bluuebunny/crossref_metadata_2025 huggingface dataset:
The Salience of Religion Under an Atheist State: Implications for Subjective Well-Being in Contemporary China
Authors: Luo Weixiang , Chen Feinian
Published: April 2021

We examine the linkage between religious involvement and life satisfaction among adults in contemporary China, a largely nonreligious society. Using data from the China Family Panel Studies (2012, 2014, and 2016), we conduct latent class analysis by using four indicators of religious involvement, including membership of religious groups, types of religion, frequency of participation, and evaluation of importance of religion in life. We classify the sample into four latent classes: (1) the pure nonreligious, (2) the nonreligious, but with some spirituality, (3) Chinese-religion adherent, and (4) organized religion adherent. Results from our fixed-effect models show that Chinese-religion and organized-religion adherents have higher levels of life satisfaction than those with no religious beliefs. Moreover, the disadvantaged groups benefit more from religious involvement in China, as evidenced by the stronger positive effect of religious adherence found among rural residents and individuals in the lowest income quartile. We discuss the benefits of religion both in terms of its public/social and private/intrinsic aspects and situate our findings in the larger social context of China.
The imperfections in statistics: Interpretations of causes of infant death in the Netherlands, 1875–1899
Authors: van den Boomen Nynke
Published: April 2021

Mortality research benefits greatly from current digitisation efforts to make historical cause-of-death statistics available on a large scale. However, the use of these sources is notoriously difficult. Reclassification systems based on the present-day standard of the International Classification of Diseases have made the comparison of causes of death over space and time considerably easier. Yet they do not necessarily uncover the imperfections hidden in the original sources. In this study, a data set on causes of death amongst infants, based on recently digitised Dutch municipal cause-of-death registers published during the period between 1875 and 1899, takes centre stage. This study explores this unique source, its origins and the potential limitations its use may have for historical research on mortality in general and infant mortality, in particular, emphasising the ongoing need to carefully consider the historical context of these sources, particularly when they are used in quantitative studies.
“Distant Toleration”: The Politics of Solidarity Work among Turkish and Syrian Women in Southern Turkey
Authors: Dağtaş Seçil , Can Şule
Published: April 2021

This article examines the politics of solidarity with and among refugee women in Turkey’s southern borderlands. Drawing on ethnographic research in Hatay, we focus on Syrian- and Turkish-led women’s organizations, whose solidarity work contextually entangles organized acts of care and support with social hierarchies, tensions, and mutual distance. These gendered social spaces complicate the scholarly critiques of depoliticization in refugee assistance by governmental and civil society organizations, and the charity–solidarity distinction on which such critiques often rely. They require a rethinking of solidarity with refugee women beyond the terms of right-based political activism.
The Influence of Nutrients Intake during Pregnancy on Baby’s Birth Weight: A Systematic Review
Authors: Souza Rafaela Cristina Vieira e , Miranda Cristianny , Ferreira Larissa Bueno , dos Santos Luana Caroline
Published: April 2021

Background and Objective

Maternal food intake during pregnancy can substantially interfere in the baby’s anthropometric measurements at birth. Our objective was to perform a systematic review that investigate the influence of nutrient intake via food during pregnancy on the baby’s anthropometric measurements at birth.

Methods

A search was performed without time limits on CINAHL, Embase, PubMed, Scopus and Web of Science databases and manual on studies references. All nutrients and baby’s anthropometric measurements at birth were included as descriptors.

Results

Thirty articles were included, the majority of prospective cohort studies, with 15.39 (2.36) quality points (maximum value: 22). Thirty-six results of associations were found, of which 17 studies had direct associations between nutrient intake and birth outcomes. Inverse associations were identified in 8 studies and 11 articles showed no significant associations in all analyses. Maternal food intake of vitamin C, calcium and magnesium during pregnancy seems to have a positive influence on the baby's birth weight, while carbohydrates intake have an inverse association with the same outcome.

Conclusion

It is suggested that vitamin C, calcium, magnesium and carbohydrates influence on baby’s birth weight. So, these specific nutrients need more attention to the consumption, in addition to carried out new studies, with robust methodologies for measuring maternal food consumption and considering the several factors that can interfere in this assessment.

