bluuebunny/crossref_metadata_2025 huggingface dataset:
Morbidity of Nerve Transfers for Brachial Plexus Birth Injury: A Systematic Review
Authors: Hinchcliff Katharine M. , Pulos Nicholas , Shin Alexander Y. , Stutz Christopher
Published: November 2020

Background:

The purpose of this article is to systematically review the peer-reviewed literature on the morbidity of nerve transfers performed in patients with brachial plexus birth injury (BPBI). Nerve transfers for restoration of function in patients with BPBI that fail nonoperative management are increasing in popularity. However, relatively little attention has been paid to the morbidity of these transfers in the growing patient. The authors systematically review the current literature regarding donor site morbidity following nerve transfer for BPBI.

Methods:

A systematic review of the Medline and EMBASE databases was conducted through February 2020. Primary research articles written in English and reporting donor site morbidity after nerve transfer for BPBI were included for review.

Results:

Thirty-six articles met inclusion criteria, all of which were retrospective reviews or case reports. There was great heterogeneity in outcomes assessed. With 5 year or less follow-up, all transfers were relatively well tolerated with the exception of the hypoglossal nerve transfer.

Conclusion:

Nerve transfers are a well-recognized treatment strategy for patients with BPBI and have an acceptable risk profile in the short term. Full hypoglossal nerve transfers for BPBI are of historical interest. Donor site morbidity is grossly underreported. This review highlights the need for more objective and systematic reporting of donor site outcomes, and the need for longer term follow-up in these patients.

Level of Evidence:

Systematic review. Level III—therapeutic.
Targeting neuropilin-1 interactions is a promising anti-tumor strategy
Authors: Liu Shao-Dan , Zhong Li-Ping , He Jian , Zhao Yong-Xiang
Published: November 2020

Neuropilins (NRP1 and NRP2) are multifunctional receptor proteins that are involved in nerve, blood vessel, and tumor development. NRP1 was first found to be expressed in neurons, but subsequent studies have demonstrated its surface expression in cells from the endothelium and lymph nodes. NRP1 has been demonstrated to be involved in the occurrence and development of a variety of cancers. NRP1 interacts with various cytokines, such as vascular endothelial growth factor family and its receptor and transforming growth factor β1 and its receptor, to affect tumor angiogenesis, tumor proliferation, and migration. In addition, NRP1+ regulatory T cells (Tregs) play an inhibitory role in tumor immunity. High numbers of NRP1+ Tregs were associated with cancer prognosis. Targeting NRP1 has shown promise, and antagonists against NRP1 have had therapeutic efficacy in preliminary clinical studies. NRP1 treatment modalities using nanomaterials, targeted drugs, oncolytic viruses, and radio-chemotherapy have gradually been developed. Hence, we reviewed the use of NRP1 in the context of tumorigenesis, progression, and treatment.
Residential proximity to major roads and fecundability in a preconception cohort
Authors: Wesselink Amelia K. , Kirwa Kipruto , Hatch Elizabeth E. , Hystad Perry , Szpiro Adam A. , Kaufman Joel D. , Levy Jonathan I. , Mikkelsen Ellen M. , Quraishi Sabah M. , Rothman Kenneth J. , Wise Lauren A.
Published: November 2020

Background:

Emerging evidence from animal and human studies indicates that exposure to traffic-related air pollution may adversely affect fertility.

Methods:

Among 7,342 female pregnancy planners from the United States and 1,448 from Canada, we examined the association between residential proximity to major roads and fecundability, the per-cycle probability of conception. From 2013 to 2019, women 21–45 years old who were trying to conceive without fertility treatment completed an online baseline questionnaire and follow-up questionnaires every 8 weeks for up to 12 months or until pregnancy. We geocoded residential addresses reported at baseline and during follow-up, and calculated distance to nearest major roads and length of major roads within buffers of 50, 100, 300, and 400 meters around the residence as proxies for traffic-related air pollution. We used proportional probabilities regression models to estimate fecundability ratios (FRs) and 95% confidence intervals (CIs), adjusting for individual- and neighborhood-level characteristics.

Results:

In the United States, the FR comparing women who lived <50 meters with those who lived ≥400 meters from the closest major road was 0.88 (95% CI = 0.80, 0.98). The association among Canadian women was similar in magnitude, but less precise (FR = 0.93; 95% CI = 0.74, 1.16). Likewise, length of major roads within buffers of 50 and 100 meters was associated with lower fecundability in both countries; associations were attenuated within larger buffers.

Conclusions:

These results are consistent with the hypothesis that traffic-related air pollution or other near-road exposures may adversely affect fecundability.
Modifications to Combined Trabeculectomy and Manual Small Incision Cataract Surgery: Outcomes and Adaptability in Resource-constrained Areas
Authors: Choudhari Nikhil S. , Mokkarala Anuraag J.R. , Tone Badal , Khanna Rohit , Garudadri Chandra S.
Published: November 2020

Precis:

We describe standardization and simplification of classic trabeculectomy combined with manual small incision cataract surgery (MSICS) to effectively manage the 2 leading and often coexisting causes of blindness and vision impairment in resource-constrained areas.

Purpose:

The purpose of this study was to describe modifications to trabeculectomy combined with MSICS and report on the outcomes of this technique. The modifications consist of standardization and simplification of the surgical steps.

