bluuebunny/crossref_metadata_2025 huggingface dataset:
576 Striving for Excellence: Beacon Application Submission and Achievement
Authors: Ha Aemilio W , Thomas Mini , Henderson Tammy L
Published: April 2021

Introduction

The American Association of Critical-Care Nurses (AACN) Beacon Award (BA) recognizes individual nursing units with Gold, Silver, or Bronze level for excellence. The BA signifies an effective and systematic approach to policies, procedures and processes that include engagement of staff and key stakeholders; fact-based evaluation strategies for continuous process improvement; and performance measures that meet or exceed relevant benchmarks. Units designated with BA show an overall higher morale and lower turnover rate. Being a verified burn unit and Magnet designated facility, the unit practice council (upc) began the application process for Beacon.

Methods

The application process started in 2017 through a core group of UPC members. Different sections of the application were written through the guidance of the team leader and with support of the unit management. Data was gathered from various hospital departments and dashboards which included: leadership structures and systems, appropriate staffing and staff engagement, effective communication, knowledge management and learning development, evidence-based practice and processes, and outcome measurements. After data collection/synthesis, small group meetings were conducted to complete the application. The application was reviewed and edited by the unit management prior to submission.

Highlights included: low infection rates in the unit exceeding national benchmarks, peer supporter events for burn survivors, team bonding, community outreach, multiple abstract submission/presentations from nursing at local/national conferences, high patient satisfaction scores, implementing new burn care practices based on evidence, and interdisciplinary rounds.

Results

Burn unit was designated as a Beacon Gold Award Recipient in 2019. This designation lasts for three years. Our burn unit became one of seven units in the nation with BA and is the second one to achieve Gold designation. During and after this process, there was an increase in staff engagement, teamwork, and exceptional quality metrics.

Conclusions

Persistent effort combined with teamwork and leadership can help a unit achieve Gold BA designation. This award requires ongoing work to refine processes and promote evidence-based practices.
581 The Effects of the COVID Pandemic on Burn Clinic
Authors: Chin Theresa L , Frerk Rita , Joe Victor C , Sabeti Sara , Burton Kimberly , Bernal Nicole O , Ochtli Ché R , Tay Erika , Carmean Melissa
Published: April 2021

Introduction

The COVID19 pandemic has led to anxiety and fears for the general public. People were concerned about coming to a medical facility where the virus might be transmitted. Furthermore, stay-at-home orders that were implemented during the pandemic did not apply to clinic visits but contributed to people staying at home even for medical care. We hypothesized that there were delays in burn care due to the pandemic.

Methods

We queried our clinic data for number of clinic visits and new burn evaluations by month. Patients referred to our clinic from March 15, 2020 to Sept 15, 2020 were reviewed for time of presentation after injury. Days from injury date to clinic referral date and days from clinic referral date to appointment date were calculated. Patients who were referred but did not show and were not seen in our ED were not included because injury date could not be determined. Univariate analysis was performed.

Results

As seen in Figure 1, our in-person clinic volume decreased in April and May 2020 but rebounded in June 2020 as compared to the number of clinic visits for the same months last year. Similarly, in Figure 2, our new burn evaluations decreased in April and May 2020 compared to our new burn volume from 2019. However, our video telehealth visits increased in March and April then decreased in June-August.

Conclusions

Our burn clinic remained open to see patients with burn injury throughout the pandemic, however, clinic visits were delayed early in the pandemic. While we had an increase in video telehealth, it does not account for the decrease in clinic visits. This may be due to low enrollment in the electronic medical record encrypted communication platform and/or limited knowledge/access to the technology. Additional care may have been informally given via telephone but not well captured. Furthermore, burn care was delivered in the following months. Additional investigation is necessary to see if the incidence of burn injury decreased.
587 Methadone and Morphine for Outpatient CO2 Laser Pain Management
Authors: Talon Mark D , McQuitty Alexis L , Zapata-Sirvent Ramon
Published: April 2021

Introduction

Burn reconstruction with CO2 laser is now very popular. Providing adequate analgesia is imperative for large total body surface area (TBSA) resurfacing. CO2 lasers’ cause significant pain during the procedure and pain similar to that of a severe sunburn post-operatively. Thus, adequate analgesia that provides peri-operative and post discharge management without delaying discharge is beneficial. At our institution, we use a multimodal analgesic preoperative and intra-operative approach to deal with this issue. The preoperative intervention utilizes a novel approach of oral methadone for older children and avoids the use of intra-operative morphine as a preemptive measure for pain management. The purpose of this outcomes review was to determine if our peri-operative analgesic practices were effective in controlling peri-operative pain.

Methods

After corporate IRB review, this project was undertaken as a quality improvement initiative and was not formally supervised by an institutional review board. A chart review of all patients who received CO2 laser treatment (CLT) was conducted. Using a Donabedian model for outcomes measure, postoperative and pre-discharge observational pain scores (scale 1–10), peri-operative analgesics, demographics, percent burn treated, incidents of rescue medication before discharge home, time to discharge and adverse reactions were collected.

