic viral and bacterial epitope scanning by VirScan, a phage-display immunoprecipitation and sequencing technology that detects the peptides recognized by antibodies in patient sera, to comprehensively analyze antiviral and antibacterial antibodies and identify serologic biomarkers to predict patient outcomes. We found significant differences in the serological profiles of the 3 populations. The number of serum antibody epitopes in patients with alcohol use disorder during abstinence was increased compared with during active alcohol use. A decreased number and diversity of viral and bacterial antibody targets were detected in the sera of patients with AH, particularly those with a higher Child-Pugh score. In patients with AH, a decrease in the serum antiviral, but not antibacterial, antibody repertoire was associated with decompensation and mortality. Ninety-day mortality in AH could be predicted using a serum viral epitope signature.

Conclusions:

Abstinence from alcohol is associated with a significant increase in serum viral and bacterial antibody response. Decreased serum antiviral antibody repertoire is predictive of decompensation of liver disease and mortality in patients with AH.
TIPE2 protein restrains invariant NKT activation and protects against immune-mediated hepatitis in mice
Authors: Song Miaomiao , Wang Han , Tian Xueqin , Gao Jingtao , Song Chen , Zhao Yuxin , Jiang Shan , Lu Wei , Guo Cun , Lv Yang , Zhao Peiqing , Li Chuang , Song Xiangfeng , Chang Tingmin , Lou Yunwei , Wang Hui
Published: September 2024

Background and Aims:

Concanavalin A (ConA) administration induces rapid and severe liver injury in mice, and invariant natural killer T (iNKT) cells are recognized to be the key effector cells in this process. However, the underlying regulatory mechanisms are not well defined.

Approach and Results:

We found that iNKT cells constitutively expressed TIPE2 (tumor necrosis factor-α-induced protein 8-like 2, or TNFAIPL2). Genetic TIPE2 ablation strongly sensitized mice to ConA-induced hepatitis, accompanied by hyperactivation of iNKT cells. Moreover, Tipe2

−/−
mice were also more susceptible to α-galactosylceramide-induced liver injury, with elevated serum ALT levels and enhanced proinflammatory cytokine production. CD1d signaling blockade or iNKT cell elimination through antibodies reduced the effect of TIPE2 deficiency on liver injury. Mechanistic studies revealed that TIPE2 in iNKT cells functioned as a negative regulator, limiting iNKT cell activity and cytokine production through PIP3- AKT/mTOR pathway. TIPE2-mediated protection from liver injury was further validated by the administration of adeno-associated viruses expressing TIPE2, which effectively ameliorated ConA-induced hepatic injury. However, TIPE2 was dispensable in 2 other liver injury models, including D-GalN/LPS and acetaminophen-induced hepatitis.

Conclusions:

Our findings reveal a new role of TIPE2 in the attenuation of iNKT cell-mediated hepatic injury. We propose that TIPE2 serves as an important regulator of immune homeostasis in the liver and might be exploited for the therapeutic treatment of autoimmune liver diseases.
MERTK Inhibitor Associated Retinal Toxicity in a Human
Authors: Caldwell Anne Strong , Milner Dallin C , Mehta Nihaal B , Marin Alejandro I , Gill Zafar S. , Manoharan Niranjan
Published: September 2024

Purpose:

The MER proto-oncogene tyrosine kinase (MERTK) helps maintain the homeostasis of the retinal pigmented epithelium (RPE). Additionally, MERTK regulates the innate immune system. As such inhibition of MERTK has gained recent interest as a target for cancer therapeutics. Herein, we present on MERTK inhibitor associated retinal toxicity in a human.

Methods:

A 43-year-old male with past medical history of esophageal adenocarcinoma was enrolled in a trial studying the MERTK inhibitor PF-07265807. As part of the study protocol, the patient was seen every two to three weeks for dilated fundus exams and ancillary testing. Data on the patient’s relevant past medical history, ophthalmic exam findings, and imaging performed at baseline and subsequent ophthalmology visits was obtained via retrospective chart review.

