bluuebunny/crossref_metadata_2025 huggingface dataset:
A Systematic Review and Meta-Analysis of the Association Between Psychopathology and Social Functioning in Schizophrenia
Authors: Handest Rasmus , Molstrom Ida-Marie , Gram Henriksen Mads , Hjorthøj Carsten , Nordgaard Julie
Published: June 2023

Background

Impaired social functioning is a major, but under-elucidated area of schizophrenia. It’s typically understood as consequential to, eg, negative symptoms, but meta-analyses on the subject have not examined psychopathology in a broader perspective and there’s severe heterogeneity in outcome measures. To enhance functional recovery from schizophrenia, a more comprehensive understanding of the nature of social functioning in schizophrenia is needed.

Study Design

In this systematic review and meta-analysis, we searched PubMed, PsycInfo, and Ovid Embase for studies providing an association between psychopathology and social functioning. Meta-analyses of the regression and correlation coefficients were performed to explore associations between social functioning and psychopathology, as well as associations between their subdomains.

Study Results

Thirty-six studies with a total of 4742 patients were included. Overall social functioning was associated with overall psychopathology (95% CI [−0.63; −0.37]), positive symptoms (95% CI [−0.39; −0.25]), negative symptoms (95% CI [−0.61; -0.42]), disorganized symptoms (95% CI [−0.54; −0.14]), depressive symptoms (95% CI [−0.33; −0.11]), and general psychopathology (95% CI [−0.60; −0.43]). There was significant heterogeneity in the results, with I2 ranging from 52% to 92%.

Conclusions

This is the first systematic review and meta-analysis to comprehensively examine associations between psychopathology and social functioning. The finding that all psychopathological subdomains seem to correlate with social functioning challenges the view that impaired social functioning in schizophrenia is mainly a result of negative symptoms. In line with classical psychopathological literature on schizophrenia, it may be more appropriate to consider impaired social functioning as a manifestation of the disorder itself.
The Family Life of Peter and Ruth Townsend: Social Science and Methods in 1950s and Early 1960s Britain
Authors: Renwick Chris
Published: June 2023

Peter Townsend (1928–2009) was one of the most important British social scientists of the twentieth century, best known for pioneering and innovative research on poverty, as well as his political campaigning, most notably for the Child Poverty Action Group. This article returns to Townsend’s influential work on ageing, for which he first became widely known, during the 1950s and early 1960s. It does so to recover the ways in which his research, first in Bethnal Green at the Institute of Community Studies (ICS), and then at the London School of Economics, as well as the professional and political networks he built during this period, were rooted in and shaped by his home life in Hampstead. As will be shown, the most important figure in the interconnecting spheres of Townsend’s career was his wife, Ruth (1927–2011), who not only was central to the construction of a way of life in which the boundaries between research, the domestic sphere, and politics were often so blurred as to be non-existent, but also made significant and underappreciated contributions to her husband’s research.
Imagining Economic Growth in Post-War Britain
Authors: Tomlinson Jim
Published: June 2023

This article contends that common representations of the history of the British economy and economic policy in the ‘Golden Age’ period (circa 1950–73) as a story of ‘failure’ rely overwhelmingly on one measure, that of Gross Domestic Product (GDP) growth. Drawing on the foundational criticisms of this metric made by Simon Kuznets, it is argued that, for this period of British economic history, shortfalls in measured GDP growth in comparison with other rich countries are a very poor measure of changes in economic well-being in the UK. If we follow this argument and discard the belief that one metric can summarize trends in such well-being, the notion of ‘failure’ in this period should be set aside in favour of a more nuanced, multidimensional assessment.
Interaction of mercury species with proteins: towards possible mechanism of mercurial toxicology
Authors: Rupa Sharmin Akther , Patwary Md Abdul Majed , Matin Mohammed Mahbubul , Ghann William Emmanuel , Uddin Jamal , Kazi Mohsin
Published: May 2023

The nature of the binding of mercurials (organic and inorganic) and their subsequent transformations in biological systems is a matter of great debate as several different hypotheses have been proposed and none of them has been conclusively proven to explain the characteristics of Hg binding with the proteins. Thus, the chemical nature of Hg-protein binding through the possible transportation mechanism in living tissues is critically reviewed herein. Emphasis is given to the process of transportation, and binding of Hg species with selenol-containing biomolecules that are appealing for toxicological studies as well as the advancement of environmental and biological research.
Evaluation of a Series of Turnip Mosaic Virus Chimeric Clones Reveals Two Amino Acid Sites Critical for Systemic Infection in Chinese Cabbage
Authors: Song Zhengxing , Seo Eun-Young , Hu Wen-Xing , Kim Jung-Kyu , Kang Jun-Seong , Lee Seung-Eun , Hammond John , Lim Hyoun-Sub
Published: June 2023