Results

74 patients were reviewed (47 male, 27 female), ages 4 to 30, average age 17. Average percent body surface area treated was 17.5%. Out of 74 cases, 18 received intra-operative morphine and 56 received oral methadone pre-operatively. All patients received routine intra-operative ketorolac and lidocaine/prilocaine cream, based on weight. In the PACU there were 2 recorded rescue doses of morphine in the morphine group and 0 in the methadone group. There was one post- operative recorded observational pain score of 5 in the methadone group and one each of 3 and 8 in the morphine group, both of which received rescue morphine. There were no differences in mean times to discharge between groups. Observational pain scores were 0 for both groups at discharge. Chi square analysis showed no statistical difference between groups. No adverse outcomes (respiratory arrest or readmission for pain) were recorded in either group.

Conclusions

Both pre-operative oral methadone and intra-operative morphine are effective in controlling peri-operative pain in our children undergoing laser surgery. Categorical age differences and low group sizes may have contributed to outcomes and should be considered in the next review.
591 A 15-Year Review of Iatrogenic Burn Injuries in an Academic Public Hospital
Authors: Andersen Emily S , Powell Lauren E , Marcaccini Robert , Feldman Michael J , Drake Mack
Published: April 2021

Introduction

Hospital-acquired burn injuries can result in significant psychological and physical consequences for patients and their families. These injuries are typically rare, but when they do occur this can lead to increased length of hospitalization, costs of stay, and potential for additional procedures. The aim of this study is to describe iatrogenic burn injuries that occurred over a 15-year period at an academic public hospital system.

Methods

After Institutional Review Board approval this study collected data on patients sustaining iatrogenic burn injuries between January 2004 and June 2019 at a large, academic public hospital system. Data was obtained from an internal database of self-reported incidents. This data included: time of injury, location in the hospital, mechanism, level of harm caused, and anatomic location of the injury. Mean and standard deviation were calculated by year, and a two-tailed t test was used to assess for significance.

Results

122 iatrogenic burn injuries met inclusion criteria and underwent focused analysis. Incidence of burn injuries were highest between 2005–2012 (average 12.3 ± 4.1 per year) as compared to 2013–2019 (average: 2.9 ± 2.1 per year). The difference between these time periods was statistically significant (P = 0.0001). A majority (77%) resulted in harm caused to the patient, with 13.1% of cases requiring additional treatment. Most (41%) of the injuries occurred on the general medical floors, followed by the operating room (33.6%). The most common etiology was hot liquid (23%), followed by electrocautery (14.8%) and other, unspecified medical devices (21.3%). None of the burn injuries had burn consults and none of these patients required surgery for their burn injuries despite the level of harm reported.

Conclusions

Iatrogenic burns are overall rare and appear to be decreasing in number over the last six years. While a large majority were reported to have caused patient harm, none required surgery and none had a burn consult while inpatient. The majority of the injuries occurred on the medical floors with a scald mechanism. This review highlights an opportunity for large academic medical systems to put more emphasis prevention in these situations as these are presumably avoidable. There is also an opportunity to reach out to the hospital system about the involvement of the burn team. In addition, this highlights the limitations of self-reported inpatient injuries as there may be under-reporting.
610 Effects of Burn Related Factors on Pediatric Burn Survivors’ Quality of Life: A Review of PROMIS Peer Relationship Survey Scores
Authors: Mandell Justin A , Andre John A , Sen Soman , Palmieri Tina L , Greenhalgh David G , Romanowski Kathleen S
Published: April 2021

Introduction

Care of the burn injured child is complex and highly individualized as no two burn injuries are exactly alike. In order to assess our outcomes in treating these children we have integrated the use of the Patient Reported Outcomes Measurement Information System (PROMIS), a standardized, valid and reliable PRO tool funded by the National Institute of Health (NIH) into our clinical practice in order to evaluate aspects of the patient’s health-related quality of life. The PROMIS pediatric assessment was developed to capture self-reported anger, depression, peer relationships, pain, and physical function. This study specifically assessed the PROMIS Pediatric Peer Relationship summary scores in burn survivors to assess quality of life. The goal of this study is to examine the relationship between such quality-of-life outcomes and burn injury related factors.

Methods

Following IRB approval, we performed a retrospective review of children with burn injuries who had completed the PROMIS at our institution between 2017 and 2019. Data collected includes patient demographics, burn injury information, PROMIS peer relationship T-scores and time since injury. Statistical analysis was conducted using chi-square, t-test ANOVA, or Pearson’s correlation coefficient. The PROMIS Peer Relationships Pediatric Item Banks assess self-reported quality of relationships with friends and other acquaintances. A standardized score, or T-score, of 50 is the average for the United States general population with a standard deviation of 10. A peer relationships T-score of 60 is one standard deviation (SD) above the average while a T-score of 40 is one SD below the average. A higher T-score correlates to a better social health.

Results

164 pediatric burn patients completed 159 initial surveys. Burn injuries (n=164) consisted of the following types: contact (n=16), electrical (n=10), fire/flame (n=75), and scald (n=63) with approximately equal representation of females (n=81) and males (n=83). The mean age at injury was 6.9 years (median 6.4) with a mean burn TBSA of 21.8% (median 15.0). On average, the initial peer relationship score was 50 (median 49). Gender, type of injury, injury age, total TBSA, hospital days, ICU days, ventilator days, OR visits, and months since injury did not significantly affect the initial PROMIS score measurement.

