bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of Isatuximab With Pomalidomide and Dexamethasone in Relapsed Myeloma: Results of a UK-Wide Real-World Dataset
Authors: Djebbari Faouzi , Rampotas Alexandros , Vallance Grant , Panitsas Fotios , Basker Nanda , Sangha Gina , Salhan Beena , Karim Farheen , Al-Kaisi Firas , Gudger Amy , Ngu Loretta , Poynton Matt , Lam Ho Pui Jeff , Morgan Lowri , Yang Laura , Young Jennifer , Walker Mairi , Tsagkaraki Ismini , Anderson Laura , Chauhan Saleena Rani , Maddams Rebecca , Soutar Richard , Triantafillou Margarita , Prideaux Steve , Obeidalla Abubaker , Bygrave Ceri , Basu Supratik , Ramasamy Karthik
Published: May 2022

Real-world data on the efficacy and tolerability of isatuximab with pomalidomide and dexamethasone (IsaPomDex) in relapsed/refractory myeloma patients have not been reported. In this UK-wide retrospective study, IsaPomDex outcomes were evaluated across 24 routine care cancer centers. The primary endpoint was overall response rate (ORR). Secondary endpoints included progression-free survival (PFS), duration of response (DOR) for patients who achieved an objective response (≥partial response [PR]), and adverse events (AEs). In a total cohort 107 patients, median follow up (interquartile range [IQR]) was 12.1 months (10.1–18.6 mo), median age (IQR) was 69 years (61–77). Median (IQR) Charlson Comorbidity Index (CCI) score was 3 (2–4); 43% had eGFR <60 mL/min. Median (IQR) number of prior therapies was 3 (3–3). Median (IQR) number of IsaPomDex cycles administered was 7 (3–13). ORR was 66.4%, with responses categorized as ≥ very good partial response: 31.8%, PR: 34.6%, stable disease: 15.9%, progressive disease: 15%, and unknown 2.8%. Median PFS was 10.9 months. Median DOR was 10.3 months. There was no statistical difference in median PFS by age (<65: 10.2 versus 65–74 13.2 versus ≥75: 8.5 mo, log-rank P = 0.4157), by CCI score (<4: 10.2 mo versus ≥4: 13.2, log-rank P = 0.6531), but inferior PFS was observed with renal impairment (≥60: 13.2 versus <60: 7.9 mo, log-rank P = 0.0408). Median OS was 18.8 months. After a median of 4 cycles, any grade AEs were experienced by 87.9% of patients. The most common ≥G3 AEs were neutropenia (45.8%), infections (18.7%), and thrombocytopenia (14%). Our UK-wide IsaPomDex study demonstrated encouraging efficacy outcomes in the real world, comparable to ICARIA-MM trial.
An Investigation of Physiological System Impairments in Individuals 4 Weeks to 6 Months Following Mild Traumatic Brain Injury
Authors: Galea Olivia , O'Leary Shaun , Treleaven Julia
Published: May 2022

Objective:

The Buffalo Concussion Treadmill Test (BCTT) was developed to identify potential physiological system impairment (PSI) underlying persistent symptoms post-mild traumatic brain injury (mTBI). This study evaluates PSI in individuals 4 weeks to 6 months post-mTBI using the BCTT “failure” criteria, and additional exploratory measures of test duration and heart rate (HR) response.

Setting:

Tertiary hospital and university.

Participants:

Participants included 73 individuals 4 weeks to 6 months post-mTBI and a comparison group of 39 healthy controls (HCs). The mTBI group was further subgrouped at screening into those considering themselves asymptomatic (Asymp mTBI) (n = 35) or symptomatic (Symp mTBI) (n = 36).

Design:

Observational cohort study.

Main Measures:

BCTT; failure rate (%), test duration (minutes), HR responses.

Results:

: Thirty percent of the mTBI group (including 50% of the Symp and 9% of the Asymp subgroups) failed the BCTT. BCTT duration and associated overall HR change was significantly lower in the mTBI group and Symp subgroup compared with HCs. Compared with HCs maximal HR percentage was higher for the first 4 minutes of the test in the mTBI group, and for the first 2 minutes of the test for the Symp subgroup.

Conclusions:

Individuals post-mTBI demonstrated PSI impairment subacutely. In some individuals this was despite an initially reported absence of symptoms. The study also showed some preliminary evidence that BCTT duration and HR responses may be additionally informative post-mTBI.
Crash Risk Following Return to Driving After Moderate-to-Severe TBI: A TBI Model Systems Study
Authors: Novack Thomas , Zhang Yue , Kennedy Richard , Rapport Lisa J. , Bombardier Charles , Bergquist Thomas , Watanabe Thomas , Tefertiller Candy , Goldin Yelena , Marwitz Jennifer , Dreer Laura E. , Walker William , Brunner Robert
Published: May 2022

Objective:

To examine motor vehicle crash frequency and risk factors following moderate-to-severe traumatic brain injury (TBI).

Setting:

Eight TBI Model Systems sites. Participants: Adults (N = 438) with TBI who required inpatient acute rehabilitation.

Design:

Cross-sectional, observational design.

Main Measures:

Driving survey completed at phone follow-up 1 to 30 years after injury.

