bluuebunny/crossref_metadata_2025 huggingface dataset:
Two Paths: Why States Join or Avoid China’s Belt and Road Initiative
Authors: Atkins Eleanor , Fravel M Taylor , Wang Raymond , Ackert Nick , Huang Sihao
Published: August 2023

Although China’s motives for developing the Belt and Road Initiative (BRI) have been well studied, scholars have yet to comprehensively examine why states seek to join the initiative. We fill this gap by examining how and why states join the BRI. Countries join by signing a Memorandum of Understanding (MOU) with China on cooperation under the BRI framework. These MOUs create few or no obligations for the states who sign them but increase the possibility of reaping future economic benefits. Thus, we argue that most states should join the BRI unless they view the costs of participation as higher. We hypothesize, and find support for, the argument that democracies are less likely to join because they view participating in a Chinese-led initiative as more costly than non-democracies. Our statistical analysis using a new dataset of BRI participants and paired case studies provides quantitative and qualitative support for this argument.
Patterns of GP and nurse independent prescriber prescriptions for antibiotics dispensed in the community in England: a retrospective analysis
Authors: Courtenay Molly , Gillespie David , Lim Rosemary
Published: August 2023

Background

Physician–nurse task shifting, a process of delegation whereby tasks are moved to other specialized healthcare workers, is used in primary care in many countries to improve access, efficiency and quality of care. One such task is the prescription of medicines.

Objectives

To identify nurse independent prescriber (NIP) and GP numbers in England, the proportions and types of NIP and GP antibiotic prescriptions dispensed in the community, and the impact of COVID-19 on the volume, rate and types of antibiotic prescriptions dispensed.

Methods

Descriptive population-based retrospective cohort study using routinely collected data on prescriptions for antibiotics dispensed in the community in England between January 2014 and October 2021.

Results

Between 2014 and 2021, numbers (headcount) of NIPs whose prescriptions were dispensed in the community rose by 146% to 34 997. GP numbers (headcount) rose by 10% to 44 681. Of the 25.373 million antibiotic prescriptions dispensed between 2014 and 2021, NIPs were responsible for 8.6%. The rate of dispensed antibiotic prescriptions per prescriber per calendar year decreased (by 50% for NIPs and by 21% for GPs) between 2014 and 2020. This decreasing trend continued following the onset of the COVID-19 pandemic across both groups. Narrow-spectrum antibiotics (penicillins, macrolides, tetracyclines) were the most frequently dispensed across both NIPs and GPs.

Conclusions

NIPs are an increasing contributory influence on total antibiotic prescribing and should be included in antimicrobial stewardship efforts. Interventions for this group need to be tailored to the population and context in which they work.
Standardized amino acid digestibility and protein quality in extruded canine diets containing hydrolyzed protein using a precision-fed rooster assay
Authors: Hsu Clare , Utterback Pamela L , Parsons Carl M , Marx Fabio , Guldenpfennig Ryan , de Godoy Maria R C
Published: August 2023

Protein hydrolysate has become a choice of alternative protein source in canine diets as it showed greater digestibility, lower allergenic responses, and various functional properties when compared with intact proteins. The objective of the study was to determine the effect of hydrolyzed protein inclusion on amino acid digestibility and protein quality in extruded canine diets when compared with a traditional protein source for adult dogs. Five treatment diets were formulated to have similar compositions except for the main protein source. The control diet was formulated with chicken meal (CM) as the primary protein source. Test hydrolyzed proteins, chicken liver and heart hydrolysate (CLH) and chicken hydrolysate (CH) were used to partially or completely substitute CM. The diets were: CONd: CM (30%) diet; 5%CLHd: 5% CLH with 25% CM diet; CLHd: CLH (30%) diet; 5%CHd: 5% CH with 25% CM diet; CHd: CH (30%) diet. A precision-fed rooster assay was used to determine standardized amino acid digestibility for the ingredients and diets. In addition, Digestible Indispensable Amino Acid Score (DIAAS)-like values were calculated for the protein ingredients. All protein ingredients had higher than 80% of digestibility for all indispensable amino acids with no difference among sources (P > 0.05). From the DIAAS-like values referencing AAFCO nutrient profile for adult dogs, CLH and CH did not have any limiting amino acid; on the other hand, CM has a lower DIAAS-like value (93.3%) than CLH and CH (P < 0.05) with tryptophan being the first-limiting amino acid. The DIAAS-like values were often lower when the amino acid combinations methionine + cysteine and phenylalanine + tyrosine were included in the calculation. When referencing NRC recommended allowances and minimal requirements, methionine was the first-limiting amino acid for all protein sources. Amino acid digestibility was mostly above 80% and comparable among the treatment diets. Regarding the digestible indispensable amino acid concentrations in the diets, all of them met the AAFCO nutrient profile for adult dogs at maintenance. In conclusion, both protein hydrolysates were highly digestible, high-quality protein sources, and a full substitution from CM to protein hydrolysate could result in greater protein quality, according to the DIAAS-like values of the ingredients, when compared with CM in extruded canine diets.
Who is a Human Rights Defender? An Appraisal of Labour Practices in the Human Rights Economy
Authors: Georgi F Richard
Published: August 2023