Results:

At the patient’s baseline visit, his dilated exam and testing were normal. Seven months after starting the MERTK inhibitor the patient developed subtle but reproducible signs of retinal toxicity with disruption of the extrafoveal ellipsoid zone on optical coherence tomography and extrafoveal hyper-autofluorescence on short wavelength fundus autofluorescence. The patient’s vision remained stable throughout the study; however, the medication was stopped due to the unknown ocular effects as well as progression of the patient’s cancer.

Discussion:

Patients taking MERTK inhibitors should be monitored by an ophthalmologist while on the drug. If toxicity develops, discussion of whether to continue the medication should take place between the patient, ophthalmologist, and oncologist, with consideration of the risks of vision loss versus benefits of taking the medication from a cancer perspective.
Digital vs manual axis marking for toric phakic intraocular lens alignment: prospective randomized intraindividual trial
Authors: List Wolfgang , Dirisamer Martin , Mayer Wolfgang Johann , Shajari Mehdi , Glatz Wilfried , Gran Jakob , Wedrich Andreas , Steinwender Gernot
Published: September 2024

Purpose:

To compare visual and refractive outcomes and postoperative axis alignment for toric implantable collamer lens (ICL) implantation in astigmatic myopia using manual vs digital marking techniques.

Setting:

Department of Ophthalmology, Medical University of Graz, Graz, Austria.

Design:

Prospective randomized single-centered intraindividual comparison.

Methods:

Patients undergoing bilateral toric ICL implantation for myopia with astigmatism ≥0.5 diopters (D) were enrolled. Patients received both marking techniques, and randomization was performed. Postoperative retroillumination photography assessed axis alignment, and visual and refractive parameters were evaluated. Duration of the surgeries was recorded.

Results:

The study included 20 patients and 40 eyes. Preoperative visual and refractive parameters showed no significant differences. Postoperatively, residual astigmatism (P = .824) and spherical equivalent (P = .309) were comparable. No notable differences between right and left eyes in preoperative (P = .371) and postoperative (P = .824) astigmatism were observed. Although slight, corrected distance visual acuity (CDVA) increased in both groups postoperatively (P = .381). Gain in CDVA was comparable between marking techniques (P = .637). Safety and efficacy indices were comparable (P = .991 and P = .189, respectively). Postoperative axial misalignment was 2.8 ± 3.1 degrees in the digital- and 4.4 ± 5.1 degrees in the manual group (P = .260). Vector analysis showed no significant differences between manual and digital marking. Duration remained uninfluenced by the marking technique (P = .970) and side of surgery (P = .682).

Conclusions:

Digital and manual marking techniques provided comparable results in axis alignment, surgical duration, and visual and refractive outcomes. Both methods were viable for precise axis alignment, with digital marking offering a potential advantage in efficacy.
Nursing Work Engagement, Professional Quality of Life, and Intent to Leave: A Structural Equation Modeling Pathway Analysis
Authors: WEI Holly , CAO Yan , CARROLL Quinton , WEI Aaron , RICHARDSON Sherry , NWOKOCHA Tricia , MCINTOSH Jennifer , HARDIN Sonya Renae
Published: September 2024

Background

Work engagement, professional quality of life (ProQOL), and intent to leave (ITL) significantly impact organizational behaviors and outcomes. Understanding the complex interrelationships among nurse work engagement, ProQOL, and ITL is essential for improving nurse retention, job satisfaction, and patient outcomes. In previous investigations, work engagement, ProQOL, and ITL relationships have primarily been analyzed individually. A more integrated approach is needed to gain a comprehensive understanding of these factors in the nursing profession.

Purpose

This study was designed to evaluate the interrelationships among work engagement, ProQOL (compassion satisfaction [CS], burnout, and secondary traumatic stress [STS]), and ITL in nurses using structural equation modeling path analysis.