Results:

TBI participants reported 1.5 to 2.5 times the frequency of crashes noted in the general population depending on the time frame queried, even when accounting for unreported crashes. Most reported having no crashes; for those who experienced a crash, half of them reported a single incident. Based on logistic regression, age at survey, years since injury, and perception of driving skills were significantly associated with crashes.

Conclusion:

Compared with national statistics, crash risk is higher following TBI based on self-report. Older age and less time since resuming driving were associated with lower crash risk. When driving was resumed was not associated with crash risk. These results do not justify restricting people from driving after TBI, given that the most who resumed driving did not report experiencing any crashes. However, there is a need to identify and address factors that increase crash risk after TBI.
Characteristics of Responders and Nonresponders in a Military Postconcussion Rehabilitation Program
Authors: Nix Caitlyn A. , Cummings Latiba D. , Lu Lisa H. , Bowles Amy O.
Published: May 2022

Objective:

To characterize treatment responders and nonresponders as measured by the Neurobehavioral Symptom Inventory (NSI) in order to understand whether certain traits in our patient population would characterize favorable response.

Setting:

Brain Injury Rehabilitation Service at Brooke Army Medical Center, Fort Sam Houston, San Antonio, Texas.

Patients:

In total, 655 active duty military patients with a diagnosis of mild traumatic brain injury (mTBI) who received treatment between 2007 and 2020 and completed self-report measures as part of routine care.

Design:

Observational retrospective analysis of outpatient clinical outcomes data.

Main Measures:

The primary outcome measure was the NSI, divided into the responder and nonresponder groups. Responders were defined by reliable change in NSI total score (decrease of ≥8 points from intake to discharge).

Findings:

Responders (n = 395) reported a higher level of symptom burden at intake on the NSI. Women responded proportionally more (70%) than men (58%). After treatment, responders reported improvements on all measures evaluated while nonresponders reported no change or slightly worse symptoms. Logistic regression analysis showed that posttraumatic stress symptoms at intake decreased odds of favorable treatment response while satisfaction with social relationships increased odds of favorable treatment response.

Conclusion:

The results from this process improvement project suggested that posttraumatic symptoms warrant programmatic attention in TBI clinics while social relationships may be a protective factor that can be capitalized to enhance troop readiness. Systematic examination of these characteristics should be conducted on a larger population within the military health system.
Comparison of Participants' Behaviors During Telepractice and In-Person Family-Centered Early Intervention
Authors: McCarthy Melissa , Leigh Greg , Arthur-Kelly Michael
Published: May 2022

Family-centered early intervention (FCEI) is characterized by the collaborative relationships that exist within triads of practitioners, caregivers, and young children whereby practitioners use capacity-building practices to foster caregivers' involvement in supporting their children's early development. Traditionally, FCEI has been provided in-person with practitioners and families physically present in the same location but, for children who are deaf or hard of hearing, access to in-person early intervention is often limited by external factors. To address these challenges, practitioners are using telepractice more frequently to connect with families through synchronous, 2-way videoconferencing. This exploratory study examined whether participants' behaviors differed when FCEI was delivered in-person and through telepractice. The Triadic Intervention and Evaluation Rating Scale (TIERS) was used to compare 2 groups of triads (16 in-person and 12 telepractice) in terms of practitioner behaviors, caregiver behaviors, and the reciprocal influences of those behaviors. Results indicated that practitioners in telepractice used most family-centered practices more frequently than practitioners in-person. Correspondingly, caregivers in telepractice had more opportunities to participate in early intervention and more frequently demonstrated a variety of participation behaviors than caregivers in-person. Although further research is required to confirm these exploratory findings, these results suggest that FCEI provided through telepractice may enhance practitioners' use of family-centered practices, which, in turn, supports greater participation by caregivers.
Including Peers in Intervention for Young Children With Disabilities
Authors: Hanline Mary Frances , Eldridge Jennifer Nicole , Robbins Audrey
Published: May 2022

The purpose of this systematic review was to describe single case design (SCD) research studies that systematically included peers in interventions designed to have positive outcomes for children with disabilities aged 3–8 years. Thirty-nine articles published in peer-referred journals in the past 10 years were analyzed in relation to study rigor and characteristics of interventions. Overall, this review supports including peers into systematic interventions for young children with disabilities, as the interventions were effective in producing positive changes in the behavior of young children with a variety of disabilities in social, communication, cognitive, play, and academic skills. No clear pattern emerged of a relationship between ecological factors (setting and interventionist) and generalization and maintenance of child behaviors. The analysis of study rigor suggests that fewer than half of the studies met current standards for SCD research and the number of studies conducting generalization, maintenance, and social validity was inadequate. A significant challenge for the field is to conduct more rigorous research to identify critical factors promoting positive behavior change for young children with disabilities when peers are included in interventions.
Molecular characteristics of cephalosporins resistant Neisseria gonorrhoeae strains isolated from Gonococcal Antimicrobial Resistance Surveillance Program in China, 2015-2016
Authors: Zhang Jin , Zhu Xiao-Yu , Liu Jing-Wei , Chen Shao-Chun , Yin Yue-Ping
Published: May 2022

Background:

An increasing level of antimicrobial resistance to extended-spectrum cephalosporins (ESCs), has been reported by the China Gonococcal Antimicrobial Resistance Surveillance Program (China-GRSP).

