bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Intraoperative Local Pain Cocktail Injections on Early Function and Patient-Reported Outcomes: A Randomized Controlled Trial
Authors: Ihejirika-Lomedico Rivka , Solasz Sara , Lorentz Nathan , Egol Kenneth A. , Leucht Philipp ,   and NYU Hip Fracture Research Group
Published: May 2023

Objective:

To determine whether a perioperative pain cocktail injection improves postoperative pain, ambulation distance, and long-term outcomes in patients with hip fracture.

Design:

Prospective, single-blinded, randomized controlled trial.

Setting:

Academic Medical Center.

Patients/Participants:

Patients with OTA/AO 31A1-3 and 31B1-3 fractures undergoing operative fixation, excluding arthroplasty.

Intervention:

Multimodal local injection of bupivacaine (Marcaine), morphine sulfate (Duramorph), ketorolac (Toradol) given at the fracture site at the time of hip fracture surgery (Hip Fracture Injection, HiFI).

Main Outcome Measurements:

Patient-reported pain, American Pain Society Patient Outcome Questionnaire (APS-POQ), narcotic usage, length of stay, postoperative ambulation, Short Musculoskeletal Function Assessment.

Results:

Seventy-five patients were in the treatment group and 109 in the control group. Patients in the HiFI group had a significant reduction in pain and narcotic usage compared with the control group on postoperative day (POD) 0 (P < 0.01). Based on the APS-POQ, patients in the control group had a significantly harder time falling asleep, staying asleep, and experienced increased drowsiness on POD 1 (P < 0.01). Patient ambulation distance was greater on POD 2 (P < 0.01) and POD 3 (P < 0.05) in the HiFI group. The control group experienced more major complications (P < 0.05). At 6-week postop, patients in the treatment group reported significantly less pain, better ambulatory function, less insomnia, less depression, and better satisfaction than the control group as measured by the APS-POQ. The Short Musculoskeletal Function Assessment bothersome index was also significantly lower for patients in the HiFI group, P < 0.05.

Conclusions:

Intraoperative HiFI not only improved early pain management and increased ambulation in patients undergoing hip fracture surgery while in the hospital, it was also associated with early improved health-related quality of life after discharge.

Level of Evidence:

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
The Making of an Educator: Professional Identity Formation Among Graduate Medical Education Faculty Through Situated Learning Theory
Authors: McMains Kevin C. , Durning Steven J. , Norton Candace , Meyer Holly S.
Published: May 2023

Introduction:

Professional identity formation (PIF) is a foundational element to professional medical education and training. Given the impact of faculty role models and mentors to student and trainee learning, mapping the landscape of PIF among faculty takes on increased importance. We conducted a scoping review of PIF through the lens of situated learning theory. Our scoping review question was: How is situated learning theory used to understand the process of PIF among graduate medical educators?

Methods:

The scoping review methodology described by Levac et al served as the architecture for this review. Medline, Embase, PubMed, ERIC, CINAHL, PsycINFO, and Web of Science Core Collection were searched (from inception) using a combination of terms that describe PIF among graduate medical educators.

Results:

Of the 1434 unique abstracts screened, 129 articles underwent full-text review, with 14 meeting criteria for inclusion and full coding. Significant results organized into three main themes: importance of using common definitions; evolution of theory over time with untapped explanatory power; identity as a dynamic construct.

Discussion:

The current body of knowledge leaves many gaps. These include lack of common definitions, need to apply ongoing theoretical insights to research, and exploration of professional identity as an evolving construct. As we come to understand PIF among medical faculty more fully, twin benefits accrue: (1) Community of practices can be designed deliberately to encourage full participation of all graduate medical education faculty who desire it, and (2) Faculty can more effectively lead trainees in negotiating the ongoing process of PIF across the landscape of professional identities.
Curriculum Evaluation and Alignment of Core Ideals
Authors: Burris Valerie F. , Owens Jacqueline K.
Published: May 2023

Curriculum evaluation, including alignment of concepts, is an ongoing challenge for nurse educators. Nursing curricular frameworks encompass varied concepts, guided by professional standards. This article examines a conceptual model, the Globe Framework, for BSN generalist practice including initial development, implementation, and evaluation. Evaluation at one school, driven by new AACN Essentials in 2021, spans from 2008 to 2020, reviewing three data points: meeting minutes, master syllabi from baccalaureate coursework, and accreditation documents. Challenges included merging two nursing departments with collaboration to reach consensus. Framework strengths include local practice environment values and multiple concepts. Findings and recommendations can inform nurse educators as they consider program evaluation and upcoming accreditation standards.
Youth Sport Participation Experiences From the Perspective of Hispanic/Latinx Parents and Their Children
Authors: Hernandez Mayrena Isamar , Miller Elena Catherine , Prieto Laura Andrea , Sehmer Madison Nicole , Schaefer Daniel Allan , Biese Kevin Mark , Columna Luis A. , Andreae Susan , McGuine Timothy A. , Snedden Traci R. , Eberman Lindsey E. , Bell David Robert
Published: May 2023