Conclusions

This study of pediatric burn patients from a single US burn center during follow-up demonstrates that burn injury related factors appear to have no statistically significant effect on initial PROMIS Pediatric Peer Relationship score measurements. In addition, on average survivors have a quality of life as it relates to peer relationships that is on par with the US general population.
640 Relationship of Pre-existing Impaired Functional Mobility to Burn Outcomes
Authors: Smith Susan L , Seoane Jacqueline , Smith Howard G , Rainey Andrew , Emerson Lisa E
Published: April 2021

Introduction

It is well-established that burn severity is determined by size of surface area affected, temperature of source and duration of exposure. Patients with impaired mobility, regardless of etiology, are less capable of avoiding and escaping traumatic injuries. Additionally, patients with impaired mobility frequently suffer from other co-morbid conditions and have specialized needs which can complicate their acute illness/injury, prolong their hospital length of stay, and impact recovery.

Methods

This was an IRB- Exempted retrospective electronic medical records review of all adult patients, aged 18 years and older with pre-existing mobility impairment, admitted as inpatients for treatment of burn-related injuries from January 1, 2009 to December 31, 2019

Results

The 10 year review of 1648 adult burn admissions meeting the initial criteria of inpatient admission and burn injury, 178 were found to have documentation supporting pre-existing functional mobility impairment (11%). Rolling walker use (33%) was most common, followed by cane (28%). Contrary to the initial hypothesis, patients actually had overall lengths of stays consistent with all burn populations at 0.81 days per % total body surface area, with average length of stay being 6.7 days. The demographic data was also consistent with national burn registry data as primarily male, Caucasian population, though older, with mean age of 61.1 years. Regression analysis identified relationships between burn size and discharge disposition. Additionally, statistically significant relationships were identified between BMI and the pre-existing co-morbid illness Diabetes and Chronic Obstructive Pulmonary Disease.

Conclusions

There is a paucity of literature describing the needs of this unique burn population. Burn-injured patients with pre-existing impaired mobility suffer from similar mechanisms of injury, although the source for the thermal burns is more likely to originate from smoking on home oxygen, are treated conservatively and return home without home health.
647 The Superhero in You: Engaging Pediatric Patients in Therapeutic Exercises
Authors: Yelvington Miranda L
Published: April 2021

Introduction

Engaging pediatric burn survivors in necessary range of motion exercises can be challenging. For younger children, difficulty understanding the reasoning behind prescribed exercises, fear and anxiety can all lead to refusal to participate. Traditional rote range of motion exercises do not engage the child’s sense of curiosity and adventure and seem more like medicine than play. We have developed a range of motion exercise program based on well-known superhero actions. For children who need to address active wrist extension and digit extension, they become “Iron Man” (Example included), “Hulk Smash” lets us work on grip and active composite flexion while becoming “Spiderman” encourages digit isolation. “Superman”, “Wonder Woman” and “Batman” allow utilization of total body movements but can be focus on shoulder flexion or abduction and cross body movements.

Methods

Traditional superhero movements were assessed to determine similarity to traditional therapy exercises. Exercises were drawn with the extremities performing the desired movements. Pediatric patients are introduced to these exercises and encouraged to act out the superhero movements with therapist directing the desired end range and directionality of movements.

Results

These characters are well known and loved by pediatric patients. In many instances, a fearful patient may become an active therapy participant through these engaging activities. Goal attainment becomes more fun and less when children are engaged in a purposeful play task. Caregivers can carry these exercises well beyond the therapy session to encourage day long exercise which is essential for contracture prevention and remediation. A recent feedback comment from the parent of a 4-year-old burn survivor specifically focused on these exercises. “Absolutely phenomenal. The therapist did “superhero” moves with my son and got him to open and close his hands. I was so relieved that the movement was normal”

Conclusions

Modifying instruction methods to include familiar and fun techniques can increase therapy participation and can decrease the fear experienced by young burn survivors when faced with moving an injured extremity.
661 Burns in the Time Of COVID: The Use Of a Poly Lactic Acid Polymer Skin Substitute Helped A Combined Adult/Pediatrics Burn Unit Change Clinical Practice During the Coronavirus Lockdown
Authors: Short Tracee
Published: April 2021

Introduction

As a verified burn center, we prepare for mass casualty & constantly strive to remain at the forefront of the burn technology & research. There was nothing that prepared us for a statewide stay-at-home order nor the hospital lockdown that would come with the coronavirus pandemic. The hospital lockdowns resulted in disheartening loneliness that would prohibit the visitation of family to the ill or injured patients. The difficulty of locking down well parents proved challenging. Our new hospital policy restricted parent movements & their anxiety of exposure also heightened the desire to discharge. We questioned whether the peds patient was better suited in the hospital or at home. This shifted our usual practice. During March-May, our hospital restricted parent movements out of the patient’s room, no visitors, no swap outs during the day. This resulted in early debridements, often at the bedside, & application of the polylactic acid polymer substitute. This allowed for a discharge within 24 hrs & return to clinic in 48 hrs.