Methods:

Data obtained from adult patients who underwent described surgical technique at rural eye care centers across 3 Indian states between January 2018 and May 2019 were analyzed retrospectively. Complete success was intraocular pressure between 6 and 18 mm Hg without supplementary medication. Qualified success allowed up to 3 topical medication(s). Data are presented as median (first and third quartiles).

Results:

We analyzed data of 70 eyes of 70 patients. Ophthalmology fellows performed 27 (38.5%) surgeries, whereas an experienced glaucoma specialist performed 43 (61.4%) surgeries. Patients were 63 (56, 67) years old. The preoperative intraocular pressure was 20 (16, 26) mm Hg on treatment with 3 (2, 3) antiglaucoma medications. Glaucoma was advanced by optic disc structural criteria in 58 (82.8%) eyes. Intraoperative mitomycin C was used in 5 (7.1%) eyes. Follow-up was 12.5 (6, 18) months. At 1 year, complete success (95% confidence interval) achieved was 55% (41-67), whereas qualified success was 83% (68-92) with 0 (0, 1) topical medications. The complete and qualified success rates did not differ between ophthalmology fellows and the glaucoma specialist (P=0.75 and 0.44, respectively).

Conclusions:

We present a straightforward, yet effective technique of combined cataract and glaucoma surgery. The technique has a potential for wider applicability, especially in the underserved regions of the world.
Impact of Trifocal and Trifocal Toric Intraocular Lenses on Spectral-domain OCT Retinal Measurements
Authors: Rementería-Capelo Laureano A. , García-Pérez Jorge L. , Contreras Inés , Blázquez Vanesa , Ruiz-Alcocer Javier
Published: November 2020

Precis:

Monofocal, trifocal, and trifocal toric intraocular lenses (IOLs) induce similar changes on overall retinal optical coherence tomography (OCT) measurements.

Purpose:

The purpose of this study was to assess whether trifocal and trifocal toric IOLs affect the measurement of retinal parameters using spectral-domain OCT.

Methods:

This cross-over study included patients undergoing implantation of a trifocal IOL: AcrySof IQ PanOptix, a trifocal toric IOL: AcrySof IQ PanOptix Toric, and a monofocal IOL: AcrySof IQ. The monofocal group was considered as the control group. The refractive target was emmetropia in all cases. Mean average macular thickness, macular volume, and retinal nerve fiber layer (RNFL) thickness were measured with the Cirrus HD-OCT. All measurements were performed before and 3 months after the surgery.

Results:

The study analyzed 150 eyes of 150 patients (50 for each IOL group). Macular thickness and macular volume showed statistically significant differences before and after the surgery for the 3 groups (P<0.05 in all cases). RNFL thickness was found to be similar before and after the surgery in all groups (P>0.05 in all cases). Mean difference values (before and after the surgery) in the monocular, trifocal, and trifocal toric group for macular thickness, macular volume, and RNFL thickness were 4.9±7.8, 7.9±10.0, and 7.7±13.7 µm, respectively; 0.1±0.2, 0.2±0.4, and 0.2±0.3 mm3, respectively; and 0.8±5.5, 1.3±6.0, and 0.8±6.7 µm, respectively. Mean differences were found to be similar for the 3 groups.

Conclusion:

The trifocal and the trifocal toric IOLs under study did not induce an additional impact on spectral-domain OCT retinal measurements compared with monofocal IOLs.
Eosinopenia as predictor of infection in patients admitted to an internal medicine ward: a cross-sectional study
Authors: Silva João M. , Costa Artur M. , Tuna Célia , Gonçalves Renato , Ferreira Sara , Belém Francisco , Evangelista Maria C. , Ascensão Margarida
Published: November 2020

Background:

The identification of infection in an internal medicine ward is crucial but not always straightforward. Eosinopenia has been proposed as a marker of infection, but specific cutoffs for prediction are not established yet. We aim to assess whether there is difference in eosinophil count between infected and noninfected patients and, if so, the best cutoffs to differentiate them.

Methods:

Cross-sectional, observational study with analysis of all patients admitted to an Internal Medicine Department during 2 consecutive months. Clinical, laboratory and imaging data were analyzed. Infection at hospital admission was defined in the presence of either a microbiological isolation or suggestive clinical, laboratory, and/or imaging findings. Use of antibiotics in the 8 days before hospital admission, presence of immunosuppression, hematologic neoplasms, parasite, or fungal infections were exclusion criteria. In case of multiple hospital admissions, only the first admission was considered.

Sensitivity and specificity values for eosinophils, leukocytes, neutrophils, and C-reactive protein were determined by receiver operating characteristic curve. Statistical analysis was performed with IBM SPSS Statistics® v25 and MedCalc Statistical Software® v19.2.3.

Results:

A total of 323 hospitalization episodes were evaluated, each corresponding to a different patient. One hundred fifteen patients were excluded. A total of 208 patients were included, 62.0% (n = 129) of them infected at admission. Ten patients had multiple infections.

Infected patients had fewer eosinophils than uninfected patients (15.8 ± 42 vs 71.1 ± 159 cell/mm3; P < .001). An eosinophil count at admission ≤69 cell/mm3 had a sensitivity of 89.1% and specificity of 54.4% (area under the curve 0.752; 95% confidence interval 0.682–0.822) for the presence of infection. Eosinophil count of >77 cells/mm3 had a negative likelihood ratio of 0.16.

