bluuebunny/crossref_metadata_2025 huggingface dataset:
Health-care providers’ perspectives on an HIV patient navigation training to improve uptake of PrEP among Black sexual minority men
Authors: Burns Paul A , Anyimukwu Chizoba , Omondi Angela A , Monger Mauda , Ward Lori , Poteat Tonia
Published: May 2023

This article examines implementational factors associated with an HIV patient navigation training intervention for health care professionals working with Black sexual minority men to improve access to and uptake of HIV prevention services among Black MSM. Utilizing qualitative analysis to better understand healthcare professionals’ perceptions of the training program, we conducted a thematic content analysis based on constructs from Professional Network and Reach Model-Systems Model Approach (PNRSMA) framework. Data analysis revealed four major themes: 1) Knowledge and skill building, 2) Novel and Innovation, 3) Barriers to Implementation, and 4) Recommendations and Future Directions. Implementation factors such as appropriate facilitators, content, mode of delivery, learning strategies, and understanding structural barriers were important to training success. Participants highlighted innovation strategies such as the use of social media and interactive communication (e.g. role-playing and bi-directional communication) enhanced learning and skill-building. The expansion of training to include other affected groups such as women and bisexual individuals and increasing the duration of the training emerged as areas for improvement and effectiveness. Our analysis of an HIV patient navigation training revealed important findings to improve the implementation process to increase uptake of PrEP and other HIV prevention, care and treatment services.
Equipment Repositories for Accessibility: A Model for Improving Access in Field Science
Authors: Devitz Amy-Charlotte
Published: May 2023

Synopsis

People with disabilities have been historically underrepresented in scientific fields as a result of systemic barriers and a “leaky pipeline” through academia. This has been especially true in field science, where a lack of resources and limited access to adaptive equipment have made accommodating disabilities in field settings seem daunting. This paper introduces the Equipment Repositories for Accessibility (ERA) model as a blueprint for universities to implement and improve the accessibility of field research and field-based courses. It first provides an overview of the history of disability in science and how systemic barriers contribute to underrepresentation and reduced access to field science. It then outlines the steps for the establishment and long-term management of the ERA model as a means of overcoming these barriers and provides a brief overview of the types of adaptive equipment available for a diverse range of accessibility needs. The scientific community benefits from the inclusion of diverse individuals and addressing barriers to accessibility is a necessary step in creating a truly intersectional academic community, which acknowledges the deeply interconnected nature of disability with other identities including race, gender, and sexuality.
IDEA+ and OBFS: Using Transdisciplinary Strategies to Create More Inclusive Spaces
Authors: McDermott Victoria , Roketenetz Lara D , Jekielek Phoebe , Struminger Rhonda
Published: May 2023

Synopsis

Professional societies play a unique role in our personal and professional lives as spaces for connection and as regulatory entities. Often composed of volunteers from a variety of backgrounds, professional societies can guide the cultural norms and expectations of an industry by acting as critical leaders for supporting diversity, equity, and inclusion initiatives. The present manuscript explains how professional societies, like the Organization of Biological Field Stations (OBFS), can embrace transdisciplinary approaches to create more inclusive (in)tangible spaces to address serious problems facing industries today. Climate change, sexism, and racism, are examples of “wicked” problems that cannot be solved using existing modes of inquiry and decision making because of their complex and interrelated nature. As members of OBFS, a professional society dedicated to the advancement of field-based research, we explain how transdisciplinarity can and has been used to begin addressing serious issues like racism and sexism in field-based research and provide steps for future professional societies to engage in transdisciplinary thinking. We close with examples of our own transdisciplinary work developed through our membership within OBFS.
Zero-truncated Poisson regression for sparse multiway count data corrupted by false zeros
Authors: López Oscar F , Dunlavy Daniel M , Lehoucq Richard B
Published: May 2023

We propose a novel statistical inference methodology for multiway count data that is corrupted by false zeros that are indistinguishable from true zero counts. Our approach consists of zero-truncating the Poisson distribution to neglect all zero values. This simple truncated approach dispenses with the need to distinguish between true and false zero counts and reduces the amount of data to be processed. Inference is accomplished via tensor completion that imposes low-rank tensor structure on the Poisson parameter space. Our main result shows that an $N$-way rank-$R$ parametric tensor $\boldsymbol{\mathscr{M}}\in (0,\infty )^{I\times \cdots \times I}$ generating Poisson observations can be accurately estimated by zero-truncated Poisson regression from approximately $IR^2\log _2^2(I)$ non-zero counts under the nonnegative canonical polyadic decomposition. Our result also quantifies the error made by zero-truncating the Poisson distribution when the parameter is uniformly bounded from below. Therefore, under a low-rank multiparameter model, we propose an implementable approach guaranteed to achieve accurate regression in under-determined scenarios with substantial corruption by false zeros. Several numerical experiments are presented to explore the theoretical results.
Stabilization of the Pendubot: a polynomial matrix approach
Authors: Wei Cui , Vardulakis Antonis , Chai Tianyou
Published: May 2023