Methods:

2038 Neisseria gonorrhoeae (NG) isolates were collected from China-GRSP between 2015 and 2016. NG multiantigen sequence typing (NG-MAST), MLST (multi-locus sequence typing) and NG sequence typing for antimicrobial resistance (NG-STAR) were used to determine characteristics and resistant determinants of cephalosporins resistant isolates.

Results:

74 (3.6%) cephalosporins resistant isolates were confirmed. MLSTST7363 was the most prevalent MLST among cefixime resistant (CFX-R) isolates, while MLSTST7365 (n = 8) in ceftriaxone resistant (CRO-R) isolates. And CFX-R strains mainly associated with penA-X(n = 27,44.3%), penA-XIII (n = 6,9.8%), penA-XVIII (n = 5, 8.2%), and CRO-R strains mainly related to penA-XVIII (n = 10,25.6%), penA-43(n = 9,23.1%), penA-XIII(n = 7,17.9%).

Conclusion:

The main conclusion of this study is that the predominant cephalosporin-resistant clones in China include locally emerged and imported linages. The CFX-R and CRO-R strains are primarily related to penA mutations and their predominant genotypes are different. With the increase of international travel, tracking high-risk resistant clones and identifying outbreaks and their association with epidemiological characteristics are critical to improve public health.
Addressing the Opioid Crisis: Medication-Assisted Therapy Waiver Training for Students
Authors: Ma Sae Byul , Feldman Corinne T. , D'Aquila Mitzi , Lowe Enya , Lie Désirée
Published: May 2022

Purpose

Physician assistant (PA) graduates should be prepared to care for patients with substance use disorders. Medication-assisted therapy (MAT) allows PA graduates to provide that care by becoming licensed to prescribe buprenorphine. However, it is unclear how feasible and effective it is to implement online MAT waiver training during PA school. This study examined student knowledge and attitudes after training to assess its impact and perceived value.

Methods

We conducted a 15-question survey after one class of students completed training during clinical rotations. Students self-reported pre/post change in awareness, knowledge, interest, comfort and confidence, perceived usefulness to practice, and assessed quality using 5-point Likert scale (higher scores = more positive) and narrative responses. Data analysis was performed using the Wilcoxon signed rank test and descriptive statistics. Free text comments were analyzed for themes using constant comparison.

Results

Fifty-five (100%) students completed training within 6 weeks. The survey response rate was 49/55 (89%). Pre-to-post score changes were significant (p < .05) from +0.39 to +1.35 with the greatest changes seen in knowledge (+1.35), comfort (+1.14), awareness (+1.06), and confidence (+1.08); the lowest change was in interest (score change +0.39). Students reported being satisfied with content organization and quality (mean 3.82) and recommended training to colleagues (3.98); 82% reported they would have preferred 3 months to complete training; 46% would have preferred training prior to the start of clinical rotations. Major themes indicated a desire for better preparation and flexibility of platform, with ambivalence about relevance to practice.

Conclusion

Online MAT waiver training is feasible and effective. However, students may not be convinced of its relevance to future practice. Faculty should offer adequate preparation and optimize integration into existing curricula.
Injection of Recombinant Tissue Plasminogen Activator into Extracorporeal Membrane Oxygenators Postpones Oxygenator Exchange in COVID-19
Authors: Mang Sebastian , Danziger Guy , Metz Carlos , Rixecker Torben , Becker André , Omlor Albert J. , Jentgen Christophe , Schmoll Christian , Seiler Frederik , Reyher Christian , Muellenbach Ralf M. , Bals Robert , Lepper Philipp M.
Published: May 2022

Coronavirus disease 2019 (COVID-19) has drastically increased the number of patients requiring extracorporeal life support. We investigate the efficacy and safety of low-dose recombinant tissue-type plasminogen activator (rtPA) injection into exhausted oxygenators to delay exchange in critically ill COVID-19 patients on veno-venous extracorporeal membrane oxygenation (V-V ECMO). Small doses of rtPA were injected directly into the draining section of a V-V ECMO circuit. We compared transmembrane pressure gradient, pump head efficiency, membrane arterial partial oxygen pressure, and membrane arterial partial carbon dioxide pressure before and after the procedure. Bleeding was compared with a matched control group of 20 COVID-19 patients on V-V ECMO receiving standard anticoagulation. Four patients received 16 oxygenator instillations with rtPA at 5, 10, or 20 mg per dose. Administration of rtPA significantly reduced transmembrane pressure gradient (Δp
m = 54.8 ± 18.1 mmHg before vs. 38.3 ± 13.3 mmHg after, p < 0.001) in a dose-dependent manner (Pearson’s R −0.63, p = 0.023), allowing to delay oxygenator exchange, thus reducing the overall number of consumed oxygenators. rtPA increased blood flow efficiency η (1.20 ± 0.28 ml/revolution before vs. 1.24 ± 0.27 ml/r, p = 0.002). Lysis did not affect membrane blood gases or systemic coagulation. Minor bleeding occurred in 2 of 4 patients (50%) receiving oxygenator lysis as well as 19 of 20 control patients (95%). Lysis of ECMO oxygenators effectively delays oxygenator exchange, if exchange is indicated by an increase in transmembrane pressure gradient. Application of lysis did not result in higher bleeding incidences compared with anticoagulated patients on V-V ECMO for COVID-19.
Effects of Adult Medicaid Dental Benefits Elimination on Child Dental Care Use
Authors: Hill Courtney M. , Jones Michael P. , Chi Donald L.
Published: May 2022

Objective:

The objective of this study was to examine the effect of adult dental benefit cuts on child dental use in Washington state Medicaid and determine if cuts affect child demographic subgroups differentially.

