bluuebunny/crossref_metadata_2025 huggingface dataset:
Does the Antarctic Oscillation modulate tropical cyclone rapid intensification over the western North Pacific?
Authors: Song Jinjie , Klotzbach Philip J , Dai Yifei , Duan Yihong
Published: May 2022

This study investigates the modulation of tropical cyclone (TCs) rapid intensification (RI) over the western North Pacific by the Antarctic Oscillation. There is a significant inverse relationship between basinwide RI number during July–November from 1982 to 2020 and the simultaneous Antarctic Oscillation index. During positive Antarctic Oscillation years, RI occurrence is significantly suppressed over the main RI region (10°–20° N and 125°–150° E) and slightly enhanced over the South China Sea. By contrast, during negative Antarctic Oscillation years, RI is significantly enhanced over the main RI region and slightly suppressed over the South China Sea. The Antarctic Oscillation influences western North Pacific RI occurrence mainly through modulation of the large-scale dynamic environment. During positive Antarctic Oscillation years, increases in 850–200 hPa vertical wind shear and decreases in both low-level vorticity and upper-level divergence all suppress RI occurrence over the main RI region, while thermodynamic variables (e.g. TC heat potential, maximum potential intensity and low-to-middle level relative humidity) show mostly weak changes. These changes in dynamic factors can be linked to a low-level anomalous western North Pacific anticyclone triggered by the positive phase of the Antarctic Oscillation and a low-level anomalous western North Pacific cyclone generated by a negative phase of the Antarctic Oscillation.
Engineered colorectal cancer tissue recapitulates key attributes of a patient-derived xenograft tumor line
Authors: Hassani Iman , Anbiah Benjamin , Kuhlers Peyton , Habbit Nicole L , Ahmed Bulbul , Heslin Martin J , Mobley James A , Greene Michael W , Lipke Elizabeth A
Published: May 2022

The development of physiologically relevant in vitro colorectal cancer (CRC) models is vital for advancing understanding of tumor biology. Although CRC patient-derived xenografts (PDXs) recapitulate key patient tumor characteristics and demonstrate high concordance with clinical outcomes, the use of this in vivo model is costly and low-throughput. Here we report the establishment and in-depth characterization of an in vitro tissue-engineered CRC model using PDX cells. To form the 3D engineered CRC-PDX (3D-eCRC-PDX) tissues, CRC PDX tumors were expanded in vivo, dissociated, and the isolated cells encapsulated within PEG-fibrinogen hydrogels. Following PEG-fibrinogen encapsulation, cells remain viable and proliferate within 3D-eCRC-PDX tissues. Tumor cell subpopulations, including human cancer and mouse stromal cells, are maintained in long-term culture (29 days); cellular subpopulations increase ratiometrically over time. The 3D-eCRC-PDX tissues mimic the mechanical stiffness of originating tumors. Extracellular matrix protein production by cells in the 3D-eCRC-PDX tissues resulted in approximately 57% of proteins observed in the CRC-PDX tumors also being present in the 3D-eCRC-PDX tissues on day 22. Furthermore, we show congruence in enriched gene ontology molecular functions and Hallmark gene sets in 3D-eCRC-PDX tissues and CRC-PDX tumors compared to normal colon tissue, while prognostic Kaplan–Meier plots for overall and relapse free survival did not reveal significant differences between CRC-PDX tumors and 3D-eCRC-PDX tissues. Our results demonstrate high batch-to-batch consistency and strong correlation between our in vitro tissue-engineered PDX-CRC model and the originating in vivo PDX tumors, providing a foundation for future studies of disease progression and tumorigenic mechanisms.
A biodegradable 3D woven magnesium-based scaffold for orthopedic implants
Authors: Xue Ju , Singh Srujan , Zhou Yuxiao , Perdomo-Pantoja Alexander , Tian Ye , Gupta Nehali , Witham Timothy F , Grayson Warren L , Weihs Timothy P
Published: May 2022

Porous Magnesium (Mg) is a promising biodegradable scaffold for treating critical-size bone defects, and as an essential element for human metabolism, Mg has shown sufficient biocompatibility. Its elastic moduli and yield strengths are closer to those of cortical bone than common, inert metallic implants, effectively reducing stress concentrations around host tissue as well as stress shielding. More importantly, Mg can degrade and be absorbed in the human body in a safe and controlled manner, thereby reducing the need for second surgeries to remove implants. The development of porous Mg scaffolds via conventional selective laser melting techniques has been limited due to Mg’s low boiling point, high vapor pressures, high reactivity, and non-ideal microstructures in additively manufactured parts. Here we present an exciting alternative to conventional additive techniques: 3D weaving with Mg wires that have controlled chemistries and microstructures. The weaving process offers high throughput manufacturing as well as porous architectures that can be optimized for stiffness and porosity with topology optimization. Once woven, we dip-coat the weaves with polylactic acid to enhance their strength and corrosion resistance. Following fabrication, we characterize their mechanical properties, corrosion behavior, and cell compatibility in vitro, and we use an intramuscular implantation model to evaluate their in vivo corrosion behavior and tissue response.
Long-term mechanical loading is required for the formation of 3D bioprinted functional osteocyte bone organoids
Authors: Zhang Jianhua , Griesbach Julia , Ganeyev Marsel , Zehnder Anna-Katharina , Zeng Peng , Schädli Gian Nutal , Leeuw Anke de , Lai Yuxiao , Rubert Marina , Müller Ralph
Published: May 2022