Conclusions:

Eosinophil count was significantly lower in infected than in uninfected patients. The cutoff 69 cells/mm3 was the most accurate in predicting infection. Eosinophil count >77 cells/mm3 was a good predictor of absence of infection.
Establishing diagnostic algorithms for SARS-CoV-2 nucleic acid testing in clinical practice
Authors: Ho Hsiang-Ling , Lin Yen-Yu , Wang Fang-Yu , Wu Chieh-Hsi , Lee Chia-Lin , Chou Teh-Ying
Published: November 2020

Background:

Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic. Our laboratory initially used a two-step molecular assay, first reported by Corman et al, for SARS-CoV-2 identification (the Taiwan Center for Disease Control [T-CDC] method). As rapid and accurate diagnosis of COVID-19 is required to control the spread of this infectious disease, the current study evaluated three commercially available assays, including the TaqPath COVID-19 Combo kit, the cobas SARS-CoV-2 test, and the Rendu 2019-nCoV Assay kit, to establish diagnostic algorithms for clinical laboratories.

Methods:

A total of 790 clinical specimens, including nasopharyngeal swabs, throat swabs, sputum, saliva, stool, endotracheal aspirate, and serum were obtained from patients who were suspected or already confirmed to have COVID-19 at the Taipei Veterans General Hospital from February to May 2020. These specimens were tested for SARS-CoV-2 using the different assays and the performance variance between the assays was analyzed.

Results:

Of the assays we evaluated, the T-CDC method and the TaqPath COVID-19 Combo kit require lots of hands-on practical laboratory work, while the cobas SARS-CoV-2 test and the Rendu 2019-nCoV Assay kit are fully automated detection systems. The T-CDC method and the TaqPath COVID-19 Combo kit showed similar detection sensitivity; however, the T-CDC method frequently delivered false-positive signals for envelope (E) and/or RNA-dependent RNA polymerase (RdRP) gene detection, thus increasing the risk of reporting false-positive results. A manual test-based testing strategy combining the T-CDC method and the TaqPath COVID-19 Combo kit was developed, which demonstrated excellent concordance rates (>99%) with the cobas and Rendu automatic systems. There were a few cases showing discrepant results, which may be due to the varied detection sensitivities as well as targets among the different platforms. Moreover, the concordance rate between the cobas and Rendu assays was 100%.

Conclusion:

Based on our evaluation, two SARS-CoV-2 diagnostic algorithms, one focusing on the manual assays and the other on the automatic platforms, were proposed. Our results provide valuable information that allows clinical laboratories to implement optimal diagnostic strategies for SARS-CoV-2 testing based on their clinical needs, such as test volume, turn-around time, and staff/resource limitations.
The precaution strategy toward the COVID-19 pandemic in the operating room of a tertiary hospital in Taiwan
Authors: Hung Jung-Jyh , Wang Fu-Der , Ma Hsu , Tsou Mei-Yung , Dai Hung-Da , Lin Yi-Han , Chen Wei-Ming , Liu Chin-Su
Published: November 2020

Background:

The pandemic of SARS-CoV-2 (COVID-19), which began in December 2019, spread mostly from person to person through respiratory droplets. A recommendation was issued to postpone all elective surgical practices. However, some confirmed or suspected COVID-19 patients required life-saving emergent surgeries.

Methods:

To facilitate emergent surgical interventions for these patients, we have reviewed the current literature and established an algorithm of precautions to be taken by operating room team members during the COVID-19 pandemic.

Results:

The initial algorithm of preparation for surgical intervention during the COVID-19 pandemic was relatively simple. However, the abrupt increase of confirmed COVID-19 cases due to returned overseas travelers since mid-March 2020 disrupted the routine hospital clinical service. Due to the large number of febrile patients, the algorithm was therefore revised according to travel history, occupation, contact and cluster history (TOCC), unexplained fever/symptoms, and emergent/nonemergent surgery. TOCC (+) patients presenting with otherwise unexplained fever/symptoms would be regarded as belonging to the fifth category of “severe special infectious pneumonia.” If the patient requires emergent surgery to relieve the non-life-threatening disorders, two times of negative COVID-19 tests are necessary before the operation is approved. For life-threatening situations without two negative results of COVID-19 tests, the operation schedule should be approved by the Chairman of Surgery Management Committee.

Conclusion:

The application of a clear and integrated algorithm for operating room team members aids in effective personal protective equipment facilitation to keep both healthcare providers and patients safe as well as to prevent hospital-based transmission of COVID-19.
Implementation of Lean in a Health System: Lessons Learned From a Meta-Analysis of Rapid Improvement Events, 2013–2017
Authors: Menachemi Nir , Tinsley Troy , Johnston Ann , Schulhof Alicia
Published: November 2020

EXECUTIVE SUMMARY

Recent data suggest that a majority of hospitals now engage in some form of Lean process improvement in an attempt to reduce costs and/or improve quality. The literature on Lean healthcare has evolved from describing theoretical benefits, implementation barriers, and best practices to studies describing where implementations have occurred and their outcomes. Nevertheless, previous studies are mostly limited to case studies in which Lean was implemented on a limited basis in a healthcare facility. In this article, we present lessons learned from the largest implementation of Lean in a single healthcare system composed of 16 hospitals, a health plan, and many outpatient clinics. Our analysis of 1,144 rapid improvement events (RIEs) over a 5-year period revealed that 45% were associated with some organizational benefit in several categories, including cost reductions, time savings, a reduction in clinical and nonclinical defects, and a reduction in workflow steps. As the organization became more experienced with RIEs, the benefits realized changed from mostly cost reductions to a more diverse mix of benefits, with time savings becoming the most common. RIEs implemented in certain settings and/or by certain types of employees were associated with the likelihood of realizing a benefit. Based on these analyses, we provide recommendations to hospital and health system leaders interested in optimizing their Lean implementations—especially on a large enterprise-wide scale.
Wall-mounted Versus Handheld Syringe Suction for Pediatric Bronchoalveolar Lavage
Authors: Herath Aruna D. , Jat Kana R. , Lodha Rakesh , Iyer Venkateswaran K. , Sarangi Jayati , Kabra Sushil K.
Published: November 2020