The last decades have witnessed a conceptual opening of human rights practices, hitherto prerogative of a chosen few legal experts, towards a multiplicity of subjectivities. This afforded human rights scholarship to address subaltern histories and reckon with past exclusions. Conversely, critical deconstruction and empirical diversification have aggravated the seemingly basic, yet thorny quest for defining human rights activism and identifying human rights defenders. This not only poses a challenge to research but, foremost, opens human rights concepts to abuse and undermines protection regimes. In this contribution to the Journal of Human Rights Practice’s Anniversary Issue, I trace the definition dilemma as it emerges from emancipatory developments in human rights practice scholarship. I am not pretending to solve this dilemma; rather, I offer ‘metaphorical dislocations’ changing the terms of discussion to elicit new avenues of thought. Taking common allusions to the economy of human rights as my point of departure, I pursue Marx’s critique of political economy as a metaphor to describe human rights activism as a labour practice that a) produces discursive value qua rendering violence legible and b) transforms activist cultures socio-politically. Hence, I encounter the subjectivity of human rights defenders in the tensions between the co-dependent dimensions of practice and its political representation. The aspiration of this think piece is to emphasize the importance of co-constructing common foundations in the research on human rights activism, and to provoke responses leading us out of the all-too-well known trenches of debate.
Exploratory analysis of the spatial distribution of adult glioma age-adjusted county incidence rates, Nebraska Medicine, 2009–2019
Authors: Ratnapradipa Kendra L , Yellala Amulya , Shonka Nicole
Published: August 2023

Background

Central nervous system (CNS) cancers including gliomas have low incidence but high mortality. The age-adjusted incidence rate for CNS cancers is higher in Nebraska than nationally. This exploratory study was motivated by glioma patient inquiries about possible clustering of cases within the state to see if more in-depth investigation was warranted.

Methods

Using electronic health records from Nebraska Medicine, we identified Nebraska adult (age ≥19) glioma patients diagnosed between January 1, 2009 and November 1, 2019. Patient residential addresses were geocoded, mapped, and combined with annual US Census data to compute age-adjusted incidence rates (AAIR) at the county level. Counties with fewer than five cases were excluded to protect patient identity. ArcGIS software was used for geocoding and mapping.

Results

Of the 285 cases included in the analysis, 53.2% were geocoded with exact match and the remainder were processed manually. Cases occurred in 47 of the 93 counties. After data suppression, 11 counties (228 cases) visually clustered in eastern and central Nebraska with AAIR ranging from 0.85 to 5.66 per 100 000.

Conclusions

Many counties in the state were excluded from analysis of this rare cancer due to the small number of cases leading to unstable rates and the need to suppress data to protect patient privacy. However, this preliminary study suggests that glioma incidence is highest in central and eastern Nebraska. Next steps include analysis of state cancer registry data to ensure more complete case ascertainment.
Weighing the Odds: Novel β-Lactam/β-Lactamase Inhibitor Use in Hospital-Acquired and Ventilator-Associated Pseudomonas aeruginosa Pneumonia for Patients Who Are Morbidly Obese
Authors: Kunz Coyne Ashlan J , Orzol Carolina , Veve Michael P , Rybak Michael J
Published: August 2023

Background

Pseudomonas aeruginosa is a leading cause of hospital-acquired and ventilator-associated bacterial pneumonia (HABP/VABP). Novel β-lactam/β-lactamase inhibitor (BL/BLI) combinations are often used for these infections; however, limited data exist to guide the dosing of BL/BLI in patients who are morbidly obese. Thus, we sought to evaluate the clinical and safety endpoints of patients who are morbidly obese (body mass index ≥35 kg/m2) and non–morbidly obese (<35 kg/m2) and receiving BL/BLI for P aeruginosa HABP/VABP.

Methods

This retrospective study was based on a cohort of patients hospitalized at 2 urban academic medical centers in Detroit, Michigan, from August 2014 through February 2021 with P aeruginosa HABP/VABP who were receiving BL/BLI (ceftazidime/avibactam, ceftolozane/tazobactam, or meropenem/vaborbactam) for ≥72 continuous hours. The primary endpoint was presumed treatment failure, defined as the presence of all-cause in-hospital mortality or the continuation of infectious symptoms. Analyses were adjusted for possible confounding with inverse probability of treatment weighting. Multivariable regression was used to identify predictors of treatment failure.

Results

In total, 285 patients with HABP (61.4%) and/or VABP (56.1%) were enrolled (morbidly obese, n = 95; non–morbidly obese, n = 190). The median Acute Physiology and Chronic Health Evaluation II score was 23 (IQR, 13–26), and 60% of patients were admitted to the intensive care unit at index culture collection. Patients who were morbidly obese demonstrated significantly greater odds of presumed treatment failure vs those who were non–morbidly obese (58.9% vs 37.9%, respectively; adjusted odds ratio, 1.675 [95% CI, 1.465–1.979]). In multivariable analysis, morbid obesity (1.06; 95% CI, 1.02–1.79), prolonged time to BL/BLI initiation (1.47; 95% CI, 1.28–2.66), renal dose–adjusted BL/BLI in the first 48 hours of therapy (1.12; 95% CI, 1.09–1.75), and continuous renal replacement therapy during BL/BLI therapy (1.35; 95% CI, 1.06–1.68) were independently associated with increased odds of presumed treatment failure.