This paper concerns the stabilization problem for an underactuated robot called the Pendubot. Relying on a computational algorithm which is based on various results of the ‘polynomial matrix approach’, we propose an output-feedback-based internally stabilizing controller to stabilize the Pendubot at the unstable vertical upright position. The algorithm utilizes results for the solution of polynomial matrix Diophantine equations required for the computation and parameterization of proper ‘denominator assigning’ and internally stabilizing controllers for linear time invariant multivariable systems and reduces the problem to that of the solution of a set of numerical linear equations. The controller presented uses only the measured output which consists of the angles of the two links and does not require knowledge of the angular velocities which are usually not directly measurable. Comparative simulations are carried out to verify the good performance of the proposed controller. Finally, experimental results are provided to demonstrate the validity and feasibility of the proposed method.
Differential effects of size-specific particulate matter on frailty transitions among middle-aged and older adults in China: findings from the China Health and Retirement Longitudinal Study (CHARLS), 2015–2018
Authors: Guo Zhen , Xue Hui , Fan Lijun , Wu Di , Wang Yiming , Chung Younjin , Liao Yilan , Ruan Zengliang , Du Wei
Published: May 2023

Background

This study aimed to assess the long-term effects of size-specific particulate matter (PM) on frailty transitions in middle-aged and older Chinese adults.

Methods

We included 13 910 participants ≥45 y of age from the China Health and Retirement Longitudinal Study (CHARLS) for 2015 and 2018 who were classified into three categories in 2015 according to their frailty states: robust, prefrail and frail. Air quality data were obtained from the National Urban Air Quality Real-time Publishing Platform. A two-level logistic regression model was used to examine the association between concentrations of PM and frailty transitions.

Results

At baseline, the total number of robust, prefrail and frail participants were 7516 (54.0%), 4324 (31.1%) and 2070 (14.9%), respectively. Significant associations were found between PM concentrations and frailty transitions. For each 10 μg/m3 increase in the 3-y averaged 2.5-μm PM (PM2.5) concentrations, the risk of worsening in frailty increased in robust (odds ratio [OR] 1.06 [95% confidence interval {CI} 1.01 to 1.12]) and prefrail (OR 1.07 [95% CI 1.01 to 1.13]) participants, while the probability of improvement in frailty in prefrail (OR 0.91 [95% CI 0.84 to 0.98]) participants decreased. In addition, the associations of PM10 and coarse fraction of PM with frailty transitions showed similar patterns.

Conclusions

Long-term exposure to PM was associated with higher risks of worsening and lower risks of improvement in frailty among middle-aged and older adults in China.
Age Differences in Comorbidities, Presenting Symptoms, and Outcomes of Influenza Illness Requiring Hospitalization: A Worldwide Perspective From the Global Influenza Hospital Surveillance Network
Authors: Andrew Melissa K , Pott Henrique , Staadegaard Lisa , Paget John , Chaves Sandra S , Ortiz Justin R , McCauley John , Bresee Joseph , Nunes Marta C , Baumeister Elsa , Raboni Sonia Mara , Giamberardino Heloisa I G , McNeil Shelly A , Gomez Doris , Zhang Tao , Vanhems Philippe , Koul Parvaiz A , Coulibaly Daouda , Otieno Nancy A , Dbaibo Ghassan , Almeida Maria Lourdes Guerrero , Laguna-Torres Victor Alberto , Drăgănescu Anca Cristina , Burtseva Elena , Sominina Anna , Danilenko Daria , Medić Snežana , Diez-Domingo Javier , Lina Bruno
Published: May 2023

Background

The Global Influenza Hospital Surveillance Network (GIHSN) was established in 2012 to conduct coordinated worldwide influenza surveillance. In this study, we describe underlying comorbidities, symptoms, and outcomes in patients hospitalized with influenza.

Methods

Between November 2018 and October 2019, GIHSN included 19 sites in 18 countries using a standardized surveillance protocol. Influenza infection was laboratory-confirmed with reverse-transcription polymerase chain reaction. A multivariate logistic regression model was utilized to analyze the extent to which various risk factors predict severe outcomes.

Results

Of 16 022 enrolled patients, 21.9% had laboratory-confirmed influenza; 49.2% of influenza cases were A/H1N1pdm09. Fever and cough were the most common symptoms, although they decreased with age (P < .001). Shortness of breath was uncommon among those <50 years but increased with age (P < .001). Middle and older age and history of underlying diabetes or chronic obstructive pulmonary disease were associated with increased odds of death and intensive care unit (ICU) admission, and male sex and influenza vaccination were associated with lower odds. The ICU admissions and mortality occurred across the age spectrum.

Conclusions

Both virus and host factors contributed to influenza burden. We identified age differences in comorbidities, presenting symptoms, and adverse clinical outcomes among those hospitalized with influenza and benefit from influenza vaccination in protecting against adverse clinical outcomes. The GIHSN provides an ongoing platform for global understanding of hospitalized influenza illness.
The Impact of Antimicrobial Therapy Duration in the Treatment of Prosthetic Joint Infections Depending on Surgical Strategies: A Systematic Review and Meta-analysis
Authors: Olearo Flaminia , Zanichelli Veronica , Exarchakou Aimilia , Both Anna , Uςkay Ilker , Aepfelbacher Martin , Rohde Holger
Published: May 2023