Hispanic/Latinx communities remain an underserved population in terms of health and physical activity opportunities. The rise of sport specialization can jeopardize these opportunities. Understanding the appeal and welcomeness that minoritized populations feel toward sport and sport specialization culture can play an important role in health promotion and breaking down barriers that widen the gap on physical activity levels in Hispanic/Latinx communities. To date, these studies have not qualitatively investigated Hispanic/Latinx youth sport dyads (parent and child) and how sport specialization perceptions have affected their sport participation experiences. We used a qualitative interpretative phenomenological analysis to explore experiences of Hispanic/Latinx high school athletes. We engaged in semistructured interviews with 12 parent-child dyads. The following 3 interrelated themes emerged: (a) expectations of youth sport participation, (b) meeting expectations of youth sport participation, (c) and (mis)alignment of cultures. Dyads describe a negative youth sport experience when both cultures do not align because of the rise in sport specialization and pay-to-play culture. Findings indicate that dyads understand what is necessary to participate in organized sport and do this by methods that are rooted in their Hispanic/Latinx culture.
Developing a Method for Quantifying Meropenem in Children—Volumetric Adsorptive Microsampling Versus Plasma Sampling
Authors: Ramadan Ola , Schatz Lea Marie , van den Heuvel Ingeborg , Masjosthusmann Katja , Groll Andreas H. , Hempel Georg
Published: May 2023

Background:

Meropenem is a carbapenem antibiotic often used in pediatric intensive care units due to its broad spectrum of activity. Therapeutic drug monitoring (TDM) is a useful tool to increase the effectiveness of meropenem by adjusting the dose based on plasma levels; however, the relatively large sample volume required for TDM can limit its use in children. Therefore, this study aimed to determine meropenem concentrations and consequently perform TDM effectively using the smallest possible sample volume. Volumetric absorptive microsampling (VAMS) is a sampling technology developed to collect a small, precise volume of blood. For the applicability of VAMS in TDM, plasma concentrations must be reliably calculated from whole blood (WB) collected by VAMS.

Methods:

VAMS technology using 10 µL of WB was evaluated and compared with EDTA-plasma sampling. High-performance liquid chromatography with UV detection was applied to quantify meropenem in VAMS and plasma samples after the removal of proteins by precipitation. Ertapenem was used as the internal standard. Samples were collected simultaneously from critically ill children receiving meropenem using VAMS and traditional sampling.

Results:

It was found that no consistent factor could be determined to calculate meropenem plasma concentrations from the WB, indicating that VAMS was not reliable in the TDM of meropenem. Therefore, to reduce the required sample amount in pediatric patients, a method for quantifying meropenem from 50 µL of plasma with a lower limit of quantification of 1 mg/L was developed and successfully validated.

Conclusions:

A simple, reliable, and low-cost method was established using high-performance liquid chromatography–UV to determine the concentration of meropenem in 50 µL of plasma. VAMS using WB does not seem to be suitable for TDM of meropenem.
Busulfan Interlaboratory Proficiency Testing Program Revealed Worldwide Errors in Drug Quantitation and Dose Recommendations
Authors: Kweekel Dina M. , McCune Jeannine S. , Punt Arjen M. , van Luin Matthijs , Franssen Eric J.F.
Published: May 2023

Background:

The clinical outcomes of busulfan-based conditioning regimens for hematopoietic cell transplantation (HCT) have been improved by personalizing the doses to target narrow busulfan plasma exposure. An interlaboratory proficiency test program for the quantitation, pharmacokinetic modeling, and busulfan dosing in plasma was developed. Previous proficiency rounds (ie, the first 2) found that 67%–85% and 71%–88% of the dose recommendations were inaccurate, respectively.

Methods:

A proficiency test scheme was developed by the Dutch Foundation for Quality Assessment in Medical Laboratories (SKML) and consisted of 2 rounds per year, with each round containing 2 busulfan samples. In this study, 5 subsequent proficiency tests were evaluated. In each round, the participating laboratories reported their results for 2 proficiency samples (ie, low and high busulfan concentrations) and a theoretical case assessing their pharmacokinetic modeling and dose recommendations. Descriptive statistics were performed, with ±15% for busulfan concentrations and ±10% for busulfan plasma exposure. The dose recommendations were deemed accurate.

Results:

Since January 2020, 41 laboratories have participated in at least 1 round of this proficiency test. Over the 5 rounds, an average of 78% of the busulfan concentrations were accurate. Area under the concentration–time curve calculations were accurate in 75%–80% of the cases, whereas only 60%–69% of the dose recommendations were accurate. Compared with the first 2 proficiency test rounds (PMID 33675302, October, 2021), the busulfan quantitation results were similar, but the dose recommendations worsened. Some laboratories repeatedly submit results that deviated by more than 15% from the reference values.

Conclusions:

The proficiency test showed persistent inaccuracies in busulfan quantitation, pharmacokinetic modeling, and dose recommendations. Additional educational efforts have yet to be implemented; regulatory efforts seem to be needed. The use of specialized busulfan pharmacokinetic laboratories or a sufficient performance in busulfan proficiency tests should be required for HCT centers that prescribe busulfan.
A classifier based on 273 urinary peptides predicts early renal damage in primary hypertension
Authors: Lin Lirong , Wang Chunxuan , Ren Jiangwen , Mei Mei , Zheng Luquan , Yang Jurong
Published: May 2023

Objectives:

Renal diseases caused by primary hypertension (HTN) are often asymptomatic without sensitive markers for early diagnosis and prediction, easily progressing to severe and irreversible renal damage in patients with clinical manifestations. This study explored whether a classifier developed based on 273 urinary peptides (CKD273) could serve as a potential biomarker for early prediction of renal damage in HTN.