Registration

This review has been registered to the PROSPERO (International prospective register of systematic reviews) (ID: CRD42020167889).
Cross-scale dynamics and the evolutionary emergence of infectious diseases
Authors: Schreiber Sebastian J , Ke Ruian , Loverdo Claude , Park Miran , Ahsan Prianna , Lloyd-Smith James O
Published: April 2021

When emerging pathogens encounter new host species for which they are poorly adapted, they must evolve to escape extinction. Pathogens experience selection on traits at multiple scales, including replication rates within host individuals and transmissibility between hosts. We analyze a stochastic model linking pathogen growth and competition within individuals to transmission between individuals. Our analysis reveals a new factor, the cross-scale reproductive number of a mutant virion, that quantifies how quickly mutant strains increase in frequency when they initially appear in the infected host population. This cross-scale reproductive number combines with viral mutation rates, single-strain reproductive numbers, and transmission bottleneck width to determine the likelihood of evolutionary emergence, and whether evolution occurs swiftly or gradually within chains of transmission. We find that wider transmission bottlenecks facilitate emergence of pathogens with short-term infections, but hinder emergence of pathogens exhibiting cross-scale selective conflict and long-term infections. Our results provide a framework to advance the integration of laboratory, clinical, and field data in the context of evolutionary theory, laying the foundation for a new generation of evidence-based risk assessment of emergence threats.
The evolutionary dynamics of viruses: virion release strategies, time delays and fitness minima
Authors: Lord Jennifer S , Bonsall Michael B
Published: April 2021

Viruses exhibit a diverse array of strategies for infecting host cells and for virion release after replication. Cell exit strategies generally involve either budding from the cell membrane or killing the host cell. The conditions under which either is at a selective advantage is a key question in the evolutionary theory of viruses, with the outcome having potentially important impacts on the course of infection and pathogenicity. Although a plethora of external factors will influence the fitness of either strategy; here, we focus just on the effects of the physical properties of the system. We develop theoretical approaches to assess the effects of the time delays between initial infection and virion release. We show that the length of the delay before apoptosis is an important trait in virus evolutionary dynamics. Our results show that for a fixed time to apoptosis, intermediate delays lead to virus fitness that is lower than short times to apoptosis — leading to an apoptotic strategy — and long times to apoptosis — leading to a budding strategy at the between-cell level. At fitness minima, selection is expected to be disruptive and the potential for adaptive radiation in virus strategies is feasible. Hence, the physical properties of the system are sufficient to explain the existence of both budding and virus-induced apoptosis. The fitness functions presented here provide a formal basis for further work focusing on the evolutionary implications of trade-offs between time delays, intracellular replication and resulting mutation rates.
English-As-A-Second-Language (ESL) Nursing Students’ Academic Integration: A Review of Literature
Authors: Sailsman Sonique
Published: April 2021

AIM

The purpose of this literature review is to provide nurse educators with the evidence necessary to support future research and expansion of programs for English-as-a-second-language (ESL) nursing students.

BACKGROUND

Nursing education has expanded significantly in response to the Institute of Medicine’s 2010 call for an increase in the number of baccalaureate-prepared nurses. The demographics of nursing students have also grown to include those who are ethnically and linguistically diverse. This literature review presents a robust compilation of evidence providing insight into the integration experience of nursing students from diverse cultural and language backgrounds.

METHOD

Peer-reviewed articles, along with other seminal sources, were identified.

RESULTS

The evidence highlights student challenges with academic language, cultural stressors, and faculty support.

CONCLUSION

Findings indicate that ESL nursing students experience challenges with academic integration. Future research can provide insight into how these students navigate specific learning environments.
Rapid Dissemination of a COVID-19 Airway Management Simulation Using a Train-the-Trainers Curriculum
Authors: Peterson William J. , Munzer Brendan W. , Tucker Ryan V. , Losman Eve D. , Harvey Carrie , Hatton Colman , Sefa Nana , Bassin Ben S. , Hsu Cindy H.
Published: April 2021

Problem

The most effective way to train clinicians to safely don and doff personal protective equipment (PPE) and perform aerosol-generating procedures (AGPs), such as intubations, is unknown when clinician educators are unavailable, as they have been during the COVID-19 pandemic. Proper PPE and airway management techniques are critical to prevent the transmission of respiratory illnesses such as COVID-19.

Approach

In March 2020, the authors implemented a structured train-the-trainers curriculum to teach PPE techniques and a modified airway management algorithm for suspected COVID-19 patients. A single emergency medicine physician trainer taught 17 subsequent emergency medicine and critical care physician trainers the proper PPE and airway management techniques. The initial trainer and 7 of the subsequent trainers then instructed 99 other emergency medicine resident and attending physicians using in situ simulation. Trainers and learners completed retrospective pre–post surveys to assess their comfort teaching the material and performing the techniques, respectively.

Outcomes

The surveys demonstrated a significant increase in the trainers’ comfort in teaching simulation-based education, from 4.00 to 4.53 on a 5-point Likert scale (P < .005), and in teaching the airway management techniques through simulation, from 2.47 to 4.47 (P < .001). There was no difference in the change in comfort level between those learners who were taught by the initial trainer and those who were taught by the subsequent trainers. These results suggest that the subsequent trainers were as effective in teaching the simulation material as the initial trainer.