Research Design:

The study used an interrupted time-series methodology to measure differences in child dental use after adult dental benefit elimination and reinstatement. Monthly data came from Washington state Medicaid enrollee and dental claim files from January 2008 to December 2015.

Subjects:

Medicaid-enrolled children with at least one Medicaid-enrolled adult in the same household were the intervention group, and Medicaid-enrolled children without a Medicaid-enrolled adult in the same household were the control group.

Measures:

The outcome was the monthly proportion of Medicaid-enrolled children with a dental examination per 10,000 Medicaid-enrolled children.

Results:

After adult dental benefits elimination, dental examinations among children with Medicaid-enrolled adults in the same household gradually decreased, corresponding to 65 fewer dental examinations per 10,000 children per year (5.4 fewer dental examinations per 10,000 children per month; 95% confidence interval: −7.7, −3.1; P=0.006). Adult dental benefits had no effect on dental examination for children without a Medicaid-enrolled adult in the same household. Dental examinations for children with a Medicaid-enrolled adult in the same household continued to gradually decrease after adult benefits reinstatement. Children younger than age 6 were the most adversely impacted by changes to adult Medicaid dental benefits.

Conclusion:

Policymakers should consider the spillover effects and ethical considerations of eliminating adult Medicaid dental benefits on children’s access to dental care.
Post-Hospital Availability of Instrumental Support May Influence Patients' Readiness for Discharge
Authors: Schultz Beth E. , Corbett Cynthia F. , Hughes Ronda G. , Bell Nathaniel
Published: May 2022

Purpose of Study:

Evaluate the relationship between unplanned acute care utilization after discharge from an index hospital admission and registered nurse and patient perceptions of available instrumental support the patient would have after discharge.

Primary Practice Setting:

Three hospitals in a large regional hospital system in the southeastern United States.

Methodology and Sample:

Retrospective, secondary quantitative analysis of 13,361 patient records (mean age 58.4 years; 51% female) from index hospitalizations evaluating patient and nurse responses to 2 questions that specifically address instrumental support on both the patient and nurse versions of the Readiness for Hospital Discharge Survey (RHDS) and subsequent unexpected care received (emergency department [ED] visit, observation stay, hospital readmission) in the acute care setting within 60 days of discharge. Logistic regression was used to evaluate the relationship between RHDS scores and unplanned care received.

Results:

Patients who required hospital-based acute care within 60 days after discharge had lower average RN-RHDS scores than those who did not require hospital-based acute care.

Implications for Case Management Practice:

Including a nursing assessment of potential postdischarge expected instrumental support may be helpful in identifying patients who are at a higher risk of experiencing postdischarge acute care utilization. Monitoring ED visits and observation stays in addition to readmissions will facilitate capturing significantly more points of care received after discharge and provide additional information regarding postdischarge care utilization.
Parent-Reported Experience Measures of Care for Children With Serious Illnesses: A Scoping Review
Authors: Ang Felicia Jia Ler , Finkelstein Eric Andrew , Gandhi Mihir
Published: May 2022

OBJECTIVE:

This scoping review aimed to: 1) identify parent-reported experience measures (PaREMs) for parents of children with serious illnesses from peer-reviewed literature, 2) map the types of care experience being evaluated in PaREMs, 3) identify and describe steps followed in the measure development process, including where gaps lie and how PaREMs may be improved in future efforts, and 4) help service providers choose a PaREM suitable for their service delivery setting and strategy.

DATA SOURCES:

Relevant articles were systematically searched from PubMed, CINAHL, and Scopus EBSCOhost databases until June 10, 2021, followed by a manual reference list search of highly relevant articles.

STUDY SELECTION:

Abstracts were screened, followed by a full-text review using predetermined inclusion and exclusion criteria.

DATA EXTRACTION:

A standardized data extraction tool was used.

DATA SYNTHESIS:

Sixteen PaREMs were identified. There were large variances in the development processes across measures, and most have been developed in high-income, English-speaking Western countries. Most only assess the quality of acute inpatient care. Few measures can be used by multiple service providers or chronic care, and many do not capture all relevant domains of the parent experience.