Methods:

Urinary CKD273 level of healthy individuals, HTN + normoalbuminuric and HTN + albuminuria patients were compared, and 22 baseline data including sex, age, renal function, and hypertensive fundus lesions were collected. Patients diagnosed with HTN, albuminuria, and normal renal function were followed up. According to the follow-up results, the cut-off value of CKD273 in predicting hypertensive renal injury was calculated and analyzed in the high-risk and low-risk groups of HTN patients for its performance in detecting early hypertensive renal injury.

Results:

Among a sum of 319 participants, average urinary CKD273 level was significantly higher in patients with HTN than in normal individuals. A total of 147 HTN patients with normal albuminuria were followed up for a mean of 3.8 years. Thirty-five patients showed urinary albumin-to-creatinine ratio (uACR) at least 30 mg/g for three consecutive times. The receiver-operating characteristic (ROC) curve showed that the urinary CKD273 cut-off value for evaluating new-onset proteinuria in patients with HTN was 0.097. Based on this cut-off value, 39 and 108 patients were included in the high-risk and low-risk groups, respectively. Specifically, compared with patients in the low-risk group, those in the high-risk group showed significantly longer duration of HTN, higher proportions of hypertensive fundus lesions and at least 30 mg/g uACR, and higher levels of homocysteine (Hcy), cystatin C (CysC), beta-2 microglobulin (β2-MG), and uACR. 76.9% of high-risk patients had significantly higher new-onset proteinuria than the low-risk group. Correlation analysis demonstrated a positive correlation between urinary CKD273 and UACR (r = 0.494, P = 0.000). The incidence of new-onset albuminuria was significantly higher in the high-risk group than in the low-risk group, as shown by Cox regression analysis. The areas under the curve of CKD273, Hcy, β2-MG, and CysC were 0.925, 0.753, 0.796, and 0.769, respectively.

Conclusion:

Urinary CKD273 is a predictor of new-onset proteinuria in patients with HTN, therefore, it can be used for diagnosing patients with early renal injury in patients with HTN, contributing to early prevention and treatment of hypertensive nephropathy.
A Novel Combination of Host Protein Biomarkers to Distinguish Bacterial From Viral Infections in Febrile Children in Emergency Care
Authors: Tan Chantal D. , van den Broek Bryan , Womersley Rebecca S. , Kaforou Myrsini , Hagedoorn Nienke N. , van der Flier Michiel , Jackson Heather , Moll Henriette A. , Snijder Rozemarijn , de Jonge Marien I. , Vermont Clementien L. ,   On behalf of PERFORM Consortium
Published: May 2023

Background:

Distinguishing bacterial and viral infections based on clinical symptoms in febrile children attending the emergency department (ED) is challenging. The aim of this study is to determine a novel combination of host protein biomarkers and to assess its performance in distinguishing between bacterial and viral infection in febrile children attending EDs.

Methods:

A literature search was performed to identify blood protein biomarkers able to distinguish bacterial and viral infections (May 2015–May 2019). We selected 7 protein biomarkers: Procalcitonin, TNF-related apoptosis-inducing ligand (TRAIL), interleukin (IL)-4, IL-6, Interferon gamma-induced protein-10 (CXCL-10), interferon-gamma and lipocalin 2 (LCN2). These were measured in blood plasma using a bead-based immunoassay in children with a confirmed bacterial or viral infection attending EDs in the Netherlands. We used generalized linear modeling to classify bacterial and viral infections and applied a previously developed feature selection algorithm to select the optimal combination of proteins. We performed a subgroup analysis of this protein signature in patients with C-reactive protein <60 mg/L, representing a clinically challenging diagnostic group.

Results:

In total 102 children were included (N = 67 bacterial; N = 35 viral). Individual performance of the 7 biomarkers in classifying bacterial versus viral infections ranged from 60.8%–74.5% area under the receiver operator curve (AUC). TRAIL, LCN2 and IL-6 were identified as the best 3-protein signature with an AUC of 86% (95% CI: 71.3%–100%). In 57 patients with C-reactive protein levels <60 mg/L, the 3-protein signature had an AUC of 85.1% (95% CI: 75.3%–94.9%).

Conclusion:

We demonstrate a promising novel combination of 3 host protein biomarkers; TRAIL, LCN2 and IL-6, which performs well in classifying bacterial and viral infections in febrile children in emergency care.
“Go With the Flow”: A Qualitative Description of Infant Feeding Experiences Among Women With HIV in the United States
Authors: Pagano-Therrien Jesica , Griswold Michele K. , Amoah Rita K.
Published: May 2023

Breastfeeding affords numerous health benefits to mothers and children, but for women with HIV in the United States, avoidance of breastfeeding is recommended. Evidence from low-income countries demonstrates low risk of HIV transmission during breastfeeding with antiretroviral therapy, and the World Health Organization recommends exclusive breastfeeding and shared decision making about infant feeding options in low-income and middle-income countries. In the United States, gaps in knowledge exist surrounding the experiences, beliefs, and feelings of women with HIV surrounding infant feeding decisions. Undergirded by a framework of person-centered care, this study describes the experiences, beliefs, and feelings of women with HIV in the United States surrounding recommendations for breastfeeding avoidance. Although no participants reported consideration of breastfeeding, multiple gaps were identified with implications for the clinical care and counseling of the mother–infant dyad.
Nocturnal Vulval Pain in Girls—A Subset of Vulvodynia?
Authors: Sagoo Manpreet K. , Lakhan Manpreet , Moyal-Barracco Micheline , Lewis Fiona M.
Published: May 2023

Objectives

The aims of the authors’ case series were to outline the clinical features of prepubertal nocturnal vulval pain syndrome and to look at management and outcomes.