Background:

Bronchoalveolar lavage (BAL) via flexible bronchoscopy is a valuable diagnostic technique in children. The quality of BAL is directly related to the volume of the fluid recovered. Continuous wall suctioning and handheld syringe suctioning are the 2 commonly used methods, but they are rarely compared in children. We aimed to compare the above 2 suctioning techniques for BAL in the pediatric age group.

Methods:

This randomized controlled study enrolled children from 1 month to 18 years of age undergoing flexible bronchoscopy and BAL. We compared continuous wall suctioning and the handheld syringe suctioning technique. The primary outcome was the percentage of BAL fluid recovery in 2 different suctioning techniques. Secondary outcomes included technical acceptable BAL and yield of various diagnostic tests in BAL.

Results:

The study included 73 children (48 boys) with a median (interquartile range) age of 30 (8, 108) months. There were 37 children in the wall mount group and 36 children in the syringe suction group. Baseline characteristics of the groups were similar. The wall mount suction had more recovery of BAL fluid compared with the syringe method (43.6±8.4% vs. 37.8±8.5%, P=0.004). The proportion of BAL having a fluid recovery of ≥40% was also high in the wall mount suction [31 (83.8%) vs. 17 (47.2%); P=0.001]. There was no difference in diagnostic yield between the groups.

Conclusion:

Wall mount suction had better BAL fluid recovery compared with handheld syringe suction in children undergoing flexible bronchoscopy. The diagnostic yield was similar in both groups.
Quantitative Measurements in Otological Surgery: Use of an Endoscopic Integrated Multipoint Laser System
Authors: Hall Andrew Christopher , Navaratnam Annakan , Sethukumar Priya , Varadharajan Kiran , Xie Carol , Nash Robert , Butler Colin
Published: November 2020

Objectives:

Assess the clinical utility of an Endoscopic Integrated Multipoint Laser System (EMLS) to otology. This is an emerging technology from automotive engineering that may offer the ability to accurately measure anatomy and pathology using an endoscope while undertaking ear surgery.

Patients:

Simulated otology patients were used incorporating the Phacon Temporal Bone synthetic models and Kyoto Kagaku Ear Examination Simulator models to allow assessment of the EMLS technology in evaluating external ear and middle ear pathology, e.g., perforation or prosthesis sizing.

Intervention:

Eight otolaryngology resident and fellows at a tertiary university teaching hospital were given training in EMLS and reviewed simulated anatomy and pathology within the models including tympanic membrane perforation, ossicular discontinuity, and a cochleostomy.

Main Outcome Measure:

Variance in measurement was assessed in relation to those made manually by an independent surgeon using surgical calipers (0.1 mm).

Results:

The 8 participants produced 47 mean measurements. The mean difference from independently made manual measurement was 0.294 mm (standard error of the mean 0.033). Maximum variance was 0.98 mm and minimum 0.01 mm.

Conclusion:

Use of an integrated endoscopic laser measurement tool allows reliable, easy-to-obtain measurements to be obtained within a simulated otological surgical environment. Translation of the technology to a thinner delivery system through a rigid endoscope offers further promise for routine use in a clinical setting.
The association of oxygen saturation, tomography findings and d-dimer levels in coronavirus disease 2019 patients
Authors: Yalçin Kadir S. , Kasapoğlu Benan , Alanli Recep , Küçükay Murat B. , Koşar Ali
Published: November 2020

Coronavirus disease is a highly contagious disease caused by systemic acute respiratory syndrome coronavirus 2 with high mortality rates. We aimed to evaluate the relationship between serum d-dimer levels and tomography findings at the time of admission in patients diagnosed with coronavirus disease 2019 (COVID-19). This study included 94 patients, 48 women (51%) and 46 men (49%), diagnosed by PCR method. Patients without any suspicious findings on thorax tomography and having oxygen saturation above 90% at the time of presentation were included as the first group. Patients with suspicious tomography findings but having oxygen saturation above 90% were designed as the second group, and patients with both suspicious tomography findings for COVID-19 and low oxygen saturation levels (<90%) at the time of admission were taken as the third group. Patients with oxygen desaturation were significantly older than the patients with normal oxygen saturations (P = 0.001). Patients with thorax tomography findings were having significantly higher d-dimer levels (P = 0.001). Patients with oxygen desaturation were having significantly higher d-dimer levels than the patients with normal oxygen saturations (P = 0.001). There was a significant negative correlation between oxygen saturation and d-dimer levels in all patients with and without tomography findings (r = −0.301, P = 0.016). Similarly, there was a significant positive correlation between the oxygen saturation and the lymphocyte count (r = 0.300, P < 0.017). Thorax tomography and d-dimer levels significantly correlate in patients with suspected COVID-19 admission. It should be kept in mind that patients with low oxygen saturation and high d-dimer levels may have serious lung involvement.
Does timing of endoscopy affect outcomes in patients with upper gastrointestinal bleeding: a systematic review and meta-analysis
Authors: Aziz Muhammad , Dasari Chandra Shekhar , Zafar Yousaf , Fatima Rawish , Haghbin Hossein , Alyousif Zakaria Abdullah , Lee-Smith Wade , Perisetti Abhilash , Nawras Ali , Garg Shashank , Inamdar Sumant , Tharian Benjamin
Published: November 2020