The aim of this systematic review was to address the question if short antibiotic treatment (SAT; at least 4 but <12 weeks) versus long antibiotic treatment (LAT) affects outcomes in prosthetic joint infections (PJIs). Database research (Medline, Embase, Web of Science, Scopus, Cochrane) retrieved 3740 articles, of which 10 studies were included in the analysis. Compared to LAT, 11% lower odds of treatment failure in the SAT group were found, although the difference was not statistically significant (pooled odds ratio, 0.89 [95% confidence interval, .53–1.50]). No difference in treatment failure was found between SAT and LAT once stratified by type of surgery, studies conducted in the United States versus Europe, study design, and follow-up. There is still no conclusive evidence that antibiotic treatment of PJIs for 12 weeks or longer is associated with better outcomes, irrespective of the type of surgical procedure. Most recent, high-quality studies tend to favor longer antibiotic courses, making them preferable in most situations.
Bioactive mineralized small intestinal submucosa acellular matrix/PMMA bone cement for vertebral bone regeneration
Authors: Miao Xinbao , Yang Shuhui , Zhu Jinjin , Gong Zhe , Wu Dongze , Hong Juncong , Cai Kaiwen , Wang Jiying , Fang Xiangqian , Lu Jiye , Jiang Guoqiang
Published: May 2023

Polymethylmethacrylate (PMMA) bone cement extensively utilized for the treatment of osteoporotic vertebral compression fractures due to its exceptional handleability and mechanical properties. Nevertheless, the clinical application of PMMA bone cement is restricted by its poor bioactivity and excessively high modulus of elasticity. Herein, mineralized small intestinal submucosa (mSIS) was incorporated into PMMA to prepare a partially degradable bone cement (mSIS–PMMA) that provided suitable compressive strength and reduced elastic modulus compared to pure PMMA. The ability of mSIS–PMMA bone cement to promote the attachment, proliferation and osteogenic differentiation of bone marrow mesenchymal stem cells was shown through cellular experiments carried out in vitro, and an animal osteoporosis model validated its potential to improve osseointegration. Considering these benefits, mSIS–PMMA bone cement shows promising potential as an injectable biomaterial for orthopedic procedures that require bone augmentation.
Relationship between mechanical load and surface erosion degradation of a shape memory elastomer poly(glycerol-dodecanoate) for soft tissue implant
Authors: Jin Kaixiang , Li Hanqin , Liang Mingkai , Li Yuqi , Wang Lizhen , Fan Yubo
Published: May 2023

Poly(glycerol-dodecanoate) (PGD) has aroused increasing attention in biomedical engineering for its degradability, shape memory and rubber-like mechanical properties, giving it potential to fabricate intelligent implants for soft tissues. Adjustable degradation is important for biodegradable implants and is affected by various factors. The mechanical load has been shown to play an important role in regulating polymer degradation in vivo. An in-depth investigation of PGD degradation under mechanical load is essential for adjusting its degradation behavior after implantation, further guiding to regulate degradation behavior of soft tissue implants made by PGD. In vitro degradation of PGD under different compressive and tensile load has proceeded in this study and describes the relationships by empirical equations. Based on the equations, a continuum damage model is designed to simulate surface erosion degradation of PGD under stress through finite element analysis, which provides a protocol for PGD implants with different geometric structures at varied mechanical conditions and provides solutions for predicting in vivo degradation processes, stress distribution during degradation and optimization of the loaded drug release.
Incidence and Risk Profiles for Suicide Mortality in Patients With Schizophrenia Receiving Homecare Case Management in Taiwan
Authors: Chen Wen-Yin , Pan Chun-Hung , Su Sheng-Shiang , Yang Tien-Wei , Chen Chiao-Chicy , Kuo Chian-Jue
Published: May 2023

Case management (CM)-based community therapy for patients with schizophrenia had little effect on reducing suicide mortality. We investigate the long-term suicide mortality outcome and associated risk factors in patients with schizophrenia receiving homecare (CM) in Taiwan. We enrolled a nationwide cohort of patients with schizophrenia who newly received homecare CM intervention (n = 13 317) between January 1, 2001, and December 31, 2015; their data were derived from Taiwan’s National Health Insurance Research Database. We calculated the incidence rate of suicide methods. We examined the demographic and medical utilization profile for suicide and then performed a nested case–control study and multivariate regression to identify independent risk factors for suicide mortality. Among the 13 317 patients who received homecare CM intervention, 1766 died during the study period, of whom 213 died by suicide, which is the leading cause of unnatural death. Jumping from a high place, self-poisoning, and hanging were the top 3 suicide methods. Increased medical utilization was noted for both psychiatric and non-psychiatric services within 3 months of suicide mortality. Comorbidities of depressive disorder, nonspecific heart diseases, pneumonia, and gastrointestinal ulcers were identified as independent risk factors for suicide mortality. Suicide was the leading cause of unnatural mortality in patients with schizophrenia receiving homecare CM intervention in Taiwan. We noted the preferred suicide methods, high medical utilization, and comorbidities before suicide. Thus, we suggest that the CM team should assess lethal methods for suicide and ensure that patients adhere to psychiatry treatment for improving the current care model for this specified population.
Risk of post-acute sequelae of SARS-CoV-2 infection associated with pre-coronavirus disease obstructive sleep apnea diagnoses: an electronic health record-based analysis from the RECOVER initiative
Authors: L Mandel Hannah , Colleen Gunnar , Abedian Sajjad , Ammar Nariman , Charles Bailey L , Bennett Tellen D , Daniel Brannock M , Brosnahan Shari B , Chen Yu , Chute Christopher G , Divers Jasmin , Evans Michael D , Haendel Melissa , Hall Margaret A , Hirabayashi Kathryn , Hornig Mady , Katz Stuart D , Krieger Ana C , Loomba Johanna , Lorman Vitaly , Mazzotti Diego R , McMurry Julie , Moffitt Richard A , Pajor Nathan M , Pfaff Emily , Radwell Jeff , Razzaghi Hanieh , Redline Susan , Seibert Elle , Sekar Anisha , Sharma Suchetha , Thaweethai Tanayott , Weiner Mark G , Jae Yoo Yun , Zhou Andrea , Thorpe Lorna E
Published: May 2023

Study Objectives

Obstructive sleep apnea (OSA) has been associated with more severe acute coronavirus disease-2019 (COVID-19) outcomes. We assessed OSA as a potential risk factor for Post-Acute Sequelae of SARS-CoV-2 (PASC).