Methods

This was a quantitative descriptive study. Data were collected from registered nurses in the United States (n = 900) using the Utrecht Work Engagement Scale, the ProQOL-5 (CS, burnout, and STS), and a demographics datasheet (including a one-item ITL question). The proposed theoretical model, incorporating major constructs, was tested using structural equation modeling.

Results

Level of work engagement in nurses impacts ITL through ProQOL. Among the mediating variables, burnout (0.31) had the largest total effect on ITL, followed by STS (0.12) and CS (−0.12). Burnout and STS were found to correlate with ITL directly, whereas CS was found to correlate with ITL indirectly.

Conclusions

Promoting work engagement, addressing burnout and STS, and fostering CS can positively influence nurse retention and job satisfaction, ultimately improving patient care quality. Healthcare leaders and policymakers should implement strategies to enhance nurse engagement, reduce burnout, and cultivate compassion satisfaction to increase nurse retention and improve organizational outcomes.
Dementia Training for Nurses in Acute Care Settings: Impacts and Barriers
Authors: LIN Pei-Chao , HSU Shao-Yun , CHEN Chang-Chun , WUNG Shu-Fen
Published: September 2024

Background

The provision of consistent, high-quality dementia care training for healthcare professionals in acute care hospital settings has been largely overlooked until recent years.

Purpose

This study was designed to investigate the effect of current healthcare professional dementia care training courses on related knowledge, attitudes, and self-efficacy in hospital nurses and to understand their training-related experiences, willingness, and perceived barriers.

Methods

Using a cross-sectional design, 201 nurses were recruited from a teaching medical center in Taiwan. A questionnaire was developed by the researchers to evaluate knowledge, attitudes, and self-efficacy related to caring for people with dementia and to elucidate participant experiences and preferences regarding dementia care training courses. Five academic and clinical dementia care experts held three content validity evaluation rounds for the developed questionnaire. Inferential statistics were used to compare the knowledge, attitudes, and self-efficacy related to caring for people with dementia between participants who had and had not attended a dementia care training course.

Results

Nearly all (96.5%) of the participants had prior experience caring for people with dementia, but only 25.9% and 7.0% respectively reported haven taken basic and advanced healthcare professional dementia care training courses. Those who had taken either the basic or advanced course earned higher mean knowledge scores than those who had taken neither (p = .009 and p = .027, respectively). Time constraints and scheduling conflicts were identified as the major barriers to attending dementia care training (n = 164, 81.6%).

Conclusions/Implications for Practice

The participants who had attended either the basic or advanced healthcare professional dementia care training course were found to have better dementia care knowledge than those who had not. Stakeholders should work to further reduce the barriers faced by nurses to attending essential dementia care training.
Who’s Behind the Wheel? Work and Health Backgrounds of New Transit Bus Operators
Authors: Olson Ryan , Stoffregen Stacy A. , Bauer Talya N. , Wipfli Brad , Anger W. Kent , Bodner Todd , Graven Peter , McHill Andrew W. , Donovan Courtney
Published: September 2024

Objective

Investigate new bus operators’ (N = 293) occupational and health backgrounds to inform how transit authorities can support their future health and job success.

Methods

New bus operators completed surveys and direct measurements that addressed demographics, work history, and 10 health risk factors.

Results

Participants averaged 42.76 years of age and were predominantly male (73.5%). Many (45.7%) came from minority backgrounds and most (66.3%) had no prior commercial driving experience. Transportation and material moving occupations were operators’ most common prior jobs followed by protective service, and sales and related occupations. Study-specific criteria classified operators as having low (49.5%), medium (37.9%), and high (12.6%) health risk levels.

