bluuebunny/crossref_metadata_2025 huggingface dataset:
Vascularized, Denervated Muscle Targets for Treatment of Symptomatic Neuromas in the Upper Extremity: Description of Operative Technique
Authors: Calotta Nicholas A. , Hanwright Philip J. , Giladi Aviram , Tuffaha Sami H.
Published: November 2021

Symptomatic neuromas of the upper extremity often cause persistent, debilitating pain that is resistant to medical management. Following upper extremity amputation, painful neuromas may disrupt rehabilitation efforts and pose a barrier to prosthetic use. Several surgical approaches have been attempted to treat neuromas, each of which suffers from limitations. We have developed a novel technique, the vascularized, denervated muscle target, that offers a compelling new option for primary prevention and secondary treatment of symptomatic neuromas of the upper extremity. Here, we provide a detailed description of our surgical technique as it is applied to neuromas of the upper extremity.
Emergency Department Initiative to Improve Sepsis Core Measure Compliance
Authors: Laux Lori , Campbell Thomas , Latouf Kathleen M. , Saunders Kerry , Schultz Joyce , Schwartzmier Michelle
Published: November 2021

The topic of sepsis has been realized among the last 20 years. A majority of patients with sepsis enter the health system through the emergency department, and health professionals need to provide evidence-based care. Within the health system, interdepartmental teams were formed with the purpose to set a system-wide standard to meet the evidence-based practice standards for sepsis. Participants were recruited from every department that was involved with the care delivery of emergency department patients with sepsis. The team developed a team charter to state the group objectives. A gap analysis was completed to set group priorities. The first priority was to develop a system-wide sepsis alert process. The Operational Excellence coach conducted direct observations and interviews at each system facility and then a sepsis alert plan was developed. Two hospitals volunteered to pilot the sepsis alert within their emergency departments, and education was completed at each hospital. Informatics nurses developed electronic medical record workflow and outcome elements to help the team with the process. The pilot process showed an increase in compliance for core measures and laid the groundwork for each hospital to develop an individualized process.
Evaluating the Feasibility and Efficacy of a Pediatric Intensive Care Unit Diary
Authors: Wang Shu-Heng , Owens Tonie , Johnson Abigail , Duffy Elizabeth A.
Published: November 2021

As the progress of critical care medicine has improved the survival rate of critically ill patients, comorbidities and long-term health care have attracted people's attention. The terms “post–intensive care syndrome” (PICS) and “PICS-family” (PICS-F) have been used in non-neurocritical care populations, which are characterized by the cognitive, psychiatric, and physical sequelae associated with intensive care hospitalization of survivors and their families. An intensive care unit (ICU) diary authored by the patient's family members may alleviate the psychological distress of the patient and his or her family. This quality improvement project focused on the development and implementation of the pediatric intensive care unit (PICU) diary in the pediatric critical care setting. The project aims to evaluate the feasibility and the potential efficacy of the PICU diary, measured through parental acceptance and satisfaction. Seventeen families of critically ill children admitted to the PICU received the PICU diary during the implementation period. Twenty-four parents completed the weekly follow-up, and 15 subsequently completed the diary entry evaluation. The use of the diary in the PICU setting is feasible and considered beneficial by families of critically ill children.
Development of Dolutegravir Single-entity and Fixed-dose Combination Formulations for Children
Authors: Singh Rajendra P. , Adkison Kimberly K. , Baker Mark , Parasrampuria Ridhi , Wolstenholme Allen , Davies Mark , Sewell Nicola , Brothers Cindy , Buchanan Ann M.
Published: November 2021

Background:

The World Health Organization (WHO) 2019 antiretroviral treatment guidelines recommend use of optimal treatment regimens in all populations. Dolutegravir-based regimens are the preferred first-line and second-line treatment in infants and children with HIV 4 weeks of age and above. There is an urgent need for optimal pediatric formulations of dolutegravir as single-entity (SE) and fixed-dose combination (FDC) to ensure correct dosing and adherence for swallowing and palatability. This article outlines the chronology of dolutegravir pediatric formulation development as granules and conventional and dispersible tablets in a total of 5 pharmacokinetic studies evaluating the relative bioavailability of dolutegravir SE and FDC formulations in healthy adults.

Methods:

The relative bioavailability studies were 2-part, Phase I, open-label, randomized studies in healthy adults. Dolutegravir SE study compared conventional dolutegravir 50 and 25 mg with equivalent conventional 10-mg and dispersible 5-mg tablets, respectively. Subsequently, dolutegravir FDC study compared adult FDC of abacavir/dolutegravir/lamivudine and adult FDC of dolutegravir/lamivudine with their respective pediatric FDC formulations, taken as dispersion immediately or swallowed whole.

Results:

As observed in previous studies, dolutegravir administered as dispersion (granules/dispersible tablets) showed relatively higher bioavailability compared with conventional tablets. The bioavailability of dolutegravir dispersible tablets (both SE and FDC) was approximately 1.6-fold higher when compared with conventional tablets. In addition, the bioavailability of abacavir/lamivudine was not impacted by dispersible formulation.