Background and aims

The timing of esophagogastroduodenoscopy (EGD) for the management of upper gastrointestinal bleeding (UGIB) remains controversial. Early EGD (E-EGD) (within 24 h of presentation) has been compared to late EGD (L-EGD) (after 24 h) in numerous studies with conflicting results. The previous systematic review included three randomized controlled trials (RCTs); however, the cutoff time for performing EGD was arbitrary. We performed an updated systematic review and meta-analysis of the studies comparing the outcomes of E-EGD and L-EGD group.

Methods

A comprehensive search of PubMed, EMBASE, Cochrane Library, and Web of Science was undertaken to include both RCTs and cohort studies. Primary outcomes including overall mortality and secondary outcomes (recurrent bleeding, need for transfusion, and length of stay) were compared. Risk ratios and standardized mean difference (SMD) with 95% confidence interval (CI) were calculated.

Results

A total of 13 observational studies (with over 1.8 million patients) were included in the final analysis. No significant difference in overall mortality (risk ratio: 0.97; CI, 0.74–1.27), recurrent bleeding (risk ratio: 1.12; CI, 0.62–2.00), and length of stay (SMD: –0.07, CI, –0.31 to 0.18) was observed for E-EGD group compared to L-EGD group. The possibility of endoscopic intervention was higher in E-EGD group (risk ratio: 1.70, CI, 1.28–2.27). Consistent results were obtained for subgroup analysis of studies with 100% nonvariceal bleed (NVB) patient (risk ratio: 1.12; CI, 0.84–1.50).

Conclusion

Given the outcomes and limitations, our meta-analysis did not demonstrate clear benefit of performing EGD within 24 h of presentation for UGIB (particularly NVB).
Structural organization of the bone marrow and its role in hematopoiesis
Authors: Lucas Daniel
Published: November 2020

Purpose of review

The bone marrow is the main site for hematopoiesis. It contains a unique microenvironment that provides niches that support self-renewal and differentiation of hematopoietic stem cells (HSC), multipotent progenitors (MPP), and lineage committed progenitors to produce the large number of blood cells required to sustain life. The bone marrow is notoriously difficult to image; because of this the anatomy of blood cell production -- and how local signals spatially organize hematopoiesis -- are not well defined. Here we review our current understanding of the spatial organization of the mouse bone marrow with a special focus in recent advances that are transforming our understanding of this tissue.

Recent findings

Imaging studies of HSC and their interaction with candidate niches have relied on ex-vivo imaging of fixed tissue. Two recent manuscripts demonstrating live imaging of subsets of HSC in unperturbed bone marrow have revealed unexpected HSC behavior and open the door to examine HSC regulation, in situ, over time. We also discuss recent findings showing that the bone marrow contains distinct microenvironments, spatially organized, that regulate unique aspects of hematopoiesis.

Defining the spatial architecture of hematopoiesis in the bone marrow is indispensable to understand how this tissue ensures stepwise, balanced, differentiation to meet organism demand; for deciphering alterations to hematopoiesis during disease; and for designing organ systems for blood cell production ex vivo.
Effectiveness of an End-of-Life Nursing Education Consortium Training on Registered Nurses' Educational Needs in Providing Palliative and End-of-Life Patient Care
Authors: Manning Jennifer , Creel Amanda , Jones Nicole
Published: November 2020

Registered nurses play a critical role in delivering effective palliative and end-of-life patient care. Previous literature has cited that registered nurses report a lack of adequate palliative care training in academic and continuing education programs. Providing care to patients at the end of life requires knowledge in a variety of areas such as nonpharmacologic symptom management, cultural considerations, and pain management. This study aimed to investigate the impact of a professional development intervention among registered nurses on their educational needs in providing palliative care. Using a 1-group pretest-posttest design, a convenience sample of registered nurses completed an electronic survey containing demographic questions and the End-of-Life Professional Caregiver Survey. The professional development intervention consisted of an 8-hour training conducted by a content expert on palliative patient care addressing the competencies developed by the End-of-Life Nursing Education Consortium. The results revealed a significant increase in participant knowledge in providing quality palliative care to patients (P < .001). Education programs on quality palliative and end-of-life patient care can effectively improve the care delivered to this patient population.
Achieving American Nurses Credentialing Center Magnet® Designation With a Virtual Site Visit
Authors: Phan Rosalyn , Radovich Patricia
Published: November 2020

Innovation has enabled organizations to highlight and engage during the COVID -19 pandemic. The use of virtual site visits to assess the organizations ’s culture and sustainability of the Magnet components during initial designation and redesignation allows for ongoing support of nursing excellence.
Nursing Empowerment
Authors: Ta'an Wafa'a F. , Alhurani Jumanah , Alhalal Eman , Al-Dwaikat Tariq N. , Al-Faouri Ibrahim
Published: November 2020

OBJECTIVE

The purpose of this study is to investigate the level of structural empowerment and explore its relationship with job performance among nurses.