Next Steps

Work is ongoing to investigate clinician- and patient-specific outcomes, including PPE adherence, appropriate AGP performance, complication rate, and learners’ skill retention. Future work will focus on implementing similar train-the-trainers strategies for other health professions, specialties, and high-risk or rare procedures.
The Content Quality of YouTube Videos for Professional Medical Education: A Systematic Review
Authors: Helming Andrew G. , Adler David S. , Keltner Case , Igelman Austin D. , Woodworth Glenn E.
Published: April 2021

Purpose

To evaluate the content quality of YouTube videos intended for professional medical education based on quality rating tool (QRT) scores and determine if video characteristics, engagement metrics, or author type are associated with quality.

Method

The authors searched 7 databases for English-language studies about the quality of YouTube videos intended for professional medical education from each database’s inception through April 2019. To be included, studies had to be published in 2005 (when YouTube was created) or later. Studies were classified according to the type of QRT used: externally validated, internally validated, or limited global. Study information and video characteristics and engagement metrics were extracted. Videos were classified by video author type.

Results

Thirty-one studies were included in this review. Three studies used externally validated QRTs, 20 used internally validated QRTs, and 13 used limited global QRTs. Studies using externally validated QRTs had average scores/total possible scores of 1.3/4, 26/80, and 1.7/5. Among the 18 studies using internally validated QRTs, from which an average percentage of total possible QRT score could be computed or extracted, the average score was 44% (range: 9%–71%). Videos with academic-physician authors had higher internally validated QRT mean scores (46%) than those with nonacademic-physician or other authors (26%; P < .05).

Conclusions

The authors found a wide variation in QRT scores of videos, with many low QRT scores. While videos authored by academic-physicians were of higher quality on average, their quality still varied significantly. Video characteristics and engagement metrics were found to be unreliable surrogate measures of video quality. A lack of unifying grading criteria for video content quality, poor search algorithm optimization, and insufficient peer review or controls on submitted videos likely contributed to the overall poor quality of YouTube videos that could be used for professional medical education.
The disruptive physician and impact on the culture of safety
Authors: Wright Crystal
Published: April 2021

Purpose of review

The disruptive physician is a growing problem in medicine. All too often, physician behavior negatively impacts the delivery of quality patient care. The hostile environment that certain behaviors create makes it difficult for team members advocate for their patients. It is imperative that physician practices develop and an understanding of how to identify the disruptive physician to maintain patient safety.

Recent findings

Disruptive physicians can damage team morale by creating a psychologically unsafe working environment. Healthcare organizations must be committed to ensuring that all team members can function effectively in their work environments. The leaders of healthcare organizations must be acutely aware of what constitutes disruptive behavior and act proactively to eliminate such behaviors. Disruptive physicians should be made acutely aware that their behavior is deemed unacceptable and efforts at correcting such behavior are imperative.

The practice of medicine is multifaceted. It is imperative that the assurance of psychological safety is met to meet the standards of high quality and safe care for patients.
Myocardial injury after noncardiac surgery – an update
Authors: Szczeklik Wojciech , Fronczek Jakub
Published: April 2021

Purpose of review

After successfully reducing mortality in the operating room, the time has come for anesthesiologists to conquer postoperative complications. This review aims to raise awareness about myocardial injury after noncardiac surgery (MINS), its definition, diagnosis, clinical importance, and treatment.

Recent findings

MINS, defined as an elevated postoperative troponin judged to be due to myocardial ischemia (with or without ischemic features), occurs in up to one in five patients having noncardiac surgery and is responsible for 16% of all postoperative deaths within 30 days of surgery. New evidence on risk factors, etiology, potential prevention strategies, treatment options, and the economic impact of MINS highlights the actionability of perioperative clinicians in caring for adult patients who are considered to be at risk of cardiovascular complications.

Millions of patients safely going through surgery suffer MINS and die shortly after the procedure every year. Without a structured approach to predicting, preventing, diagnosing, and treating MINS, we lose the opportunity to provide our patients with the best chance of deriving benefit from noncardiac surgery. The perioperative community needs to come together, appreciate the clinical relevance of MINS, and step up with high-quality research in the future.
Advances in anesthetic and obstetric management of patients with placenta accreta spectrum
Authors: Merrill Jessica , Sultan Pervez , Sharawi Nadir
Published: April 2021

Purpose of review

The incidence of placenta accreta spectrum is increasing and it is a leading cause of peripartum hysterectomy and massive postpartum hemorrhage. The purpose of the present article is to provide a contemporary overview of placenta accreta spectrum pertinent to the obstetric anesthesiologist.