Two infectious clones of turnip mosaic virus (TuMV), pKBC-1 and pKBC-8, with differential infectivity in Chinese cabbage ( Brassica rapa subsp. pekinensis), were obtained. Both infected Nicotiana benthamiana systemically, inducing similar symptoms, whereas only virus KBC-8 infected Chinese cabbage systemically. To identify the determinants affecting infectivity on Chinese cabbage, chimeric clones were constructed by restriction fragment exchange between the parental clones and tested on several Chinese cabbage cultivars. Chimeric clones p1N8C and p8N1C demonstrated that the C-terminal portion of the polyprotein determines systemic infection of Chinese cabbage despite only three amino acid differences in this region, in the cylindrical inclusion (CI), viral protein genome-linked (VPg), and coat protein (CP). A second pair of hybrid constructs, pHindIII-1N8C and pHindIII-8N1C, failed to infect cultivars CR Victory and Jinseonnorang systemically, yet pHindIII-1N8C caused hypersensitive response-like lesions on inoculated leaves of these cultivars, and could systemically infect cultivars CR Chusarang and Jeongsang; this suggests that R genes effective against TuMV may exist in the first two cultivars but not the latter two. Constructs with single amino acid changes in both VPg (K2045E) and CP (Y3095H) failed to infect Chinese cabbage, implying that at least one of these two amino acid substitutions is essential for successful infection on Chinese cabbage. Successful infection by mutant KBC-8-CP-H and delayed infection with mutant HJY1-VPg-E following mutation or reversion suggested that VPg (2045K) is the residue required for infection of Chinese cabbage and involved in the interaction between VPg and eukaryotic initiation factor eIF(iso)4E, confirmed by yeast two-hybrid assay.
Patients and Parents’ Satisfaction and Self-Reported Evaluation After Single-Event Multilevel Surgery in Cerebral Palsy
Authors: Morais Filho Mauro César de , Fujino Marcelo H. , Kawamura Cátia M. , Lopes José Augusto F. , Benavides Daniela M. , Muzaurieta Aurelio A.
Published: May 2023

Purpose:

The aim of this study was to analyze the results of single-event multilevel surgery (SEMLS) in cerebral palsy (CP) based on objective gait outcomes and self-reported evaluations.

Methods:

In total, 258 patients with spastic diplegic CP, GMFCS I-III, who underwent SEMLS and with preoperative and postoperative gait analyses, were included in the SEMLS group (SG). The same database was used to compose the control group (CG) formed of 88 subjects who had performed at least 2 gait analyses and did not undergo surgical intervention between tests. Demographic data, Gait Deviation Index (GDI), and a self-reported questionnaire were analyzed, and results were compared between groups.

Results:

The GDI decreased from 59.6 to 57.9 in the CG and increased from 51.3 to 58.4 in the SG (P<0.001). There was no change in patients’ walking ability in the CG. The number of patients who walk community distances increased after SEMLS in the group that had a GDI improvement >5 points (from 12.3% to 24.7%, P=0.008) and in patients GMFCS I and II (from 9.2% to 20.4%, P=0.028). According to patient and parental responses on satisfaction, the most significant improvements were reported in self-esteem, mobility, body image, and independence. In total, 51.1% of the patients were extremely satisfied or satisfied, while 3.9% were unsatisfied or extremely unsatisfied with the treatment results. Of the parents surveyed, 60.1% were extremely satisfied or satisfied, whereas just 5.0% were unsatisfied or extremely unsatisfied.

Conclusions:

In the studied group, an improvement in outdoor walking for community distances after SEMLS, as reported in questionnaires, was observed only when GDI increase was >5 points and in GMFCS I and II.

Level of Evidence:

Level III.
An Update on Pediatric Acute Hematogenous Osteomyelitis in New Zealand - A Decade on
Authors: McDonald Anna C.E. , Julian Jack , Voss Lesley M. , Boyle Matthew J. , Crawford Haemish A.
Published: May 2023

Introduction:

New Zealand (NZ) has high rates of pediatric acute hematogenous osteomyelitis (AHO) with males and children of Pasifika and Māori ethnicity overrepresented.

Aims:

To update the incidence of Pediatric AHO over 10 years, identifying trends in presentation, organisms, treatment, and outcomes.

Methods:

A 10-year retrospective review of children aged 6 weeks to 15 years admitted with Pediatric AHO across two centers from 2008 to 2017. Demographic data, features of presentation, investigations, management, and complications were collected. Incidence was calculated from census data. Data were compared with our osteomyelitis database from the previous decade.(1)

Results:

796 cases were identified. The incidence was 18 per 100,000 per annum. The average age was 7.7 years. Pasifika and Māori children are overrepresented (57%). 370 children (51%) came from low socioeconomic areas. Methicillin-sensitive Staphylococcus aureus was the most common pathogen (87%). Methicillin-resistant Staphylococcus aureus (MRSA) rates are low (4.4%). Forty-four (5.5%) children were admitted to the Pediatric Intensive Care Unit (PICU) with 9% mortality. The mean duration of antibiotics was 40 days. 325 children (41%) had surgery. Chronic infection has increased from 1.7% to 5.7%.