Conclusions

Among hospitalized patients receiving BL/BLI for P aeruginosa HABP/VABP, those who were morbidly obese had significantly greater odds of presumed treatment failure when compared with those who were non–morbidly obese.
Breast myiasis in an elderly male patient: a case report
Authors: Sierra Natalia , Toro Ana C , Valencia Manuela , Prada Ángela M , Varela Gabriel J , Herazo Fernando A
Published: August 2023

Fly larvae cause myiasis. The most common of these are Cordylobia anthropophaga and Dermatobia hominis. Clinically, myiasis manifests as an erythematous papule that may become ulcerated and form furuncular lesions. In patients who have been in endemic areas, these larvae are to be suspected. Below, we present a 75-year-old male with a clinical picture of a palpable mass in the areola associated with the outflow of serohematic fluid through a central orifice. A breast intraductal lesion was suspected, so a breast ultrasound and biopsy were performed, which showed a structure compatible with myiasis. The diagnostic challenge was the high number of different diagnoses and the little knowledge of health professionals about tropical diseases.
Colonoscopy for foreign body retrieval in ileocecal valve: a rare case report
Authors: Doya Leen J , Mohammad Mohammad F , Mohammad Aria , Ibrahim Ali
Published: August 2023

Foreign body (FB) ingestion is a common emergency among the pediatric population. They usually pass spontaneously through the gastrointestinal (GI) tract. In rare cases, it may cause complications because of the impaction. That depends on the type of an FB, its location, the patient’s age and the duration of impaction. Colonoscopy as management of FB ingestion in the ileocecal valve (IC) is rare in the medical literature review. Herein, we reported a case of an FB (thin needle-shaped FB 4 cm long) in the IC that was removed from the IC by colonoscopy. Although colonoscopic retrieval of impacted foreign bodies at the GI tract in children has been rarely reported in the literature review, it may be helpful in young children to avoid invasive surgical treatment.
Soft pinning: Experimental validation of static correlations in supercooled molecular glass-forming liquids
Authors: Das Rajsekhar , Bhowmik Bhanu Prasad , Puthirath Anand B , Narayanan Tharangattu N , Karmakar Smarajit
Published: August 2023

Enormous enhancement in the viscosity of a liquid near its glass transition is a hallmark of glass transition. Within a class of theoretical frameworks, it is connected to growing many-body static correlations near the transition, often called “amorphous ordering.” At the same time, some theories do not invoke the existence of such a static length scale in the problem. Thus, proving the existence and possible estimation of the static length scales of amorphous order in different glass-forming liquids is very important to validate or falsify the predictions of these theories and unravel the true physics of glass formation. Experiments on molecular glass-forming liquids become pivotal in this scenario as the viscosity grows several folds (∼1014), and simulations or colloidal glass experiments fail to access these required long-time scales. Here we design an experiment to extract the static length scales in molecular liquids using dilute amounts of another large molecule as a pinning site. Results from dielectric relaxation experiments on supercooled Glycerol with different pinning concentrations of Sorbitol and Glucose, as well as the simulations on a few model glass-forming liquids with pinning sites, indicate the versatility of the proposed method, opening possible new avenues to study the physics of glass transition in other molecular liquids.
Preventing Suicide: Time to Mobilize the Physical Therapist Workforce
Authors: McGrath Ryan L , Shephard Sophie , Hemmings Laura , Verdon Sarah , Parnell Tracey
Published: August 2023

Each year, approximately 700,000 people, including 46,000 Americans, die by suicide; however, many more people experience suicidal thoughts and behaviors. Historically, the prevention of suicide has largely been the domain of mental health professionals working within specialist mental health care settings. An issue with this approach is that many individuals who experience suicidal ideation never disclose these thoughts to a mental health professional. The nonprofessional and paraprofessional mental health movement aims to bring suicide prevention to the people who need it, rather than wait for them to seek help. The nonprofessional and paraprofessional mental health movement does so by upskilling people who are not recognized as mental health professionals but may have contact with people experiencing suicidal thoughts and behaviors. In this Perspective, we argue that physical therapists are well-positioned to engage in suicide prevention. For example, physical therapists working in pain management are likely to frequently encounter clients experiencing suicidal thoughts and behaviors. Physical therapy is also viewed as a physical health profession, meaning that they may have contact with a broad range of populations at high risk of suicide who may be difficult to reach through traditional channels (eg, men from rural communities). Physical therapists will require training on how to provide crisis support, including how to link clients with appropriate mental health services. However, given the size of the physical therapist workforce globally, the impact of mobilizing the physical therapist workforce could be significant.
Race Structure and Molecular Diversity of Colletotrichum lindemuthianum of Common Bean in Zambia
Authors: Sansala Miyoba , Kuwabo Kuwabo , Hamabwe Swivia M. , Kachapulula Paul , Parker Travis , Mukuma Chikoti , Kamfwa Kelvin
Published: August 2023