Mechanical loading has been shown to influence various osteogenic responses of bone-derived cells and bone formation in vivo. However, the influence of mechanical stimulation on the formation of bone organoid in vitro is not clearly understood. Here, three-dimensional (3D) bioprinted human mesenchymal stem cells-laden graphene oxide composite scaffolds were cultured in a novel cyclic-loading bioreactors for up to 56 d. Our results showed that mechanical loading from day 1 (ML01) significantly increased organoid mineral density, organoid stiffness, and osteoblast differentiation compared with non-loading and mechanical loading from day 21. Importantly, ML01 stimulated collagen I maturation, osteocyte differentiation, lacunar-canalicular network formation and YAP expression on day 56. These finding are the first to reveal that long-term mechanical loading is required for the formation of 3D bioprinted functional osteocyte bone organoids. Such 3D bone organoids may serve as a human-specific alternative to animal testing for the study of bone pathophysiology and drug screening.
Adsorption characteristics of bovine serum albumin onto α-Fe2O3 nanoparticles prepared via the alcohol solution combustion process of ferric nitrate
Authors: Li Yongjin , Zhu Ziye , Lv Zhixiang , Wang Zhou , Chen Yuefang
Published: May 2022

The α-Fe2O3 nanoparticles were prepared via the alcohol solution combustion process of ferric nitrate. The scanning electron microscopy (SEM), energy dispersive spectroscopy (EDS). X-ray diffraction (XRD), and vibrating sample magnetometer (VSM) were taken to characterize the prepared α-Fe2O3 nanoparticles. The average particle sizes of the as-prepared α-Fe2O3 nanoparticles were approximately 180 nm, and their magnetic property was approximately 0.42 emu·g−1 after the measurement. The different concentrations of BSA solutions and the adsorption times were investigated to investigate the adsorption characteristics of bovine serum albumin (BSA) onto α-Fe2O3 nanoparticles. For larger adsorption capacity and higher removal rate, the dose of α-Fe2O3 nanoparticles in aqueous solution was selected at 2.5 mg·ml−1. The adsorption process of BSA onto α-Fe2O3 nanoparticles conformed to the pseudo-first-order kinetic model. While, the correlation coefficient (R2) of the Temkin isothermal model was higher than Langmuir model and Freundlich isothermal model, suggesting that the isothermal model of BSA onto α-Fe2O3 nanoparticles was more in line with Temkin isotherm model. Which suggested that the adsorption behavior of magnetic α-Fe2O3 nanoparticles for BSA belonged to multi-molecular layer chemisorption. When BSA concentration was 600 mg·l−1 and the pH of solution was 5, the adsorption capacity of BSA onto magnetic α-Fe2O3 nanoparticles achieved 114.2 mg·g−1, and the adsorption rate could still reach 70.3% of the first time after 7 cycles.
Study on divertor heat flux under n = 3 and n = 4 resonant magnetic perturbations using infrared thermography diagnostic in EAST
Authors: LIANG Ruirong , GONG Xianzu , ZHANG Bin , YANG Zhendong , JIA Manni , SUN Youwen , MA Qun , ZHANG Jiayuan , HU Yunchan , QIAN Jinping
Published: May 2022

Resonant magnetic perturbations (RMPs) with high toroidal mode number n are considered for controlling edge-localized modes (ELMs) and divertor heat flux in future ITER H-mode operations. In this paper, characteristics of divertor heat flux under high-n RMPs (n = 3 and 4) in H-mode plasma are investigated using newly upgraded infrared thermography diagnostic in EAST. Additional splitting strike point (SSP) accompanying with ELM suppression is observed under both RMPs with n = 3 and n = 4, the SSP in heat flux profile agrees qualitatively with the modeled magnetic footprint. Although RMPs suppress ELMs, they increase the stationary heat flux during ELM suppression. The dependence of heat flux on

q

95

during ELM suppression is preliminarily investigated, and further splitting in the original strike point is observed at

q

95

=
4

during ELM suppression. In terms of ELM pulses, the presence of RMPs shows little influence on transient heat flux distribution.
The effects of dilution gas on nanoparticle growth in atmospheric-pressure acetylene microdischarges
Authors: LIU Xiangmei , DONG Xiaotian , LI Hongying , ZHAO Shuxia
Published: May 2022

A two-dimensional multi-fluid model is developed to investigate the effects of dilution gas on microplasma properties and nanoparticle behavior in atmospheric-pressure radio-frequency acetylene discharges. The percentage of dilution gases (argon and helium) percentage varied from 0% to 90%, with the pressure kept constant. Simulation results show that the dilution gas percentage has a significant influence on the spatial distributions of the electron density and temperature, as well as on the formation of nanoparticles in acetylene microplasmas. With increasing dilution gas percentage, the electron density profile changes continuously from being high at the edge to high in the center. A mode transition from a mixed discharge mode with both α regime and drift-ambipolar regime into α regime occurs, which is associated with a sudden decrease in the electron density of the presheaths and an increase in the electron temperature of the bulk plasma. The mode transition point corresponds to the lowest number density ratio of hydrocarbon ions to acetylene. The highest number density ratio is observed at a dilution percentage of 90%, and causes more effective nucleation and coagulation of nanoparticles. Furthermore, owing to the high ionization potential of helium, the transition point moves to a larger dilution gas percentage in