Conclusions:

NZ has high rates of AHO, however, the incidence has decreased from the previous decade. Males, those in low socioeconomic areas, Pasifika and Māori have high disease burden. The use of MRI as a diagnostic modality has increased. Future studies should focus on improving treatment via prospective analysis and reporting long-term morbidity to improve outcomes for children with severe disease and reduce rates of chronic infection.
Yangxinshi Tablets Versus Trimetazidine on Exercise Tolerance After Percutaneous Coronary Intervention: Rationale and Design of the Double-blind, Randomized HEARTRIP Trial
Authors: Li Yi , Zhang Jian , Chen Hong , Zhang Yi , Li Jing , Yu Haichu , Meng Xiaoping , Yuan Haitao , Shao Lili , Han Yaling
Published: June 2023

Improving exercise tolerance is indisputably beneficial for long-term survival in patients treated with percutaneous coronary intervention (PCI). Although previous studies suggested that Yangxinshi tablets effectively improve exercise tolerance in patients with coronary heart disease, the evidence is limited due to the lack of high-quality randomized trials. The Effects of Yangxinshi Tablets on Exercise Tolerance Compared with Trimetazidine in Patients after PCI (HEARTRIP) trial is a multicenter, double-blind, double-dummy, active drug-controlled, randomized trial designed to test if the effects of Yangxinshi tablets on exercise tolerance are non-inferior to those of trimetazidine in patients undergoing PCI. A total of 668 patients who have undergone PCI for the first time and completed a cardiopulmonary exercise test (CPET) will be enrolled and randomly assigned, in a 1:1 ratio, to receive Yangxinshi tablets (3 tablets, 3 times/d) plus trimetazidine-placebo or trimetazidine (20 mg, 3 times/d) plus Yangxinshi-placebo for 24 weeks. The primary endpoint is metabolic equivalent of tasks (METs) measured by CPET at 24 weeks after randomization. The secondary endpoints include comprehensive CPET indicators, incidence of major adverse cardiac and cerebrovascular events, and depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), and quality of life (Seattle Angina Questionnaire) scores. This study will appraise current clinical evidence on the beneficial effect of Yangxinshi tablets on improving exercise tolerance after PCI and may substantiate their use as an effective pharmacological option for cardiac rehabilitation patients. The HEARTRIP study protocol received approval from the ethics committee of the General Hospital of Northern Theater Command (Shenyang, China). The procedures set out in this protocol are in accordance with the principles of the Declaration of Helsinki and the Good Clinical Practice guidelines. The results will be published following the guidelines of the CONSORT statement in a peer-reviewed scientific journal (Trial registration number: NCT03809273).
Trauma systems in Italy: the Lombardy experience
Authors: Cioffi Stefano Piero Bernardo , Cimbanassi Stefania , Sammartano Fabrizio , Chiara Osvaldo
Published: June 2023

The epidemiology of major trauma in Italy reflects the current European trend. Most injuries come from road crash, domestic, and workplace accidents. During recent decades, the improvement of trauma systems led to a dramatic reduction of preventable deaths. This article describes the history, development, and current organization of the Lombardy trauma system, which has been one of the first to be developed in Italy.
COVID-19 and cardiovascular complications: updates of emergency medicine
Authors: Zhao Jianli , Xie Yaoli , Meng Zhijun , Liu Caihong , Wu Yalin , Zhao Fujie , Ma Xinliang , Christopher Theodore A. , Lopez Bernard J. , Wang Yajing
Published: June 2023

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and SARS-CoV-2 variants, has become a global pandemic resulting in significant morbidity and mortality. Severe cases of COVID-19 are characterized by hypoxemia, hyperinflammation, cytokine storm in lung. Clinical studies have reported an association between COVID-19 and cardiovascular disease (CVD). Patients with CVD tend to develop severe symptoms and mortality if contracted COVID-19 with further elevations of cardiac injury biomarkers. Furthermore, COVID-19 itself can induce and promoted CVD development, including myocarditis, arrhythmia, acute coronary syndrome, cardiogenic shock, and venous thromboembolism. Although the direct etiology of SARS-CoV-2–induced cardiac injury remains unknown and underinvestigated, it is suspected that it is related to myocarditis, cytokine-mediated injury, microvascular injury, and stress-related cardiomyopathy. Despite vaccinations having provided the most effective approach to reducing mortality overall, an adapted treatment paradigm and regular monitoring of cardiac injury biomarkers is critical for improving outcomes in vulnerable populations at risk for severe COVID-19. In this review, we focus on the latest progress in clinic and research on the cardiovascular complications of COVID-19 and provide a perspective of treating cardiac complications deriving from COVID-19 in emergency medicine.
Mouse nerve growth factor suppresses neuronal apoptosis in valproic acid-induced autism spectrum disorder rats by regulating the phosphoinositide-3-kinase/serine/threonine kinase signaling pathway
Authors: Jian Jie , Li Li-Guo , Zhao Peng-Ju , Zheng Rui-Juan , Dong Xian-Wen , Zhao Yong-Hong , Yin Bao-Qi , Li Sheng , Cheng Hui , Li Hong-Lei , Li En-Yao
Published: June 2023

Background

Autism spectrum disorder (ASD) is a group of neurodevelopmental disorders characterized by deficits in social communication and restrictive behaviors. Mouse nerve growth factor (mNGF), a neurotrophic factor, is critical for neuronal growth and survival, and the mNGF treatment is considered a promising therapy for neurodegeneration. In light of this, we aimed to evaluate the effect of mNGF on neurological function in ASD.

Methods

An ASD rat model was established by intraperitoneal injection of valproic acid (VPA). Social behavior, learning, and memory of the rats were measured. TdT-mediated dUTP Nick-end labeling and Nissl assays were performed to detect neuronal apoptosis and survival in the hippocampus and prefrontal cortex. Apoptosis-related proteins and oxidative stress markers were detected.