Methods

Clinical details of prepubertal girls experiencing episodes of nocturnal vulval pain with no identifiable cause were recorded and analyzed. Parents completed a questionnaire to look at outcomes.

Results

Eight girls with age at onset of symptoms between 3.5 and 8 years (mean 4.4 years) were included. Each patient described intermittent episodes of vulval pain lasting between 20 minutes and 5 hours, starting 1–4 hours after falling asleep. They were crying and rubbing or holding the vulva with no obvious cause seen. Many were not fully awake and 75% had no recollection of the events. Management focused on reassurance alone. The questionnaire showed that 83% had full resolution of symptoms with a mean duration of 5.7 years.

Conclusions

Prepubertal nocturnal vulval pain syndrome may be a subset of vulvodynia (generalized, spontaneous, intermittent) to be included in the clinical spectrum of night terrors. Recognizing the clinical key features should aid prompt diagnosis and reassurance of the parents.
Incidence and risk factors for revision and contralateral anterior cruciate ligament reconstruction: A population-based retrospective cohort study
Authors: Paudel Yuba Raj , Sommerfeldt Mark , Voaklander Don
Published: May 2023

There is a limited data on epidemiology of primary and recurrent anterior cruciate ligament reconstruction (ACLR) in Canada. The objectives of this study were to examine the incidence and factors associated with recurrent ACLR (revision and contralateral ACLR) in a western Canadian province of Alberta. We conducted a retrospective cohort study with an average follow up of 5.7 years. Albertans aged 10 to 60 years with a history of primary ACLR between 2010/11 to 2015/16 were included in the study. Participants were followed up until March 2019 to observe outcomes: Ipsilateral revision ACLR and contralateral ACLR. Kaplan Meir approach was used to estimate event free survival and Cox proportional hazard regression analysis was conducted to identify associated factors. Of the total participants with a history of primary ACLR on a single knee (n = 9292), n = 359, 3.9% (95% confidence interval: 3.5–4.3) underwent a revision ACLR. A similar proportion among those having primary ACLR on either knee (n = 9676), n = 344, 3.6% (95% confidence interval: 3.2–3.9) underwent a contralateral primary ACLR. Young age (<30 years) was associated with increased risk of contralateral ACLR. Similarly, young age (<30 years), having initial primary ACLR in winter and having allograft were associated with a risk of revision ACLR. Clinicians can use these findings in their clinical practice and designing rehabilitation plans as well as to educate patients about their risk for recurrent anterior cruciate ligament tear and graft failure.
Probiotic modulation of gut microbiota by Bacillus coagulans MTCC 5856 in healthy subjects: A randomized, double-blind, placebo-control study
Authors: Majeed Muhammed , Nagabhushanam Kalyanam , Mundkur Lakshmi , Paulose Shaji , Divakar Hema , Rao Sudha , Arumugam Sivakumar
Published: May 2023

Background:

Probiotics are known to rebalance the gut microbiota in dysbiotic individuals, but their impact on the gut microbiome of healthy individuals is seldom studied. The current study is designed to assess the impact and safety of Bacillus coagulans (Weizmannia coagulans) microbial type culture collection 5856 (LactoSpore®) supplementation on microbiota composition in healthy Indian adults.

Methods:

The study participants (N = 30) received either LactoSpore (2 billion colony-forming units/capsule) or placebo for 28 days. The general and digestive health were assessed through questionnaires and safety by monitoring adverse events. Taxonomic profiling of the fecal samples was carried out by 16S rRNA amplicon sequencing using the Illumina MiSeq platform. The bacterial persistence was enumerated by quantitative reverse transcription-polymerase chain reaction.

Results:

Gut health, general health, and blood biochemical parameters remained normal in all the participants. No adverse events were reported during the study. Metataxonomic analysis revealed minimal changes to the gut microbiome of otherwise healthy subjects and balance of Bacteroidetes and Firmicutes was maintained by LactoSpore. The relative abundance of beneficial bacteria like Prevotella, Faecalibacterium, Blautia, Megasphaera, and Ruminococcus showed an increase in probiotic-supplemented individuals. The quantitative polymerase chain reaction analysis revealed highly variable numbers of B. coagulans in feces before and after the study.

Conclusion:

The present study results suggest that LactoSpore is safe for consumption and does not alter the gut microbiome of healthy individuals. Minor changes in a few bacterial species may have a beneficial outcome in healthy individuals. The results reiterate the safety of B. coagulans microbial type culture collection 5856 as a dietary supplement and provide a rationale to explore its effect on gut microbiome composition in individuals with dysbiosis.
PAX5 fusion genes in acute lymphoblastic leukemia: A literature review
Authors: Fouad Fatma Mohamed , Eid Jehane I.
Published: May 2023

Acute lymphoblastic leukemia (ALL) is a common cancer affecting children worldwide. The development of ALL is driven by several genes, some of which can be targeted for treatment by inhibiting gene fusions. PAX5 is frequently mutated in ALL and is involved in chromosomal rearrangements and translocations. Mutations in PAX5 interact with other genes, such as ETV6 and FOXP1, which influence B-cell development. PAX5/ETV6 has been observed in both B-ALL patients and a mouse model. The interaction between PAX5 and FOXP1 negatively suppresses the Pax5 gene in B-ALL patients.