Conclusions:

These studies demonstrate the successful development of pediatric dolutegravir-containing formulations as SE and FDC that permit pediatric dosing in line with WHO recommendations.
Molds and More: Rare Fungal Infections in Preterm Infants <24 Weeks of Gestation
Authors: Mehler Katrin , Cornely Oliver , Seifert Harald , Zweigner Janine , Janssen Saskia , Oberthuer André
Published: November 2021

Background:

Extreme immature infants are at an increased risk of fungal infection due to immaturity of the skin barrier and the immune system. Besides Candida infections, in particular, Aspergillus may cause life-threatening diseases in preterm infants. Frequently, Aspergillus primarily affects the skin and may cause extensive damage.

Methods:

We searched our hospital database for fungal infections other than Candida in preterm infants treated between 2015 and 2020 at our level III neonatal intensive care unit of the University Hospital of Cologne.

Results:

In total, 13 preterm infants were identified. Of these, 11 had cutaneous Aspergillosis, one infant had severe enterocolitis caused by Aspergillus and Rhizopus and one had invasive intraabdominal Trichosporon mucoides infection. All infants were born <24 weeks of gestation, were delivered due to premature labor or chorioamnionitis, and had received prenatal steroids and/or hydrocortisone. Voriconazole and liposomal Amphotericin B were first-line treatments and the length of treatment varied between 3 and 148 days. Two infants died associated with severe infection. Liver toxicity was observed in six infants treated with Voriconazole. Therapeutic drug management for Voriconazole was performed in four infants. Target levels were not achieved by the doses that are recommended.

Conclusions:

Rare fungal infections, predominantly cutaneous Aspergillosis affects the most immature preterm infants and may cause severe disease. Treatment with Voriconazole has a high rate of liver toxicity and target levels are difficult to achieve in extremely immature infants.
Components of Stress and Their Associations With Sleep Problems
Authors: Virtanen Marianna , Myllyntausta Saana , Karkkola Petri , Pentti Jaana , Ropponen Annina , Vahtera Jussi , Stenholm Sari
Published: November 2021

Objective:

To identify latent components from among 13 work and nonwork stressors and to examine whether the accumulation of stress factors within these components was associated with sleep problems.

Methods:

A cohort of older employees(n= 2771 individuals,n= 3921 person-observations) responded to at least two surveys. Principal Component Analysis (PCA) was used to identify latent components. Analysis of variance was used to examine their associations with sleep.

Results:

The components were: “Physical workload and shift work,” “Psychosocial workload,” “Social and environmental nonwork adversity,” and “Life event- and health-related nonwork adversity.” They were consistently associated with sleep problems, except for “Physical workload and shift work.” “Social and environmental nonwork adversity” was associated with sleep problems at follow-up.

Conclusions:

Clusters of work- and nonwork-related stressors were identified, and their accumulation was associated with sleep problems among older employees.
Cost of Lost Productivity Due to Erectile Dysfunction and Impact of Employer Benefit Exclusion of Penile Prosthesis Implantation Treatment
Authors: Rojanasarot Sirikan , Bhattacharyya Samir K. , Burnett Arthur L.
Published: November 2021

Objective:

We examined the cost of lost productivity due to erectile dysfunction (ED) and employer benefit exclusion of penile prosthesis implantation (PPI) among men with employer-sponsored health insurance.

Methods:

A decision-analytic model was developed using administrative claims data, US Bureau of Labor Statistics, and published literature. The economic impact of ED productivity loss and PPi benefit exclusion was reported in2019USD.

Results:

Men with ED had an additional 282.7 hours/ year of work impairment compared to men without ED, resulting in annual incremental costs of $7270. US employers excluding PPi benefits could lose $9.3billion/year of work due to additional work impairment from ED.

Conclusions:

Productivity loss due to ED and PPI benefit exclusion have considerable economic impacts on men with ED and their employers. continuous advocacy for benefit exclusion removal is needed to ensure appropriate patient access.
Sirolimus Leads to Rapid Improvement in Fibroadipose Vascular Anomalies
Authors: Al-Huniti Ahmad , Fantauzzi Michelle , Willis Laura , Sadlier Muriel , Amaral Joao G. , Carcao Manuel D.
Published: November 2021

Purpose:

Fibroadipose vascular anomaly (FAVA) is a complex vascular anomaly associated with postzygotic somatic PIK3CA mutations. FAVAs can cause significant pain, swelling, and musculoskeletal dysfunction. Treatment options are limited. Sirolimus is a well-tolerated and effective treatment for patients with FAVA. We report our experience of using sirolimus to treat 11 children with FAVAs.

Methods:

We conducted a retrospective review of all patients with FAVA treated with sirolimus in our institution.

Results:

Fourteen patients (10 females) were referred for sirolimus therapy for FAVA. Eleven patients were initiated on sirolimus at a mean age of 14 years (range: 9–17.9 years) and were then treated for a mean of 19 months (range: 1–46 months). Five had previously undergone sclerotherapy without benefit. Sirolimus was initiated at a dose of either 2.5 mg/m2 once daily or 0.8 mg/m2 twice daily. Doses were titrated to maintain sirolimus trough levels of 5–15 ng/L. Goals of treatment were improvement in pain and musculoskeletal dysfunction. All 11 patients reported reduced pain; 7 reporting this within 3 weeks of starting sirolimus. This allowed for discontinuation of analgesia. Function improved significantly in 9 of 11, leading to resumption of sports or work participation. Sirolimus side effects were similar to prior reports, most commonly mouth sores, mildly elevated lipids and acne. There was no grade III/IV toxicity.