Anthracnose, caused by the fungus Colletotrichum lindemuthianum, is a major disease of common bean (Phaseolus vulgaris L.) worldwide. C. lindemuthianum is genetically highly variable, and understanding the pathogen’s diversity and distribution is a key step in developing common bean varieties with durable anthracnose resistance. The objectives of this study were to (i) characterize the race structure of C. lindemuthianum in Zambia and (ii) assess the molecular diversity of C. lindemuthianum in Zambia. A field survey was conducted in 20 bean-growing districts in Zambia to collect anthracnose symptomatic bean plants. A total of 103 C. lindemuthianum isolates were collected and characterized based on their reactions on 12 common bean race differential cultivars. RAM and ERIC-BOX DNA markers were used to assess molecular diversity of 60 isolates. A total of 58 races were characterized from the 103 isolates. Race 5 was the least virulent, and race 1631 was the most virulent based on their reaction on the 12 race differential cultivars. Race 19 had the highest recovery frequency (11%) and was the most extensively dispersed among the 22 bean-growing districts from where the isolates were collected. Only six races had previously been reported in Zambia, and 52 races were identified as new races reported for the first time in Zambia. Two races were virulent only on Andean cultivars, 11 races were virulent only on Middle American cultivars, and 45 races were virulent on both Andean and Middle American cultivars. No individual isolate showed pathogenicity on all the differential cultivars, and no isolate overcame the Co-4, Co-5, and Co-7 resistance gene pyramid that naturally exists in G2333. Phylogenetic analysis categorized the 60 isolates in six major clusters and six subclusters. The 60 isolates showed high genetic heterogeneity among and within a race of the same virulence. The study has revealed the existence of both Andean and Middle American races and extensive molecular diversity of C. lindemuthianum in Zambia. The knowledge on the race structure of C. lindemuthianum that this study has provided will be valuable for making breeding decisions on the host plant resistance genes required for developing common bean varieties with durable resistance to anthracnose in Zambia.
Spatiotemporal Patterns of Iris Yellow Spot Virus and Its Onion Thrips Vector, Thrips tabaci, in Transplanted and Seeded Onion Fields in New York
Authors: Komondy Lidia , Hoepting Christy , Fuchs Marc , Pethybridge Sarah J. , Nault Brian A.
Published: August 2023

Onion thrips, Thrips tabaci (Lindeman), transmits iris yellow spot virus (IYSV) and is one of the most important pests of Allium crops. IYSV is a member of the species Tospovirus iridimaculaflavi in the genus Orthotospovirus of the family Tospoviridae. This virus typically reduces overall onion bulb quality and weight but can also prematurely kill onion plants. IYSV is neither seed nor mechanically transmitted. Onion fields are typically established via seeds and transplants. A decade ago, onion thrips tended to colonize transplanted fields before seeded fields because plants in transplanted fields were larger and more attractive to thrips than smaller onions in seeded fields. Therefore, we hypothesized that the incidence of IYSV in transplanted fields would be detected early in the season and be spatially aggregated, whereas IYSV would be absent from seeded fields early in the season and initial epidemic patterns would be spatially random. In 2021 and 2022, IYSV incidence and onion thrips populations were quantified in 12 onion fields (four transplanted fields and eight seeded fields) in New York. Fields were scouted four times throughout the growing season (n = 96 samples), and a geospatial and temporal analysis of aggregation and incidence was conducted to determine spatiotemporal patterns in each field type. Results indicated that spatial patterns of IYSV incidence and onion thrips populations were similar early in the season, indicating that transplanted onion fields are no longer the dominant early-season source of IYSV in New York. These findings suggest the need to identify other important early-season sources of IYSV that impact New York onion fields.
Sepsis-2.5: Resolving Conflicts Between Payers and Providers
Authors: Rodenberg Howard , Glasser Theodore , Bartfield Alison , Katugaha Shalika
Published: August 2023

Competing definitions of sepsis have significant clinical implications and impact both medical coding and hospital payment. Although clinicians may prefer Sepsis-2, payer use of Sepsis-3 to validate clinical diagnoses may result in denial of payment or requests to recoup previously paid funds from healthcare providers. The Sepsis-2.5 project was a cooperative effort between a hospital system and a private payer to develop a community-based, literature-supported consensus definition for sepsis characterized by the presence of clinical illness, a source of infection, and evidence of organ dysfunction. This new definition (“Sepsis-2.5”) has been instrumental in resolving provider-payer conflicts in defining clinical sepsis and reimbursing care.
Cluster analysis reveals a homogeneous subgroup of PCOS women with metabolic disturbance associated with adverse reproductive outcomes
Authors: Chen Hanxiao , Zeng Rujun , Zeng Xun , Qin Lang
Published: August 2023

Background:

Polycystic ovarian syndrome (PCOS) is a heterogeneous and complex reproductive endocrinological disease that could lead to infertility. There were many attempts to classify PCOS but it remains unclear whether there is a specific subgroup of PCOS that is associated with the best or worst reproductive outcomes of assisted reproductive techniques (ART).

Methods:

Infertile PCOS patients who underwent their first cycle of in vitro fertilization (IVF) in West China Second University Hospital, Sichuan University from January 2019 to December 2021 were included. Basic clinical and laboratory information of each individual were extracted. Unsupervised cluster analysis was performed. Controlled ovarian stimulation parameters and reproductive outcomes were collected and compared between the different clusters of PCOS.