Recent findings

Recent changes in the terminology used to report invasive placentation were proposed to clarify diagnostic criteria and guidelines for use in clinical practice. Reduced morbidity is associated with scheduled preterm delivery in a center of excellence using a multidisciplinary team approach. Neuraxial anesthesia as a primary technique is increasingly being used despite the known risk of major bleeding. The use of viscoelastic testing and endovascular interventions may aid hemostatic resuscitation and improve outcomes.

Accurate diagnosis and early antenatal planning among team members are essential. Obstetric anesthesiologists should be prepared to manage a massive hemorrhage, transfusion, and associated coagulopathy. Increasingly, viscoelastic tests are being used to assess coagulation status and the ability to interpret these results is required to guide the transfusion regimen. Balloon occlusion of the abdominal aorta has been proposed as an intervention that could improve outcomes in women with placenta accreta spectrum, but high-quality safety and efficacy data are lacking.
Immunomodulators in anesthesia
Authors: Cruz Fernanda F. , Rocco Patricia R.M. , Pelosi Paolo
Published: April 2021

Purpose of review

Anesthetics are known to have immunomodulatory effects. These can be detrimental, inducing immunosuppression and facilitating the development of opportunistic infections, especially when used at high doses, for prolonged periods, or in patients with preexisting immune deficiency; or beneficial, modulating the inflammatory response, particularly in critical illness and systemic hyperinflammatory states.

Recent findings

Anesthetics can have microbicidal properties, and both anti- and pro-inflammatory effects. They can act directly on immune cells as well as modulate immunity through indirect pathways, acting on the neuroimmune stress response, and have recently been described to interact with the gut microbiota.

Anesthesiologists should take into consideration the immunomodulatory properties of anesthetic agents in addition to their hemodynamic, neuroprotective, and other impacts. In future, patient stratification according to the perioperative assessment of serum biomarkers associated with postoperative complications may be used to guide anesthetic agent selection based on their immunomodulatory properties.
A decade later, there are still major issues to be addressed in paediatric anaesthesia
Authors: Habre Walid , Disma Nicola
Published: April 2021

Purpose of review

Despite real advances in paediatric anaesthesia management, such as a growing awareness of the relevance of anaesthesia conduct as well as of the lack of evidence for neurotoxicity of anaesthetic agents, it must be said that there are still important questions in our specialty that remain unanswered. Standardization and harmonization of airway management, analgesia techniques and outcome measures are the important issues we are facing at the beginning of this decade.

Recent findings

Major improvements in airway management of neonates and infants resulted from the introduction of videolaryngoscopes and the systematic use of nasal oxygenation during endotracheal intubation. Similarly, the increasing popularity of dexmedetomidine has led to the generalization of its use, which, considering that it may produce undesirable effects, poses a challenge for the future. Moreover, recent systematic reviews have confirmed a lack of evidence for the efficacy of many techniques used in clinical practice.

The shift in research from the neurotoxicity of anaesthetic agents to factors related to anaesthetic conduct are discussed. Examples for an improvement in anaesthesia management are highlighted with advocacy for including these evidence-based findings in routine clinical practice. Finally, the impact of using clinically relevant age-related and patient-centred perioperative outcomes is essential for comparing and/or interpreting the safety and efficacy of anaesthesia and analgesia management in children.
Pediatric airway management
Authors: Hsu Grace , von Ungern-Sternberg Britta S. , Engelhardt Thomas
Published: April 2021

Purpose of review

Children are at risk of severe hypoxemia in the perioperative period owing to their unique anatomy and physiology. Safe and effective airway management strategies are therefore key to the practice of pediatric anesthesia. The goal of this review is to highlight recent publications (2019–2021) aimed to advance pediatric airway safety and to highlight a proposed simple, pediatric-specific, universal framework to guide clinical practice.

Recent findings

Recent investigations demonstrate that infants with normal and difficult airways experience high incidences of multiple laryngoscopy attempts and resulting hypoxemia. Video laryngoscopy may improve tracheal intubation first attempt success rate in infants with normal airways. In infants with difficult airways, standard blade video laryngoscopy is associated with higher first attempt success rates over non-standard blade video laryngoscopy. Recent studies in children with Pierre Robin sequence and mucopolysaccharidoses help guide airway equipment and technique selection. Department airway leads and hospital difficult airway services are necessary to disseminate knowledge, lead quality improvement initiatives, and promote evidence-based practice guidelines.

Pediatric airway management morbidity is a common problem in pediatric anesthesia. Improvements in individual practitioner preparation and management strategies as well as systems-based policies are required. A simple, pediatric-specific, universal airway management framework can be adopted for safe pediatric anesthesia practice.
Peripartum management for women with opioid dependence
Authors: Shah Jarna R. , Ramseyer Abigail , Coker Jessica
Published: April 2021

Purpose of review

Opioid use disorder (OUD) in pregnancy has more than quadrupled in prevalence over the past two decades and continues to increase steadily every year. With no defined standard of care for the management of pain during the peripartum period, variability in treatment plans potentially leaves room for interrupted patient care, decreased patient satisfaction, and poorer outcomes. The impact of OUD and its management during the peripartum period has become more widely discussed over the past several years and is the focus of this review.