Additionally, ELN and PML genes have been found to fuse with PAX5, leading to adverse effects on B-cell differentiation. ELN-PAX5 interaction results in the decreased expression of LEF1, MB1, and BLNK, while PML-PAX5 is critical in the early stages of leukemia. PAX5 fusion genes prevent the transcription of the PAX5 gene, making it an essential target gene for the study of leukemia progression and the diagnosis of B-ALL.
Veterans' Experiences of Support in Managing Comorbid Sleep Apnea and Type 2 Diabetes
Authors: Song Yeonsu , Choi Sarah E. , Papazyan Anna , Macey Paul M. , Alessi Cathy A. , Fung Constance H. , Josephson Karen R. , Martin Jennifer L.
Published: May 2023

Background

Obstructive sleep apnea (OSA) is highly prevalent in patients with Type 2 diabetes, more so in veterans compared with nonveterans. Positive airway pressure is the recommended first-line treatment for OSA. However, adherence to both positive airway pressure and diabetes management regimens can be challenging for older adults. Support from family or friends may improve glucose control or sleep-apnea-related symptoms, yet the evidence is limited when both conditions coexist.

Objectives

This study aimed to describe veterans' experiences of support from family and friends with managing comorbid sleep apnea and Type 2 diabetes.

Methods

We conducted a postal survey of older veterans with OSA and Type 2 diabetes from one healthcare system. Questions include demographic and health-related information, information about sleep apnea and diabetes treatment and education received, related support from family or a friend, perceived benefits of regular positive airway pressure device use on improving sleep health, and perceived benefits of education for family or a friend on sleep apnea and diabetes. Descriptive and bivariate analyses were performed.

Results

Of 145 respondents (mean age = 72 years), 43% reported receiving help for Type 2 diabetes from family or a friend. Almost two thirds of the respondents were currently using a positive airway pressure device, of whom 27% received support with device use from family or friends. About one third of veterans perceived family and friends receiving education on treating sleep apnea and diabetes to be very or extremely helpful. Such perceived benefit was higher among those who were married or identified as non-White. Veterans using a positive airway pressure device had lower hemoglobin A1c levels than nonusers.

Discussion

Veterans perceived that additional education for the individuals providing support would be beneficial. Future studies could address interventions to increase sleep apnea and Type 2 diabetes knowledge among families and friends of veterans with these comorbid conditions. In addition, patients' adherence to positive airway pressure may be enhanced by support from family and friends.
Diagnostic Utility of Menin Immunohistochemistry in Patients With Multiple Endocrine Neoplasia Type 1 Syndrome
Authors: Verschuur Anna Vera D. , Kok Aranxa S.M. , Morsink Folkert H.M. , de Leng Wendy W.J. , van den Broek Medard F.M , Koudijs Marco J. , Offerhaus Johan A. , Valk Gerlof D. , Vriens Menno R. , van Nesselrooij Bernadette P.M. , Hackeng Wenzel M. , Brosens Lodewijk A.A.
Published: May 2023

A clinical diagnosis of multiple endocrine neoplasia type 1 (MEN1) syndrome is usually confirmed with genetic testing in the germline. It is expected that menin protein expression is lost in MEN1-related tumors. Therefore, we investigated the potential of menin immunohistochemistry in parathyroid adenomas as an additional tool in the recognition and genetic diagnosis of MEN1 syndrome. Local pathology archives were searched for parathyroid tumors from patients with MEN1 syndrome and without MEN1, including sporadic, patients with multiple endocrine neoplasia type 2A and hyperparathyroidism-jaw parathyroid tumors. Menin immunohistochemistry was performed and its use to identify MEN1-related tumors was assessed. Twenty-nine parathyroid tumors from 16 patients with MEN1 and 61 patients with parathyroid tumors from 32 non-MEN1 were evaluated. Immunohistochemical nuclear menin loss in one or more tumors was found in 100% of patients with MEN1 and 9% of patients with non-MEN1. In patients with multiple tumors, menin loss in at least one tumor was seen in 100% of 8 patients with MEN1 and 21% of patients with 14 non-MEN1. Using a cutoff of at least 2 tumors showing menin loss per patient, the positive and negative predictive values for the diagnosis MEN1 were both 100%. The practical and additional value of menin immunohistochemistry in clinical genetic MEN1 diagnosis is further illustrated by menin immunohistochemistry in 2 cases with a germline variant of unknown significance in the MEN1 gene. Menin immunohistochemistry is useful in the recognition of MEN1 syndrome as well as in the clinical genetic analysis of patients with inconclusive MEN1 germline testing.
Overview of the Health Communication Curriculum in Canadian Master of Public Health Programs
Authors: MacKay Melissa , Li Yan , Papadopoulos Andrew , McWhirter Jennifer E.
Published: May 2023

Context:

Competency-based public health education ensures practitioners are well equipped to positively influence the health of the public. The Public Health Agency of Canada's Core Competencies for Public Health has named communication as an essential competency area for practitioners. However, little is known about how Master of Public Health (MPH) programs in Canada support trainees in developing the recommended core competencies in communication.

Objective:

Our research aims to provide an overview of the extent to which communication is embedded in the curriculum of MPH programs in Canada.