Results

mNGF improved locomotor activity, exploratory behavior, social interaction, and spatial learning and memory in VPA-induced ASD rats. In the hippocampus and prefrontal cortex, mNGF suppressed neuronal apoptosis, increased the number of neurons, superoxide dismutase, and glutathione levels, and decreased reactive oxygen species, nitric oxide, TNF-α, and IL-1β levels compared with the VPA group. In addition, mNGF increased the levels of Bcl-2, p-phosphoinositide-3-kinase (PI3K), and p-serine/threonine kinase (Akt), and decreased the levels of Bax and cleaved caspase-3, while the PI3K inhibitor LY294002 reversed these effects.

Conclusion

These data suggest that mNGF suppressed neuronal apoptosis and ameliorated the abnormal behaviors in VPA-induced ASD rats, in part, by activating the PI3K/Akt signaling pathway.
Obesity and fertility: a literature review of the association between parental obesity at the time of conception and embryo quality
Authors: Fufezan Maria Louise , Mocanu Edgar V.
Published: June 2023

Obesity [body mass index (BMI) ≥30 kg/m2] has been shown to be a risk factor in reducing the rate of successful in vitro fertilization (IVF) outcomes. In this systematized literature review, we investigate whether embryo quality specifically is affected by single-parent obesity (maternal or paternal) and obesity in both parents at the time of conception. We systematically searched for studies published over the last 10 years that graded embryo quality in conventional IVF and intracytoplasmic sperm injection procedures. Studies that did not use measured weight and height for BMI calculation were excluded. Ten eligible articles were found across 13 public databases. Comparing the results of 1845 couples, both female and male obesity independently caused faster preimplantation embryo development (P <0.05). The fertilization rate was not affected by either female, male, or combined parental obesity (P>0.05). Day 3 embryo quality does not seem to be affected by either female or male obesity alone. The 2 studies that investigated the effect of combined parental obesity on embryo quality reached contradictory findings. Male, but not female, >7% BMI reduction following bariatric surgery significantly increased the number of top-quality embryos compared with their results before surgery (P<0.05). We conclude that embryos of couples with single-parent obesity are not of lower quality compared with those of normal-weight parents. Combined parental obesity may affect embryo quality. BMI reduction could lead toward a successful outcome in obese infertile couples, regardless of whether they are undergoing IVF or not.
How to measure arterial stiffness independently of blood pressure: the QKD method
Authors: Gosse Philippe , Boulestreau Romain , Doublet Julien , Laurent Stephane , Cremer Antoine
Published: June 2023

Objective:

Arterial stiffness, an important predictor of cardiovascular event, has two components: one linked to the nonlinear elastic behaviour of the arterial wall and dependent of the blood pressure (BP) at the time of measurement, and the other linked to the structural modifications of the arterial wall as the consequences of the long-term effects of all cardiovascular risk factors, including BP. This second component is certainly the most important one and can be assessed with 24-h ambulatory monitoring of cardio-arm pulse transmission time (QKD method).

Methods:

The working hypothesis of this study is that QKD100-60, the value of the QKD for a 100 mmHg SBP and 60 bpm heart rate is independent of 24-h SBP in both normotensive volunteers and treated hypertensive patients, in whom the long-term influence of BP is limited, whereas QKD100-60 is not independent of 24-h SBP in untreated hypertensive patients in whom high BP was able to damage the arterial wall on the long term. So we studied the relationships of QKD100-60 with 24-h BP and heart rate together with age, sex, height in multivariate regression analysis in three groups of patients; normal, untreated and treated hypertensive patients. QKD was measured with Novacor devices.

Results:

In the normal population (n = 323, aged 29 ± 10 years) and in the treated hypertensive population (n = 425, aged 58 ± 13 years) the QKD100-60 was indeed not significantly related to 24-h SBP. In the untreated hypertensive population (n = 614, aged 51 ± 13 years) the QKD100-60 was weakly but significantly related to 24-h SBP (r = 0.249, P < 0.0001).

Conclusion:

Ambulatory monitoring of QKD provides indices of arterial stiffness independent of BP level at the time of measurement and most interestingly of 24-h BP with the potential to refine risk in patients with low traditional risk scores.
Role of descemet's stripping without keratoplasty in management of endothelial disease
Authors: Northey Luke C. , Moloney Gregory
Published: May 2023

Purpose of review

To summarize recent literature on Descemet's stripping only (DSO) in management of endothelial disease with particular focus on Fuchs endothelial corneal dystrophy (FECD).

Recent findings

DSO is currently indicated in patients with early FECD, central guttae, and preserved peripheral corneal endothelial cell (CEC) count. Time to corneal clearance may be accelerated and maintained with addition of topical rho-kinase inhibitor (ROCKi). There are reports describing successful use of DSO to treat endothelial disease due to iatrogenic trauma. In patients with transcription factor 4 gene mutation, increased cytosine, thymine, guanine (CTG) triplet repeat load may be associated with DSO failure risk. Emerging pharmacotherapies and cell-suspension treatments may improve procedure effectiveness and expand clinical indications.