Recent findings

Current recommendations including developing a detailed institutional plan for the management of pain for women with OUD during the intrapartum and postpartum periods. There is tremendous value in exploring partnerships with other specialties, including addiction medicine, and behavioral health and obstetrics in development of policies and procedures. Consistency within institutions is critical to improve patient outcomes.

This review will address both pain management recommendations and best clinical practices regarding management of the parturient during the transition periods of the peripartum, intrapartum, and postpartum period. Novel approaches and perspectives from case reports and narrative experience will also be discussed. There are many opportunities in this field for further studies, research, and evidence-based guidelines that promote an established standard of care.
Perioperative thrombocytopenia
Authors: Lombard Frederick W. , Popescu Wanda M. , Oprea Adriana D. , Kertai Miklos D.
Published: April 2021

Purpose of review

In this review, we discuss recent developments and trends in the perioperative management of thrombocytopenia.

Recent findings

Large contemporary data base studies show that preoperative thrombocytopenia is present in about 8% of asymptomatic patients, and is associated with increased risks for bleeding and 30-day mortality. Traditionally specific threshold platelet counts were recommended for specific procedures. However, the risk of bleeding may not correlate well with platelet counts and varies with platelet function depending on the underlying etiology. Evidence to support prophylactic platelet transfusion is limited and refractoriness to platelet transfusion is common. A number of options exist to optimize platelet counts prior to procedures, which include steroids, intravenous immunoglobulin, thrombopoietin receptor agonists, and monoclonal antibodies. In addition, intraoperative alternatives and adjuncts to transfusion should be considered. It appears reasonable to use prophylactic desmopressin and antifibrinolytic agents, whereas activated recombinant factor VII could be considered in severe bleeding. Other options include enhancing thrombin generation with prothrombin complex concentrate or increasing fibrinogen levels with fibrinogen concentrate or cryoprecipitate.

Given the lack of good quality evidence, much research remains to be done. However, with a multidisciplinary multimodal perioperative strategy, the risk of bleeding can be decreased effectively.
Deep Spinal Infection after Outpatient Epidural Injections for Pain: A Retrospective Sample Cohort Study Using a Claims Database in South Korea
Authors: Lee Chang-Soon , Park Young Jae , Moon Jee Youn , Kim Yong-Chul
Published: April 2021

Background

Deep spinal infection is a devastating complication after epidural injection. This study aimed to investigate the incidence of deep spinal infection primarily after outpatient single-shot epidural injection for pain. Secondarily, this study assessed the national trends of the procedure and risk factors for said infection.

Methods

Using South Korea’s National Health Insurance Service sample cohort database, the 10-yr national trend of single-shot epidural injections for pain and the incidence rate of deep spinal infection after the procedure with its risk factors were determined. New-onset deep spinal infections were defined as those occurring within 90 days of the most recent outpatient single-shot epidural injection for pain, needing hospitalization for at least 1 night, and receiving at least a 4-week course of antibiotics.

Results

The number of outpatient single-shot epidural injections per 1,000 persons in pain practice doubled from 40.8 in 2006 to 84.4 in 2015 in South Korea. Among the 501,509 injections performed between 2007 and 2015, 52 cases of deep spinal infections were detected within 90 days postprocedurally (0.01% per injection). In multivariable analysis, age of 65 yr or more (odds ratio, 2.91; 95% CI, 1.62 to 5.5; P = 0.001), living in a rural area (odds ratio, 2.85; 95% CI, 1.57 to 5.0; P < 0.001), complicated diabetes (odds ratio, 3.18; 95% CI, 1.30 to 6.7; P = 0.005), multiple epidural injections (three times or more) within the previous 90 days (odds ratio, 2.34; 95% CI, 1.22 to 4.2; P = 0.007), and recent use of immunosuppressants (odds ratio, 2.90; 95% CI, 1.00 to 6.7; P = 0.025) were significant risk factors of the infection postprocedurally.

Conclusions

The incidence of deep spinal infection after outpatient single-shot epidural injections for pain is very rare within 90 days of the procedure (0.01%). The data identify high-risk patients and procedure characteristics that may inform healthcare provider decision-making.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Safety of Tranexamic Acid in Hip and Knee Arthroplasty in High-risk Patients
Authors: Poeran Jashvant , Chan Jimmy J. , Zubizarreta Nicole , Mazumdar Madhu , Galatz Leesa M. , Moucha Calin S.
Published: April 2021

Background

With increasing use of tranexamic acid in total hip and knee arthroplasties, safety concerns remain. Using national claims data, this study examined tranexamic acid use in patients with preexisting comorbidities. The hypothesis was that tranexamic acid use is not associated with increased complication risk in hip and knee arthroplasty patients with comorbidities.