Methods

We assessed the impact of preexisting OSA on the risk for probable PASC in adults and children using electronic health record data from multiple research networks. Three research networks within the REsearching COVID to Enhance Recovery initiative (PCORnet Adult, PCORnet Pediatric, and the National COVID Cohort Collaborative [N3C]) employed a harmonized analytic approach to examine the risk of probable PASC in COVID-19-positive patients with and without a diagnosis of OSA prior to pandemic onset. Unadjusted odds ratios (ORs) were calculated as well as ORs adjusted for age group, sex, race/ethnicity, hospitalization status, obesity, and preexisting comorbidities.

Results

Across networks, the unadjusted OR for probable PASC associated with a preexisting OSA diagnosis in adults and children ranged from 1.41 to 3.93. Adjusted analyses found an attenuated association that remained significant among adults only. Multiple sensitivity analyses with expanded inclusion criteria and covariates yielded results consistent with the primary analysis.

Conclusions

Adults with preexisting OSA were found to have significantly elevated odds of probable PASC. This finding was consistent across data sources, approaches for identifying COVID-19-positive patients, and definitions of PASC. Patients with OSA may be at elevated risk for PASC after SARS-CoV-2 infection and should be monitored for post-acute sequelae.
Cadmium-induced stress: a close look at the relationship between autophagy and apoptosis
Authors: Tuffour Alex , Adebayiga Kosiba Anthony , Addai Peprah Frank , Gu Jie , Zhou Yang , Shi Haifeng
Published: May 2023

Stress is acknowledged as one of the major factors responsible for autophagy induction, a tightly regulated process that acts as a pro-death or pro-survival mechanism within cells. Cadmium (Cd), a toxic heavy metal, induces apoptosis and autophagy in cells after exposure to low concentrations. This is due to Cd’s ability to induce oxidative stress in cells and tissues by overproducing reactive oxygen species. Several proteins have been found to mediate the process of autophagy but aspects of their specific roles and targets remain undefined. Though LC3-II and p62 have traditionally been used as biomarkers that define autophagy, recent findings have revealed some limitations to LC3-II because it can be accumulated in cells in an autophagy-independent manner, whereas p62 remains a good determinant of the process. In addition to LC3-II and p62, recent studies have suggested that a new member of the autophagy protein family, the vacuole membrane protein 1 (VMP1), is essential in driving autophagy and could be an important biomarker for detecting the initiation and progression of autophagy. This review therefore focuses on current trends in autophagy biomarkers, the effect of Cd on the expression of LC3-II, p62, VMP1, and Beclin-1 and their relation and inter-regulatory roles in autophagy and apoptosis, pharmacological importance, and the mechanisms involved.
Textbook outcome in gallbladder carcinoma after curative-intent resection: a 10-year retrospective single-center study
Authors: Li Qi , Liu Hengchao , Gao Qi , Xue Feng , Fu Jialu , Li Mengke , Yuan Jiawei , Chen Chen , Zhang Dong , Geng Zhimin
Published: May 2023

Background:

Textbook outcome (TO) can guide decision-making among patients and clinicians during preoperative patient selection and postoperative quality improvement. We explored the factors associated with achieving a TO for gallbladder carcinoma (GBC) after curative-intent resection and analyzed the effect of adjuvant chemotherapy (ACT) on TO and non-TO patients.

Methods:

A total of 540 patients who underwent curative-intent resection for GBC at the Department of Hepatobiliary Surgery of the First Affiliated Hospital of Xi'an Jiaotong University from January 2011 to December 2020 were retrospectively analyzed. Multivariable logistic regression was used to investigate the factors associated with TO.

Results:

Among 540 patients with GBC who underwent curative-intent resection, 223 patients (41.3%) achieved a TO. The incidence of TO ranged from 19.0% to 51.0% across the study period, with a slightly increasing trend over the study period. The multivariate analysis showed that non-TO was an independent risk factor for prognosis among GBC patients after resection (P =0.003). Age ≤60 years (P =0.016), total bilirubin (TBIL) level ≤34.1 μmol/L (P <0.001), well-differentiated tumor (P =0.008), no liver involvement (P <0.001), and T1–2 stage disease (P =0.006) were independently associated with achieving a TO for GBC after resection. Before and after propensity score matching (PSM), the overall survival outcomes of non-TO GBC patients who received ACT and those who did not were statistically significant; ACT improved the prognosis of patients in the non-TO group (P <0.050).

Conclusion:

Achieving a TO is associated with a better long-term prognosis among GBC patients after curative-intent resection, and ACT can improve the prognosis of those with non-TO.
Medication Safety Event Reporting
Authors: Cohen Tara N. , Berdahl Carl T. , Coleman Bernice L. , Seferian Edward G. , Henreid Andrew J. , Leang Donna W. , Nuckols Teryl K.
Published: May 2023

Background:

Incident reports submitted during times of organizational stress may reveal unique insights.