DSO can be used as the initial surgical treatment in management of symptomatic endothelial disease due to FECD where peripheral CEC function appears preserved. Stand-alone DSO or DSO combined with cataract surgery is effective and postoperative topical ROCKi supplementation will improve time to corneal clearance and CEC count.
RAND/UCLA Modified Delphi Panel on the Severity, Testing, and Medical Management of PIK3CA-Related Spectrum Disorders (PROS)
Authors: Broder Michael S , Adams Denise M , Canaud Guillame , Collins Christy , Davis Kristen , Frieden Ilona J. , Gibbs Sarah N , Hammill Adrienne M , Keppler-Noreuil Kim M , Nakano Taizo A , Penington Anthony , Srivastava Siddharth , Tollefson Megha M , Warman Matthew L
Published: May 2023

Objective(s):

PIK3CA-related overgrowth spectrum (PROS) is a group of disorders caused by somatic variants in the PIK3CA gene. We aimed to update recommendations on the severity classification, testing, and medical management of patients with PROS.

Methods:

Using validated consensus methodology, we convened a 13-member panel in 2020 and reviewed current evidence on how to diagnose and treat PROS. The panel was asked to rate the level of disease severity, and the appropriateness of whether to test for a mutation and medical therapy in 217 patient scenarios before a virtual meeting. Panelists discussed areas of disagreement and completed ratings following the meeting.

Results:

The panel developed clinical presentations and endorsed the disease severity framework defined by functional impairment, a reduction in quality of life, and risk of death. Panelists agreed it is appropriate to test for a PIK3CA gene variant in every moderately/severely affected patient. Panelists agreed it may be appropriate to consider an mammalian (mechanistic) target of rapamycin inhibitor in some severely affected patients and some moderately affected patients with progressive disease. Although clinical trials have only recently begun and the evidence remains limited, panelists also agreed it may be appropriate to consider treatment with phosphoinositide 3-kinase/serine/threonine protein kinase inhibitors in severely affected patients with a confirmed PIK3CA variant or without a confirmed variant but with progressive disease.

Conclusion:

These recommendations represent the consensus of experts informed by published literature and experience. Future research should validate this guidance using clinical data. Once validated, we hope these recommendations will improve outcomes for patients with PROS.
Medications for opioid use disorder: An interactive educational program developed for the nurse practitioner curriculum
Authors: Culp-Roche Amanda , Vaughn Jacqueline , Arms Tamatha , Roberto Anka , Hubbell Sara , Link Tamara
Published: June 2023

Opioid overdose deaths remain a major public health concern in the United States and led to the recent changes in regulations that allow nurse practitioners (NPs) to prescribe buprenorphine without the previously required Drug Addiction Treatment Act waiver. Previously, waiver requirements included 24 hours of opioid use disorder (OUD) and medications for OUD (MOUD) training. Although this training is no longer required, NPs need education related to providing nonstigmatizing care to individuals with OUD and safe MOUD prescribing practices. A combination of online didactic modules, in-person simulation activities, and experiential learning was provided to psychiatric mental health NP (PMHNP) and family NP (FNP) students enrolled in a Doctor of Nursing Practice (DNP) program. OUD was presented through a chronic care lens to normalize treatment and decrease stigma, and harm reduction principles were included to increase safe prescribing of MOUD. Fifty-six students completed the didactic training, 51 students participated in the simulation, and 11 students completed shadowing experiences with an experienced MOUD provider. Psychiatric mental health NP and FNP graduates of this DNP program have the knowledge and skills to provide MOUD to individuals struggling with OUD, thus potentially increasing access to care and decreasing overdose deaths.
Taking ACTION: A Prognostic Tool for Pediatric Ventricular Assist Device Mortality
Authors: Boucek Katerina , Alzubi Anaam , Zafar Farhan , O’Connor Matthew J. , Mehegan Mary , Mokshagundam Deepa , Davies Ryan R. , Adachi Iki , Lorts Angela , Rosenthal David N.
Published: June 2023

We sought to develop a contemporary risk assessment tool for use in pediatric ventricular assist device (VAD) candidates to estimate risk for mortality on the device using readily available preimplantation clinical data. Training and testing datasets were created from Advanced Cardiac Therapies Improving Outcomes Network (ACTION) registry data on patients supported with a VAD from 2012 to 2021. Potential risk factors for mortality were assessed and incorporated into a simplified risk prediction model utilizing an open-source, gradient-boosted decision tree machine learning library, known as random forest. Predictive performance was assessed by the area under the receiver operating characteristic curve in the testing dataset. Nine significant risk factors were included in the final predictive model which demonstrated excellent discrimination with an area under the curve of 0.95. In addition to providing a framework for establishing pediatric-specific risk profiles, our model can help inform team expectations, guide optimal patient selection, and ultimately improve patient outcomes.
Haemophilic arthropathy: basic protocols for clinical examination and imaging
Authors: Querol F. , Querol-Giner F. , Aguilar M. , Bonanad S. , Marqués E. , Blasco JM. , Pérez-Alenda S.
Published: May 2023

In haemophilia, screening protocols in the prevention and treatment of common lesions still require unification of criteria. Patients with haemophilia seek medical consultation exclusively for two reasons: because they have requested an appointment for a routine check-up (1−2 times a year in case of severe haemophilia) or because they have developed acute bleeding that requires treatment.

The purpose of this paper is to emphasize the importance of an early differential diagnosis of joint damage and to review the techniques that allow an effective evaluation.

The World Federation of Haemophilia recommends the ‘Primary Prophylaxis’ treatment modality, and today, severe haemophilia patients adhering to that factor VIII/IX therapy have significantly reduced common injuries: haematomas, haemarthrosis, synovitis, and haemophilic arthropathy. The basic protocols and minimum data for the control of musculoskeletal health are described.