C

2

H

2

/He microplasmas. Finally, the growth of nanoparticles via coagulation is studied.
Strichartz and uniform Sobolev inequalities for the elastic wave equation
Authors: Kim Seongyeon , Kwon Yehyun , Lee Sanghyuk , Seo Ihyeok
Published: May 2022

We prove dispersive estimate for the elastic wave equation by which we extend the known Strichartz estimates for the classical wave equation to those for the elastic wave equation. In particular, the endpoint Strichartz estimates are deduced. For the purpose we diagonalize the symbols of the Lamé operator and its semigroup, which also gives an alternative and simpler proofs of the previous results on perturbed elastic wave equations. Furthermore, we obtain uniform Sobolev inequalities for the elastic wave operator.
A Sierpinski carpet like fractal without standard self-similar energy
Authors: Cao Shiping , Qiu Hua
Published: May 2022

We construct a Sierpinski carpet like fractal, on which a diffusion with sub-Gaussian heat kernel estimate does not exist, in contrast to previous researches on the existence of such diffusions, on the generalized Sierpinski carpets and recently introduced unconstrained Sierpinski carpets.
Early Introduction and Rise of the Omicron Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Variant in Highly Vaccinated University Populations
Authors: Petros Brittany A , Turcinovic Jacquelyn , Welch Nicole L , White Laura F , Kolaczyk Eric D , Bauer Matthew R , Cleary Michael , Dobbins Sabrina T , Doucette-Stamm Lynn , Gore Mitch , Nair Parvathy , Nguyen Tien G , Rose Scott , Taylor Bradford P , Tsang Daniel , Wendlandt Erik , Hope Michele , Platt Judy T , Jacobson Karen R , Bouton Tara , Yune Seyho , Auclair Jared R , Landaverde Lena , Klapperich Catherine M , Hamer Davidson H , Hanage William P , MacInnis Bronwyn L , Sabeti Pardis C , Connor John H , Springer Michael
Published: May 2022

Background

The Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is highly transmissible in vaccinated and unvaccinated populations. The dynamics that govern its establishment and propensity toward fixation (reaching 100% frequency in the SARS-CoV-2 population) in communities remain unknown. Here, we describe the dynamics of Omicron at 3 institutions of higher education (IHEs) in the greater Boston area.

Methods

We use diagnostic and variant-specifying molecular assays and epidemiological analytical approaches to describe the rapid dominance of Omicron following its introduction into 3 IHEs with asymptomatic surveillance programs.

Results

We show that the establishment of Omicron at IHEs precedes that of the state and region and that the time to fixation is shorter at IHEs (9.5–12.5 days) than in the state (14.8 days) or region. We show that the trajectory of Omicron fixation among university employees resembles that of students, with a 2- to 3-day delay. Finally, we compare cycle threshold values in Omicron vs Delta variant cases on college campuses and identify lower viral loads among college affiliates who harbor Omicron infections.

Conclusions

We document the rapid takeover of the Omicron variant at IHEs, reaching near-fixation within the span of 9.5–12.5 days despite lower viral loads, on average, than the previously dominant Delta variant. These findings highlight the transmissibility of Omicron, its propensity to rapidly dominate small populations, and the ability of robust asymptomatic surveillance programs to offer early insights into the dynamics of pathogen arrival and spread.
A yeast cell cycle model integrating stress, signaling, and physiology
Authors: Adler Stephan O , Spiesser Thomas W , Uschner Friedemann , Münzner Ulrike , Hahn Jens , Krantz Marcus , Klipp Edda
Published: May 2022

The cell division cycle in eukaryotic cells is a series of highly coordinated molecular interactions that ensure that cell growth, duplication of genetic material, and actual cell division are precisely orchestrated to give rise to two viable progeny cells. Moreover, the cell cycle machinery is responsible for incorporating information about external cues or internal processes that the cell must keep track of to ensure a coordinated, timely progression of all related processes. This is most pronounced in multicellular organisms, but also a cardinal feature in model organisms such as baker's yeast. The complex and integrative behavior is difficult to grasp and requires mathematical modeling to fully understand the quantitative interplay of the single components within the entire system. Here, we present a self-oscillating mathematical model of the yeast cell cycle that comprises all major cyclins and their main regulators. Furthermore, it accounts for the regulation of the cell cycle machinery by a series of external stimuli such as mating pheromones and changes in osmotic pressure or nutrient quality. We demonstrate how the external perturbations modify the dynamics of cell cycle components and how the cell cycle resumes after adaptation to or relief from stress.
The Firm
Authors: Morgan Glenn
Published: May 2022