Purpose:

To understand the insights conveyed in hospital incident reports about how work system factors affected medication safety during a coronavirus disease-2019 (COVID-19) surge.

Methods:

We randomly selected 100 medication safety incident reports from an academic medical center (December 2020 to January 2021), identified near misses and errors, and classified contributing work system factors using the Human Factors Analysis and Classification System-Healthcare.

Results:

Among 35 near misses/errors, incident reports described contributing factors (mean 1.3/report) involving skill-based errors (n = 20), communication (n = 8), and tools/technology (n = 4). Reporters linked 7 events to COVID-19.

Conclusions:

Skill-based errors were the most common contributing factors for medication safety events during a COVID-19 surge. Reporters rarely deemed events to be related to COVID-19, despite the tremendous strain of the surge on nurses. Future efforts to improve the utility of incident reports should emphasize the importance of describing work system factors.
Treatment Guideline Nonadherence Pretransport Associated With Need for Higher Level of Care in Children Transferred to a Pediatric Tertiary Care Center for Status Epilepticus
Authors: Philpott Natalia Garza , Dante Siddhartha A. , Philpott David , Perin Jamie , Bhatia Pooja , Henderson Eric , Costabile Philomena , Stratton Maera , Dabrowski Ania , Kossoff Eric H. , Klein Bruce L. , Noje Corina
Published: May 2023

Objectives

We sought to investigate the association between adherence to the American Epilepsy Society (AES) 2016 guidelines for management of convulsive status epilepticus (SE) and clinical outcomes among children requiring interhospital transport for SE. We hypothesized that pretransport guideline nonadherence would be associated with needing higher level of care posttransfer.

Methods

This was a retrospective cohort study of children aged 30 days to 18 years transferred to our pediatric tertiary center from 2017 to 2019 for management of SE. Their care episodes were classified as 2016 American Epilepsy Society guideline adherent or nonadherent. There were 40 referring hospitals represented in this cohort.

Results

Of 260 care episodes, 55 (21%) were guideline adherent, 184 (71%) were guideline nonadherent, and 21 (8%) had insufficient data to determine guideline adherence. Compared with the adherent group, patients in the nonadherent care group had longer hospitalizations (32 hours [17–68] vs 21 hours [7–48], P = 0.006), were more likely to require intensive care unit admission (47% vs 31%), and less likely to be discharged home from the emergency department (16% vs 35%; χ2 test, P = 0.01). Intubation rates did not differ significantly between groups (25% vs 18%, P = 0.37). When we fit a multivariable model to adjust for confounding variables, guideline nonadherence was associated with need for higher level of care (odds ratio, 2.04; 95% confidence interval, 1.04–3.99). Treatment guideline adherence did not improve over the 3-year study period (2017: 22%, 2018: 19%, 2019: 29% [χ2 test for differences between any 2 years, P = 0.295]).

Conclusions

Guideline nonadherence pretransport was associated with longer hospitalizations and need for higher level of care among children transferred for SE at our institution. These findings suggest a need to improve SE guideline adherence through multifaceted quality improvement efforts targeting both the prehospital and community hospital settings.
The Impact of a Multifaceted Simulation Education and Feedback Program for Community Emergency Departments on Pediatric Diabetic Ketoacidosis Management
Authors: Waddell Kristen , Gaither Stacy L. , Rockwell Nicholas , Tofil Nancy M. , Rutledge Chrystal
Published: May 2023

Objectives

We sought to determine if general emergency departments (GEDs) were managing pediatric diabetic ketoacidosis (DKA) correctly and if management could be improved using a multilayered educational initiative. We hypothesized that a multifaceted program of in situ simulation education and formal feedback on actual patient management would improve community GED management of pediatric DKA.

Methods

This study combined a prospective simulation-based performance evaluation and a retrospective chart review. A community outreach simulation education initiative was developed followed by a formal patient feedback process.

Results

Fifteen hospitals participated in simulation sessions and the feedback process. All hospitals were scored for readiness to provide care for critically ill pediatric patients using the Emergency Medical Services for Children (EMSC) Pediatric Readiness Assessment. Six of the 15 have had a second hospital visit that included a DKA scenario with an average performance score of 60.3%. A total of 158 pediatric patients with DKA were included in the chart review. The GEDs with higher patient volumes provided best practice DKA management more often (63%) than those with lower patient volumes (40%). Participating in a DKA simulated scenario showed a trend toward improved care, with 47.2% before participation and 68.2% after participation (P = 0.091). Participating in the formal feedback process improved best practice management provided to 68.6%. Best practice management was further improved to 70.3% if the GED participated in both a DKA simulation and the feedback process (P = 0.04).

Conclusions

A multifaceted program of in situ simulation education and formal feedback on patient management can improve community GED management of pediatric patients with DKA.
“To Ablate or Not to Ablate: The Question if Umbilectomy Decreases Donor Site Complications in DIEP Flap Breast Reconstruction?”
Authors: Kevin Perez , Teotia Sumeet S. , Haddock Nicholas T.
Published: May 2023

Objectives:

There have been several considerations made in improving outcomes for DIEP flap breast reconstruction. The aim of this study is to evaluate the impact of umbilectomy in abdominally based breast reconstruction.