In summary, the primary goal of the haematologist-led multidisciplinary care team treating patients with haemophilia is likely to restore and/or preserve joint and musculoskeletal health, which is essential to promoting quality of life. Appropriate factor replacement regimens are required to prevent bleeding, these should be combined with physical activity and a physiotherapy program, in accordance with the recommendations of the World Health Organization for the general population.
Arterial versus end-tidal carbon dioxide levels in children with congenital heart disease: a prospective cohort study in patients undergoing pulmonary catheterization
Authors: Movahedi Asl Masood , Delavar Shohreh , Taghizadeh Imani Ashkan , Goudarzi Mehrdad
Published: June 2023

Background:

Capnography has been the standard in the operating room for a long time now. When variable amounts of intrapulmonary shunt and intracardiac shunt are taken into account, arterial carbon dioxide (CO2) and end-tidal CO2 typically match rather well. The gap between arterial and end-tidal CO2 widens in patients with cardiopulmonary disorders. The current study sought to determine how arterial and end-tidal CO2 correlated with each other and with hemoglobin saturation both before and after pulmonary catheterization in a pediatric population with congenital heart disease.

Methods:

Fifty-seven children with congenital heart disease who underwent cardiopulmonary catheterization between March 2018 and April 2019 were included in a prospective cohort study at Children’s Medical Center. Arterial and end-tidal CO2, and hemodynamic variables were assessed prior to the catheterization procedure. Then the patients underwent catheterization, and before being extubated, these variables were again assessed and compared to the baseline levels.

Results:

End-tidal CO2 increased significantly in cyanotic patients following the catheterization procedure, and the difference between arterial and end-tidal CO2 decreased significantly. End-tidal CO2, arterial CO2, and their difference did not significantly change in non-cyanotic patients following the catheterization procedure. End-tidal and arterial CO2 were not significantly correlated in cyanotic patients (r=0.411, P=0.128), but they were correlated after the catheterization procedure (r=0.617, P=0.014).

Conclusions:

End-tidal CO2 can estimate arterial CO2 in non-cyanotic patients reasonably. End-tidal CO2 cannot be used to estimate arterial CO2 in cyanotic patients since there is no association. After cardiac defect correction, end-tidal CO2 can be a reliable predictor of arterial CO2.
The pattern of sarcoid uveitis at a tertiary care center in Nepal
Authors: Kharel (Sitaula) Ranju , Poudel Arika , Shrestha Shreeji , Jha Saket
Published: June 2023

Introduction:

Sarcoidosis is an idiopathic, multisystemic granulomatous disorder involving the eye with various ocular presentations, the most common being sarcoid uveitis. The diagnosis was based on typical clinical features, chest radiography, laboratory findings and biopsy based on revised International Workshop on Ocular Sarcoidosis criteria. Here in, the authors aim to present the first report on the trend of cases of sarcoid uveitis in Nepal.

Materials and Methods:

A retrospective quantitative cross-sectional study was conducted at the uveitis clinic of the Institute of Medicine by obtaining medical data from the medical record section on sarcoid uveitis cases visiting from March 2018 to March 2021. Demographic profile, ocular findings, laboratory findings and treatment details were documented and statistical analysis was done via Statistical Program for Social Science (SPSS) version 23.

Results:

Out of 50 eyes of 30 patients included in the study; 66.6% patients (n=20) had bilateral and 33.3% (n=10) had unilateral ocular involvement. Anterior with intermediate uveitis (26.7%) was the most common type of uveitis among the cases. Serum angiotensin converting enzyme was raised in 66.7%, Chest X-ray showed hilar changes in 63.33%, and high-resolution computed tomography showed mediastinal, hilar lymphadenopathy with or without the involvement of the lung in 63.33% of patients.

Conclusion:

Sarcoid uveitis may have varied ocular presentations, the commonest being anterior and intermediate uveitis. The commonest complications are cataract and cystoid macular oedema, which are associated with vision loss. Steroids and immunomodulators are the mainstays of treatment.
Transformative Change in Nursing
Authors: Barginere Cynthia
Published: June 2023

Addressing today's challenges in nursing requires a new mindset and a renewed commitment to improving the quality, safety, and equity of health care. Together, this approach can achieve truly transformational change in nursing that will last for generations. Setting visionary, future-oriented goals can draw upon key scholarship from the past as well as from fresh thinking on what is needed to improve health care at every level. Nurses are essential in this pursuit, given their central role in providing direct care and their leadership role in codesigning new models and systems of care.
INnovation, QUality Improvement, Research, and Evidence-Based Practice (INQUIRE)
Authors: Keen Alyson , Radecki Bethany , Snyderman William , Rader Tiffany , Hemmelgarn Allison , Sierp Amanda
Published: May 2023

Background:

Despite scholarly articles and pathway models delineating quality improvement (QI), evidence-based practice (EBP), research, and innovation, guidance is lacking when determining the project method. A practical, step-by-step approach is needed to support project navigation.

Purpose:

To describe development and evaluation of a decision-making pathway model.

Methods:

The INQUIRE Model was developed using an iterative approach and was evaluated with 23 national conference attendees. The evaluation included 4 Likert-type items ranging from 1 (strongly disagree) to 7 (strongly agree).