Results:

Our analysis clustered women with PCOS into "reproductive", "metabolic", and "balanced" clusters based on nine traits. Reproductive group was characterized by high levels of testosterone (T), sex hormone-binding globulin (SHBG), follicular stimulation hormone (FSH), luteinizing hormone (LH), and anti-Müllerian hormone (AMH). Metabolic group was characterized by high levels of body mass index (BMI), fasting insulin, and fasting glucose. Balanced group was characterized by low levels of the aforementioned reproductive and metabolic parameters, except for SHBG. Compared with PCOS patients in reproductive and balanced clusters, those in metabolic cluster had lower rates of good quality day 3 embryo and blastocyst formation. Moreover, PCOS patients in the reproductive cluster had greater fresh embryo transfer (ET) cancelation rate and clinical pregnancy rate after fresh ET than metabolic cluster (odds ratio [OR] = 3.37, 95% confidence interval [CI]: 1.77–6.44, and OR = 6.19, 95% CI: 1.58–24.24, respectively). And compared with PCOS of metabolic cluster, PCOS of balanced cluster also had higher chance for fresh ET cancelation (OR = 2.83, 95% CI: 1.26–6.35).

Conclusion:

Our study suggested that PCOS patients in metabolic cluster may be associated with adverse reproductive outcomes and might need individualized treatment and careful monitoring before and during ART.
The Gene Expression Classifier ALLCatchR Identifies B-cell Precursor ALL Subtypes and Underlying Developmental Trajectories Across Age
Authors: Beder Thomas , Hansen Björn-Thore , Hartmann Alina M. , Zimmermann Johannes , Amelunxen Eric , Wolgast Nadine , Walter Wencke , Zaliova Marketa , Antić Željko , Chouvarine Philippe , Bartsch Lorenz , Barz Malwine J. , Bultmann Miriam , Horns Johanna , Bendig Sonja , Kässens Jan , Kaleta Christoph , Cario Gunnar , Schrappe Martin , Neumann Martin , Gökbuget Nicola , Bergmann Anke Katharina , Trka Jan , Haferlach Claudia , Brüggemann Monika , Baldus Claudia D. , Bastian Lorenz
Published: August 2023

Current classifications (World Health Organization-HAEM5/ICC) define up to 26 molecular B-cell precursor acute lymphoblastic leukemia (BCP-ALL) disease subtypes by genomic driver aberrations and corresponding gene expression signatures. Identification of driver aberrations by transcriptome sequencing (RNA-Seq) is well established, while systematic approaches for gene expression analysis are less advanced. Therefore, we developed ALLCatchR, a machine learning-based classifier using RNA-Seq gene expression data to allocate BCP-ALL samples to all 21 gene expression-defined molecular subtypes. Trained on n = 1869 transcriptome profiles with established subtype definitions (4 cohorts; 55% pediatric / 45% adult), ALLCatchR allowed subtype allocation in 3 independent hold-out cohorts (n = 1018; 75% pediatric / 25% adult) with 95.7% accuracy (averaged sensitivity across subtypes: 91.1% / specificity: 99.8%). High-confidence predictions were achieved in 83.7% of samples with 98.9% accuracy. Only 1.2% of samples remained unclassified. ALLCatchR outperformed existing tools and identified novel driver candidates in previously unassigned samples. Additional modules provided predictions of samples blast counts, patient’s sex, and immunophenotype, allowing the imputation in cases where these information are missing. We established a novel RNA-Seq reference of human B-lymphopoiesis using 7 FACS-sorted progenitor stages from healthy bone marrow donors. Implementation in ALLCatchR enabled projection of BCP-ALL samples to this trajectory. This identified shared proximity patterns of BCP-ALL subtypes to normal lymphopoiesis stages, extending immunophenotypic classifications with a novel framework for developmental comparisons of BCP-ALL. ALLCatchR enables RNA-Seq routine application for BCP-ALL diagnostics with systematic gene expression analysis for accurate subtype allocation and novel insights into underlying developmental trajectories.
STRategies to Improve Pain and Enjoy life (STRIPE): results of a pragmatic randomized trial of pain coping skills training and opioid medication taper guidance for patients on long-term opioid therapy
Authors: Wartko Paige D. , Krakauer Chloe , Turner Judith A. , Cook Andrea J. , Boudreau Denise M. , Sullivan Mark D.
Published: August 2023

Because long-term opioid therapy (LtOT) for chronic pain has uncertain benefits and dose-dependent harms, safe and effective strategies for opioid tapering are needed. Adapting a promising pilot study intervention, we conducted the STRategies to Improve Pain and Enjoy life (STRIPE) pragmatic clinical trial. Patients in integrated health system on moderate-to-high dose of LtOT for chronic noncancer pain were randomized individually to usual care plus intervention (n = 79) or usual care only (n = 74). The intervention included pain coping skills training and optional support for opioid taper, delivered in 18 telephone sessions over a year, with pharmacologic guidance provided to participants' primary care providers by a pain physician. Coprimary outcomes were daily opioid dose (morphine milligram equivalent [MME]), calculated using pharmacy dispensing data, and the self-reported Pain, Enjoyment of Life and General Activity scale at 12 months (primary time point) and 6 months. Secondary outcomes included opioid misuse, opioid difficulties, opioid craving, pain self-efficacy, and global impression of change, depression, and anxiety. Only 41% randomized to the intervention completed all sessions. We did not observe significant differences between intervention and usual care for MME (adjusted mean difference: −2.3 MME; 95% confidence interval: −10.6, 5.9; P = 0.578), the Pain, Enjoyment of Life, General Activity scale (0.0 [95% confidence interval: −0.5, 0.5], P = 0.985), or most secondary outcomes. The intervention did not lower opioid dose or improve pain or functioning. Other strategies are needed to reduce opioid doses while improving pain and function for patients who have been on LtOT for years with high levels of medical, mental health, and substance use comorbidity.
Supervisor Training
Authors: Sinelnikov Sergey , Prentice Emily A. , Bryant Claire S.
Published: August 2023

Objective

This study presents a pilot evaluation of a new online training program created to improve supervisors’ ability to protect worker safety by recognizing and responding to signs of impairment from diverse causes.