Design:

We conducted an online scan of Canadian MPH course titles and descriptions to determine how many MPH programs offer communication-focused courses (ie, health communication), knowledge mobilization courses (eg, knowledge translation), and other courses that may support communication skills. Two researchers coded the data; discrepancies were resolved via discussion.

Results:

Of the 19 MPH programs in Canada, less than half (n = 9) offer courses specifically focused on communication (ie, health communication); these courses are mandatory in only 4 programs. Seven programs offer knowledge mobilization courses; none are mandatory. Sixteen MPH programs offer a total of 63 other public health courses that are not focused on communication but contain communication terms (eg, marketing, literacy) in their course descriptions. No Canadian MPH program has a communication-focused stream or option.

Conclusion:

Canadian-trained MPH graduates may not be receiving sufficient communication training to equip them for effective and precise public health practice. This is particularly concerning, given that current events have underlined the importance of health, risk, and crisis communication.
Impulsivity in Depression: Its Relation to Suicidality
Authors: Öğüt Çağri , Başar Koray , Karahan SEVİLAY
Published: May 2023

Objective:

Impulsivity is an important risk for suicidality, which is common in patients with major depressive disorder (MDD). The goal of this study was to examine multiple facets of impulsivity in depressed patients compared with healthy controls and to assess their relationship to suicidality.

Method:

Outpatients diagnosed with MDD using the Structured Clinical Interview for DSM-IV were recruited. Two groups were constituted as “MDD in remission” (n=32) and “MDD” (n=71). The “healthy control” group (n=30) consisted of individuals who had never been diagnosed with any psychiatric disorder. Impulsivity was assessed with the Barratt Impulsivity Scale (BIS), a self-rating measure, and with the following behavioral tasks: Go/No-go Task, Iowa Gambling Task, and Balloon Analogue Risk Task. The scores of the 3 groups (n=133) were compared to evaluate the effect of MDD. The scores were also analyzed and compared in the patients in the 2 MDD groups (n=103) with respect to their current and lifetime suicidality.

Results:

There was no difference in the 3 groups in task scores, but nonplanning BIS was correlated with the severity of depressive symptoms. Patients with suicidal ideation (SI) had higher BIS total and attention impulsivity scores and more commission errors on the Go/No-go Task, reflecting failure in response inhibition, compared with the patients without SI.

Conclusions:

Failure to show differences in impulsivity-related tasks suggests that there might be no relationship between the state of depression and impulsivity. However, these findings confirm that there is an association between SI and response inhibition and the attention facet of impulsivity in depression.
Artificial Intelligence in Violence Risk Assessment: Addressing Racial Bias and Inequity
Authors: Ratajczak Robert , Cockerill Richard G.
Published: May 2023

Although there has been no shortage of technological innovation in recent decades, a solution to sociodemographic disparities in the forensic setting has remained elusive. Artificial intelligence (AI) is a uniquely powerful emerging technology that is likely to either exacerbate or mitigate existing disparities and biases. This column argues that the implementation of AI in forensic settings is inevitable, and that practitioners and researchers should focus on developing AI systems that reduce bias and advance sociodemographic equity rather than attempt to impede the use of this novel technology.
Antidepressant Strategies for Treatment of Acute Depressive Episodes Among Veterans
Authors: Shiroma Paulo R. , Thuras Paul , Atkinson David M. , Baltutis Eric , Bloch Martin , Westanmo Anders
Published: May 2023

Objective:

The 2016 VA/DoD Clinical Practice Guideline for Management of Major Depressive Disorder offers consensus-based recommendations when response to the initial antidepressant medication is suboptimal; however, little is known about “real-world” pharmacological strategies used by providers treating depression in the Veterans Affairs Health Care System (VAHCS).

Methods:

We extracted pharmacy and administrative records of patients diagnosed with a depressive disorder and treated at the Minneapolis VAHCS between January 1, 2010 and May 11, 2021. Patients with bipolar disorder, psychosis-spectrum, or dementia diagnoses were excluded. An algorithm was developed to identify antidepressant strategies: monotherapy (MONO); optimization (OPM); switching (SWT); combination (COM); and augmentation (AUG). Additional data extracted included demographics, service utilization, other psychiatric diagnoses, and clinical risk for hospitalization and mortality.

Results:

The sample consisted of 1298 patients, 11.3% of whom were female. The mean age of the sample was 51 years. Half of the patients received MONO, with 40% of those patients receiving inadequate doses. OPM was the most common next-step strategy. SWT and COM/AUG were used for 15.9% and 2.6% of patients, respectively. Overall, patients who received COM/AUG were younger. OPM, SWT, and COM/AUG occurred more frequently in psychiatric services settings and required a greater number of outpatient visits. The association between antidepressant strategies and risk of mortality became nonsignificant after accounting for age.

Conclusions:

Most of the veterans with acute depression were treated with a single antidepressant, while COM and AUG were rarely used. The age of the patient, and not necessarily greater medical risks, appeared to be a major factor in decisions about antidepressant strategies. Future studies should evaluate whether implementation of underutilized COM and AUG strategies early in the course of depression treatment are feasible.
Evaluation of Conflict of Interest in Consulting Fee Payments in Plastic Surgery and Related Specialties
Authors: Summerville Lesley , Boas Samuel R , Wee Corinne , Isbester Kelsey , Kumar Anand
Published: May 2023

Background:

The Physician Payments Sunshine Act (PPSA) was enacted to increase transparency regarding physician and industry financial interests. Consulting fee payments comprise a large proportion of these financial relationships. We hypothesized that there are discrepancies amongst industry-derived consulting payments to medical and surgical specialties. The purpose of this study was to evaluate the distribution of consulting fee payments to plastic surgery and related specialties.