The goal of this chapter is to focus on firms as political actors engaging with states and markets in order to shape markets and favorable outcomes at the level of the international political economy. The chapter distinguishes between different forms of power which firms can exercise in these arenas—lobbying power, structural power, and the power of expertise. This in turn is affected by, first, forms of ownership and governance, emphasizing the difference between shareholder-driven firms, stakeholder firms, family- and privately-owned firms, and state-owned firms. Secondly, multinational corporations (MNCs) vary significantly in terms of the political arenas which are relevant to them, and where they seek to exercise power, reflecting different sectoral conditions of competition e.g., manufacturing, finance, professional services, agribusiness and extractive industries, and platform/IT companies. The chapter provides a framework for understanding the role of different sorts of multinationals in shaping markets and international economic regimes through their influence over states and international organizations.
Common and Uncommon Imaging Presentations of Ectopic Pregnancy
Authors: Schallert Kellan , DeAngelis Gia , Krishnaraj Arun
Published: May 2022

Ectopic pregnancy most commonly occurs in a fallopian tube (~95%1) (Figure 1). Major risk factors for ectopic pregnancy include a history of pelvic inflammatory disease or previous tubal surgery. Additional risk factors include smoking, assisted reproductive technology, and the use of an intrauterine device.2 Ectopic pregnancies located outside the fallopian tube have a poorer prognosis, as they have more blood supply, grow larger, and have an elevated risk of catastrophic hemorrhage if ruptured. The clinical presentation of pelvic pain, elevated β-human chorionic gonadotropin, and vaginal bleeding is similar, regardless of the location of an ectopic pregnancy; thus, imaging plays a crucial role in directing management. Early diagnosis by imaging has played a key role in reducing maternal mortality and allowing patients to pursue more conservative management options to reduce morbidity and preserve future fertility. However, ruptured ectopic pregnancy still remains the leading cause of maternal death in the first trimester.3 Uncommon locations of ectopic pregnancy often are missed or incorrectly diagnosed at initial imaging, resulting in poor outcomes.
Treating patients with acute COPD in the ED
Authors: O'Hara Ryan
Published: May 2022

ED clinicians typically discharge patients on 5-day regimens of azithromycin and corticosteroids after an acute COPD exacerbation. This article discusses various studies that evaluated chronic azithromycin therapy to prevent exacerbations in patients with COPD. Although ED clinicians typically do not prescribe chronic medications, they can provide patient-centered care and determine a patient's follow-up to see if chronic azithromycin is needed.
Atrioesophageal fistula
Authors: Jones Sarah , Kara Areeba
Published: May 2022

Atrioesophageal fistula with resulting air emboli is a rare but potentially fatal complication of radiofrequency catheter ablation (RFCA) for atrial fibrillation. Patients typically present within 60 days after RFCA with fever, neurologic deficits, chest pain, and gastrointestinal bleeding. Chest CT with IV contrast reveals the atrioesophageal fistula in most cases, and CT of the head or MRI of the brain commonly reveals signs of air emboli. Early diagnosis, initiation of antibiotics, and immediate surgical intervention may improve patients' chances of survival.
A brief introduction to PAs in Germany
Authors: Heistermann Peter , Lang Tamika , Heilmann Claudia , Meyer-Treschan Tanja
Published: May 2022

The first German physician assistant (PA) program began in 2005 at Steinbeis University in Berlin. Since 2005, there has been a rapid expansion of PA education, and 22 German universities have opened or are planning to develop PA programs. In fall 2021, about 1,100 PAs worked in Germany, mostly in the inpatient setting, with a scope of practice focused on delegation and the performance of medical and administrative activities. After completing a PA program, students are awarded a bachelor of science; programs also offer options for specialization. With no formal PA program-specific accreditation processes, the universities are responsible for ensuring the quality and content of PA courses. The profession is not regulated in Germany, and laws to guide PA education and scope of practice are necessary for the further development of the profession.
In Patients Come Second, Health Care Workers Come First
Authors: Brown Theresa
Published: May 2022

A provocative approach to fixing what's wrong with health care.
Acupuncture Safe and Effective to Manage Postcesarean Pain
Authors: Rosenberg Karen
Published: May 2022

According to this study:

Preoperative use of acupuncture is safe, has a clinically relevant effect on pain, and accelerates patient mobilization after a cesarean delivery.
Costs and benefits of routine hemoglobin A1c screening prior to total joint arthroplasty: a cost-benefit analysis
Authors: Zhuang Thompson , Shapiro Lauren M. , Amanatullah Derek F. , Maloney William J. , Kamal Robin N.
Published: May 2022

Background:

Poorly controlled diabetes mellitus (DM) increases the risk for periprosthetic joint infection (PJI) after total joint arthroplasty (TJA). While institutional protocols include hemoglobin A1c (HbA1c) screening in TJA patients, the costs and benefits of routine preoperative screening have not been described.

Methods:

The authors created a decision tree model to evaluate short-term costs and risk reduction for PJIs with routine screening of primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients. Probabilities and costs were obtained from published sources. They calculated net costs and absolute risk reduction in PJI for routine screening versus no screening. The authors also performed sensitivity analyses of model inputs including probabilistic sensitivity analyses (PSAs) consisting of 10,000 Monte Carlo simulations.

Results:

In patients with DM, routine screening before THA resulted in net cost savings of $81 per patient with 286 patients needing to be screened to prevent 1 PJI, while screening before TKA incurred net additional costs of $25,810 per PJI prevented. Routine screening in patients with DM undergoing THA or TKA was cost-saving across 75.5% or 21.8% of PSA simulations, respectively. In patients with no history of DM, routine screening before THA or TKA incurred net additional costs of $24,583 or $87,873 per PJI prevented, respectively.