Conclusion:

Sirolimus is a well-tolerated and effective treatment for patients with FAVA. Initial symptom improvement is rapid, with significantly reduced pain and improved function. We believe that sirolimus should be considered for all patients with FAVA as a first-line therapy before surgical/interventional approaches.
The Effects of a Pass-Fail Curriculum on a Physician Assistant Program
Authors: Garbas Breann , Fromm Jason
Published: November 2021

Purpose

The grading scale for students in a physician assistant program of study is not standardized. Students may be evaluated on a traditional 5-tiered A to F scale or a pass-fail system. The decision to change from ordered grading to pass-fail at an established program in the southeast was done following a change in the affiliated School of Medicine. The purpose of this study was to review effects on student scores following such a change.

Methods

The Physician Assistant National Certifying Exam (PANCE) and PACKRAT 2 exam scores for the last 2 cohorts of students scored in the 5-tiered system (2016, N = 60 and 2017, N = 59) were compared against the same for the first 2 cohorts (2018, N = 59 and 2019, N = 58) of the pass-fail system. Nonrandom sampling of all students in each cohort year was evaluated using 2-tailed t-testing.

Results

A total of 236 student scores were evaluated using a 95% confidence interval. The traditionally scored classes outperformed all pass-fail cohorts (means 460.67/491.86 versus 503.34/493.92). P values were found to be significant at all values between the 5-tier scored classes and the pass-fail cohorts in PANCE scoring, resulting in failure to reject the null hypothesis. This was also true for the PACKRAT 2 with the exception of the 2019 cohort, which was significant only for outperformance of the other pass-fail cohort. For the purpose of this study, the only analysis performed was scoring.

Conclusion

For cohorts undergoing curricular change, unforeseen impacts on initial standardized exam scores may occur. In this study, PANCE scores for the first year of the 2 pass-fail cohorts decreased while the overall program scores remained at or above the national average. The pass-fail cohort did show an upward trend in the second year of the curriculum, suggesting that as programs become more familiar with the pass-fail system, steady improvements occur. This suggests that while an anticipated drop in initial scores may be expected, further studies are needed to evaluate the impact on stress reduction, long retention, and intraclass competition.
Randomized Clinical Trial of a Self-care and Communication Intervention for Parents of Adolescent/Young Adults Undergoing High-Risk Cancer Treatment
Authors: Haase Joan E. , Stegenga Kristin , Robb Sheri L. , Hooke Mary C. , Burns Debra S. , Monahan Patrick O. , Stump Timothy E. , Henley Amanda K. , Haut Paul R. , Cherven Brooke , Roll Lona , Langevin Anne-Marie , Pickler Rita H. , Albritton Karen , Hawkins DeAnna , Osterkamp Erin , Mitby Pauline , Smith Jackie , Diaz Virginia R. , Garcia-Frausto Erica , Moore Margo
Published: November 2021

Background

Parents of adolescents and young adults (AYAs) with cancer offer primary support to their children and often experience their own high levels of distress, affecting parent-AYA communication and quality of life.

Objective

To reduce parent distress and improve communication during high-risk cancer treatment, we examined efficacy of a self-care and communication intervention for parents and indirect benefit for AYAs receiving a therapeutic music video (TMV) intervention.

Methods

In this study, we conducted a multisite, randomized controlled trial with AYAs and parents enrolled as dyads (n = 110). Parents were randomized to intervention or low-dose control; all AYAs received TMV. Data collection occurred at baseline, 2 weeks post intervention (T2), and 90 days post intervention (T3).

Results

There were no significant between-group differences on primary outcomes for parents or AYAs. We did find significant differences favoring the parent intervention group on parenting confidence at T2 and marginally better outcomes for family adaptability/cohesion at T3. Both groups exhibited significant within-group improvement for parent distress (state anxiety, T3; perceived stress, T2 and T3; mood, T3), state anxiety (T2) intervention only, and family strengths control group only. Qualitative data demonstrate the parent intervention raised self-awareness and parent confidence in the short term.

Conclusion

Parents found their intervention helpful. Absence of significant results may be due to short intervention duration, need for tailored content, underpowered sample, and potential indirect parent benefit from AYA participation in TMV. The parent intervention did not provide an indirect benefit for AYAs.

Implications for Nursing

Parents identified their own need for communication and support from nurses. Nurses can optimize AYA care by attending to parent needs through supportive listening and encouraging self-care.
A Clinical Nurse Specialist–Driven Project to Improve Emergency Department Triage Accuracy
Authors: Campbell Denise , Fetters Lisa , Getzinger Jac , Perko Alayna , Slater Scott
Published: November 2021

Purpose/Aims

The purpose of this quality improvement project was to examine the use of video-simulated scenarios and mobile technology to improve accuracy of emergency department (ED) nurses' triage using the Emergency Severity Index (ESI).