Methods

We reviewed the charts of 10 pediatric patients that normally would have remained hospitalized pre-COVID & these patients were admitted underwent debridement & early application of a polylactic acid polymer skin substitute. The charts were reviewed to determine if there were any readmissions, ER visits, delays in wound healing, delays in OR time, if needed, opposition from parents or nurses from about readiness for discharge.

Results

The charts indicated there was one return admission. The readmit was from a planned split thickness skin graft & the polylactic acid polymer was used to stage the deeper area while allowing the majority to heal. Charts demonstrated satisfaction of the parents that didn’t want to be in the hospital during COVID. No nurses felt uncomfortable & all patients demonstrated stable vitals & good UOP at the time of discharge. This indicates several initial application on admission & was discharged within 24 hours.

Conclusions

This could at face value be a simple means to an end. The review of records indicates this was successful by most definitions of outcome. The limitation discovered was the ability to optimize outpatient therapy. Burns in the time of COVID, made use reexamine how we have cared for burns & whether there was room to perform more without an inpatient or a decreased inpatient stay. This change in practice also illustrated the ability to the wounds we initially thought may be deeper & possibly need excision actually healed well with no current development of hypertrophic scarring. Our institution will consider the early practice of debridement & lactic acid polymer application even when the restriction are eased. It also forced us to reevaluate how much we are grafting & reexamine what can heal on its own.
Legal Air Cover
Authors: Bolton Patrick , Panizza Ugo , Gulati Mitu
Published: April 2021

The economic harm being caused by the novel coronavirus may soon result in multiple sovereign debtors moving into default territory, but the existing playbook for dealing with multi-sovereign emerging market debt crises is blank. Currently, the only way to deal with a debt crisis is to carry out protracted country-by-country and contract-by-contract negotiated workouts. Expert groups are attempting to design a mechanism to run multiple sovereign debt workouts simultaneously but any design will take time to configure and get international buy-in. This article sets forth some options to provide temporary legal protection to debtor countries while they are diverting resources to respond to the Covid-19 pandemic. This is the notion of ‘legal air cover’. The options we propose involve ex-post state intervention in debt contracts and come with risks, but we show that in the case of Greece, where such an intervention was necessary in 2012, there were no negative spillovers on periphery eurozone debt markets associated with the Greek ex-post modification of contract terms.
Unusual visual and olfactory perceptions during radiotherapy sessions: an investigation of the organs responsible
Authors: Hara N , Isobe A , Yamada K , Kosugi Y , Oshima M , Kawamoto T , Shikama N , Sasai K
Published: April 2021

During radiotherapy sessions to treat brain tumors or head-and-neck cancers, some patients experience unusual visual and/or olfactory perceptions. This prospective study sought to answer two questions: (i) what proportion of patients experience these unpleasant sensations?, and (ii) which organs are responsible? Eligible patients had brain or near-orbital tumors treated by helical tomotherapy. All were aged 10 years or older, able to communicate, and interviewed by a radiation oncologist at least once weekly during radiation therapy. If they had experienced such sensations, they were encouraged to join the second phase of the study. The patients were asked to indicate, using a button, when a sensation commenced and ended. The recorded data were collated with the treatment log. Thirty-eight consecutive patients were eligible. Twenty-six experienced visual and 13 olfactory sensations. The radiation doses to the organs related to the visual or olfactory sensations did not differ between patients who reported sensations and those who did not. Seventeen patients were enrolled in the second phase of the study. All 14 with visual sensations reported that the sensations occurred when the X-rays passed at eye level. Olfactory sensations were reported by eight out of nine patients when the X-rays passed through the olfactory epithelium and/or ethmoid sinus level. In conclusion, 68% of patients experienced visual sensations caused by X-rays passing through the level of the eyes, and 34% complained of olfactory sensations. With the exception of one patient, olfactory sensations occurred when the X-rays passed through the levels of the olfactory epithelium and/or ethmoid sinus.
A morphological analysis of energy policy analysis research—emerging issues and concerns
Authors: Govindarajan Hari Krishnan , L.S. Ganesh
Published: April 2021

Morphological analysis (MA) is a reliable technique for identifying research opportunities in policy analysis. This article presents a MA of the energy policy analysis literature of over four decades of research to enable structured understanding of the field. A three-stage research method has been adopted to identify and review journal articles and research publications. The MA affirms that energy policy analysis research literature points to energy–economy–sustainability–policy interactions. These interactions are studied from the issues and concerns perspective. The MA framework (MAF) representation of energy policy issues and concerns comprises 4 dimensions, 11 sub-dimensions and 50 variants. This MAF representation of the energy policy analysis literature can be useful for researchers to systematically study the domain and identify significant research opportunities, emerging themes and priorities in energy policy analysis research. The article also suggests immediate and promising research opportunities in the domain using the MAF. MA is also a reliable method for researchers who study other public policy domains.
Prospects for plant productivity: from the canopy to the nucleus
Authors: González Fernanda G , Manavella Pablo A
Published: April 2021