Conclusions:

Routine HbA1c screening in patients with DM prior to THA with referral of patients with elevated HbA1c for glycemic optimization may prevent PJI and reduce healthcare costs. In contrast, routine screening in patients with DM prior to TKA or in patients with no history of DM is not cost-saving.

Level of Evidence:

Economic Level IV.
Shock
Authors: Patel Samir , Holden Kyle , Calvin Bob , DiSilvio Briana , Dumont Tiffany
Published: May 2022

Shock is a life-threatening condition of circulatory failure that causes an imbalance between cellular oxygen supply and demand resulting in organ dysfunction. It is important to recognize promptly as it is reversible in earlier stages but will transition to an irreversible phase if left untreated. This will result in multiorgan failure and subsequent death. The clinician should therefore consider shock in the differential for all patients with new organ failure. This article will review the pathophysiology, classification, evaluation, and management of shock.
Factor V Leiden
Authors: Morrow Morgan , Lynch-Smith Donna
Published: May 2022

Background

Factor V Leiden (FVL) is a hereditary thrombophilia, which causes the blood to be more hypercoagulable; in essence, the blood tends to clot more easily, especially under certain circumstances. It is the most common genetic mutation, causing thrombophilia in patients of white background. Patients that have FVL are at a higher risk to develop venous thromboembolism (VTE) after surgery and trauma.

Objective

The purpose of this review is to identify FVL as a risk factor, which may impede optimum acute cardiopulmonary management which may contribute to a longer length of stay (LOS) in the hospital.

Methods

This article is a systematic review of the literature involving research printed in peer-reviewed journals from 2015 to 2018. The University of Tennessee Health Science Center online library, PubMed, and Google Scholar were used for the literature search.

Results

The results of this study determined that although FVL is in fact a risk factor, which may impede optimum acute cardiopulmonary management which may contribute to a longer LOS, management of VTE is no different for a person with FVL compared with those without FVL.

Conclusion

Factor V Leiden is a risk factor for the development of VTE, specifically deep vein thrombosis, in surgical, trauma, pregnant, and hormone replacement therapy patients, thus increasing LOS and recurrence of such events. Regardless of FVL status, management of VTE should be initiated promptly and discontinued when appropriate.
Evaluation of Pediatric Cardiac Intensive Care Advanced Practice Provider’s Leadership Education and Experience During Emergencies
Authors: Florez Amy R. , Riley Christine M. , Zender Jill E. , Cooper David S. , Henry Brandon M. , Justice Lindsey B.
Published: May 2022

Background

The number of advanced practice providers (APPs) in pediatric critical care has increased dramatically over recent years, leading to increased opportunities to lead resuscitation teams during pediatric emergent events.

Objectives

The aim of this study was to better understand the emergency leadership experience, training, and education that pediatric cardiac intensive care unit APPs receive.

Methods

This study was a cross-sectional descriptive studying using survey responses. The self-administered survey was administered to APP and attending physician members of the Pediatric Cardiac Intensive Care Society. Survey results were analyzed.

Results

One hundred seven pediatric cardiac intensive care unit APPs (n = 53) and attending physicians (n = 54) responded to the survey. Half of APPs felt that attendings allowed APPs to lead emergent events, and 50.9% had never functioned in the team leader role. Most respondents (77.5%) rated their comfort functioning in the role during emergent situations as moderate or lower. Increased APP experience level was associated with a higher number of codes led, increased comfort leading codes, and improved mental model sharing (all Ps < .0001). The number of codes an APP had previously led was associated with increased comfort leading codes (P < .0001) and mental model sharing (P = .0002). One-third of attendings said they allow APPs to lead codes in their unit. Half of attendings who do not allow APPs to function as the team leader would follow formal training.

Discussion

Opportunities for APPs to function as team leaders during emergent events continue to increase. A leadership educational program would be beneficial to pediatric critical care APPs. It may also have the additional benefit of improving physician comfort with APPs leading code events and patient outcomes.
One Year Post-Discharge Outcomes After Implementation of an ICU Early Mobility Protocol
Authors: Tymkew Heidi , Sledge Jennifer A. , Vyers Kara , Arroyo Cassandra , Schallom Marilyn
Published: May 2022

Background

Early mobility benefits include improved strength, decreased length of stay (LOS), and delirium. The impact of an early mobility protocol on return to activities of daily living (ADL) is less studied.

Objective

The aim of this study was to examine 1-year outcomes including ADL performance after the institution of an ICU early mobility protocol.

Methods

One year after the initiation of an early mobility protocol in 7 intensive care units (ICUs) at an academic medical center, patients with an ICU stay of 7 days or more were enrolled in a 1-year follow-up phone call study. Baseline demographic data included the following: average ICU mobility and highest ICU mobility level achieved (4 levels), highest ICU mobility score (10 levels) at ICU admission, ICU discharge (DC), hospital DC, LOS, and delirium positive days. At 4 time points after DC (1, 3, 6, 12 months), patients were contacted regarding current residence, employment, readmissions, and current level of ADL from the Katz ADL (scored 0-6) and Lawton instrumental ADL scales (scored 0-8).