Design

A quality improvement project with a pre/post educational intervention design consisting of a convenience sample (n = 33) of ED registered nurses (RNs) at a large tertiary hospital in the Midwest was used.

Methods

A retrospective chart review (n = 495) was completed to obtain ESI accuracy for each triage RN. For 12 consecutive weeks, the ED RNs received different video simulations via mobile technology to determine the ESI level. After receiving their scores, the project team provided the RNs the correct ESI score with rationale via mobile technology. Post intervention, a retrospective chart review was conducted to evaluate RNs' ESI accuracy.

Results

Results of this ED triage educational intervention to improve the accuracy of ED nurses' ESI scores were not significant; however, this novel approach may be considered in addition to other teaching strategies to improve outcomes.

Conclusions

Triage nurses' ESI scoring accuracy can be inconsistent. Therefore, to ensure patients are receiving prompt and appropriate care for their acuity level, it is important to continuously provide education on ESI scoring.
A Clinical Nurse Specialist–Led Initiative to Reduce Catheter-Associated Urinary Tract Infection Rates Using a Best Practice Guideline
Authors: Pajerski Dawn M. , Harlan Melissa D. , Ren Dianxu , Tuite Patricia K.
Published: November 2021

Purpose

The purpose of this clinical nurse specialist–led initiative was to reduce catheter-associated urinary tract infection rates to less than 1 infection per 1000 catheter days, to reduce catheter device utilization, and to improve staff adherence to documentation requirements on a traumatic brain injury rehabilitation unit.

Description of the Project

Catheter-associated urinary tract infections are costly hospital-acquired infections increasing length of stay and morbidity for patients. Following an education intervention, a best practice initiative was implemented. Staff performance based on electronic health record documentation, infection rates, and device utilization were compared before and after a bundle of interventions including education, staff competency, simulation, and audits.

Outcomes

Catheter-associated urinary tract infection rates were reduced from 16.67 to 0 per 1000 catheter days and device utilization ratio from 0.122 to 0.056 per patient day. The unit maintained zero infections upon project completion. Following initiative implementation, documentation improved related to urinary catheter necessity, daily care interventions, patient education, and urine output.

Conclusion

This initiative resulted in reductions in device utilization and catheter infection rates, which were maintained following project completion. Adherence to documentation audit criteria also improved.
Accuracy of Machine Learning Models to Predict In-hospital Cardiac Arrest
Authors: Moffat Laura M. , Xu Dongjuan
Published: November 2021

Purpose/Aims

Despite advances in healthcare, the incidence of in-hospital cardiac arrest (IHCA) has continued to rise for the past decade. Identifying those patients at risk has proven challenging. Our objective was to conduct a systematic review of the literature to compare the IHCA predictive performance of machine learning (ML) models with the Modified Early Warning Score (MEWS).

Design

The systematic review was conducted following the Preferred Reporting Items of Systematic Review and Meta-Analysis guidelines and registered on PROSPERO CRD42020182357.

Method

Data extraction was completed using the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies checklist. The risk of bias and applicability were evaluated using the Prediction model Risk of Bias Assessment Tool.

Results

Nine articles were included in this review that developed or validated IHCA prediction models and compared them with the MEWS. The studies by Jang et al and Kim et al showed that their ML models outperformed MEWS to predict IHCA with good to excellent predictive performance.

Conclusions

The ML models presented in this systematic review demonstrate a novel approach to predicting IHCA. All included studies suggest that ML models had similar or better predictive performance compared with MEWS. However, there is substantial variability in performance measures and concerns for risk of bias.
SARS-CoV-2 infection and coronavirus disease 2019 severity in persons with HIV on antiretroviral treatment
Authors: del Amo Julia , Polo Rosa , Moreno Santiago , Jarrín Inma , Hernán Miguel A.
Published: November 2021

The relative susceptibility of people with HIV (PWH) to Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is debated. Numerous studies have been published with apparently contradictory findings, but comparisons are difficult because they have been conducted in populations with different characteristics (e.g. age, prevalence comorbidities) and have used different comparison groups (e.g. HIV-negative cohorts, coronavirus disease 2019 (COVID-19) hospitalized patients, general population), and because of challenges to measure the most important confounders. Here, we review the evidence regarding risk and severity of SARS-CoV-2 infection in PWH compared with persons without HIV. Publications originate largely from high-income settings where the majority of the PWH are on antiretroviral therapy (ART). Despite early evidence supporting higher frequency of SARS-CoV-2 testing in PWH on ART, HIV infection is not associated with SARS-CoV-2 infection, once confounding by socioeconomic characteristic is taken into account. Most publications identify increased COVID-19 severity in PWH compared with people without HIV from the general population or compared with COVID-19 hospitalized patients. The only study with an adequate comparison group to reduce confounding, has not identified differences in COVID-19 disease severity by HIV. Publications consistently identify that COVID-19 severity in PWH is not homogeneous and increases with age and baseline comorbidities. As PWH have a higher prevalence of comorbidities than people without HIV, examining their respective contribution to poor health outcomes is not straight forward as comorbidities could mediate the effect of HIV on COVID-19 outcomes.
The Use of Vastus Lateralis Muscle Flap for Functional Lip Reconstruction
Authors: Lelala Bruce , Pienaar Conrad , Hudson Donald A.
Published: November 2021

Background:

Total or near-total lip defects poses a serious challenge to a reconstructive surgeon with static procedures not providing desired functional and aesthetic outcomes. The dynamic lip reconstructive methods using functional muscles have become a current issue in recent years showing admirable results. This study present 3 cases of successful total and near-total lip reconstruction are presented using vastus lateralis muscle.