Results:

The model guides users through project planning steps based on an identified trigger (eg, problem, opportunity, and challenge) to ultimately select a project method that aligns with the project scope and availability of a solution. Model evaluation found identification of the project method improved by 14%, scanning for a solution by 8%, avoiding missed steps by 36%, and building a team by 10%.

Conclusion:

Findings suggest INQUIRE can enhance project planning and method (eg, QI, EBP, research, and innovation) selection. Organizations should evaluate project planning current state to identify the potential benefit of model incorporation.
A Program of Assessment Model for Point-of-Care Ultrasound Training for Pediatric Critical Care Providers: A Comprehensive Approach to Enhance Competency-Based Point-of-Care Ultrasound Training
Authors: Maxson Ivanna Natasha , Su Erik , Brown Kyle A. , Tcharmtchi M. Hossein , Ginsburg Sarah , Bhargava Vidit , Wenger Jesse , Centers Gabriela I. , Alade Kiyetta H. , Leung Stephanie K. , Gowda Sharada H. , Flores Saul , Riley Alan , Thammasitboon Satid ,   on behalf of the Pediatric Research Collaborative on Critical Ultrasound (PeRCCUS), a subgroup of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network
Published: June 2023

Point-of-care ultrasound (POCUS) is increasingly accepted in pediatric critical care medicine as a tool for guiding the evaluation and treatment of patients. POCUS is a complex skill that requires user competency to ensure accuracy, reliability, and patient safety. A robust competency-based medical education (CBME) program ensures user competency and mitigates patient safety concerns. A programmatic assessment model provides a longitudinal, holistic, and multimodal approach to teaching, assessing, and evaluating learners. The authors propose a fit-for-purpose and modifiable CBME model that is adaptable for different institutions’ resources and needs for any intended competency level. This educational model drives and supports learning, ensures competency attainment, and creates a clear pathway for POCUS education while enhancing patient care and safety.
Reconsideration of the Diagnostic Criteria for an Atypical Placental Site Nodule Comparing Typical Placental Site Nodule of the Uterus: A Report of Two Cases
Authors: Jo Uiree , Kim Gi Hwan , Kim Kyu-Rae
Published: May 2023

Placental site nodules (PSNs) are non-neoplastic remnants of chorionic-type intermediate trophoblastic cells from a previous gestation that form a well-defined single nodule or multiple nodules in the uterine and extrauterine sites. As the cases of PSNs transformed into gestational trophoblastic tumors were described in the literature, “atypical placental site nodules” (APSNs) have been considered as putative transitional lesions between PSNs and gestational trophoblastic tumors. Although histologic criteria and cutoff point of Ki-67 proliferation index for differentiating an APSN from a typical PSN have not been clearly defined, nodules larger than 5 mm with increased cellularity, a corded or nested appearance, marked nuclear atypia, increased mitotic activity, and an increased Ki-67 proliferation index (>5% or >8%) of intermediate trophoblastic cells seem to be accepted as diagnostic criteria for APSNs. However, some of the criteria, including lesion size and histologic features of the trophoblastic cells in the nodule are not only subjective but have features inherent of the intermediate trophoblastic cells of the fetal membrane and a typical PSN. We thought that it is not reasonable to consider them as diagnostic features of APSNs, if not associated with cellular proliferation. We present 2 cases of incidentally identified PSNs that were larger than 10 mm in size with a corded or nested arrangement of trophoblastic cells, which could have been categorized as APSNs according to the currently proposed criteria to discuss whether the currently proposed diagnostic criteria for APSNs are appropriate.
TP53 Mutation-driven Stratified Mucin-producing Carcinoma Coexisting With Squamous Cell Carcinoma of the Vulva: A Case Study
Authors: Wadia Roxanne , McHenry Austin , Abi-Raad Rita , Hui Pei
Published: May 2023

Associated with high-risk human papillomavirus infection, invasive stratified mucin-producing carcinoma is a recently characterized adenocarcinoma of the cervix. It often occurs in association with adjacent stratified mucin-producing intraepithelial lesion. Differentiated vulvar intraepithelial neoplasia and related invasive squamous cell carcinoma often arise in background vulvar lichen sclerosus with TP53 mutation as the underlying molecular signature. We present a unique case of vulvar invasive stratified mucin-producing carcinoma-like component coexisting with invasive squamous cell carcinoma in a 64-year-old woman. Both neoplastic components were proven TP53-driven processes arising in the background of differentiated vulvar intraepithelial neoplasia and lichen sclerosus. The invasive stratified mucin-producing carcinoma-like component behaved aggressively in this case, evidenced by the presence of lymphovascular invasion and inguinal lymph node metastasis.
Assessing the reliability of the CD4 depletion model in the presence of ending the HIV epidemic initiatives
Authors: Tang Michael E. , Goyal Ravi , Anderson Christy M. , Mehta Sanjay R. , Little Susan J.
Published: June 2023

Background:

Accurate estimates of HIV incidence are necessary to monitor progress towards Ending the HIV Epidemic (EHE) initiative targets (90% decline by 2030). US incidence estimates are derived from a CD4 depletion model (CD4 model). We performed simulation-based analyses to investigate the ability of this model to estimate HIV incidence when implementing EHE interventions that have the potential to shorten the duration between HIV infection and diagnosis (diagnosis delay).