CONCLUSIONS:

Service providers should integrate PaREMs into their settings to track and improve the quality of care. Given the multidisciplinary nature of pediatric care and the often-unpredictable disease trajectories of seriously ill children, measures that are applicable to multiple providers and varying lengths of care are essential for standardized assessment of quality of care and coordination among providers. To improve future PaREM development, researchers should follow consistent and methodologically robust steps, ideally in more diverse sociocultural and health systems contexts. Future measures should widen their scope to be applicable over the disease trajectory and to multiple service providers in a child’s network of care for a comprehensive evaluation of experience.
Ultrasound-Guided Paravenous Saphenous Nerve Block for Lower Extremity Abscess Incision and Drainage in a Male Adolescent
Authors: Allen Kelsey W. , Moake Matthew M.
Published: May 2022

The use of ultrasound-guided regional anesthesia is growing as a modality for analgesia provision within the pediatric emergency department. We present a case in which a paravenous saphenous nerve block was used for anesthesia during incision and drainage of a lower extremity abscess. We further review the technique and literature concerning this straightforward and effective procedure.
The Outcomes of an Individualized Physical Therapy Program in CALFAN Syndrome: A Case Report
Authors: Yigit Sedat , Albayrak Hatice Mutlu , Perk Yücel Peren , Usgu Serkan , Yakut Yavuz
Published: May 2022

Purpose:

This case report investigated the effectiveness of an individualized physical therapy program in CALFAN syndrome.

Case Description:

A 13-year-old girl participated in physical therapy, which included trunk stabilization, balance training, and functional exercises for 12 weeks.

Assessments:

The International Cooperative Ataxia Rating Scale; Trunk Impairment Scale; Pediatric Quality of Life Inventory; Functional Independence Measure for Children; Quick Disability of the Arm, Shoulder, and Hand Questionnaire; 9-Hole Peg Test; and Cobb measurement were used as outcome measures.

Results:

Positive changes were observed in the International Cooperative Ataxia Rating Scale; Quick Disability of the Arm, Shoulder, and Hand Questionnaire; Pediatric Quality of Life Inventory; Trunk Impairment Scale; Functional Independence Measure; and the 9-Hole Peg Test. The Cobb angle was increased by 2° in the thoracic region and reduced by 11° in the lumbar region.

Conclusions:

Physical therapy improved quality of life, functional independence, trunk control, and upper extremity performance.

What This Adds to Evidence:

This case report is the first to support the effectiveness of physical therapy for a child with CALFAN syndrome.
Infants With Congenital Muscular Torticollis Requiring Supplemental Physical Therapy Interventions
Authors: Greve Kelly R. , Goldsbury Courtney M. , Simmons Erin A.
Published: May 2022

Purpose:

To describe supplemental intervention (SI) frequency in infants with congenital muscular torticollis (CMT) and compare groups of infants who received first-choice intervention only to infants who received SI.

Methods:

Data were retrospectively extracted from a registry. Baseline and treatment variables were collected and analyzed.

Results:

The cohort included 907 infants with 85 receiving SI. Order of SI frequency was kinesiological tape, manual techniques, tubular orthosis for torticollis (TOT) collar, and the Benik system. Statistically significant differences were found in baseline age, passive cervical range of motion (ROM), muscle function, and treatment time between groups. A positive association was found for CMT presentation, classification grade, plagiocephaly type, and external referrals between groups.

Conclusions:

Nine percent of infants received SI, most frequently kinesiological tape. Infants who received SI had larger baseline passive ROM and muscle function differences and more visits over a longer duration but had similar CMT resolution. Education is needed when using SI.
Public Health Department Accreditation and Innovation: A Brief Report of the Approaches Used to Promote Innovation
Authors: Lang Britt , Rich Naomi , Kronstadt Jessica , Harris April
Published: May 2022

To examine the relationship between public health accreditation and innovation, we analyzed accredited health departments' self-reported responses to a prompt within the Public Health Accreditation Board's (PHAB's) Annual Report regarding any approaches to pursuing innovation within their health department. We found that of the 205 health departments examined, 75 (37%) described elements of the health department's approach to fostering innovation. The most common approaches to innovation included partnerships (59% of those health departments that described their innovation approaches) and leadership (27%). Other common elements, mentioned by at least 20% of health departments that provided their innovation approach, include funding, internal collaboration, training, and devoting time to innovation. Both larger health departments and state health departments were more likely than smaller health departments and local health departments to describe elements of their approach in fostering innovation, suggesting that those types of health departments may have access to resources and flexibility in staffing, both integral elements for promoting innovation.
Structuring Equity Into Minnesota's COVID-19 Response: Lessons Learned and Future Investments
Authors: Chute Sara , Chomilo Nathan T. , Dionne Jackie , Huntley Chelsie , Linde Ann , Wanduragala Danushka
Published: May 2022

Background:

The Minnesota Department of Health (MDH) integrated 3 intentional teams into their novel coronavirus 2019 (COVID-19) response to ensure equity was not lost in the speed of response.

Implementation:

These teams—the Cultural, Faith, and Disability Communities Branch, Tribal COVID-19 Healthcare Team, and Vaccine Equity Branch were able to reach communities through trusted partners, elevate the voices of communities most impacted, respect tribal sovereignty, establish equity leadership, and set equity goals and metrics.

Lessons Learned:

The top-down nature of incident command, combined with pre-COVID-19 systems and structures that impede equity, led to both barriers and opportunities for centering equity in response efforts. Inclusion of staff and community voice in decisions and guidance leads to better results; each community's unique needs have to be considered. Equity metrics and goals help direct resources to the most disadvantaged. State, local, and tribal public health infrastructure was built quickly and needs ongoing resources to be sustained.

Future Investments:

MDH is leveraging new funding to embed successful response structures into the organization. These structures are intended to build state, local, and tribal capacity and address systemic challenges at MDH.