Methods:

This is a retrospective analysis of a consecutive series of 3 patients (2 men and 1 woman) aged 44 to 56 years (mean) who had resection of extensive squamous cell carcinoma 2 had both upper and lower lip involved and 1 had lower lip involvement only. After resection patients had near total full thickness lower lip defect and 40% upper lip defect. The innervated vastus lateralis muscle free flap was transferred to the lip and end-to-end vascular anastomosis on the facial artery and end-to-side to internal jaguar vein was performed. The marginal mandibular branch of the facial nerve was used for nerve coaptation. The inner and outer surfaces of the flaps were grafted with a thick-split-thickness skin graft. Drooling rating scale and patient and observer scar assessment scale as well as electromyography were performed to evaluate oral competency and aesthetic outcome.

Results:

All patients underwent single stage near-total lower lip and 2 had part of upper lip reconstruction successfully and survived the surgical operation. One patient lost the skin graft and was managed consecutively and muscle granulated and healed. Two patients underwent radiation therapy and 1 died before starting radiation due to other unnatural causes. The 2 patients achieved perfect oral sphincter competence without drooling and at 9months postoperative demonstrated successful reinnervation of the vastus lateralis muscle.

Conclusions:

This study demonstrates that lip reconstruction using an innervated vastus lateralis muscle free flap is a reliable method, providing a functional lip
The Detrimental Impact of the COVID-19 Pandemic on Major Trauma Outcomes in the Netherlands
Authors: Driessen Mitchell L. S. , Sturms Leontien M. , Bloemers Frank W. , Duis Henk Jan ten , Edwards Michael J. R. , den Hartog Dennis , Kuipers E. J. , Leenhouts Peter A. , Poeze Martijn , Schipper Inger B. , Spanjersberg Richard W. , Wendt Klaus W. , de Wit Ralph J. , van Zutphen Stefan W. A. M. , de Jongh Mariska A. C. , Leenen Luke P. H.
Published: November 2021

Objective:

To evaluate the impact of the COVID-19 pandemic on the outcome of major trauma patients in the Netherlands.

Summary Background Data:

Major trauma patients highly rely on immediate access to specialized services, including ICUs, shortages caused by the impact of the COVID-19 pandemic may influence their outcome.

Methods:

A multi-center observational cohort study, based on the Dutch National Trauma Registry was performed. Characteristics, resource usage, and outcome of major trauma patients (injury severity score ≥16) treated at all trauma-receiving hospitals during the first COVID-19 peak (March 23 through May 10) were compared with those treated from the same period in 2018 and 2019 (reference period).

Results:

During the peak period, 520 major trauma patients were admitted, versus 570 on average in the pre-COVID-19 years. Significantly fewer patients were admitted to ICU facilities during the peak than during the reference period (49.6% vs 55.8%; P=0.016). Patients with less severe traumatic brain injuries in particular were less often admitted to the ICU during the peak (40.5% vs 52.5%; P=0.005). Moreover, this subgroup showed an increased mortality compared to the reference period (13.5% vs 7.7%; P=0.044). These results were confirmed using multivariable logistic regression analyses. In addition, a significant increase in observed versus predicted mortality was recorded for patients who had a priori predicted mortality of 50% to 75% (P=0.012).

Conclusions:

The COVID-19 peak had an adverse effect on trauma care as major trauma patients were less often admitted to ICU and specifically those with minor through moderate brain injury had higher mortality rates.
Surgeon Postoperative Opioid Prescribing Intensity and Risk of Persistent Opioid Use Among Opioid-naive Adult Patients
Authors: Wunsch Hannah , Hill Andrea D. , Bethell Jennifer , Fu Longdi , Bateman Brian T. , Ladha Karim S. , Wijeysundera Duminda N. , Neuman Mark D.
Published: November 2021

Objective:

The aim of this study was to determine the relationship between surgeon opioid prescribing intensity and subsequent persistent opioid use among patients undergoing surgery.

Summary Background Data:

The extent to which different postoperative prescribing practices lead to persistent opioid use among surgical patients is poorly understood.

Methods:

Retrospective population-based cohort study assessing opioid-naive adults who underwent 1 of 4 common surgeries. For each surgical procedure, the surgeons' opioid prescribing intensity was categorized into quartiles based on the median daily dose of morphine equivalents of opioids dispensed within 7 days of the surgical visit for all the surgeons' patients. The primary outcome was persistent opioid use in the year after surgery, defined as 180 days or more of opioids supplied within the year after the index date excluding prescriptions filled within 30 days of the index date. Secondary outcomes included a refill for an opioid within 30 days and emergency department visits and hospitalizations within 1 year.