BACKGROUND

Empowered nurses display more authority and an awareness of the accomplishment of their contribution to organizational goals.

METHODS

A cross-sectional study was conducted with a convenience sample of nurses in 4 hospitals in Jordan. Data were collected using a self-administered questionnaire.

RESULTS

A total of 195 nurses responded to the questionnaires, including 88 males (45.1%) and 107 females (54.9%). Overall, participants perceived their work environment to be moderately empowering. There is a significant positive correlation between structural empowerment and job performance.

CONCLUSIONS

Highly empowered nurses display higher performance than less empowered nurses. Nurse managers must create an empowering work environment that supports nurses' job performance positively through structural empowerment. Applying structural empowerment in the work setting is crucial for ensuring the highest quality of patient care, improving nurses' performance, and reaching the organizational goals.
Race and Insurance Impact on Hospital Admission From the Emergency Department for Patients Diagnosed With Heart Failure
Authors: Young Tammy
Published: November 2020

OBJECTIVE

The purpose of this study was to analyze if patient race and the presence of insurance predict the odds of admission from the emergency department (ED) for patients diagnosed with congestive heart failure (CHF).

BACKGROUND

Excessive hospital readmissions for patients with CHF are considered a quality-of-care issue. Previous studies have not considered race and insurance in conjunction with quality measures in predicting hospital admission from the ED for these patients.

METHODS

A secondary data analysis was conducted from cross-sectional archival data from the 2015 National Hospital Ambulatory Medical Care Survey using cross-tabulations with χ
2 followed by multiple logistic regression analysis.

RESULTS

Race and the presence of insurance were not significant in predicting the odds of admission from the ED for patients with CHF.

CONCLUSIONS

Being seen in the ED within the last 72 hours and seen by provider types consulting physician and nurse practitioner were significant (P ≤ .05) in predicting the odds of admission related to a diagnosis of CHF.
Supporting Well-being Through the Implementation of Education and a Relaxing Retreat Space
Authors: Van Horne Sam , Downing Vanessa , Farley Heather
Published: November 2020

OBJECTIVE

The objective of this study was to determine whether an innovative program including psychoeducation grounded in positive psychology and awareness of cognitive biases, along with access to a dedicated relaxation environment, would lower burnout for nurses.

BACKGROUND

Promoting well-being of nurses is an essential goal of healthcare leaders because of the negative effects of burnout out on nurses' health and patient outcomes.

METHODS

A prospective cohort analysis was conducted to examine whether exposure to the OASIS (Opportunity to Achieve Staff Inspiration and Strength) education content and using the OASIS rooms were associated with improvements in quality of life or turnover intention among nurses.

RESULTS

Nurses who reported receiving 3 to 6 education sessions and who used the OASIS room reported lower levels of burnout, on average, than nurses who did not receive any education sessions.

CONCLUSION

The OASIS program has the potential to be an effective, easy-to-deliver education program that can integrate well-being into the workday of nursing professionals.
Clinical Presentation and Risk Factors for Poor Outcomes Among Adult Patients With Posterior Reversible Encephalopathy Syndrome
Authors: Vallone Marcelo G. , Vázquez Carolina , Pigretti Santiago , Oses Lucrecia L. , Angriman Federico , Zurru María C.
Published: November 2020

Background:

Posterior reversible encephalopathy syndrome (PRES) is an acute neurological condition with unknown global incidence, variable clinical presentation, and prognosis.

Objectives:

To describe a cohort of patients with PRES with a focus on brain magnetic resonance imaging (MRI) patterns and their relationship with short-term clinical outcomes.

Methods:

Retrospective cohort study. The authors included patients if they were older than 15 years and had a PRES diagnosis on the basis of a positive brain MRI at any time during the in-hospital stay.

Results:

Forty-four patients were included in the present analysis. The median age was 57 years (interquartile range, 32.0-68.5) and 70.5% were women. Hypertension (59.1%), history of transplantation (27.3%), previous chemotherapy (27.3%), chronic renal failure (38.6%), and autoimmune disease (15%) were the main comorbid conditions present. The classic triad of seizures, headache, and visual impairment was present in 18.0% of the cases. Eighty-six percent of patients were admitted to the intensive care unit, with 36.0% needing invasive life support. Brain MRI showed a dominant parieto-occipital pattern in 26 patients, whereas cytotoxic edema and bleeding were present in 27.3% and 29.6%, respectively. In-hospital mortality was 11.4%. The median modified Rankin Scale at hospital discharge was 1 (0-2.5). Risk factors associated with low modified Rankin Scale scores were: headache, visual impairment, and parieto-occipital pattern. Decreased level of consciousness and mechanical ventilation requirement were associated with greater discharge disability.

Conclusions:

Characteristic symptoms and signs of PRES and classic MRI patterns are associated with better clinical outcomes.
The Effect of Blue-blocking Lenses on Photostress Recovery Times
Authors: Alzahrani Hind Saeed , Khuu Sieu K. , Ali Adiba , Roy Maitreyee
Published: November 2020

SIGNIFICANCE

The selective reduction in visible wavelengths transmitted through commercially available blue-blocking lenses (BBLs) is known to influence the appearance and contrast detection of objects, particularly at low light levels. This influence may impair the human retinal receptor response time to dynamic light changes during photostress events.