Conclusion:

While equity can be incorporated into pandemic response and incident command structures, ongoing investment to support public health infrastructure is vital to sustaining equity.
Evaluation of the First Year of the Cross-Sector Innovation Initiative: Lessons Learned in Advancing Cross-Sector Alignment
Authors: Napp David , Conklin Jane
Published: May 2022

The Cross-sector Innovation Initiative (CSII) funded 10 communities for 2 years to support public health, health care, and social services sector alignment and community engagement to improve health equity and population health. The CSII is founded on the idea that working in alignment across sectors, in partnership with the community, better positions agencies and the communities they serve to address health inequities in meaningful and innovative ways. This evaluation identified the activities that sites undertook during the first year of the program to align sectors and engage the community, and factors that facilitated and hindered those efforts. The evaluation utilized secondary data from project reports and primary data from observations of peer-to-peer learning events. This evaluation found that cross-sector alignment benefits from a sustained focus on longer-term goals and the ability to build, strengthen, and maintain trust and commitment among cross-sector partners and community stakeholders and to explicitly include community voice and participation.
Lessons Learned: The Varied Responses of Massachusetts' Local Health Departments During the COVID-19 Pandemic
Authors: Mauzy Steven , Putney Kimberly , Baroni Emily , Dey Andrew , Elangovan Kavya , Ji Grace , McHale Samantha , Prabha Gargi , Sarkisova Natalya , Granger Stephanie , Black Kristin , Lindenmayer Joann
Published: May 2022

Context:

Massachusetts' decentralized public health model holds tightly to its founding principle of home rule and a board of health system established in 1799. Consequently, Massachusetts has more local health departments (n = 351) than any other state. During COVID-19, each health department, steeped in centuries of independence, launched its own response to the pandemic.

Objectives:

To analyze local public health resources and responses to COVID-19.

Design:

Semistructured interviews and a survey gathered quantitative and qualitative information about communities' responses and resources before and during the pandemic. Municipality demographics (American Community Survey) served as a proxy for community health literacy. We tracked the frequency and content of local board of health meetings using minutes and agendas; we rated the quality of COVID-19 communications on town Web sites.

Setting:

The first 6 months of the COVID-19 pandemic in Massachusetts: March-August 2020.

Participants:

Health directors and agents in 10 south-central Massachusetts municipalities, identified as the point of contact by the Academic Public Health Corps.

Main Outcome Measures:

We measured municipality resources using self-reported budgets, staffing levels, and demographic-based estimates of community health literacy. We identified COVID-19 responses through communities' self-reported efforts, information on town Web sites, and meeting minutes and agendas.

Results:

Municipalities excelled in communicating with residents, local businesses, and neighboring towns but lacked the staffing and funding for an efficient and coordinated response. On average, municipal budgets ranged from $5 to $16 per capita, and COVID-19 consumed 75% of health department staff time. All respondents noted extreme workload increases. While municipal Web sites received high scores for Accurate Information, other categories (Navigability; Timeliness; Information Present) were less than 50%.

Conclusions:

Increased support for regionalization and sustained public health funding would improve local health responses during complex emergencies in states with local public health administration.
Exploring Care Left Undone in Pediatric Nursing
Authors: Bagnasco Annamaria , Rossi Silvia , Dasso Nicoletta , Catania Gianluca , Zanini Milko , Aleo Giuseppe , Scelsi Silvia , Petralia Paolo , Watson Roger , Sasso Loredana
Published: May 2022

Objectives

This study aimed to investigate the association between nursing care left undone in pediatrics and factors related to nursing staff characteristics and work environment.

Methods

The data of the present study were extracted from our RN4CAST@IT-Ped database, a cross-sectional observational study, which included 13 hospitals belonging to the Italian Association of Paediatric Hospitals. Through convenience sampling, nurses and pediatric nurses providing direct care in routine pediatric wards were enrolled in the study. Data aggregated by clinical care area were analyzed, through descriptive and inferential statistics methods using IBM SPSS 22.0 software.

Results

We collected data from 399 pediatric nurses working in surgical wards, 1208 in medical wards, and 631 in critical care units. Some of the investigated factors have shown an association with the risk of omitting essential nursing activities, like health care judged of poor quality, patient safety judged as poor, and nurses’ intention-to-leave the job. For every nursing activity under investigation, we found some significant statistical associations.

Conclusions

Our results are consistent with the international literature showing that nurses miss some activities more frequently. Understanding the associations underpinning care left undone could be a starting point for the implementation of patient-centered care and the improvement of the quality and safety of care in pediatric settings, as well as the work environment.
Understanding Hazards for Adverse Drug Events Among Older Adults After Hospital Discharge: Insights From Frontline Care Professionals
Authors: Xiao Yan , Smith Aaliyah , Abebe Ephrem , Hannum Susan M. , Wessell Andrea M. , Gurses Ayse P.
Published: May 2022

Objectives

Care transitions pose a high risk of adverse drug events (ADEs). We aimed to identify hazards to medication safety for older adults during care transitions using a systems approach.

Methods

Hospital-based professionals from 4 hospitals were interviewed about ADE risks after hospital discharge among older adults. Concerns were extracted from the interview transcript, and for each concern, hazard for medication-related harms was coded and grouped by its sources according to a human factors and systems engineering model that views postdischarge ADEs as the outcome of professional and patient home work systems.