Methods:

Our simulation study evaluates the impact of three parameters on the accuracy of incidence estimates derived from the CD4 model: rate of HIV incidence decline, length of diagnosis delay, and sensitivity of using CD4 counts to identify new infections (recency error). We model HIV incidence and diagnoses after the implementation of a theoretical prevention intervention and compare HIV incidence estimates derived from the CD4 model to simulated incidence.

Results:

Theoretical interventions that shortened the diagnosis delay (10–50%) result in overestimation of HIV incidence by the CD4 model (10–92%) in the first year and by more than 10% for the first six years after implementation of the intervention. Changes in the rate of HIV incidence decline and the presence of recency error had minimal impact on the accuracy of incidence estimates derived from the CD4 model.

Conclusion:

In the setting of EHE interventions to identify persons living with HIV earlier during infection, the CD4 model overestimates HIV incidence. Alternative methods to estimate incidence based on objective measures of incidence are needed to assess and monitor EHE interventions.
Bilateral Rhinogenous Optic Neuropathy Caused by the Regrowth of a Large Sphenoid Sinus Mucocele
Authors: Yoshida Haruo , Kihara Chiharu , Kumai Yoshihiko
Published: June 2023

A 59-year-old man, who had a history of left blind at 36 years old, suddenly lost right visual acuity. Magnetic resonance imaging revealed a large left sphenoid sinus cyst, which protruded intracranially. The cyst was fenestrated by endoscopic sinus surgery, but his right vision did not recover. Ten cases of bilateral rhinogenous optic neuropathy caused by mucocele have been reported, and the cause was sphenoid sinus in 9 cases. Postoperative visual acuity in these cases was poor, especially in slow progressive cases, because it was diagnosed as an unknown cause, and surgery was delayed. Rhinogenous optic neuropathy caused by mucocele should be differentiated from bilateral visual impairment of unknown cause. The authors highlight the importance of early diagnosis of sphenoid sinus mucocele and fully informing patients about the future risk of bilateral visual impairment, even if they are asymptomatic or have been treated.
Presentation and Treatment of a Patient With Jacobs Syndrome and Metopic Craniosynostosis
Authors: Swearingin Tyler J. , Kirby Benjamin J. , Muzaffar Arshad R.
Published: June 2023

Jacobs syndrome is a rare trisomy (47, XYY) found in ~1 in 1000 male children associated with infertility, autism spectrum disorders, macrocephaly, hypertelorism, tall stature, and macroorchidism. Diagnosis is often delayed due to relatively subtle phenotypic changes. Craniosynostosis, a fusion of the cranial sutures, has been described in ~1 in 2000 live births, of which 25% are related to a diagnosed syndrome with the most common being Apert and Crouzon. Craniosynostosis does not have a known association with Jacobs syndrome and no prior cases have been reported. This case report seeks to describe the presentation and treatment of a patient with Jacobs syndrome and metopic craniosynostosis.
Peroral Endoscopic Myotomy
Authors: Dawley Natalie
Published: June 2023

This article aims to explore details of research, evidence, and key concepts intended for nurses and other healthcare clinicians surrounding the paradigm shift in therapeutic endoscopy relating to the third-space endoscopic procedure, peroral endoscopic myotomy. Although many medical publications detail the procedure, there are no specific guidelines for nurses to reference when caring for the patient undergoing peroral endoscopic myotomy. With scant published resources available to direct nurses distinctly in the delivery of exceptional care to patients undergoing peroral endoscopic myotomy, there is an identified need for collated information to be accessible to all nurses providing perioperative teaching and care. As peroral endoscopic myotomy continues to transpire as a mainstream or preferred standard treatment for patients who suffer from achalasia, relevant education remains to be fully understood and assessed in the nursing arena. By examining nursing considerations for patient care, indications, techniques, and advancements regarding this ever-emergent breakthrough, readers will discover guidance in comprehensive care encompassing patients undergoing the peroral endoscopic myotomy procedure.
Feasibility study of a novel co-designed online training program for circus coaches working with preschool-aged children born preterm
Authors: Coulston Free , Toovey Rachel , Sellick Kath , Mainzer Rheanna M , Binstock Loni , Spittle Alicia
Published: May 2023

Purpose

Providing specialised training to community-based physical activity instructors (such as circus coaches) has been identified as a potential strategy to increase participation for preschool-aged children born preterm. The objective of this study was to determine the feasibility of a novel co-designed training program “CirqAll: professional development for circus coaches” (CirqAll:PD), which aimed to increase coaches’ knowledge, skills, and confidence in working with children born preterm.

Materials and methods

CirqAll:PD consisted of 10-hours of online self-directed content and four 90-minute online workshops completed over four weeks. Recruitment capability, acceptability, implementation fidelity and limited efficacy testing were evaluated using a case series design.

Results

Fifty-one circus coaches were enrolled, and 27 completed CirqAll:PD. Reasons for attrition were primarily related to the Theoretical Framework of Acceptability’s (TFA) concept of burden. All 27 coaches indicated that CirqAll:PD was acceptable (TFA questionnaire). Overall intervention fidelity was high (high adherence to planned delivery, moderate adherence to dosage, and excellent participant responsiveness). Limited efficacy testing revealed positive trends regarding coaches’ knowledge, skills, and confidence (Determinants of Implementation Behaviour Questionnaire).

Conclusions

These results support the feasibility of CirqAll:PD. Adaptations to reduce attrition and burden on participants are required prior to further testing.