PURPOSE

This study aimed to assess whether BBLs selectively affect photostress recovery times (PSRTs) for chromatic and achromatic stimuli of different Weber contrasts that were viewed on a dark black background.

METHODS

Photostress recovery times were measured in 12 younger participants (18 to 39 years old) with no history of ocular disease or abnormal vision. Photostress recovery times were evaluated for four brands of BBLs, which were compared with a control lens. In these experiments, after exposure to an intense light source for 5 seconds, the time taken to recover vision and correctly identify a computer-generated letter stimulus viewed under low and high luminance levels was determined, which means perception is likely to be governed by mesopic and photopic conditions. Across conditions, the letter stimulus was achromatic and chromatic and could differ in luminance contrast.

RESULTS

Under photopic stimulus conditions, although reducing luminance contrast increased PSRTs, BBLs had no significant effect on PSRTs relative to control lens. However, under mesopic stimulus conditions, BBLs significantly affect PSRTs for both achromatic (F
2.006,8.02 = 61.95, P < .0001) and chromatic stimuli (F
3,16 =139.01, P < .0001), particularly for blue targets, which had considerably longer PSRTs (38.40 seconds). The brand of BBL was also shown to selectively affect PSRTs, with those with transmittance profiles that block the most blue light having longer PSRTs.

CONCLUSIONS

The present study suggests that, although the color and contrast of the target stimuli affected recovery times, the difference in recovery times between different types of BBLs was noticed only under low-light-level stimulus conditions.
Pulmonary Adenocarcinomas of Low Malignant Potential
Authors: Yambayev Ilyas , Sullivan Travis B. , Suzuki Kei , Zhao Qing , Higgins Sara E. , Yilmaz Osman H. , Litle Virginia R. , Moreira Paulo , Servais Elliot L. , Stock Cameron T. , Quadri Syed M. , Williamson Christina , Rieger-Christ Kimberly M. , Burks Eric J.
Published: November 2020

Lung cancer screening has improved mortality among high-risk smokers but has coincidentally detected a fraction of nonprogressive adenocarcinoma historically classified as bronchoalveolar carcinoma (BAC). In the National Lung Screening Trial (NLST) the majority of BAC—comprising 29% of computed tomography–detected stage I lung adenocarcinoma—were considered overdiagnosis after extended follow-up comparison with the control arm. In the current classification, adenocarcinoma in situ and minimally invasive adenocarcinoma have replaced BAC but together comprise only ∼5% of stage I lung adenocarcinoma. Lepidic and subsets of papillary and acinar adenocarcinoma also infrequently recur. We, therefore, propose criteria for low malignant potential (LMP) adenocarcinoma among nonmucinous adenocarcinoma measuring ≤3 cm in total, exhibiting ≥15% lepidic growth, and lacking nonpredominant high-grade patterns (≥10% cribriform, ≥5% micropapillary, ≥5% solid), >1 mitosis per 2 mm2, angiolymphatic or visceral pleural invasion, spread through air spaces or necrosis. We tested these criteria in a multi-institutional cohort of 328 invasive stage I (eighth edition) and in situ adenocarcinomas and observed 16% LMP and 7% adenocarcinoma in situ/minimally invasive adenocarcinoma which together (23%) approximated the frequency of overdiagnosed stage I BAC in the NLST. The LMP group had 100% disease-specific survival. The proposed LMP criteria, incorporating multiple histologic parameters, may be a clinically useful “low-grade” prognostic group. Validation of these criteria in additional retrospective cohorts and prospective screen-detected cohorts should be considered.
IRE1 Less Common Homozygous Genotype in Families With Positive History of Cancer and Individuals Born With Cleft Lip/Palate
Authors: Assis Ionária O. , Lacerda Rosa Helena W. , Cavalcante Bianca G.N. , Bezamat Mariana , Modesto Adriana , Vieira Alexandre R.
Published: November 2020

The aim of this study was to test if the marker rs196929 in IRE1 associated with cleft lip and palate depending on the family history for cancer. A consecutive sample of 836 individuals were recruited between April and October of 2019 (303 born with cleft lip and palate, 256 relatives mostly of the maternal side of individuals born with cleft lip and palate, and 277 unaffected unrelated individuals). Parents or guardians of the children answered a questionnaire with basic demographic information about their children and their family history of cleft lip and palate and cancer. DNA was obtained from whole saliva and IRE1 rs196929 was genotyped using TaqMan chemistry and end-point analysis. Over-representation of alleles was determined using chi-square as implemented in PLINK using an alpha of 0.05. There was an excess of less common homozygotes of IRE1 rs196929 among relatives of individuals born with cleft lip and palate when they had positive family history of cancer in comparison with individuals born with cleft lip and palate or with unrelated unaffected individuals (P = 0.0006 and P < 0.001, respectively). This pattern was similar when families reported one type of cancer or multiple ones, or when cancer affecting females (breast or reproductive tract) or the structures of the gastro-intestinal tract were considered. These results provide support for a role of the ER stress IRE1-XPB1 pathway in the higher frequency of cancer in families of individuals born with cleft lip and palate.
Invitro and Invivo Study of PCL-Hydrogel Scaffold to Advance Bioprinting Translation in Microtia Reconstruction
Authors: Mukherjee Payal , Chung Johnson , Cheng Kai , Gupta Ruta , Haag Hannah , Williams Zoe , Wallace Gordon
Published: November 2020

Background:

Bioprinting has shown promise in the area of microtia reconstruction. However clinical translation has been challenged by the lack of robust techniques to control delivery of stem cells. Hybrid printing allowing multiple materials, both cell and support, to be printed together may overcome these challenges.