Results:

Among 112,744 surgical patients, patients with surgeons in the highest intensity quartile (Q4) were more likely to fill an opioid prescription within 7 days after surgery compared with those in the lowest quartile (Q1) (83.3% Q4 vs 65.4% Q1). In the primary analysis, the incidence of persistent opioid use in the year after surgery was rare in both highest and lowest quartiles (0.3% Q4 vs 0.3% Q1), adjusted odds ratio (AOR) of 1.18, 95% CI 0.83–1.66). However, multiple analyses using stricter definitions of persistent use that included the requirement of a prescription filled within 7 days of discharge after surgery showed a significant association with surgeon quartile (up to an AOR 1.36, 95% CI 1.25, 1.47). Patients in Q4 were more likely to refill a prescription within 30 days (4.8% Q4 vs 4.0% Q1, AOR 1.14, 95% CI 1.04–1.24).

Conclusions:

Surgeons' overall prescribing practices may contribute to persistent opioid use and represent a target for quality improvement. However, the association was highly sensitive to the definition of persistent use used.
Hypoglycaemia combined with mild hypokalaemia reduces the heart rate and causes abnormal pacemaker activity in a computational model of a human sinoatrial cell
Authors: Bernjak Alan , Iqbal Ahmed , Heller Simon R. , Clayton Richard H.
Published: November 2021

Low blood glucose, hypoglycaemia, has been implicated as a possible contributing factor to sudden cardiac death (SCD) in people with diabetes but it is challenging to investigate in clinical studies. We hypothesized the effects of hypoglycaemia on the sinoatrial node (SAN) in the heart to be a candidate mechanism and adapted a computational model of the human SAN action potential developed by Fabbriet al., to investigate the effects of hypoglycaemia on the pacemaker rate. Using Latin hypercube sampling, we combined the effects of low glucose (LG) on the human ether-a-go-go-related gene channel with reduced blood potassium, hypokalaemia, and added sympathetic and parasympathetic stimulus. We showed that hypoglycaemia on its own causes a small decrease in heart rate but there was also a marked decrease in heart rate when combined with hypokalaemia. The effect of the sympathetic stimulus was diminished, causing a smaller increase in heart rate, with LG and hypokalaemia compared to normoglycaemia. By contrast, the effect of the parasympathetic stimulus was enhanced, causing a greater decrease in heart rate. We therefore demonstrate a potential mechanistic explanation for hypoglycaemia-induced bradycardia and show that sinus arrest is a plausible mechanism for SCD in people with diabetes.
A chronology of subterranean clover burr detachment mechanics and implications for seed harvestability
Authors: Moss W. M. , Nichols P. G. H. , Ryan M. H. , Foster K. J. , Guzzomi A. L.
Published: November 2021

Seed retention has not been evaluated for subterranean clover (Trifolium subterraneumL.), because its geocarpic seed-bearing burrs are currently harvested by suction systems. Development of improved harvest methods requires knowledge of subterranean clover seed retention characteristics and their changes with plant development. This study evaluates burr attachment and peduncle tensile strength during burr maturity until plant senescence across the three subspecies:subterraneum(cv. Dalkeith),yanninicum(cv. Monti) andbrachycalycinum(cv. Mawson). Peduncle tensile strength was greater than burr-to-peduncle attachment strength for each subspecies, with peak mean peduncle strength 30–130% greater than peak mean burr-to-peduncle attachment strength. Both strength measurements decreased significantly (greater than 50% for each subspecies) as the plant senesced, which was associated with reductions in burr moisture content, and burr and peduncle diameters. Microscopy indicated a ductile to brittle transition as peduncles senesced, reducing energy absorption and increasing the likelihood of failure at defects. These results are important for the commercial production of subterranean clover seed and suggest it may be possible to harvest seed before plant senescence with dig-invert machinery, similar to that used for peanut harvesting. However, this approach would require harvesting prior to maximum seed development and the implications for seed viability and yield need to be further evaluated.
A runtime alterable epidemic model with genetic drift, waning immunity and vaccinations
Authors: Getz Wayne M. , Salter Richard , Luisa Vissat Ludovica , Koopman James S. , Simon Carl P.
Published: November 2021

We present methods for building a Java Runtime-Alterable-Model Platform (RAMP) of complex dynamical systems. We illustrate our methods by building a multivariant SEIR (epidemic) RAMP. Underlying our RAMP is an individual-based model that includes adaptive contact rates, pathogen genetic drift, waning and cross-immunity. Besides allowing parameter values, process descriptions and scriptable runtime drivers to be easily modified during simulations, our RAMP can used within R-Studio and other computational platforms. Process descriptions that can be runtime altered within our SEIR RAMP include pathogen variant-dependent host shedding, environmental persistence, host transmission and within-host pathogen mutation and replication. They also include adaptive social distancing and adaptive application of vaccination rates and variant-valency of vaccines. We present simulation results using parameter values and process descriptions relevant to the current COVID-19 pandemic. Our results suggest that if waning immunity outpaces vaccination rates, then vaccination rollouts may fail to contain the most transmissible variants, particularly if vaccine valencies are not adapted to deal with escape mutations. Our SEIR RAMP is designed for easy use by others. More generally, our RAMP concept facilitates construction of highly flexible complex systems models of all types, which can then be easily shared as stand-alone application programs.
In situmeasurements of reef squid polarization patterns using two-dimensional polarization data mapped onto three-dimensional tessellated surfaces
Authors: Brady P. C. , Cummings M. E. , Gruev V. , Hernandez T. , Blair S. , Vail A. , Garcia M.
Published: November 2021