Methods:

This is a retrospective study that evaluated post-operative outcomes of patients who underwent DIEP autologous flap breast reconstruction at an academic center between January 2015 – December 2021 performed by one of two reconstructive surgeons. Primary outcome variables included abdominal donor site complications. Secondary outcome variables included treatment outcomes for complications. Covariates included demographic information, comorbidities, cancer treatment, and smoking.

Results:

Four hundred eight patients underwent DIEP flap breast reconstruction with one hundred ninety-four (47.5%) undergoing umbilectomy. Umbilectomy resulted in decreased number of total wounds per patient (0.35 ± 0.795) compared to umbilical preservation (0.75 ± 1.322, p < 0.001) as well as decreased associated risk of any reported wounds (OR = 0.530, p = 0.009). Associations that trended towards significance occurred between umbilectomy and minor wound separation, and partial necrosis; both showing decreased risks. Significant association was noted between umbilectomy and donor site seroma (χ2(1) = 6.348, p = 0.016) showing an increased risk (OR = 5.761).

Conclusion:

The topic of umbilectomy should be discussed with patients and considered as a part of DIEP flap breast reconstruction given the reduction in the risk of abdominal donor site wounds. Though umbilectomy decreases the rate of wounds it can increase risk of seroma, thus other interventions such as progressive tension sutures may be explored to aid in reducing seroma and improving wound healing.
Comparison of trans-alar suture technique and external wedge resection for alar base narrowing
Authors: Kaboodkhani Reza , Kazemi Tayebeh , Naderi Noushin , Rabiei Nikta , Babaei Amirhossein
Published: May 2023

Background:

Alar narrowing is indicated in some rhinoplasty surgeries. This study compared trans-alar sutures and external wedge resection for alar narrowing in the patients undergoing rhinoplasty.

Methods:

This study was a single-blind randomized controlled trial with a parallel design. Participants were randomly allocated to trans-alar suturing technique or external wedge resection groups (1:1 allocation ratio). Primary outcomes were scar formation and satisfaction score (Rhinoplasty Outcome Evaluation [ROE] questionnaire and patient component of Patient Scar Assessment Questionnaire [PSAQ]) after 12 months. Secondary outcomes were the duration of procedure, amount of bleeding, and need for bleeding control.

Results:

In total, 44 and 46 patients completed the study in the trans-alar suture and external wedge resection groups, respectively. The post-operative assessment showed a significantly lower scar formation rate in the trans-alar suture group (75.0% vs. 37.0%; p<0.001). ROE questionnaire revealed no statistically significant difference in patient satisfaction between two groups. The PSAQ results showed that patients who received trans-alar sutures had a lower overall score (1 (1 to 1)) compared with the external wedge resection group (2 to 1 to 4.50) (p-value<0.001). The duration of the procedure (p<0.001), amount of bleeding (p<0.001), and need for bleeding control (p-value=0.009) were significantly lower in the trans-alar suture group than in the external wedge resection group.

Conclusion:

Trans-alar sutures result in high post-operative patient satisfaction. This approach has a decreased incidence of scarring, operation time, bleeding, and the necessity for bleeding control.
Impact of CXCR4-Directed PET/CT on Staging and Proposed Oncologic Management in Patients With Digestive System Tumors
Authors: Weich Alexander , Serfling Sebastian E. , Schlötelburg Wiebke , Higuchi Takahiro , Hartrampf Philipp E. , Schirbel Andreas , Heinrich Marieke , Buck Andreas K. , Rowe Steven P. , Kosmala Aleksander , Werner Rudolf A.
Published: May 2023

Purpose

To elucidate the influence of CXC motif chemokine receptor 4 (CXCR4)–directed imaging on staging and proposed oncologic management in patients with digestive system tumors compared with guideline-appropriate imaging (GAI).

Methods

From our PET/CT database, we retrospectively identified 37 patients with advanced digestive system tumors, which had been scheduled for CXCR4-targeted [68Ga]Ga-pentixafor PET/CT for potential theranostic considerations. In all subjects, concurrent GAI was also available. Patients were afflicted with gastroenteropancreatic neuroendocrine neoplasms (21/37 [56.8%]), pancreatic duct adenocarcinoma (6/37 [16.2%]), cholangiocarcinoma (5/37 [13.5%]), hepatocellular carcinoma (4/37 [10.8%]), and colorectal carcinoma (1/37 [2.7%]). Staging results and impact on proposed oncologic management by a board-certified gastroenterologist were compared between GAI and [68Ga]Ga-pentixafor PET/CT.

Results

Relative to GAI, CXCR4-directed PET/CT resulted in staging changes in 14 of 37 patients (37.8%). Upstaging was seen in 1 of 14 patients (7.1%), whereas downstaging was recorded in the remaining 13 of 14 patients (92.9%). Among those, staging changes would not have triggered any changes in oncological management in 4 of 14 (28.6%). For the remaining 10 of 14 patients (71.4%), however, findings on [68Ga]Ga-pentixafor PET/CT would have impacted subsequent clinical algorithm, including the necessity for further diagnostic steps or failure to initiate antitumor therapy.