Methods

The study design relied on a mixed-methods approach with two waves of surveys and interviews immediately after training completion and after 3 months to gauge changes in participants’ perceived knowledge and competencies.

Results

Participants had a positive reaction to training and found it relevant to their job responsibilities and aligned with existing organizational safety programs, practices, and policies. There was statistically significant improvement in perceived impairment knowledge and competencies. The study also provided early indications of training transfer.

Conclusions

The study offers encouraging results that may be used to improve the impairment recognition and response training for supervisors and support future investigations of its impact.
Exercise as a therapeutic intervention in chronic kidney disease: are we nearly there yet?
Authors: Castle Ellen M. , Billany Roseanne E. , Lightfoot Courtney J. , Annema Coby , De Smet Stefan , Graham-Brown Matthew P.M. , Greenwood Sharlene A.
Published: August 2023

Purpose of review

The opportunity to review the more recent evidence for prescribing exercise-based physical rehabilitation for people living with chronic kidney disease (CKD) is timely. There has been a recent global focus evaluating how physical activity interventions might improve health-related quality of life and outcomes for people living with chronic health conditions in a post-COVID era. There is finally a long overdue commitment from the kidney research and clinical community to deliver pragmatic interventions to help people living with CKD to be able to live well with their condition.

Recent findings

This article reviews recent research, and discusses the challenges and potential solutions, for providing exercise-based therapeutic options for people living with CKD; including predialysis self-management interventions, options for both prehabilitation and posttransplant rehabilitation, pragmatic considerations for delivery of exercise therapy for people receiving haemodialysis treatment and the role of virtual kidney-specific rehabilitation.

Whilst there remains a need for further research in this area of patient care, there is now a body of evidence and kidney-specific guidelines that firmly support a rollout of pragmatic and scalable exercise-based interventions for people living with CKD. We are indeed nearly there now.
Self-report of Nurse Professionalism and Factors Affecting It
Authors: Kurucová Radka , Kohanová Dominika , Žiaková Katarína
Published: August 2023

OBJECTIVE

To evaluate the perception of professionalism by nurses and identify factors that affect the evaluation of professionalism.

BACKGROUND

Professionalism is conceptualized as the set of beliefs related to the autonomy of the profession. Lack of professional respect, a disruptive work environment, and suppression of progressivism in the profession are identified as factors that lead to leaving the profession.

METHODS

The study was carried out according to the CHEERIES (Checklist for Reporting Results of Internet E-Surveys) checklist and included 250 RNs. The Nurses' Professionalism Inventory (NPI) was used.

RESULTS

The mean composite score of the NPI indicates a positive reflection of the professionalism of the nurse. Nurse education and job position were the most significant factors that affected perception of professionalism (P < 0.05).

CONCLUSIONS

The results show the need to examine the issue of professionalism in nursing to a greater extent and implement the findings of research on innovations at all levels of nursing education.
Transvaginal Posterior Levatorplasty Combined with Perineoplasty: An Effective Surgical Method for Vaginal Rejuvenation
Authors: Wang Keke , Li Fengyong , Li Qiang , Wei Lan , Zhou Yu , Cao Yujiao , Liu Meichen , Li Yilin , Che Kexin , Yuan Ye
Published: August 2023

Background:

Gynecologic cosmetic surgery and rejuvenation surgery have become increasingly popular, with growing demand for vaginal surgery to address vaginal laxity. Follow-up data on the effectiveness of these procedures remain limited. The authors conducted a retrospective study to investigate the effects of transvaginal posterior levatorplasty combined with perineoplasty on vaginal rejuvenation.

Methods:

The study included 45 patients who underwent transvaginal posterior levatorplasty combined with perineoplasty between July of 2020 and May of 2022. Patient characteristics before operation, at baseline, and 3, 6, and 12 months postoperatively, and questionnaires on patient symptoms, quality of life, and sexual function, including the Vaginal Laxity Questionnaire and Female Sexual Function Index, were evaluated. Pelvic ultrasound imaging was performed preoperatively and 3 months postoperatively.

Results:

Mean vaginal capacity index and vaginal laxity scores were different at baseline and 6 and 12 months postoperatively (P < 0.01). Female sexual function, including libido, sexual arousal, lubrication, orgasm, sexual satisfaction, and pain levels, were significantly improved (preoperative, 21.68 ± 4.15; 6 months postoperatively, 26.88 ± 2.44; 1 year postoperatively, 29.97 ± 2.10; P < 0.01). Symptoms of stress urinary incontinence and recurrent vaginitis were improved in 78.6% and 90.5% of patients, respectively. On pelvic floor ultrasound, retrovesical angle, urethral rotation angle, levator hiatus, and bladder neck distance were significantly different preoperatively and 3 months postoperatively (P < 0.01). Overall satisfaction was 93.3% at 12 months postoperatively.