Reef squids belong to a group reputed for polarization sensitivity, yet polarization patterns of reef squid have not been quantifiedin situ. To quantify polarization patterns from video polarimetric data, we developed a protocol to map two-dimensional polarization data onto squid-shaped three-dimensional tessellated surfaces. This protocol provided a robust data container used to investigate three-dimensional regions-of-interest, producing data lineouts derived from the squid's geometry. This protocol also extracted polarimeter and squid body orientations and the solar heading from polarization images. When averaged over the solar heading, the ventral midline gave a low degree of polarization (2.4 ± 5.3%), and the area between the ventral and flank midlines had higher values (9.0 ± 5.3%). These averaged data had a large discontinuity in the angle of polarization (AoP) at the mantle's ventral midline (64 ± 55°), with larger discontinuities measured on individual squid. Ray-tracing calculations demonstrated that the AoP pattern was not related to the squid's surface-normal geometry. However, the AoP followed virtual striation axes on the squid's surface oriented 24° to the squid's long axis, similar in angle (27°) to the striations of birefringent collagen fibres documented in other squid species’ skin.
Effectiveness of self-help plus (SH+) in reducing anxiety and post-traumatic symptomatology among care home workers during the COVID-19 pandemic: a randomized controlled trial
Authors: Riello Marianna , Purgato Marianna , Bove Chiara , Tedeschi Federico , MacTaggart David , Barbui Corrado , Rusconi Elena
Published: November 2021

This article describes a randomized controlled trial to evaluate the effectiveness of a supervised online delivery of self-help plus (SH+), during the second wave of COVID-19 contagions in Northern Italy. The SH+ is a psychological intervention developed by the World Health Organization to increase a person's ability to deal with stress. In this trial, it was tested primarily as a tool to reduce anxiety and post-traumatic symptomatology in workers of residential nursing and care homes. In order to partial out non-specific effects of the intervention, the SH+ was compared to an equally supervised and structured alternative activity. Secondarily, in view of future emergencies, the potential of SH+ as a tool to reduce perceived stress, increase subjective well-being and foster individual resilience was explored. At post-intervention, the preregistered analysis revealed no difference in self-reported anxiety and/or post-traumatic symptomatology between the group receiving the SH+ and the group engaged in an alternative activity. Some specific and positive effects of the SH+ intervention were only found on self-reported intervention effectiveness and engagement in exploratory analyses. These findings raise the question whether the previously documented effectiveness of the SH+ on self-reported symptomatology and on the prevention of psychiatric conditions could be attributed mostly to non-specific rather than specific factors connected with participant enrolment in a psychological intervention. Indeed, the effects of the SH+ had been previously compared only to the effects of not being engaged in any alternative activity (often described in the literature as ‘treatment as usual’—or ‘enhanced treatment as usual’, when some relevant information is given to the control group as a one-off). Given the negative findings of this study, before the SH+ is implemented in clinical practice, further studies should be conducted to examine its short- and long-term beneficial effects, by means of randomized studies that employ alternative but similarly structured interventions as control conditions, aiming to minimize the confounding effect of non-specific factors.
Optimal allocation of resources to healthcare workers or the general populace: a modelling study
Authors: Vo MyVan , Glasser Joshua A. , Feng Zhilan
Published: November 2021

We consider a model that distinguishes susceptible; infected, but not yet infectious; pre-symptomatic, symptomatic, asymptomatic, and hospitalized infectious; recovered and dead members of two groups: healthcare workers (HCW) and members of the community that they serve. Because of the frequency or duration of their exposures to SARS-CoV-2, a greater fraction of HCW would experience severe COVID-19 symptoms that require medical care, which reduces mortality rates, absent personal protective equipment (PPE). While N95 masks (and, possibly, other scarce medical resources) are available to members of both groups, they do not use them equally well (i.e. efficacy and compliance differ). We investigated the optimal allocation of potentially scarce medical resources between these groups to control the pandemic and reduce overall infections and mortality via derivation and analysis of expressions for the reproduction numbers and final size. We also simulated prevalence and cumulative incidence, quantities relevant to surge capacity and population immunity, respectively. We found that, under realistic conditions, the optimal allocation is virtually or entirely to HCW, but that allocation of surplus masks and other medical resources to members of the general community also reduces infections and deaths.
Assessing information-sharing networks within small-scale fisheries and the implications for conservation interventions
Authors: Arlidge William N. S. , Firth Josh A. , Alfaro-Shigueto Joanna , Ibanez-Erquiaga Bruno , Mangel Jeffrey C. , Squires Dale , Milner-Gulland E. J.
Published: November 2021