Results

Thirty-eight professionals participated (5 hospitalists, 24 nurses, 4 clinical pharmacists, 3 pharmacy technicians, and 2 social workers). Hazards were classified into 6 groups, ranked by frequencies of hazards coded: (1) medication tasks related at home, (2) patient and caregiver related, (3) hospital work system related, (4) home resource related, (5) hospital professional-patient collaborative work related, and (6) external environment related. Medications most frequently cited when describing concerns included anticoagulants, insulins, and diuretics. Top coded hazard types were complex dosing, patient and caregiver knowledge gaps in medication management, errors in discharge medications, unaffordable cost, inadequate understanding about changes in medications, and gaps in access to care or in sharing medication information.

Conclusions

From the perspective of hospital-based frontline health care professionals, hazards for medication-related harms during care transitions were multifactorial and represented those introduced by the hospital work system as well as defects unrecognized and unaddressed in the home work system.
Growth Differentiation Factor-15 Correlates with Mortality and Severity in Severe Burns
Authors: Onishi Shinya , Ebihara Takeshi , Togami Yuki , Matsubara Tsunehiro , Matsumoto Hisatake , Osuka Akinori , Ogura Hiroshi , Oda Jun
Published: May 2022

Background:

Growth differentiation factor-15 (GDF-15) is expressed in almost all tissues of the body and is necessary for the body's defense response to stress such as inflammation. It has been reported to be associated with incidence and mortality in many diseases, including systemic inflammatory response syndromes. There are no reports on GDF-15 in burns. The purpose of this study was to investigate the trend of GDF-15 in blood in patients with severe burns and to determine its relationship with severity and mortality.

Methods:

This was a retrospective, observational, single-center study. The level of GDF-15 in the blood was measured and compared with clinical parameters, including prognosis. Time points for sample collection were the day of injury, 4 days after injury, and 1 week after injury.

Results:

Eighty-three patients were enrolled in the study. At all time points, GDF-15 levels in the nonsurvivor group were significantly higher than those in the survivor group. In the analysis using the ROC curve for 28-day survival, the AUC of the GDF-15 value on the day of injury was 0.798, which was higher than those of % total body surface area, burn index, and Sequential Organ Failure Assessment (SOFA) score. GDF-15 levels correlated positively with SOFA score, and the relationship became stronger along with the time course of severe burn.

Conclusions:

In the acute phase of severe burn, GDF-15 levels were associated with mortality and SOFA scores.
The Las Vegas military-civilian partnership: An origin story and call to action
Authors: Kilburn Jeremy P. , Streit Stephanie , Degoes John J. , Andersen Allison , Gardner Michael , Fraser Douglas R. , Fildes John
Published: May 2022

Military-civilian partnerships (MCPs) in urban American trauma centers have existed for more than 60 years to assist in the development and maintenance of wartime skills of military medical professionals. In the last 5 years, MCPs have gained congressional support, and their number and variety have grown substantially. The historical impact of these flagship trauma MCPs is well documented, with bidirectional benefit in the advancement of trauma care during the wars in Iraq and Afghanistan both deployed and stateside, and the future aim of MCPs lies primarily in mitigating the “peacetime effect.” The majority of data regarding MCPs; however, focus on trauma care and are biased toward surgeons specifically. The Las Vegas (LV) MCP began in 2002 with the similar goal of sustaining Air Force (AF) expeditionary medical skills by embedding AF medics from nearby Nellis Air Force Base (AFB) into University Medical Center of Southern Nevada (UMC), the only Level 1 Trauma Center in Nevada. Over nearly 20 years, the LV-MCP has evolved into an innovative market-based collaboration composed of numerous relationships and programs that are designed to develop and sustain critical skills for military medical personnel in all aspects of expeditionary medicine. This includes AF medical personnel providing care to federal beneficiaries as well as civilian patients in a variety of medical settings. The partnership's central coordinating authority, the Office of Military Medicine-Las Vegas (OMM-LV), brings together military and civilian organizations with distinct and intersecting missions to support the greater LV population and the DoD mission of readiness. The LV-MCP is presented here as a model for the future of MCPs within the integrated local and national trauma and medical systems.
Synaptic resilience is associated with maintained cognition during
ageing
Authors: King Declan , Holt Kris , Toombs Jamie , He Xin , Dando Owen , Okely J. A. , Rose Jamie , Gunn Ciaran , Correia Adele , Montero Carmen , Tulloch Jane , Lamont Douglas , Taylor Adele M , Harris Sarah E , Redmond Paul , Cox Simon R , Henstridge Christopher M , Deary Ian J , Smith Colin , Spires-Jones Tara L
Published: May 2022

INTRODUCTION

It remains unclear why age increases risk of Alzheimer’s disease and why
some people experience age-related cognitive decline in the absence of
dementia. Here we test the hypothesis that resilience to molecular changes
in synapses contribute to healthy cognitive ageing.

METHODS

We examined post-mortem brain from people in mid-life (n=15), healthy
ageing with either maintained cognition (n=8) or lifetime cognitive decline
(n=7), and Alzheimer’s disease (n=13). Synapses were examined with high
resolution imaging, proteomics, and RNA sequencing. Stem cell-derived
neurons were challenged with Alzheimer’s brain homogenate.