Conclusion

[68Ga]Ga-pentixafor PET/CT missed tumor lesions in 13 patients with digestive system tumors, which would have led to inappropriate downstaging and clinical treatment of 10 patients. As such, our results do not support a more widespread use of [68Ga]Ga-pentixafor PET/CT for clinical staging in those tumor entities.
Artificial intelligence evaluation of focused assessment with sonography in trauma
Authors: Levy Brittany E. , Castle Jennifer T. , Virodov Alexandr , Wilt Wesley S. , Bumgardner Cody , Brim Thomas , McAtee Erin , Schellenberg Morgan , Inaba Kenji , Warriner Zachary D.
Published: May 2023

BACKGROUND

The focused assessment with sonography in trauma (FAST) is a widely used imaging modality to identify the location of life-threatening hemorrhage in a hemodynamically unstable trauma patient. This study evaluates the role of artificial intelligence in interpretation of the FAST examination abdominal views, as it pertains to adequacy of the view and accuracy of fluid survey positivity.

METHODS

Focused assessment with sonography for trauma examination images from 2015 to 2022, from trauma activations, were acquired from a quaternary care level 1 trauma center with more than 3,500 adult trauma evaluations, annually. Images pertaining to the right upper quadrant and left upper quadrant views were obtained and read by a surgeon or radiologist. Positivity was defined as fluid present in the hepatorenal or splenorenal fossa, while adequacy was defined by the presence of both the liver and kidney or the spleen and kidney for the right upper quadrant or left upper quadrant views, respectively. Four convolutional neural network architecture models (DenseNet121, InceptionV3, ResNet50, Vgg11bn) were evaluated.

RESULTS

A total of 6,608 images, representing 109 cases were included for analysis within the “adequate” and “positive” data sets. The models relayed 88.7% accuracy, 83.3% sensitivity, and 93.6% specificity for the adequate test cohort, while the positive cohort conferred 98.0% accuracy, 89.6% sensitivity, and 100.0% specificity against similar models. Augmentation improved the accuracy and sensitivity of the positive models to 95.1% accurate and 94.0% sensitive. DenseNet121 demonstrated the best accuracy across tasks.

CONCLUSION

Artificial intelligence can detect positivity and adequacy of FAST examinations with 94% and 97% accuracy, aiding in the standardization of care delivery with minimal expert clinician input. Artificial intelligence is a feasible modality to improve patient care imaging interpretation accuracy and should be pursued as a point-of-care clinical decision-making tool.

LEVEL OF EVIDENCE

Diagnostic Test/Criteria; Level III.
Alpha-methyltyrosine reduces the acute cardiovascular and behavioral sequelae in a murine model of traumatic brain injury
Authors: Woodman Ryan , Miller Coleman , Student Jeffrey , Freeman Kalev , Perl Daniel , Lockette Warren
Published: May 2023

BACKGROUND

Increased catecholamines contribute to heightened cardiovascular reactivity and behavioral deficits after traumatic brain injury (TBI); adrenergic receptor blockade has limited success in reducing adverse sequelae of TBI. Injury-induced increases in the synthesis of catecholamines could contribute to adverse outcomes in TBI. Inhibition of catecholamine synthesis with alpha-methyltyrosine (αMT) could offer a benefit after TBI.

METHODS

Original research trial in mice randomized to αMT (50 mg·kg−1·d−1) or vehicle for 1 week after TBI induced by controlled cortical impact. Primary outcomes of cardiovascular reactivity and behavioral deficits were assessed after 1 week. Secondary outcomes included blood brain barrier permeability and quantification of gene transcription whose products determine intraneuronal chloride concentrations, the release of catecholamines, and activation of the sympathetic nervous system. These genes were the alpha-2 adrenergic receptor (“Adra2c”), the sodium-potassium-chloride cotransporter (“Nkcc1”), and the potassium chloride cotransporter (“Kcc2”). We also assessed the effect of TBI and αMT on the neuronal chloride/bicarbonate exchanger (“Ae3”).

RESULTS

Traumatic brain injury–induced increases in blood pressure and cardiac reactivity were blocked by αMT. Inhibition of catecholamine synthesis decreased blood brain barrier leakage and improved behavioral outcomes after TBI. Traumatic brain injury diminished the transcription of Adra2c and enhanced expression of Nkcc1 while reducing Kcc2 transcription; αMT prevented the induction of the Nkcc1 by TBI without reversing the effects of TBI on Kcc2 expression; αMT also diminished Ae3 transcription.

CONCLUSION

Traumatic brain injury acutely increases cardiovascular reactivity and induces behavioral deficits in an αMT-sensitive manner, most likely by inducing Nkcc1 gene transcription. Alpha-methyltyrosine may prove salutary in the treatment of TBI by attenuating the enhanced expression of Nkcc1, minimizing blood brain barrier leakage, and diminishing central catecholamine and sympathetic output. We also found an unreported relationship between Kcc2 and the chloride/bicarbonate exchanger, which should be considered in the design of trials planned to manipulate central intraneuronal chloride concentrations following acute brain injury.
Structural and Functional Changes of Brain in Children With Intermittent Exotropia: A Study Combining Multiple MRI Modalities
Authors: Zhu Hui , Guo Wei , Wu Qian , Hu Hao , Xu Xiaoquan , Wu Feiyun , Du Jiangbo , Liu Hu , Hu Zhibin
Published: May 2023

Background:

To investigate structural and functional changes of brain in children with intermittent exotropia (IXT) and their relationship with clinical features.