Methods:

This cross-sectional study utilized the publicly available CMS Open Payments Program database for 2018. Consulting fee payments to physicians practicing in dermatology, internal medicine, neurosurgery, orthopedic surgery, otolaryngology, and plastic surgery were isolated and analyzed to identify discrepancies in consulting payments among these specialties and within plastic surgery.

Results:

A total of $250,518,240 was paid in consulting fees to specialties analyzed, with the largest average payment made to orthopedic surgeons and neurosurgeons. Nearly half of physicians were paid at least $5,000 for consulting fees in 2018. Most payments were not associated with contextual information. Among US plastic surgeons, 4.2% held financial relationships with corporations and were likely to be paid more when consulting for small companies.

Conclusions:

Consulting payments make up a large proportion of payments included in the Open Payments Database. While gender, state, company type, and sole proprietorship did not correlate with higher pay, plastic surgeons who consulted for small companies were paid more per payment than those working for large companies (Figure 1). Future studies are warranted to determine if these industry financial relationships impact physician behavior.
The Impact of Childhood Traumatization on Diabetes Mellitus Type 2 Risk in World War II Refugees and Their Offspring
Authors: Wildenberg Katharina S. , Zillich Lea , Streit Fabian , Maier Bernhard C. L. , Distel Daniela , Hammes Hans-Peter , Witt Stephanie H. , Deuschle Michael
Published: May 2023

Objective

Type 2 diabetes mellitus (T2D) is a chronic disease that is influenced by different factors. The extent to which degree adverse childhood events (ACEs) can modify the potential to development of T2D is still not explored and therefore represents one of the central questions of the childhood escape–late life outcome (DRKS00012419) study. In addition, transgenerational effects were considered in the analyses.

Methods

The study analyzed the association of self-reported traumatic experiences and T2D disease of refugees from East Prussia, who were displaced from their former homeland at the end of the World War II. In addition, an independent sample consisting of participants of first-generation offspring of refugees was analyzed.

Results

Of the 242 refugees, all aged between 73 and 93 years, 17.36% reported T2D disease, whereas among the offspring (n = 272), aged between 47 and 73 years, it was 5.5%, meaning reduced T2D prevalence for both generations compared with the German population of comparable age. In the refugee generation, emotional neglect showed a negative association with development of T2D in later life. In women, separation from close caregivers in childhood showed a negative association with later T2D. In contrast, experiencing emotional abuse in childhood showed a positive association with later T2D. The offspring generation showed no associations of adverse childhood events and reported T2D diagnoses in later life.

Conclusions

Our results demonstrate that individual trauma in childhood is responded to with different mechanisms that can lead to both increased and decreased reported T2D diagnoses in adulthood and thus should by no means be considered in a generalized manner.
Adverse Childhood Experiences Predict Diurnal Cortisol Throughout Gestation
Authors: Panisch Lisa S. , Murphy Hannah R. , Wu Qiuyi , Brunner Jessica L. , Duberstein Zoe T. , Arnold Molly S. , Best Meghan , Barrett Emily S. , Miller Richard K. , Qiu Xing , O’Connor Thomas G.
Published: May 2023

Objective

Adverse childhood experiences (ACEs) are associated with negative prenatal and perinatal health outcomes and may, via these pathways, have intergenerational effects on child health and development. We examine the impact of ACEs on maternal salivary cortisol, a key measure of prenatal biology previously linked with pregnancy-related health outcomes.

Methods

Leveraging assessments across three trimesters, we used linear mixed effect models to analyze the influence of ACEs on maternal prenatal diurnal cortisol patterns in a diverse cohort of pregnant women (analytic sample n = 207). Covariates included comorbid prenatal depression, psychiatric medications, and socio-demographic factors.

Results

Maternal ACEs were significantly associated with flatter diurnal cortisol slopes (i.e., less steep decline), after adjusting for covariates, with effects consistent across gestation (estimate = 0.15 SE 0.06, p = 0.008).

Conclusions

ACEs experienced prior to pregnancy may have a robust and lasting influence on maternal prenatal hypothalamic-pituitary-adrenal activity throughout gestation, a key biological marker associated with perinatal and child health outcomes. The findings suggest one route of intergenerational transmission of early adverse experiences and underscore the potential value of assessing pre-pregnancy adverse experiences for promoting perinatal and maternal and child health.
Microbiota in the oral cavity of school-age children living with HIV who started antiretroviral therapy at young ages in South Africa
Authors: Kuhn Louise , Wang Tian , Li Fan , Strehlau Renate , Tobin Nicole H. , Violari Avy , Brooker Sarah , Patel Faeezah , Liberty Afaaf , Shiau Stephanie , Arpadi Stephen M. , Wadhwa Sunil , Yin Michael T. , Wang Shuang , Tiemessen Caroline T. , Aldrovandi Grace M.
Published: May 2023

Background:

Infancy is an important developmental period when the microbiome is shaped. We hypothesized that earlier antiretroviral therapy (ART) initiation would attenuate HIV effects on microbiota in the mouth.