RESULTS

Synaptic pathology increased, and expression of genes involved in
synaptic signalling decreased between mid-life, healthy ageing and
Alzheimer’s. In contrast, brain tissue and neurons from people with
maintained cognition during ageing exhibited decreases in synaptic
signalling genes compared to people with cognitive decline.

DISCUSSION

Efficient synaptic networks without pathological protein accumulation
may contribute to maintained cognition during ageing.
Correlated retrograde and developmental regulons implicate multiple retrograde signals as coordinators of chloroplast development in maize
Authors: Kendrick Rennie , Chotewutmontri Prakitchai , Belcher Susan , Barkan Alice
Published: May 2022

Signals emanating from chloroplasts influence nuclear gene expression, but roles of retrograde signals during chloroplast development are unclear. To address this gap, we analyzed transcriptomes of four non-photosynthetic maize mutants and interpreted them in the context of transcriptome dynamics during normal leaf development. We analyzed two albino mutants lacking plastid ribosomes and two chlorotic mutants with thylakoid targeting or plastid transcription defects. The ∼2700 differentially expressed genes fall into six major categories based on the polarity and mutant-specificity of the change. These distinct retrograde responses correlate with distinct developmental dynamics, with down-regulated genes expressed later in normal development and up-regulated genes acting early. Photosynthesis genes are down-regulated specifically in the albino mutants, whereas up-regulated genes are enriched for functions in chloroplast biogenesis and cytosolic translation. TOR signaling is elevated in plastid ribosome-deficient mutants and declines in concert with plastid ribosome buildup during leaf development. Our results implicate three plastid signals as integral players during photosynthetic differentiation. One signal requires plastid ribosomes and activates photosynthesis genes. A second signal reflects attainment of chloroplast maturity and represses chloroplast biogenesis genes. A third signal responds to nutrient consumption by developing chloroplasts and represses TOR, which down-regulates cell proliferation genes early in leaf development.

One sentence summary

Transcriptomes of non-photosynthetic maize mutants when interpreted in the context of normal developmental dynamics implicate three plastid signals as coordinators of photosynthetic differentiation.

The author responsible for distribution of materials integral to the findings presented in this article in accordance with the policy described in the Instructions for Authors (https://academic.oup.com/plcell/pages/General-Instructions) is Alice Barkan (abarkan@uoregon.edu)
Optogenetic control of the integrated stress response reveals proportional encoding and the stress memory landscape
Authors: Batjargal Taivan , Zappa Francesca , Grant Ryan J , Piscopio Robert A , Chialastri Alex , Dey Siddharth S , Acosta-Alvear Diego , Wilson Maxwell Z
Published: May 2022

The Integrated Stress Response (ISR) is a conserved signaling network that detects cellular damage and computes adaptive or terminal outcomes. Understanding the mechanisms that underly these computations has been difficult because natural stress inputs activate multiple parallel signaling pathways and classical ISR inducers have pleiotropic effects. To overcome this challenge, we engineered photo-switchable control over the ISR stress sensor kinase PKR (opto-PKR), which allows virtual control of the ISR. Using controlled light inputs to activate opto-PKR we traced information flow in the ISR both globally, in the transcriptome, and for key ISR effectors. Our analyses revealed a biphasic, input-proportional transcriptional response with two dynamic modes, transient and gradual, that correspond to adaptive and terminal ISR outcomes. Using this data, we constructed an ordinary differential equation (ODE) model of the ISR which predicted system hysteresis dependent on prior stress durations and that stress memory encoding may lead to resilience. Our results demonstrate that the input dynamics of the ISR encode information in stress levels, durations, and the timing between stress encounters.
Functional network properties derived from wide-field calcium imaging differ with wakefulness and across cell type
Authors: O’Connor D , Mandino F , Shen X , Horien C , Ge X , Herman P , Crair M , Papademetris X , Lake EMR , Constable RT
Published: May 2022

To improve ‘bench-to-bedside’ translation, it is integral that knowledge flow bidirectionally—from animal models to humans, and vice versa. This requires common analytical frameworks, as well as open software and data sharing practices. We share a new pipeline (and test dataset) for the preprocessing of wide-field optical fluorescence imaging data—an emerging mode applicable in animal models—as well as results from a functional connectivity and graph theory analysis inspired by recent work in the human neuroimaging field. The approach is demonstrated using a dataset comprised of two test-cases: (1) data from animals imaged during awake and anesthetized conditions with excitatory neurons labeled, and (2) data from awake animals with different genetically encoded fluorescent labels that target either excitatory neurons or inhibitory interneuron subtypes. Both seed-based connectivity and graph theory measures (global efficiency, transitivity, modularity, and characteristic path-length) are shown to be useful in quantifying differences between wakefulness states and cell populations. Wakefulness state and cell type show widespread effects on canonical network connectivity with variable frequency band dependence. Differences between excitatory neurons and inhibitory interneurons are observed, with somatostatin expressing inhibitory interneurons emerging as notably dissimilar from parvalbumin and vasoactive polypeptide expressing cells. In sum, we demonstrate that our pipeline can be used to examine brain state and cell-type differences in mesoscale imaging data, aiding translational neuroscience efforts. In line with open science practices, we freely release the pipeline and data to encourage other efforts in the community.