Conclusions:

Transvaginal posterior levatorplasty combined with perineoplasty is effective for the improvement of patient symptoms, quality of life, sexual function, stress urinary incontinence, and postnatal constipation. Further research on the underlying mechanisms is required.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Pericardial Fat Is Associated With Less Severe Multiorgan Failure Over Time in Patients With Coronavirus Disease-19
Authors: Aydeniz Eda , Weberndorfer Vanessa , Brandts Lloyd , Smulders Martijn W. , van Herpt Thijs T.W. , Martens Bibi , Vernooy Kevin , Linz Dominik , van der Horst Iwan C.C. , Wildberger Joachim E. , van Bussel Bas C.T. , Driessen Rob G.H. , Mihl Casper
Published: August 2023

Purpose:

Pericardial fat (PF) and epicardial adipose tissue (EAT) may enhance the proinflammatory response in corona virus-19 (COVID-19) patients. Higher PF and EAT volumes might result in multiorgan failure and explain unfavorable trajectories.

The aim of this study was to examine the association between the volume of PF and EAT and multiorgan failure over time.

Materials and Methods:

All mechanically ventilated COVID-19 patients with an available chest computed tomography were prospectively included (March-June 2020). PF and EAT volumes were quantified using chest computed tomography scans. Patients were categorized into sex-specific PF and EAT tertiles. Variables to calculate Sequential Organ Failure Assessment (SOFA) scores were collected daily to indicate multiorgan failure. Linear mixed-effects regression was used to investigate the association between tertiles for PF and EAT volumes separately and serial SOFA scores over time. All models were adjusted.

Results:

Sixty-three patients were divided into PF and EAT tertiles, with median PF volumes of 131.4 mL (IQR [interquartile range]: 115.7, 143.2 mL), 199.8 mL (IQR: 175.9, 221.6 mL), and 318.8 mL (IQR: 281.9, 376.8 mL) and median EAT volumes of 69.6 mL (IQR: 57.0, 79.4 mL), 107.9 mL (IQR: 104.6, 115.1 mL), and 163.8 mL (IQR: 146.5, 203.1 mL). Patients in the highest PF tertile had a statistically significantly lower SOFA score over time (1.3 [−2.5, −0.1], P=0.033) compared with the lowest PF tertile. EAT tertiles were not significantly associated with SOFA scores over time.

Conclusion:

A higher PF volume is associated with less multiorgan failure in mechanically ventilated COVID-19 patients. EAT volumes were not associated with multiorgan failure.
Bovine Acellular Dermal Matrix–Based Breast Reconstruction in Previously Irradiated Breasts
Authors: Lisa Andrea , Carbonaro Riccardo , Bottoni Manuela , Ostapenko Edvin , Rietjens Mario
Published: August 2023

Radiation therapy is considered today an integral part of the management of breast cancer. However, radiotherapy significantly increases the incidence of total complications in breast reconstruction. Several procedures have been adopted to reduce complication rates in irradiated fields, including the use of acellular dermal matrices (ADMs). We conducted a retrospective analysis of our single-center experience with ADM-assisted implant-based reconstruction or revision surgeries for capsular contracture treatment in irradiated breasts. We divided our population into 4 groups based on prior surgical history: group A (previous quadrantectomy), group B (previous mastectomy and expander reconstruction), group C (previous mastectomy and implant reconstruction), and group D (prior quadrantectomy followed by mastectomy and implant reconstruction). At the European Oncology Institute in Milan, Italy, between June 2017 and April 2019, we identified 84 patients for a total of 86 irradiated breasts reconstructed with implant and ADM. We observed a total of 12 reconstructive failure, with the highest rate of failure in group B (16.6%) and in group D (15.38%). Overall, we recorded 22 total complications (24.4%): 12 major complications and 10 minor complications. The most common complication was infection, with 9 cases (10.4%), 6 of which were classified as severe and required implant removal. In group B, we observed the highest complication rate, both major and minor, with 7 of 42 patients (16.6%) experiencing each. Before reconstruction with ADM, the Baker grade ranged from 3 to 4, with a mean of 3.25. At the 2-year follow-up, the Baker grade ranged from 1 to 4, with a mean of 1.9. Surgeons were highly satisfied with the aesthetic result in 72.1% of cases, moderately in 8.1% and unsatisfied in 5.81%, and in 13.9%, the outcome was not assessable because of reconstructive failure. The worst aesthetic result was in group B. We observed significant reduction in capsular contracture in revision surgeries despite a moderately high rate of complications in previous quadrantectomy and radiotherapy. In our experience, breast reconstruction with implant and ADM is not the primary surgical indication in case of prior irradiation, but it can be considered as a valid alternative with reasonable safety profile, to be used in selected cases.
Incidence, Characteristics, and Outcomes of Robin Sequence: A Population-Based Analysis in the United States
Authors: Chocron Yehuda , Alabdulkarim Abdulaziz , Czuzoj-Shulman Nicholas , Abenhaim Haim A. , Gilardino Mirko S.
Published: August 2023

Introduction:

While the literature is replete of clinical studies reporting on the Robin sequence (RS), population-based analyses are scarce with significant variability within the literature in terms of reported incidence, demographic parameters, and outcomes. The authors have conducted a 20-year population-based analysis to guide clinical practice.