Methods

Among 765,011 total hip/knee arthroplasties (2013 to 2016, Premier Healthcare claims), tranexamic acid use was assessed in three high-risk groups: group I with patients with a history of venous thromboembolism, myocardial infarction, seizures, or ischemic stroke/transient ischemic attack (n = 27,890); group II with renal disease (n = 44,608); and group III with atrial fibrillation (n = 45,952). The coprimary outcomes were blood transfusion and new-onset “composite complications” (venous thromboembolism, myocardial infarction, seizures, and ischemic stroke/transient ischemic attack). Associations between tranexamic acid use and outcomes were measured separately by high-risk group. The odds ratios and Bonferroni-adjusted 99.9% CIs are reported.

Results

Overall, 404,974 patients (52.9%) received tranexamic acid, with similar frequencies across high-risk groups I (13,004 of 27,890 [46.6%]), II (22,424 of 44,608 [50.3%]), and III (22,379 of 45,952 [48.7%]). Tranexamic acid use was associated with decreased odds of blood transfusion in high-risk groups I (721 of 13,004 [5.5%] vs. 2,293 of 14,886 [15.4%]; odds ratio, 0.307; 99.9% CI, 0.258 to 0.366), group II (2,045 of 22,424 [9.1%] vs. 5,159 of 22,184 [23.3%]; odds ratio, 0.315; 99.9% CI, 0.263 to 0.378), and group III (1,325 of 22,379 [5.9%] vs. 3,773 of 23,573 [16.0%]; odds ratio, 0.321; 99.9% CI, 0.266 to 0.389); all adjusted comparisons P < 0.001. No increased odds of composite complications were observed in high-risk group I (129 of 13,004 [1.0%] vs. 239 of 14,886 [1.6%]; odds ratio, 0.89, 99.9% CI, 0.49 to 1.59), group II (238 of 22,424 [1.1%] vs. 369 of 22,184 [1.7%]; odds ratio, 0.98; 99.9% CI, 0.58 to 1.67), and group III (187 of 22,379 [0.8%] vs. 290 of 23,573 [1.2%]; odds ratio, 0.93; 99.9% CI, 0.54 to 1.61); all adjusted comparisons P > 0.999.

Conclusions

Although effective in reducing blood transfusions, tranexamic acid is not associated with increased complications, irrespective of patient high-risk status at baseline.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Ultrasound Evaluation of Gastric Emptying Time in Healthy Term Neonates after Formula Feeding
Authors: Lee Jennifer J. , Price Jerri C. , Duren Andrew , Shertzer Alon , Hannum Robert , Akita Francis A. , Wang Shuang , Squires Judy H. , Panzer Oliver , Herrera Jacquelin , Sun Lena S. , Davis Nicholas A.
Published: April 2021

Background

The current American Society of Anesthesiologists fasting guideline for formula-fed infants in the periprocedural setting is 6 h. Prolonged fasting in very young infants is associated with an increased risk for hypoglycemia and dehydration as well as patient discomfort and patient/parental dissatisfaction. This study aimed to determine the time to gastric emptying in healthy neonates after formula feeding by serially evaluating the gastric antrum with ultrasound. The authors hypothesized that gastric emptying times in formula-fed neonates are significantly shorter than the current 6 h fasting recommendation.

Methods

After institutional review board approval and written informed parental consent, ultrasound examination was performed in healthy full-term neonates before and after formula feeding at 15-min intervals until return to baseline. Ultrasound images of the gastric antrum were measured to obtain cross-sectional areas, which were then used to estimate gastric antral volumes.

Results

Forty-six of 48 recruited neonates were included in the final analysis. Gastric emptying times ranged from 45 to 150 min and averaged 92.9 min (95% CI, 80.2 to 105.7 min; 99% CI, 76.0 to 109.8 min) in the overall study group. No significant differences were found in times to gastric emptying between male and female neonates (male: mean, 93.3 [95% CI, 82.4 to 104.2 min]; female: mean, 92.6 [95% CI, 82.0 to 103.2 min]; P = 0.930) or those delivered by vaginal versus cesarean routes (vaginal: mean, 93.9 [95% CI, 81.7 to 106.1 min]; cesarean: mean, 92.2 [95% CI, 82.5 to 101.9 min]; P = 0.819).

Conclusions

These results demonstrate that gastric emptying times are substantially less than the current fasting guideline of 6 h for formula-fed, healthy term neonates.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Leveraging Videoconferencing Technology to Augment Surgical Training During a Pandemic
Authors: Madani Amin , Hirpara Dhruvin , Chadi Sami A. , Dhar Preeti , Okrainec Allan
Published: April 2021

Objective:

Our objective was to review the use of videoconferencing as a practical tool for remote surgical education and to propose a model to overcome the impact of a pandemic on resident training.