Results

A convenience sample of 106 patients was enrolled with a mean age of 58 ± 15.4 years, ICU LOS of 18 ± 11.5 days, and hospital LOS of 37.5 ± 31 days; 58 (55%) were male; 4 expired before DC. Mobility results included mean mobility level of 1.6 ± 0.8, mean highest mobility level 3.3 ± 0.9; ICU mobility score was 5.9 ± 2.4 at time of ICU DC and 7.3 ± 2.5 at hospital DC. Katz ADL scores improved from 4.8 at 1 month to 5.6 at 12 months (P = .002), and Lawton IADL scores improved from 4.2 to 6.6 (P < .001). Mobility scores were predictors of 1 month Katz (P = .004) and Lawton (P < .001) scores. None of the mobility levels or scores were predictive for readmissions. Most patients were not working before admission, and not all returned to work. Days positive for delirium were predictive of 1 month Katz and Lawton (P = .014, .002) scores. Impact of delirium was gone by 1 year.

Discussion

In this critically ill patient population followed for 1 year, ICU mobility positively impacted return to ADLs and improved ADLs over time but not readmissions. Delirium positive days decreased ADL scores, but the effect diminished over time.
PrabotulinumtoxinA for Treatment of Millennials With Moderate to Severe Glabellar Lines: Post Hoc Analyses of the Phase III Clinical Study Data
Authors: Ogilvie Patricia , Jones Derek H. , Avelar Rui L. , Jonker Anneke , Monroe Rose , Carruthers Jean
Published: May 2022

BACKGROUND

The use of esthetic products by millennials is increasing, yet published clinical trial data in this population are limited.

OBJECTIVE

To compare the efficacy and safety of prabotulinumtoxinA for the treatment of moderate to severe glabellar lines in millennial and nonmillennial patients.

METHODS AND MATERIALS:

Post hoc analyses were performed on the pooled population of all patients treated with 20U prabotulinumtoxinA in the 3 single-dose Phase III glabellar line clinical studies. Patients were grouped by age: millennials (born 1982–2000) versus nonmillennials (born ≤1981). One key efficacy end point was the proportion of responders with a ≥1-point improvement from baseline at maximum frown on the 4-point Glabellar Line Scale. Adverse events were also summarized.

RESULTS

Responder rates among millennials (n = 65) were greater than those of nonmillennials (n = 668) by 7.7% on average across all visits; differences were statistically significant at Day 90. Responder rates at Day 90 were 90.2% and 76.1%, respectively (absolute difference of 14.0%, p = .01). Headache was the most common treatment-related adverse event, occurring in 9.0% and 9.4% of millennials and nonmillennials, respectively.

CONCLUSION

A single dose of 20U prabotulinumtoxinA administered for the treatment of glabellar lines was similarly well-tolerated by both millennials and nonmillennials; overall, it was more efficacious in millennials.
Developing Parents Plus
Authors: Sawyer Brook E. , Hammer Carol Scheffner , Santoro Julie K. , Smith Julie C. , Feil Edward G.
Published: May 2022

In this article, we describe the development and investigation of the social validity of Parents Plus, a parent-implemented intervention for preschool children with developmental language disorder. Parents Plus is a fully online intervention that is delivered through three components: (a) training delivered through an app that educates parents on how to use focused stimulation (FS), a language facilitation strategy; (b) parent implementation of FS during naturally occurring routines; and (c) remote practice-based coaching provided by a coach via Zoom. Parents Plus was developed in three steps: (a) initial content development with input from parents and professional advisory board members, (b) brief field test with five parent–child dyads, and (c) full-length field test with seven parent–child dyads. Throughout the development process, we collected social validity data on the intervention's goals, procedures, content and outcomes. Each step was followed by revisions to Parents Plus. Findings suggest that Parents Plus has strong social validity. Recommendations for early intervention practice are provided based on lessons learned, such as different methods to scaffold learning experiences for parents.
Latinx Mothers' Experiences With Linkage to Early Intervention
Authors: Quebles Irina , Perrigo Judith L. , Bravo Rocío , Patel Gera Mona , Poulsen Marie Kanne , Wheeler Barbara Yoshioka , Williams Marian E.
Published: May 2022

This study explored the experiences and perspectives of Latinx mothers of children younger than 3 years who had participated in a developmental screening initiative provided by 2 Federally Qualified Health Centers in an urban setting, had positive developmental screenings, and were referred to early intervention (EI) services. A 2-phase mixed-methods explanatory design was implemented in English and Spanish. In Phase 1, a telephone survey was conducted with 62 parents. In Phase 2, qualitative semistructured interviews (regarding parental experiences with their child's developmental screening, the process of linking to services, the EI evaluation, and subsequent services received) were conducted with a subset of 13 Phase 1 mothers. Results from the phone survey showed that 91% of children were found eligible for EI and 92% were receiving EI services. More than 90% of mothers reported positive experiences with their children's developmental screening, learning about their child's development, and accessing services. However, results from the semistructured interviews revealed that mothers had mixed experiences with the developmental screening process and linkage to EI services. Findings from this study provide insights into the perceived value of EI services by Latinx families and the need for improved system supports to access and navigate EI services.
Measuring corneal astigmatism using OCT in keratoconus
Authors: Llorens-Quintana Clara , Lee Daniel J. , Pavlatos Elias , Chamberlain Winston , Huang David , Li Yan
Published: May 2022

Purpose:

To measure net corneal astigmatism using optical coherence tomography (OCT) (Avanti) in individuals with keratoconus and compare the repeatability and accuracy with those obtained using Scheimpflug imaging (Pentacam HR).