Methods:

Oral swabs were collected from 477 children living with HIV (CLWH) and 123 children without (controls) at two sites in Johannesburg, South Africa. CLWH had started ART <3 years of age; 63% <6 months of age. Most were well-controlled on ART at median age 11 years when the swab was collected. Controls were age-matched and recruited from the same communities. Sequencing of V4 amplicon of 16S rRNA was done. Differences in microbial diversity and relative abundances of taxa were compared between groups.

Results:

CLWH had lower alpha diversity than controls. Genus-level abundances of Granulicatella, Streptococcus and Gemella were greater and Neisseria and Haemophilus less abundant among CLWH than controls. Associations were stronger among boys. Associations were not attenuated with earlier ART initiation. Shifts in genus-level taxa abundances in CLWH relative to controls were most marked in children on lopinavir/ritonavir regimens; with fewer shifts seen if on efavirenz ART regimens.

Conclusions:

A distinct profile of less diverse oral bacterial taxa was observed in school-aged CLWH on ART compared to uninfected controls suggesting modulation of microbiota in the mouth by HIV and/or its treatments. Earlier ART initiation was not associated with microbiota profile. Proximal factors, including current ART regimen, were associated with contemporaneous profile of oral microbiota and may have masked associations with distal factors like age at ART initiation.
Bone and Renal Health in Infants With or Without Breastmilk Exposure to Tenofovir-Based Maternal Antiretroviral Treatment in the PROMISE Randomized Trial
Authors: Vhembo Tichaona , Baltrusaitis Kristin , Tierney Camlin , Owor Maxensia , Dadabhai Sufia , Violari Avy , Theron Gerhard , Moodley Dhayendre , Mukwasi-Kahari Cynthia , George Kathleen , Shepherd John , Siberry George K. , Browning Renee , Fowler Mary Glenn , Stranix-Chibanda Lynda ,   for the IMPAACT P1084s study team
Published: May 2023

Background:

We assessed bone and kidney outcomes in infants randomized postdelivery as mother–infant pairs within the IMPAACT PROMISE trial to maternal tenofovir disoproxil fumarate–based antiretroviral treatment (mART) or infant nevirapine prophylaxis (iNVP) to prevent breastfeeding HIV transmission.

Methods:

Infants were coenrolled in the P1084s substudy on randomization day and followed through Week 74. Lumbar spine bone mineral content (LS-BMC) was assessed at entry (6–21 age days) and Week 26 by dual-energy x-ray absorptiometry. Creatinine clearance (CrCl) was calculated at entry; Weeks 10, 26, and 74. Student t tests compared mean LS-BMC and CrCl at Week 26 and mean change from entry between arms.

Results:

Of 400 enrolled infants, the mean (SD; n) for entry LS-BMC was 1.68 g (0.35; n = 363) and CrCl was 64.2 mL/min/1.73 m2 (24.6; n = 357). At Week 26, 98% of infants were breastfeeding and 96% on their assigned HIV prevention strategy. The mean (SD) Week 26 LS-BMC was 2.64 g (0.48) for mART and 2.77 g (0.44) for iNVP; mean difference (95% confidence interval [CI]) −0.13 g (−0.22 to −0.04), P = 0.007, n = 375/398 (94%). Mean absolute (−0.14 g [−0.23 to −0.06]) and percent (−10.88% [−18.53 to −3.23]) increase in LS-BMC from entry was smaller for mART than iNVP. At Week 26, the mean (SD) CrCl was 130.0 mL/min/1.73 m2 (34.9) for mART vs. 126.1 mL/min/1.73 m2 (30.0) for iNVP; mean difference (95% CI) 3.8 (−3.0 to 10.7), P = 0.27, n = 349/398 (88%).

Conclusion:

Week 26 mean LS-BMC was lower in infants in the mART group compared with the iNVP group. However, this difference (∼0.23 g) was less than one-half SD, considered potentially clinically relevant. No infant renal safety concerns were observed.
FDG PET/CT Findings of Malignant Rhabdoid Tumor Arising From a Renal Allograft
Authors: Xiao Zhengguang , Lu Wenjie , Dong Aisheng , Wang Yang
Published: May 2023

Malignant rhabdoid tumor of the kidney is a rare aggressive malignancy with poor prognosis. We describe FDG PET/CT findings in a case of malignant rhabdoid tumor of the renal allograft with regional lymph node and pulmonary metastases. The primary renal tumor and lymph node metastases showed intense FDG uptake. The pulmonary metastases showed minimal FDG uptake due to small size. Posttreatment FDG PET/CT showed no evidence of residual disease. This case suggests that FDG PET/CT may be useful in the management of malignant rhabdoid tumor from the transplanted kidney.
3D-Ring CZT System With New Low- and Medium-Energy Range
Authors: Callaud Aurélien , Metrard Gilles , Bailly Matthieu
Published: May 2023

New 3D-ring CZT systems with low- and medium-energy-range detectors allow for simultaneous dual-isotope lung scintigraphy. We compared 10-, 7-, 5-, and 3-minute acquisitions for 99mTc and 81mKr performed simultaneously on StarGuide CZT-SPECT/CT and reframed in 50 patients. Ventilation/perfusion mismatches were calculated (mean, 15.6% ± 28%), and Spearman correlation coefficients of mismatches were 0.994, 0.994, and 0.984 between 10- and 7-, 5-, and 3-minute acquisitions, respectively. No visual difference in image quality or final diagnosis was found. 3D-ring CZT-SPECT with low and medium energy range detectors allows ultrafast dual-isotope lung scintigraphy up to 3 minutes.