The effectiveness of behavioural interventions in conservation often depends on local resource users' underlying social interactions. However, it remains unclear to what extent differences in related topics of information shared between resource users can alter network structure—holding implications for information flows and the spread of behaviours. Here, we explore the differences in nine subtopics of fishing information related to the planned expansion of a community co-management scheme aiming to reduce sea turtle bycatch at a small-scale fishery in Peru. We show that the general network structure detailing information sharing about sea turtle bycatch is dissimilar from other fishing information sharing. Specifically, no significant degree assortativity (degree homophily) was identified, and the variance in node eccentricity was lower than expected under our null models. We also demonstrate that patterns of information sharing between fishers related to sea turtle bycatch are more similar to information sharing about fishing regulations, and vessel technology and maintenance, than to information sharing about weather, fishing activity, finances and crew management. Our findings highlight the importance of assessing information-sharing networks in contexts directly relevant to the desired intervention and demonstrate the identification of social contexts that might be more or less appropriate for information sharing related to planned conservation actions.
Bayesian inference of a non-local proliferation model
Authors: Szymańska Zuzanna , Skrzeczkowski Jakub , Miasojedow Błażej , Gwiazda Piotr
Published: November 2021

From a systems biology perspective, the majority of cancer models, although interesting and providing a qualitative explanation of some problems, have a major disadvantage in that they usually miss a genuine connection with experimental data. Having this in mind, in this paper, we aim at contributing to the improvement of many cancer models which contain a proliferation term. To this end, we propose a new non-local model of cell proliferation. We select data that are suitable to perform Bayesian inference for unknown parameters and we provide a discussion on the range of applicability of the model. Furthermore, we provide proof of the stability of posterior distributions in total variation norm which exploits the theory of spaces of measures equipped with the weighted flat norm. In a companion paper, we provide detailed proof of the well-posedness of the problem and we investigate the convergence of the escalator boxcar train (EBT) algorithm applied to solve the equation.
Schizotypy is associated with difficulties detecting emotional facial expressions
Authors: Uono Shota , Sato Wataru , Sawada Reiko , Kawakami Sayaka , Yoshimura Sayaka , Toichi Motomi
Published: November 2021

People with schizophrenia or subclinical schizotypal traits exhibit impaired recognition of facial expressions. However, it remains unclear whether the detection of emotional facial expressions is impaired in people with schizophrenia or high levels of schizotypy. The present study examined whether the detection of emotional facial expressions would be associated with schizotypy in a non-clinical population after controlling for the effects of IQ, age, and sex. Participants were asked to respond to whether all faces were the same as quickly and as accurately as possible following the presentation of angry or happy faces or their anti-expressions among crowds of neutral faces. Anti-expressions contain a degree of visual change that is equivalent to that of normal emotional facial expressions relative to neutral facial expressions and are recognized as neutral expressions. Normal expressions of anger and happiness were detected more rapidly and accurately than their anti-expressions. Additionally, the degree of overall schizotypy was negatively correlated with the effectiveness of detecting normal expressions versus anti-expressions. An emotion–recognition task revealed that the degree of positive schizotypy was negatively correlated with the accuracy of facial expression recognition. These results suggest that people with high levels of schizotypy experienced difficulties detecting and recognizing emotional facial expressions.
The goal-relevance of affective stimuli is dynamically represented in affective experience
Authors: Asutay Erkin , Västfjäll Daniel
Published: November 2021

Affect is a continuous and temporally dependent process that represents an individual's ongoing relationship with its environment. However, there is a lack of evidence on how factors defining the dynamic sensory environment modulate changes in momentary affective experience. Here, we show that goal-dependent relevance of stimuli is a key factor shaping momentary affect in a dynamic context. Participants (
N
= 83) viewed sequentially presented images and reported their momentary affective experience after every fourth stimulus. Relevance was manipulated through an attentional task that rendered each image either task-relevant or task-irrelevant. Computational models were fitted to trial-by-trial affective responses to capture the key dynamic parameters explaining momentary affective experience. The findings from statistical analyses and computational models showed that momentary affective experience was shaped by the temporal integration of the affective impact of recently encountered stimuli, and that task-relevant stimuli, independent of stimulus affect, prompted larger changes in experienced pleasantness compared with task-irrelevant stimuli. These findings clearly show that dynamics of affective experience reflect goal-relevance of stimuli in our surroundings.
Insect-host control of obligate, intracellular symbiont density
Authors: Whittle Mathilda , Barreaux Antoine M. G. , Bonsall Michael B. , Ponton Fleur , English Sinead
Published: November 2021

Many insects rely on intracellular bacterial symbionts to supplement their specialized diets with micronutrients. Using data from diverse and well-studied insect systems, we propose three lines of evidence suggesting that hosts have tight control over the density of their obligate, intracellular bacterial partners. First, empirical studies have demonstrated that the within-host symbiont density varies depending on the nutritional and developmental requirements of the host. Second, symbiont genomes are highly reduced and have limited capacity for self-replication or transcriptional regulation. Third, several mechanisms exist for hosts to tolerate, regulate and remove symbionts including physical compartmentalization and autophagy. We then consider whether such regulation is adaptive, by discussing the relationship between symbiont density and host fitness. We discuss current limitations of empirical studies for exploring fitness effects in host–symbiont relationships, and emphasize the potential for using mathematical models to formalize evolutionary hypotheses and to generate testable predictions for future work.