Population growth has been closely associated with agricultural production, since the first famine predicted by Malthus (1798) up to the Green Revolution of the past century. Today, we continue to face increasing demand for food and crop production (Tilman et al., 2011). Considering the combined caloric or protein content of the 275 major crops used directly as human foods or as livestock and fish feeds, Tilman et al. (2011) forecast a 100% increase in global demand for crops from 2005 to 2050. Meeting this demand with the lowest impact on the environment could be achieved by sustainable intensification of existing cropland with reduced land clearing (Tilman et al., 2011; Fischer and Connor, 2018).
Ten Years of Collaborative Progress in the Quest for Orthologs
Authors: Linard Benjamin , Ebersberger Ingo , McGlynn Shawn E , Glover Natasha , Mochizuki Tomohiro , Patricio Mateus , Lecompte Odile , Nevers Yannis , Thomas Paul D , Gabaldón Toni , Sonnhammer Erik , Dessimoz Christophe , Uchiyama Ikuo ,   QFO Consortium, Altenhoff Adrian , Ouangraoua Aida , Vesztrocy Alex Warwick , Linard Benjamin , Dessimoz Christophe , Szklarczyk Damian , Durand Dannie , Emms David , Moi David , Thybert David , Sonnhammer Erik , Kriventseva Evgenia , Tang Haiming , Chiba Hirokazu , Uchiyama Ikuo , Ebersberger Ingo , Huerta-Cepas Jaime , Fernandez-Breis Jesualdo Tomas , Blake Judith A , Pryszcz Leszek , Martin Maria-Jesus , Houben Marina Marcet , Patricio Mateus , Muffato Matthieu , Glover Natasha , Lecompte Odile , Thomas Paul D , Schiffer Philipp , Capella-Gutierrez Salvador , Cosentino Salvatore , McGlynn Shawn E , Kuraku Shigehiro , Forslund Sofia , Kelly Steven , Lewis Suzanna , Jones Tamsin , de Farias Tarcisio Mendes , Maeda Taro , Gabaldon Toni , Iwasaki Wataru , Pearson William , Wang Yan , Nevers Yannis , Hara Yuichiro
Published: April 2021

Accurate determination of the evolutionary relationships between genes is a foundational challenge in biology. Homology—evolutionary relatedness—is in many cases readily determined based on sequence similarity analysis. By contrast, whether or not two genes directly descended from a common ancestor by a speciation event (orthologs) or duplication event (paralogs) is more challenging, yet provides critical information on the history of a gene. Since 2009, this task has been the focus of the Quest for Orthologs (QFO) Consortium. The sixth QFO meeting took place in Okazaki, Japan in conjunction with the 67th National Institute for Basic Biology conference. Here, we report recent advances, applications, and oncoming challenges that were discussed during the conference. Steady progress has been made toward standardization and scalability of new and existing tools. A feature of the conference was the presentation of a panel of accessible tools for phylogenetic profiling and several developments to bring orthology beyond the gene unit—from domains to networks. This meeting brought into light several challenges to come: leveraging orthology computations to get the most of the incoming avalanche of genomic data, integrating orthology from domain to biological network levels, building better gene models, and adapting orthology approaches to the broad evolutionary and genomic diversity recognized in different forms of life and viruses.
An Examination of Day-to-Day and Intraindividual Pain Variability in Low Back Pain
Authors: Wesolowicz Danielle M , Bishop Mark D , Robinson Michael E
Published: April 2021

Objective

This study aimed to capture day-to-day changes in pain intensity in individuals with low back pain (LBP), which may be indicative of patients’ ability to modulate their pain levels. A secondary aim was to explore the presence of latent subgroups characterized by pain level, intraindividual pain variability, and change in pain over a 14-day period.

Subjects

Participants were 54 adults with self-reported LBP recruited from outpatient physical therapy clinics and the community.

Methods

Over the course of 14 days, participants completed daily measures of pain intensity, catastrophizing, pain self-efficacy, and negative affect. Change in pain intensity as well as total amount of intraindividual pain variability were also calculated.

Results

Daily increases in maladaptive coping and affective responses (i.e., higher catastrophizing, higher negative affect, lower pain self-efficacy) were associated with increases in pain intensity. A hierarchical cluster analysis revealed three subgroups: 1) moderate pain intensity, moderate pain variability, increase in pain over time; 2) low pain intensity, low pain variability, no change in pain over time; and 3) moderate pain intensity, high pain variability, decrease in pain over time. Cluster 2 demonstrated more adaptive coping and affective responses at baseline and during the 14-day period, and clusters 1 and 3 did not differ in their coping or affective responses.