Objective:

This study assesses the degradation behavior and tissue compatibility of hybrid scaffolds (PCL-Hydrogel) compared to single material Polycaprolactone (PCL) scaffolds in-vitro and in-vivo. Sheep demonstrate similar fascial anatomy to humans. This is the first reported study using a sheep model to study hybrid scaffolds for microtia.

Methods:

PCL and PCL-Hydrogel samples of increasing porosity were subjected to an accelerated enzymatic degradation assay to study degradation behavior in-vitro. In addition, a 6-month study using Merino-Dorset sheep was conducted to compare the biological reaction of the host to PCL and PCL-hydrogel scaffolds.

Results:

In-vitro degradation showed homogenous degradation of the scaffold. PCL presented the dominating influence on degradation volume compared to hydrogel. In-vivo, there was no evidence of skin irritation or infection over 6 months in both control and test, though PCL-hydrogel scaffolds showed higher levels of tissue ingrowth.

Conclusion:

Homogenous degradation pattern of porous scaffolds may create less surrounding tissue irritation. Hybrid scaffolds had good biological compatibility and showed better tissue ingrowth than PCL alone.
Intravenous Immunoglobulin in the Treatment of Alternating Hemiplegia of Childhood
Authors: Samanta Debopam , Ramakrishnaiah Raghu
Published: November 2020

Alternating hemiplegia of childhood (AHC) is a neurological disorder with early-onset alternating hemiplegia and other paroxysmal events such as epilepsy and dystonia due to de novo pathogenic mutations in the ATP1A3. Physicians and scientists investigated several agents in the treatment without strong evidence of definitive long-term benefit. Knowledge regarding utility of anti-inflammatory agents in the treatment is scarce except the anecdotal report of corticosteroid use. We described 2 patients with AHC who were exposed to intravenous immunoglobulin (IVIG) treatment because of an alternative diagnosis. An 8-year-old girl received 4 years of periodic IVIG infusion and was free of paroxysmal events during the first 16 months of therapy. A 2-year-old boy received IVIG infusion for 10 months and remained seizure-free for 2 years since the beginning of the treatment, but without a definite change in hemiplegic episodes. Our report is the first description of IVIG use in patients with AHC. Although these patients did not achieve complete remission, partial responsiveness was noted. Although the definite role of IVIG in the treatment of AHC cannot be extrapolated from our study, further prospective controlled studies should be done because of the recent discovery of the connection between an anti-inflammatory hormone (Oubain) and Na+/K+ ATPase.
Born to be young? Prenatal thyroid hormones increase early-life telomere length in wild collared flycatchers
Authors: Stier Antoine , Hsu Bin-Yan , Marciau Coline , Doligez Blandine , Gustafsson Lars , Bize Pierre , Ruuskanen Suvi
Published: November 2020

The underlying mechanisms of the lifelong consequences of prenatal environmental condition on health and ageing remain little understood. Thyroid hormones (THs) are important regulators of embryogenesis, transferred from the mother to the embryo. Since prenatal THs can accelerate early-life development, we hypothesized that this might occur at the expense of resource allocation in somatic maintenance processes, leading to premature ageing. Therefore, we investigated the consequences of prenatal TH supplementation on potential hallmarks of ageing in a free-living avian model in which we previously demonstrated that experimentally elevated prenatal TH exposure accelerates early-life growth. Using cross-sectional sampling, we first report that mitochondrial DNA (mtDNA) copy number and telomere length significantly decrease from early-life to late adulthood, thus suggesting that these two molecular markers could be hallmarks of ageing in our wild bird model. Elevated prenatal THs had no effect on mtDNA copy number but counterintuitively increased telomere length both soon after birth and at the end of the growth period (equivalent to offsettingca4 years of post-growth telomere shortening). These findings suggest that prenatal THs might have a role in setting the ‘biological' age at birth, but raise questions about the nature of the evolutionary costs of prenatal exposure to high TH levels.
Quantum aspects of evolution: a contribution towards evolutionary explorations of genotype networks via quantum walks
Authors: Santiago-Alarcon Diego , Tapia-McClung Horacio , Lerma-Hernández Sergio , Venegas-Andraca Salvador E.
Published: November 2020

Quantum biology seeks to explain biological phenomena via quantum mechanisms, such as enzyme reaction rates via tunnelling and photosynthesis energy efficiency via coherent superposition of states. However, less effort has been devoted to study the role of quantum mechanisms in biological evolution. In this paper, we used transcription factor networks with two and four different phenotypes, and used classical random walks (CRW) and quantum walks (QW) to compare network search behaviour and efficiency at finding novel phenotypes between CRW and QW. In the network with two phenotypes, at temporal scales comparable to decoherence timeTD, QW are as efficient as CRW at finding new phenotypes. In the case of the network with four phenotypes, the QW had a higher probability of mutating to a novel phenotype than the CRW, regardless of the number of mutational steps (i.e. 1, 2 or 3) away from the new phenotype. Before quantum decoherence, the QW probabilities become higher turning the QW effectively more efficient than CRW at finding novel phenotypes under different starting conditions. Thus, our results warrant further exploration of the QW under more realistic network scenarios (i.e. larger genotype networks) in both closed and open systems (e.g. by considering Lindblad terms).