Summary Background Data:

In response to the coronavirus disease 2019 pandemic, most institutions and residency programs have been restructured to minimize the number of residents in the hospital as well as their interactions with patients and to promote physical distancing measures. This has resulted in decreased resident operative exposure, responsibility, and autonomy, hindering their educational goals and ability to achieve surgical expertise necessary for independent practice.

Methods:

We conducted a narrative review to explore the use of videoconferencing for remote broadcasting of surgical procedures, telecoaching using surgical videos, telesimulation for surgical skills training, and establishing a didactic lecture series.

Results and Conclusions:

We present a multimodal approach for using practical videoconferencing tools that provide the means for audiovisual communication to help augment residents’ operative experience and limit the impact of self-isolation, redeployment, and limited operative exposure on surgical training.
Quality of Life-CI: Development of an Early Childhood Parent-Proxy and Adolescent Version
Authors: Cejas Ivette , Coto Jennifer , Sarangoulis Christina , Sanchez Chrisanda M. , Quittner Alexandra L.
Published: April 2021

Objectives:

Severe to profound hearing loss is associated with communication, social, and behavioral difficulties that have been linked to worse health-related quality of life (HRQoL) compared to individuals with normal hearing. HRQoL has been identified as an important health outcome that measures functional ability, particularly for chronic conditions and disabilities. The current study developed the QoL-cochlear implant (CI) for early childhood and adolescents using the recommended Food and Drug Administration and European Medicines Agency guidelines on patient-reported outcomes.

Design:

Three phases of instrument development were conducted for both the early childhood (0 to 5 years old; parent proxy) and adolescent/young adult (13 to 22 years old) versions of the QoL-CI. Phase 1 included the development of our conceptual framework, which informed the discussion guides for stakeholder focus groups (e.g., audiologists, physicians, and therapists) at CI clinics in Miami and Philadelphia (n = 39). Open-ended interviews with parents (N = 18 for early childhood; N = 6 for adolescent/young adult version) and adolescents/young adults using CIs (n = 17) were then completed at both sites during phase 2. All interviews were transcribed and coded to identify common themes, which were then used to draft items for the QoL-CI. Both versions of the QoL-CI were developed using Qualtrics to allow for quick, easy electronic administration of the instruments on a tablet device. Last, phase 3 included cognitive testing in a new sample (N = 19 early childhood, N = 19 adolescent) to ensure that the draft instruments were clear, comprehensive, and easy to use.

Results:

Participant responses obtained via the open-ended interviews yielded an early childhood and adolescent version of the QoL-CI that was reportedly easy to complete and comprehensive. The final QoL-CI Early Childhood instrument yielded 35 questions across eight functional domains (environmental sounds, communication, social functioning, behavior, CI device management and routines, school, CI benefits, and early intervention). Similarly, the final QoL-CI adolescent/young adult version consisted of 46 items across eight domains (noisy environments, communication, CI usage and management, advocacy, social functioning, emotional functioning, acceptance, and independence).

Conclusions:

The QoL-CI is a condition-specific QoL instrument that can be used for children ages birth through 22 years. These instruments capture the “whole” child by not only focusing on communication and auditory skills but also academic, social and emotional functioning. Once validated, these CI-specific measures will enable providers to track long-term outcomes and evaluate the efficacy of new interventions to improve overall CI use and QoL for pediatric and young adult users.
Exploring the Types of Stories Hearing Parents Tell About Rearing their Children Who Use Cochlear Implants
Authors: Barker Brittan A. , Scharp Kristina M. , Chandler Kelsey L. , Bowman Emma B.
Published: April 2021

Objectives:

The majority of children born in the United States with hearing loss (HL) are born to parents with hearing. Many of these parents ultimately choose cochlear implantation for their children. There are now decades of research showing which these children’s speech, language, listening, and education seem to benefit from cochlear implantation. To date, however, we know little about the experiences of the parents who guided these children throughout their journeys. We propose that elucidating the types of stories these parents tell is a first step toward understanding their varied experiences and has the potential to ultimately improve healthcare outcomes for both children and their families. Thus, to better understand parents’ experience, we asked the following research question: what types of stories do parents with hearing tell about rearing their children with HL who use cochlear implants?

Design:

In this prospective qualitative study, we used a narrative approach. Specifically, we conducted narrative interviews with 20 hearing parents who are rearing young children (mean age = 5.4 years) born with HL who use cochlear implants. We then used thematic narrative analysis to identify recurring themes throughout the narratives that coalesced into the types of stories parents told about their experiences.