Conclusions

These findings provide support that day-to-day changes in pain, coping, and affective responses are meaningful and provide additional evidence of pain variability as a potential phenotypic characteristic.
Protein-based lateral flow assays for COVID-19 detection
Authors: Mahmoudinobar Farbod , Britton Dustin , Montclare Jin Kim
Published: April 2021

To combat the enduring and dangerous spread of COVID-19, many innovations to rapid diagnostics have been developed based on proteinprotein interactions of the SARS-CoV-2 spike and nucleocapsid proteins to increase testing accessibility. These antigen tests have most prominently been developed using the lateral flow assay (LFA) test platform which has the benefit of administration at point-of-care, delivering quick results, lower cost, and does not require skilled personnel. However, they have gained criticism for an inferior sensitivity. In the last year, much attention has been given to creating a rapid LFA test for detection of COVID-19 antigens that can address its high limit of detection while retaining the advantages of rapid antibodyantigen interaction. In this review, a summary of these proteinprotein interactions as well as the challenges, benefits, and recent improvements to protein based LFA for detection of COVID-19 are discussed.
Correlates of COVID-19 vaccine hesitancy in Austria: trust and the government
Authors: Schernhammer Eva , Weitzer Jakob , Laubichler Manfred D , Birmann Brenda M , Bertau Martin , Zenk Lukas , Caniglia Guido , Jäger Carlo C , Steiner Gerald
Published: April 2021

Background

With the coronavirus disease 2019 (COVID-19) pandemic surging and new mutations evolving, trust in vaccines is essential.

Methods

We explored correlates of vaccine hesitancy, considering political believes and psychosocial concepts, conducting a non-probability quota-sampled online survey with 1007 Austrians.

Results

We identified several important correlates of vaccine hesitancy, ranging from demographics to complex factors such as voting behavior or trust in the government. Among those with hesitancy towards a COVID-19 vaccine, having voted for opposition parties (opp) or not voted (novote) were (95% Confidence Intervall (CI)opp, 1.44–2.95) to 2.25-times (95%CInovote, 1.53–3.30) that of having voted for governing parties. Only 46.2% trusted the Austrian government to provide safe vaccines, and 80.7% requested independent scientific evaluations regarding vaccine safety to increase willingness to vaccine.

Conclusions

Contrary to expected, psychosocial dimensions were only weakly correlated with vaccine hesitancy. However, the strong correlation between distrust in the vaccine and distrust in authorities suggests a common cause of disengagement from public discourse.
Dyslipidaemia and mortality in COVID-19 patients: a meta-analysis
Authors: Zuin M , Rigatelli G , Bilato C , Cervellati C , Zuliani G , Roncon L
Published: April 2021

Background

The prevalence and prognostic implications of pre-existing dyslipidaemia in patients infected by the SARS-CoV-2 remain unclear.

Aim

To assess the prevalence and mortality risk in COVID-19 patients with pre-existing dyslipidaemia.

Design

Systematic review and meta-analysis.

Methods

Preferred reporting items for systematic reviews and meta-analyses guidelines were followed in abstracting data and assessing validity. We searched MEDLINE and Scopus to locate all the articles published up to 31 January 2021, reporting data on dyslipidaemia among COVID-19 survivors and non-survivors. The pooled prevalence of dyslipidaemia was calculated using a random-effects model and presenting the related 95% confidence interval (CI), while the mortality risk was estimated using the Mantel–Haenszel random-effect models with odds ratio (OR) and related 95% CI. Statistical heterogeneity was measured using the Higgins I2 statistic.

Results

Of about 18 studies, enrolling 74 132 COVID-19 patients (mean age 70.6 years), met the inclusion criteria and were included in the final analysis. The pooled prevalence of dyslipidaemia was 17.5% of cases (95% CI: 12.3–24.3%, P < 0.0001), with high heterogeneity (I2 = 98.7%). Pre-existing dyslipidaemia was significantly associated with higher risk of short-term death (OR: 1.69, 95% CI: 1.19–2.41, P = 0.003), with high heterogeneity (I2 = 88.7%). Due to publication bias, according to the Trim-and-Fill method, the corrected random-effect ORs resulted 1.61, 95% CI 1.13–2.28, P < 0.0001 (one studies trimmed).

Conclusion

Dyslipidaemia represents a major comorbidity in about 18% of COVID-19 patients but it is associated with a 60% increase of short-term mortality risk.
A Model of Endogenous Risk Intolerance and LSAPs: Asset Prices and Aggregate Demand in a “COVID-19” Shock
Authors: Caballero Ricardo J , Simsek Alp
Published: April 2021

We theoretically investigate the interaction of endogenous risk intolerance and monetary policy following a large recessionary shock. As asset prices dip, risk-tolerant agents’ wealth share declines. This decline reduces the market’s risk tolerance and triggers a downward loop in asset prices and aggregate demand when the interest rate policy is constrained. In this context, large-scale asset purchases are effective because they transfer unwanted risk to the government’s balance sheet. These effects are sizable when the model is calibrated to match the estimates of aggregate asset demand inelasticity. The COVID-19 shock illustrates the environment we seek to capture.
IMPROVEMENTS OF 111IN SPECT IMAGES RECONSTRUCTED WITH SPARSELY ACQUIRED PROJECTIONS BY DEEP LEARNING GENERATED SYNTHETIC PROJECTIONS
Authors: Rydén T , Emma W , Van Essen M , Svensson J , Bernhardt P
Published: April 2021