Setting:

Casey Eye Institute, Portland, Oregon.

Design:

Prospective cross-sectional observational study.

Methods:

Net corneal astigmatism was calculated in keratoconic and normal eyes using OCT and Scheimpflug imaging with 4 settings—pupil or vertex centration settings with a 3 or 4 mm circular analytical zone. Corneal elevation maps were obtained from OCT images and fitted with the Zernike polynomials to obtain net corneal astigmatism. Manifest refraction astigmatism was used to evaluate the accuracy of net corneal astigmatism measurements. The coefficient of repeatability from 2 repeated measures was calculated.

Results:

46 eyes with manifest or subclinical keratoconus and 52 normal control eyes were analyzed. For OCT measurements in keratoconus, better accuracy was achieved with pupil centration and 3 mm analytical zone; however, better repeatability was achieved with vertex centration and 4 mm analytical zone (coefficient of repeatability = 0.53 diopters, the Fligner-Killeen test with Bonferroni adjustment P < .0017). Agreement with manifest refraction was significantly better with OCT compared with that using Pentacam HR (generalized mixed-effect model with Bonferroni adjustment P < .00625). No statistically significant difference was found between instruments or settings in control eyes.

Conclusions:

OCT was able to measure net corneal astigmatism with better accuracy and precision in keratoconic eyes than the Pentacam HR. Measurements may be more accurate using pupil centration and a smaller analytical zone in patients with keratoconus.
Emerging Lessons and Policy Options for Sexually Transmitted Infection Telehealth Payment: A Narrative Review
Authors: Crowley Jeffrey S. , Hidalgo Julia , McGuire Jean Flatley , Haddad Marwan S.
Published: May 2022

Long before the SARS-CoV-2 (hereafter COVID-19) pandemic, sexually transmitted infection (STI) prevention and control was underresourced in the United States, leading to large and sustained increases in reportable STIs and harmful sequelae of these infections. The abrupt disruption associated with the national shutdown of many public services in early 2020 forced STI clinics and programs to rapidly adopt new models of care, including the greatly increased use of telehealth services. Federal policy makers took actions to relax many requirements in Medicare and other programs that previously impeded the use of telehealth. Numerous states also adopted emergency policies to facilitate the delivery of telehealth services through Medicaid, many of which are related to payment for services. It is unresolved whether and which policies will or should be extended after the public health emergency. How these services are financed and reimbursed underpins the ability to effectively prevent and treat STIs and improve public health. Ultimately, payment systems need to support the solvency and stability of sexual health clinics and other health care services organizations in ways that support providers and that also improve patient satisfaction and retention in care. The Centers for Disease Control and Prevention and state/local health departments have important roles to play in supporting the dialogue needed to create new payment models and facilitate communication and technical assistance across public health and insurance systems. Sexual health providers must be engaged in iterative processes that continue to evolve and can be evaluated over time.
Why Is Patient Safety a Challenge? Insights From the Professionalism Opinions of Medical Students’ Research
Authors: McGurgan Paul M. , Calvert Katrina L. , Nathan Elizabeth A. , Narula Kiran , Celenza Antonio , Jorm Christine
Published: May 2022

Objectives

Despite increased emphasis on education and training for patient safety in medical schools, there is little known about factors influencing decision making regarding patient safety behaviors. This study examined the nature and magnitude of factors that may influence opinions around patient safety–related behaviors as a means of providing insights into how Australian doctors and medical students view these issues relative to members of the public.

Methods

A national, multicenter, prospective, cross-sectional survey was conducted using responses to hypothetical patient safety scenarios involving the following: fabricating results, personal protective equipment, presenteeism, and reporting concerns.

Australian enrolled medical students, medical doctors, and members of the public were surveyed.

Participant responses were compared for the different contextual variables within the scenarios and the participants’ demographic characteristics.

Results

In total, 2602 medical student, 809 doctors, and 503 members of the Australian public participated. The 3 demographic groups had significantly differing opinions on many of the patient safety dilemmas. Doctors were more tolerant of medical students not reporting concerning behaviors and attending placements despite recent illness. Medical students’ opinions frequently demonstrated a “transition effect,” bridging between the doctors and publics’ attitudes, consistent with professional identity formation.

Conclusions

Opinions on the acceptability of medical students’ patient safety–related behaviors were influenced by the demographics of the cohort and the contextual complexity of the scenario. Although the survey used hypothetical scenarios, doctors and medical students’ opinions seem to be influenced by cognitive dissonances, biases, and heuristics, which may negatively affect patient safety.
Patient Safety and Legal Regulations: A Total-Scale Analysis of the Scientific Literature
Authors: Yeung Andy Wai Kan , Kletecka-Pulker Maria , Klager Elisabeth , Eibensteiner Fabian , Doppler Klara , El-Kerdi Amer , Willschke Harald , Völkl-Kernstock Sabine , Atanasov Atanas G.
Published: May 2022

Objective

The aim of the study was to quantitatively analyze the scientific literature landscape covering legal regulations of patient safety.