Conclusions

About half of the sample had medium-to-high health risks and most lacked commercial driving experience. Such information may help employers proactively support new bus operators’ health and job success.
A Longitudinal Study on the Impact of Working From Home During the COVID-19 Pandemic
Authors: Graham Melissa , Weale Victoria , Lambert Katrina A. , Kinsman Natasha , Stuckey Rwth , Oakman Jodi
Published: September 2024

Objective

The aim of the study is to examine the impact of working from home during the COVID-19 pandemic on general health, stress, work–family, and family–work conflict over-time and identify differences by gender and parental status.

Methods

Trajectory analyses described outcomes over time. Multinomial logistic regression relates the effects of gender, children, and the interaction between them, on group membership based on the latent class growth analyses.

Results

Not all trajectories followed the expected cubic pattern. Females had less family–work conflict (high/low: OR = 0.29, 95% CI: 0.17–0.66; moderate/low OR = 0.37, 95% CI: 0.20–0.67). Children increased the odds of family–work conflict (high/low: OR = 8.48, 95% CI: 3.38–21.25; moderate/low OR = 2.98, 95% CI: 1.63–5.43). Work–family conflict was worse for those with children (high-to-moderate decline/low-stable: OR = 2.59, 95% CI 1.25–5.41).

Conclusions

Work from home has implications for health and well-being of employees with differences based on gender and parental status for stress, work–family, and family–work conflict.
An Assessment of Neonatal Nurses’ Knowledge and Provision of Child Passenger Safety Information
Authors: Davis Tiffany L. , Chappelow Michelle L. , Heflin Heidi D. , O’Neil Joseph , Zonfrillo Mark R.
Published: September 2024

Background:

Nurses who care for newborn infants in the hospital have an opportunity to serve as a resource for child passenger safety (CPS). Literature lacks information on what CPS knowledge and provision of information exists for neonatal nurses.

Objective:

In this study, we assessed neonatal nurses’ knowledge and provision of CPS information.

Methods:

The study design included an adapted, cross-sectional, and anonymous survey. A generic survey link was distributed to National Association of Neonatal Nurses’ members. Descriptive and univariate analyses were used to summarize the data.

Results:

One hundred thirteen registered nurses working in the hospital, representing 27 states, completed the survey. Approximately 38.1% (N = 43) “high knowledge” respondents answered 2 scenario-based and 3 knowledge-based CPS questions correctly. Nurses addressed CPS for parents/caregivers during newborn hospitalization through car seat tolerance screenings (85.8%), verbal education or answering questions (83.2%), and providing a pamphlet or handout (52.2%). Barriers to providing CPS recommendations were nursing staff not being trained in CPS (55.8%), perceived liability (50.4%), and lack of understanding/unaware of CPS guidelines (47.8%).

Conclusion:

Neonatal nurses can benefit from CPS training and hospital policies which outline nurse expectations and liabilities.
Risk Factors for Neonatal Clavicular Fractures
Authors: Kadar Assaf , Yaniv Noga , Rutenberg Tal Frenkel , Turjeman Adi , Shemesh Shai , Sidon Eliezer , Cohen Matan J.
Published: September 2024

Background:

Neonatal clavicular fractures represent the most common fracture during delivery. We aimed to define risk factors associated with these fractures in a large population-based database.

Methods:

Data were extracted from Clalit Health Services’ electronic health records from 2000 to 2020. Newborns with clavicular fractures were compared with a healthy control group. The following parameters were compared—for the newborns: sex, birth weight, birth height, and head circumference; for the delivery process: assisted delivery, cesarean section, use of epidural, birth week, and number of fetuses; and for the mother: age at delivery, socioeconomic status, height, weight, and body mass index (BMI).