Methods:

Twenty-one IXT patients (mean age 9.38 ± 2.62 years) and 21 age-, gender-, education-, and handedness-matched healthy controls (HCs, mean age 9.52 ± 3.28 years) underwent high-resolution T1 imaging, diffusion tensor imaging (DTI), and resting-state functional MRI (rs-fMRI). The gray and white matter volume analyzed by voxel-based morphometry (VBM) based on T1 imaging, the fractional anisotropy (FA) and mean diffusivity (MD) indices based on DTI, and the amplitude of low frequency fluctuation (ALFF) value based on rs-fMRI were compared between these 2 groups. The correlations between MRI-derived parameters in significant brain regions and various clinical characteristics of IXT were analyzed.

Results:

Compared with HCs, IXT children showed significantly decreased FA in right precentral gyrus (PRG) and right postcentral gyrus (POG), and significantly decreased ALFF in bilateral calcarine sulcus, bilateral cuneus, left lingual gyrus, and left superior occipital gyrus. The FA value in right PRG and right POG was negatively correlated with disease duration (r = −0.520, P = 0.016), angle of exodeviation at near (r = −0.549, P = 0.010), and angle of exodeviation at distance (r = −0.547, P = 0.010).

Conclusions:

IXT children exhibited abnormalities of white matter microstructure and reduced spontaneous neural activities in brain regions involving in oculomotor performance and binocular fusion. Further studies are needed to determine whether these findings are related to the neuropathologic mechanism or downstream changes of IXT.
Climate-driven variability of the Southern Ocean CO
2
sink
Authors: Mayot N. , Le Quéré C. , Rödenbeck C. , Bernardello R. , Bopp L. , Djeutchouang L. M. , Gehlen M. , Gregor L. , Gruber N. , Hauck J. , Iida Y. , Ilyina T. , Keeling R. F. , Landschützer P. , Manning A. C. , Patara L. , Resplandy L. , Schwinger J. , Séférian R. , Watson A. J. , Wright R. M. , Zeng J.
Published: May 2023

The Southern Ocean is a major sink of atmospheric CO
2
, but the nature and magnitude of its variability remains uncertain and debated. Estimates based on observations suggest substantial variability that is not reproduced by process-based ocean models, with increasingly divergent estimates over the past decade. We examine potential constraints on the nature and magnitude of climate-driven variability of the Southern Ocean CO
2
sink from observation-based air–sea O
2
fluxes. On interannual time scales, the variability in the air–sea fluxes of CO
2
and O
2
estimated from observations is consistent across the two species and positively correlated with the variability simulated by ocean models. Our analysis suggests that variations in ocean ventilation related to the Southern Annular Mode are responsible for this interannual variability. On decadal time scales, the existence of significant variability in the air–sea CO
2
flux estimated from observations also tends to be supported by observation-based estimates of O
2
flux variability. However, the large decadal variability in air–sea CO
2
flux is absent from ocean models. Our analysis suggests that issues in representing the balance between the thermal and non-thermal components of the CO
2
sink and/or insufficient variability in mode water formation might contribute to the lack of decadal variability in the current generation of ocean models.

This article is part of a discussion meeting issue 'Heat and carbon uptake in the Southern Ocean: the state of the art and future priorities'.
Southern ocean carbon and heat impact on climate
Authors:   The SO-CHIC consortium, Sallée J. B. , Abrahamsen E. P. , Allaigre C. , Auger M. , Ayres H. , Badhe R. , Boutin J. , Brearley J. A. , de Lavergne C. , ten Doeschate A. M. M. , Droste E. S. , du Plessis M. D. , Ferreira D. , Giddy I. S. , Gülk B. , Gruber N. , Hague M. , Hoppema M. , Josey S. A. , Kanzow T. , Kimmritz M. , Lindeman M. R. , Llanillo P. J. , Lucas N. S. , Madec G. , Marshall D. P. , Meijers A. J. S. , Meredith M. P. , Mohrmann M. , Monteiro P. M. S. , Mosneron Dupin C. , Naeck K. , Narayanan A. , Naveira Garabato A. C. , Nicholson S-A. , Novellino A. , Ödalen M. , Østerhus S. , Park W. , Patmore R. D. , Piedagnel E. , Roquet F. , Rosenthal H. S. , Roy T. , Saurabh R. , Silvy Y. , Spira T. , Steiger N. , Styles A. F. , Swart S. , Vogt L. , Ward B. , Zhou S.
Published: May 2023

The Southern Ocean greatly contributes to the regulation of the global climate by controlling important heat and carbon exchanges between the atmosphere and the ocean. Rates of climate change on decadal timescales are therefore impacted by oceanic processes taking place in the Southern Ocean, yet too little is known about these processes. Limitations come both from the lack of observations in this extreme environment and its inherent sensitivity to intermittent processes at scales that are not well captured in current Earth system models. The Southern Ocean Carbon and Heat Impact on Climate programme was launched to address this knowledge gap, with the overall objective to understand and quantify variability of heat and carbon budgets in the Southern Ocean through an investigation of the key physical processes controlling exchanges between the atmosphere, ocean and sea ice using a combination of observational and modelling approaches. Here, we provide a brief overview of the programme, as well as a summary of some of the scientific progress achieved during its first half. Advances range from new evidence of the importance of specific processes in Southern Ocean ventilation rate (e.g. storm-induced turbulence, sea–ice meltwater fronts, wind-induced gyre circulation, dense shelf water formation and abyssal mixing) to refined descriptions of the physical changes currently ongoing in the Southern Ocean and of their link with global climate.

This article is part of a discussion meeting issue ‘Heat and carbon uptake in the Southern Ocean: the state of the art and future priorities’.