Methods

This retrospective bibliometric analysis queried Web of Science database to identify relevant publications. The identified scientific literature was quantitatively evaluated to reveal prevailing study themes, contributing journals, countries, institutions, and authors, as well as citation patterns.

Results

The identified 1295 publications had a mean of 13.8 citations per publication and an h-index of 57. Approximately 78.8% of them were published since 2010, with the United States being the top contributor and having the greatest publication growth. A total of 79.2% (n = 1025) of the publications were original articles, and 12.5% (n = 162) were reviews. The top authors (by number of publications published on the topic) were based in the United States and Spain and formed 3 collaboration clusters. The top institutions by number of published articles were mainly based in the United States and United Kingdom, with Harvard University being on top. Internal medicine, surgery, and nursing were the most recurring clinical disciplines. Among 4 distinct approaches to improve patient safety, reforms of the liability system (n = 91) were most frequently covered, followed by new forms of regulation (n = 73), increasing transparency (n = 67), and financial incentives (n = 38).

Conclusions

Approximately 78.8% of the publications on patient safety and its legal implications were published since 2010, and the United States was the top contributor. Approximately 79.2% of the publications were original articles, whereas 12.5% were reviews. Healthcare sciences services was the most recurring journal category, with internal medicine, surgery, and nursing being the most recurring clinical disciplines. Key relevant laws around the globe were identified from the literature set, with some examples highlighted from the United States, Germany, Italy, France, Sweden, Poland, and Indonesia. Our findings highlight the evolving nature and the diversity of legislative regulations at international scale and underline the importance of healthcare workers to be aware of the development and latest advancement in this field and to understand that different requirements are established in different jurisdictions so as to safeguard the necessary standards of patient safety.
Implementing Root Cause Analysis and Action: Integrating Human Factors to Create Strong Interventions and Reduce Risk of Patient Harm
Authors: Wolf Laurie , Gorman Kristen , Clark Joshua , Gleason Jonathan , Henrickson Parker Sarah
Published: May 2022

Objectives

The goal of this study was to develop a systems approach for root cause analysis and action to achieve strong, sustainable interventions. The team integrated human factors principles into the design of interventions to ensure solutions maintain compatibility with human capabilities and limitations resulting in stronger solutions to prevent reoccurrence.

Methods

This study was conducted at a 7-hospital health system located in southwestern Virginia. Including human factors in a new root cause analysis and action process allowed the team to design strong interventions. To assess the results of this process, a team evaluated all interventions over a 4-year period (2.75-y preimplementation and 1.4-y postimplementation). Interventions were initially blind coded and then consensus coding was executed to finalize the strength of each intervention according to the VA National Center for Patient Safety evaluation tool.

Results

The new process resulted in an efficient method to address adverse events with increased staff satisfaction and interventions more resilient to human error. The number of events with strong interventions increased from 43% to 69% after implementation of the new process.

Conclusions

Tailoring an event investigation process to an organizational culture is critical to implementation success. Adding human factors into the design of interventions helped facilitate intervention implementation and sustainability. Blinded ratings showed that with the integration of human factors, there was improved strength of interventions. This indicates that a focus on strong system improvement (rather than weaker individual human-based solutions) will lead to improved staff satisfaction and patient safety.
Time Between Viral Loads for People With HIV During the COVID-19 Pandemic
Authors: El-Nahal Walid G. , Shen Nicola M. , Keruly Jeanne C. , Jones Joyce L. , Fojo Anthony T. , Manabe Yukari C. , Moore Richard D. , Gebo Kelly A. , Chander Geetanjali , Lesko Catherine R.
Published: May 2022

Background:

During the COVID-19 pandemic, patients experienced significant care disruptions, including laboratory monitoring. We investigated changes in the time between viral load (VL) checks for people with HIV (PWH) associated with the pandemic.

Setting and Methods:

This was an observational analysis of VLs of PWH in routine care at a large subspecialty clinic. At pandemic onset, the clinic temporarily closed its onsite laboratory. The exposure was time period (time varying): prepandemic (January 1, 2019–March 15, 2020); pandemic laboratory closed (March 16–July 12, 2020); and pandemic laboratory open (July 13–December 31, 2020). We estimated time from an index VL to a subsequent VL, stratified by whether the index VL was suppressed (≤200 copies/mL). We also calculated cumulative incidence of a nonsuppressed VL following a suppressed index VL, and of resuppression following a loss of viral suppression.

Results:

Compared with prepandemic, hazard ratios for next VL check were 0.34 (95% CI: 0.30 to 0.37, laboratory-closed) and 0.73 (CI: 0.68 to 0.78, laboratory-open) for suppressed patients, and 0.56 (CI: 0.42 to 0.79, laboratory-closed) and 0.92 (95% CI: 0.76 to 1.10, laboratory-open) for nonsuppressed patients. The 12-month cumulative incidence of loss of suppression was the same in the pandemic laboratory-open (4%) and prepandemic (4%) period. The hazard of resuppression following the loss of suppression was lower during the pandemic laboratory-open versus the prepandemic period (hazard ratio: 0.68, 95% CI: 0.50 to 0.92).

Conclusions:

Early pandemic restrictions and laboratory closure significantly delayed VL monitoring. Once the laboratory reopened, nonsuppressed patients resumed normal monitoring. Suppressed patients still had a delay but no significant loss of suppression.