The aim was to improve single-photon emission computed tomography (SPECT) quality for sparsely acquired 111In projections by adding deep learning generated synthetic intermediate projections (SIPs). Method: The recently constructed deep convolutional network for generating synthetic intermediate projections (CUSIP) was used for improving 20 sparsely acquired 111In-octreotide SPECTs. Reconstruction was performed with 120 (120P) or 30 (30P) projections, or 120 projections with 90 SIPs generated from 30 projections (30–120SIP). The SPECT reconstructions were performed with attenuation, scatter and collimator response corrections. Postfiltered 30P reconstructed SPECT was also analyzed. Image quality were quantitatively evaluated with root-mean-square error, peak signal-to-noise ratio and structural similarity index metrics. Result: The 30–120SIP reconstructed SPECT had statistically significant improved image quality parameters compared to 30P reconstructed SPECT with and without post filtering. The images visual appearance was similar to slightly filtered 120P SPECTs. Thereby, substantial acquisition time reduction with SIPs seems possible without image quality degradation.
FREQUENCY RESPONSE AND DISTORTION PROPERTIES OF RECONSTRUCTION ALGORITHMS IN COMPUTED TOMOGRAPHY
Authors: Larsson Joel , Båth Magnus , Thilander-Klang Anne
Published: April 2021

Denoising reconstruction techniques can introduce nonlinear properties into computed tomography (CT) systems. These nonlinear algorithms introduce distortion which affects the assessment of the resolution of the system. The purpose of the present study was to decouple and investigate amplitude modulation and waveform distortion in reconstruction algorithms in CT. The methodology developed by Wells, J. R. and Dobbins, J. T. III [Frequency response and distortion properties of nonlinear image processing algorithms and the importance of imaging context. Med. Phys. 40, 091906 (2013)] was adapted to CT reconstruction algorithms. The CT simulating program ASTRA Toolbox© for MATLAB™ was used for the reconstruction of the sinusoidal wave functions. Filtered back projection and the simultaneous iterative reconstruction technique were investigated with simple nonlinear mechanisms: a median filter and a non-negative constraint, respectively. The native reconstruction algorithms were not free from nonlinear waveform distortion, however, none of the metrics showed any dependence on the contrast-to-noise ratio (CNR). Furthermore, the algorithms including nonlinear mechanisms showed a clear and specific CNR dependence, indicating the necessity for distortion analysis in nonlinear CT reconstruction.
Combining carbon and oxygen isotopic signatures to identify ozone-induced declines in tree water-use efficiency
Authors: Li Pin , Feng Zhaozhong , Shang Bo , Uddling Johan
Published: April 2021

Ground-level ozone (O3) pollution affects the plant carbon and water balance, but the relative contributions of impaired photosynthesis and the loss of stomatal functioning to the O3-induced reductions in water-use efficiency (WUE) remain unclear. We combined the leaf stable dual isotopic signatures of carbon (δ13C) and oxygen (δ18O) with related instantaneous gas exchange performance to determine the effects of O3 dose on the net photosynthetic rate (An), stomatal conductance (gs) and intrinsic WUE (iWUE = An/gs) in four tree species (one being a hybrid) exposed to five O3 levels. The iWUE declined for each step increase in O3 level, reflecting progressive loss of the coupling between leaf carbon gain and water loss. In ambient compared with charcoal-filtered air, the decreased iWUE was associated with reductions in both An and gs (i.e., decreased δ13C and increased δ18O). In elevated O3 treatments, however, the iWUE declines were caused by reduced An at constant or increased gs. The results show that the dual isotope approach provides a robust way to gather time-integrated information on how O3 pollution affects leaf gas exchange. Our study highlights that O3-induced decoupling between photosynthesis and stomatal regulation causes large and progressive declines in the WUE of forest trees, demonstrating the need for incorporating this hitherto unaccounted for effect into vegetation models.
Partnering for maximum impact
Authors: Pabico Christine , Abel Sarah
Published: April 2021

Pathway to Excellence® and Sigma team up to benefit nurses
Combining Ethics Inquiry and Clinical Experience in a Premedical Health Care Ethics Internship
Authors: McLean Margaret R. , Bottrell Melissa M.
Published: April 2021

Problem

The professional formation of physicians begins in the premedical years, and educators are now recommending that medical ethics and humanities courses be considered essential components to becoming a physician rather than elective prerequisites for medical school admission. As a result, questions have arisen about how to teach students ethical reasoning skills before their professional training, as they have limited opportunities now to develop these skills and the related competencies in a real-world medical context.

Approach

The authors describe Santa Clara University’s Health Care Ethics Internship (HCEI), an undergraduate college experience that emphasizes ethical inquiry and immerses students in health care settings to foster deep learning. The HCEI includes mentored clinical rotations integrated with classroom inquiry into ethical theory, structured reflection, and professional development considerations. A survey of former students (academic years 2001–2002 to 2017–2018) explored their perceptions of these program components and the impact of the experience on their preprofessional readiness, career choice, and professional capabilities.

Outcomes

Of 185 former students who could be contacted, 89 (48.1%) completed the survey. Students reported that the HCEI: (1) assisted them in gaining admission to medical school, (2) had a positive influence on their career decisions, (3) increased their professional capabilities, (4) helped them develop preprofessional competencies, (5) gave them knowledge and experience they used in their personal and professional ethical decision making, and (6) increased their moral sensitivity and ethical responsibility.