Methods:

A birth cohort was created from the available datasets in the Healthcare Cost and Utilization Project—Kids’ Inpatient Database (HCUP-KID; 2000–2019). Robin sequence patients were identified and further stratified by syndromic status. Incidence, demographic parameters, and outcomes including mortality and tracheostomy rates were computed. A subset analysis comparing the isolated and syndromic cohorts was conducted. Data was analyzed through a χ2 or t test.

Results:

The incidence of RS was 5.15:10,000 (95% CI: 4.99–5.31) from a birth cohort of 7.5 million. Overall, 63.3% of the cohort was isolated RS and 36.7% had syndromic RS. Robin sequence patients had a significantly higher rate of cardiac (25.9%) and neurological (8.6%) anomalies compared with the general birth cohort and were most commonly managed in urban teaching hospitals (P<0.0001). The pooled mortality and tracheostomy rates were 6.6% and 3.6%, respectively. Syndromic status was associated with a longer length of hospital stay (27.8 versus 13.6 d), tracheostomy rate (6.2% versus 2.1%), and mortality (14.1% versus 2.2%) compared with isolated RS (P<0.0001).

Conclusions:

The true incidence of RS is likely higher than previously reported estimates. Isolated RS patients have a low associated mortality and tracheostomy rate and are typically managed in urban teaching hospitals. Syndromic status confers a higher mortality rate, tracheostomy rate, and length of stay compared with nonsyndromic counterparts.
Rare Occipital Artery Pseudoaneurysm After Radical Neck Dissection
Authors: Xu Chen , Song Yonghai , Chang Hongguang , Fang Junyan , He Jie
Published: August 2023

Pseudoaneurysm formation in the occipital artery, post radical neck dissection, leading to a bulging mass, is a rare but potentially fatal occurrence. The authors treated a patient with pseudoaneurysm of occipital artery, post radical neck dissection, presenting with pain and swelling after 17 days of surgery. A pseudoaneurysm involving occipital artery was revealed by digital subtraction angiography and treated by endovascular micro-coil embolization.
Eyebrow Reconstruction in Craniofacial Clefts by Abnormal Hairline Extention
Authors: Kalantar-Hormozi Abdoljalil , Noori Mehran , Karimi Amirhossein
Published: August 2023

The absence of eyebrows, whether complete or partial, has been observed in specific types of craniofacial clefts, primarily occurring in Tessier clefts numbers 9 to 13. To address this defect, several techniques have been used to improve eyebrow appearance, such as the island scalp flap and scalp strip grafting technique. However, these methods did not yield satisfactory esthetic results. In this study, the authors present findings from 7 patients with craniofacial clefts, in whom the eyebrows were completely reconstructed through the rotation flap technique, using abnormal frontal hairline extension, in 1 or 2 stages. The result was natural-looking and highly satisfactory, with no associated morbidity.
Characterization of the mitochondrial proteome in the ctenophoreMnemiopsis leidyiusing MitoPredictor
Authors: Muthye Viraj , Lavrov Dennis V.
Published: August 2023

ii.

Mitochondrial proteomes have been experimentally characterized for only a handful of animal species. However, the increasing availability of genomic and transcriptomic data allows one to infer mitochondrial proteins using computational tools. MitoPredictor is a novel random-forest classifier, which utilizes orthology-search, mitochondrial targeting signal (MTS) identification, and protein domain content to infer mitochondrial proteins in animals. MitoPredictor’s output also includes an easy-to-use R Shiny applet for the visualization and analysis of the results. In this article, we provide a guide for predicting and analyzing the mitochondrial proteome of the ctenophoreMnemiopsis leidyiusing MitoPredictor.
Addressing tuberculosis in artisanal and small-scale mining activities in sub-Saharan Africa: meta-analysis and a call for actions
Authors: Mayeri Daniel Garhalangwanamuntu , Kambale Richard Mbusa , Bugeme Patrick Musole , Ngaboyeka Gaylor Amani , Mushagalusa Charles , Zahinda Franck Mugisho , Tamuzi Jacques L. , Katoto Patrick DMC
Published: August 2023

Background

Tuberculosis (TB) is a significant health issue in sub-Saharan African (SSA) countries, and artisanal mining (AM) may be a contributing factor. However, no systematic review has investigated the association between AM and TB in SSA. Therefore, this study aims to assess the burden of TB among artisanal miners in SSA.

Methods

We conducted a comprehensive search of PubMed, Medline-OVID, EMBASE, and Scopus databases for studies on AM and TB published up to January 25, 2022. We presented the findings of seven studies that met our inclusion criteria narratively and through figure synthesis, and used inverse-variance weighted random-effects models to combine effect estimates for meta-analysis.

Results

The overall prevalence of TB among artisanal workers was estimated to be 15% (95%CI: 8, 23), with higher rates in high TB burden countries (19%, 95%CI: 11, 28) compared to upper-moderate burden countries (8%, 95%CI: 3, 19. Further, exposure to silica dust, a common byproduct of AM, significantly increased the incidence of TB, with a pooled relative risk of 2.19 (95% CI: 1.77, 2.71). Additionally, we found that a higher number of artisanal miners in Ghana was associated with a reduction in TB incidence.

Conclusion

Our findings suggest that exposure to silica dust in AM is a neglected but a significant risk factor for TB in SSA. More studies and efforts are needed to address this threat to TB control.