Results:

We found a rate of 0.28% for neonatal clavicular fractures (5015 clavicular fractures/1 755 660 deliveries). Male gender and heavier birth weight were found to be significantly associated with clavicular fractures (P < .001). Increased risk was also associated with lower socioeconomic status, baseline weight, and maternal BMI (P < .001 for all). Assisted delivery increased the risk of clavicular fracture (OR = 2.274; 95% CI, 1.661-3.115; P < .0001), while cesarean section and use of epidural were found to be protective (OR = 0.149; 95% CI, 0.086-0.26; P < .0001; and OR = 0.687; 95% CI, 0.0531-0.89; P < .004, respectively).

Conclusions:

This study provides insight into the risk factors associated with neonatal clavicular fractures on the largest group of patients reported to date.
An Internet-Based Developmental Home Care Support Program Improved Maternal Psychological Symptoms and Infant Growth
Authors: Zhang Jun , Chen Bowen , Yang Xinyi , Cao Mi , Mahoney Ashley Darcy , Zhu Luyang , Yu Nancy Xiaonan
Published: September 2024

Objective: To examine the effects of an internet-based Developmental Home Care Support program (DHCSP) to reduce maternal psychological symptoms and improve preterm infants’ physical growth outcomes. Methods: A randomized controlled trial was conducted. The mother-infant dyads (n
m = 34, n
p = 40) were randomly assigned to either the DHCSP intervention group or the control group. Data were collected at discharge (T0), 1-month corrected age (T1), and 2-month follow-up (T2), including mothers’ postpartum depressive and posttraumatic stress disorder (PTSD) symptoms and mother-proxy infants’ body length, weight, and head circumference. Results: There were no significant differences in sociodemographic characteristics between the 2 groups at T0, except for mothers’ age and monthly household income (both P = .01). Mothers in the DHCSP group reported significantly higher decreases in depression symptoms (β = −2.24; 95% confidence interval [CI], −4.31 to −0.16, P = .03), and their preterm infants showed significantly more increases in body length (β = 2.09; 95% CI, 0.30-3.87, P = .02) than the control participants at T2. The 2 groups did not show significant differences in mothers’ PTSD symptoms or infants’ body weight and head circumference. Conclusion: The internet-based DHCSP intervention was effective in improving mothers’ depressive symptoms and infants’ body length.
Comparison of State–Trait Anxiety and Fear of Childbirth According to Attachment Styles of Pregnant Women
Authors: Yıldırım Yusuf Ezel , Çetinay Aydın Pınar , İnan Ünlü Alevhan , Karaca İbrahim , Ekin Murat
Published: September 2024

Aims/Background:

Fear of childbirth (FoC) and its extreme form, tokophobia, is a clinical condition that can lead to many negative consequences, and its importance is increasingly understood. This article aims to assess the severity of FoC and anxiety levels according to different attachment styles and to investigate the relationships between these factors.

Design/Methods:

A cross-sectional study was conducted in a state hospital in the largest city in Turkey. Three hundred pregnant women attending the Antenatal Outpatient Clinic were included. A sociodemographic questionnaire, Wijma Delivery Expectancy/Experience Questionnaire—version-A (W-DEQ), Spielberger State–Trait Anxiety Inventory and Adult Attachment Style Scale were administered.

Results:

8.1% of participants had tokophobia (W-DEQ sum score ≥85). FoC was significantly higher in pregnant women who had a history of pregnancy loss and past psychiatric history. For multiparous women, adverse birth outcomes were also associated with higher FoC. State and trait anxiety were positively correlated with FoC levels. Regarding the attachment patterns, pregnant women with avoidant attachment styles presented with higher levels of FoC than those with secure attachment styles. In logistic regression analysis, higher anxiety levels, adverse birth outcomes, and insecure attachment styles were found to predict severe and clinical FoC.

Conclusion:

FoC has a considerable effect on pregnant women, albeit at different clinical levels. Adverse birth outcomes, high anxiety levels, and insecure attachment styles were associated with higher FoC. Therefore, antenatal patients with adverse birth outcomes and higher anxiety levels, which are risk factors for FoC, should be carefully evaluated in terms of tokophobia and referred to mental health professionals when necessary.