Next Steps

Integrating clinical rotations into ethics education exposes premedical students to real-world ethical questions, helps them develop a nuanced understanding of a health care career, and prepares them for the medical school admissions process. Other universities should consider implementing a similar program to prime their students for continued professional and moral development during medical school and residency.
Medicine, Machines, and Medical Education
Authors: Wartman Steven A.
Published: April 2021

While advances in science and technology continue to be at the forefront of the evolution of medical practice, the 21st century is also undergoing a unique and profound cultural shift that is changing the very nature of what it means to be a medical professional, namely humankind’s transition to an information-based internet society. Medical care will increasingly depend on computer-generated probabilities guided and supported by a growing variety of individuals in health care–related professions, including statisticians, technologists, and information managers. Perhaps the biggest challenge to the profession will come from the erosion of professional autonomy, driven by smart machines, social networks, and internet search engines. As a result of these and other changes, physicians are facing a systematic loss of control, often without the direct input and leadership of the profession itself.

In this commentary, the author urges the profession to adopt several strategies, including shifting its focus from reimbursement to the care patients value most, meaningfully addressing critical issues in health policy, becoming the definitive source for publicly available medical information, reimagining medical education, and overhauling the existing accreditation and licensing systems. Medical education must go beyond a focus on physicians whose professional identity revolves around being the exclusive source of medical knowledge. In the digitized 21st century, medical education should emphasize the centrality of the humanistic interface with patients such that the doctor–patient relationship is paramount in the complex medical world of machines and social media. Removing the roadblocks to successful professional reform is no small task, but the process can begin with a grassroots movement that empowers physicians and facilitates organizational and behavioral change. Failure to take action may well hasten the diminishment of patient care and the profession’s trusted role in society.
Efficacy and toxicity of intravesical Bacillus Calmette-Guérin therapy in elderly patients with non-muscle-invasive bladder cancer
Authors: Matsuoka Yuki , Taoka Rikiya , Kohashiguchi Kana , Tohi Yoichiro , Miyauchi Yasuyuki , Kato Takuma , Tsunemori Hiroyuki , Ueda Nobufumi , Sugimoto Mikio
Published: April 2021

Objectives:

This study aimed to compare the efficacy and toxicity of intravesical Bacillus Calmette-Guérin (BCG) therapy between elderly and younger patients with non-muscle-invasive bladder cancer (NMIBC).

Material and methods:

This retrospective study included 87 NMIBC patients who received intravesical BCG between January 2011 and December 2018. We compared the treatment outcomes of patients ≥75 and <75 years old. Our primary endpoint was intravesical recurrence-free survival after treatment. The secondary endpoint was the toxicity caused by intravesical BCG.

Results:

The elderly and younger patients included 38 and 49 patients with mean ages of 80.6 and 66.3 years (p < 0.01), respectively. Their baseline parameters were similar, aside from age. The elderly and younger patients’ 5-year recurrence-free survival rates were 59.4% and 51.6%, respectively, and were not significantly different (log-rank test, p = 0.72). Moderate to severe pain on micturition requiring prescription medications was observed more frequently in the elderly patients than in the younger patients (p < 0.01). No elderly patients required hospitalization for any adverse events. However, 3 (6.1%) younger patients were treated for urinary tract infection in the hospital.

Conclusions:

The efficacy and toxicity of intravesical BCG therapy for NMIBC patients are not associated with age. Therefore, elderly patients with high-risk NMIBC should be treated in the same manner as younger patients in clinical practice.
Comparison of the clinical usefulness of different urinary tests for the initial detection of bladder cancer: a systematic review
Authors: Sciarra Alessandro , Di Lascio Giovanni , Del Giudice Francesco , Leoncini Pier Paolo , Salciccia Stefano , Gentilucci Alessandro , Porreca Angelo , Chung Benjamin I. , Di Pierro Giovanni , Busetto Gian Maria , De Berardinis Ettore , Maggi Martina
Published: April 2021

Objectives:

The standard initial approach in patients with hematuria or other symptoms suggestive of bladder cancer (BC) is a combination of cystoscopy and urine cytology (UC); however, UC has low sensitivity particularly in low-grade tumors. The aim of the present review was to critically analyze and compare results in the literature of promising molecular urinary tests for the initial diagnosis of BC.

Methods:

We searched in the Medline and Cochrane Library databases for literature from January 2009 to January 2019, following the PRISMAguidelines.

Results:

In terms of sensitivity, ImmunoCyt showed the highest mean and median value, higher than UC. All tests analyses showed higher mean and median sensitivity when compared with UC. In terms of specificity, only UroVysion and Microsatellite analyses showed mean and median values similar to those of UC, whereas for all other tests, the specificity was lower than UC. It is evident that the sensitivity of UC is particularly low in low grade BC. Urinary tests mainly had improved sensitivity when compared to UC, and ImmunoCyt and UroVysion had the highest improvement in low grade tumors.

Conclusions:

Most of the proposed molecular markers were able to improve the sensitivity with similar or lower specificity when compared to UC. However, variability of results among the different studies was strong. Thus, as of now, none of these markers presented evidences so as to be accepted by international guidelines for diagnosis of BC.