Findings:

Thematic narrative analysis revealed five story types: (1) stories of personal growth, (2) proactive stories, (3) stories of strain and inundation, (4) detached stories, and (5) stories of persistence.

Conclusions:

In the present study, different types of stories emerged from parents’ experiences that share common events—a family’s baby is identified at birth with unexpected permanent HL, the family chooses to pursue cochlear implantation for their child, and then the family raises said pediatric cochlear implant user into adulthood. Despite these similarities, the stories also varied in their sensemaking. Some parents told stories in which a positive life narrative turned bad, whereas others told stories in which a narrative of surviving turned into one of thriving. These findings specifically contribute to the field of hearing healthcare by providing professionals with insight into parents’ sensemaking via the types of stories they shared centered on their perceptions and experiences following their child’s diagnosis of HL and their decision to pursue cochlear implantation.
Reliability of Serological Prestin Levels in Humans and its Relation to Otoacoustic Emissions, a Functional Measure of Outer Hair Cells
Authors: Parker Ashley , Parham Kourosh , Skoe Erika
Published: April 2021

Objectives:

Serological biomarkers, common to many areas of medicine, have the potential to inform on the health of the human body and to give early warning of risk of compromised function or illness before symptoms are experienced. Serological measurement of prestin, a motor protein uniquely produced and expressed in outer hair cells, has recently been identified as a potential biomarker to inform on the health of the cochlea. Before any test can be introduced into the clinical toolkit, the reproducibility of the measurement when repeated in the same subject must be considered. The primary objective of this study is to outline the test-retest reliability estimates and normative ranges for serological prestin in healthy young adults with normal hearing. In addition, we examine the relation between serum prestin levels and otoacoustic emissions (OAEs) to compare this OHC-specific protein to the most common measure of OHC function currently used in hearing assessments.

Design:

We measured prestin levels serologically from circulating blood in 34 young adults (18 to 24 years old) with clinically normal pure-tone audiometric averages at five different timepoints up to six months apart (average intervals between measurements ranged from <1 week to 7 weeks apart). To guide future studies of clinical populations, we present the standard error of the measurement, reference normative values, and multiple measures of reliability. Additionally, we measured transient evoked OAEs at the same five timepoints and used correlation coefficients to examine the relation between OAEs and prestin levels (pg/mL).

Results:

Serum prestin levels demonstrated good to excellent reliability between and across the five different time points, with correlation coefficients and intraclass correlations >0.8. Across sessions, the average serum prestin level was 250.20 pg/mL, with a standard error of measurement of 7.28 pg/mL. Moreover, positive correlations (generally weak to moderate) were found between prestin levels and OAE magnitudes and signal-to-noise ratios.

Conclusions:

Findings characterize serum prestin in healthy young adults with normal hearing and provide initial normative data that may be critical to interpreting results from individuals with sensorineural hearing loss. Our results demonstrate reliability of serum prestin levels in a sample of normal-hearing young adults across five test sessions up to 6 months apart, paving the way for testing larger samples to more accurately estimate test-retest standards for clinical protocols, including those involving serial monitoring. The positive correlations between serum prestin and OAE levels, although weak to moderate, reinforce that the source of serum prestin is likely the outer hair cells in the inner ear, but also that serum prestin and OAEs each may also index aspects of biologic function not common to the other.
Exosomal circ_0004136 enhances the progression of pediatric acute myeloid leukemia depending on the regulation of miR-570-3p/TSPAN3 axis
Authors: Bi Jing , Pu Yuanlin , Yu Xinqiao
Published: April 2021

Circular RNAs (circRNAs) have been implicated in the progression of pediatric acute myeloid leukemia (AML). Although circ_0004136 has been found to play a crucial role in AML, our understanding of its molecular mechanism remains very limited. The levels of circ_0004136, miR-570-3p and tetraspanin 3 (TSPAN3) were determined by quantitative real-time PCR or western blot. Cell viability, migration, invasion, cell cycle and apoptosis were detected using the Cell Counting Kit-8, transwell and flow cytometry assays. Targeted relationships among circ_0004136, miR-570-3p and TSPAN3 were validated by dual-luciferase reporter and RNA immunoprecipitation assays. Our data showed that circ_0004136 could be transmitted by exosomes, and exosomal circ_0004136 was highly expressed in AML serum and cells. Circ_0004136 was unusually stable and mainly localized in the cytoplasm. Circ_0004136 knockdown mediated by exosomes hampered AML cell viability, cell cycle progression, migration and invasion, and promoted cell apoptosis. Moreover, circ_0004136 worked as a sponge of miR-570-3p and TSPAN3 was a functional target of miR-370-3p in AML cells. The suppression of circ_0004136 knockdown mediated by exosomes on AML cell malignant progression was reversed by miR-570-3p downregulation, and the increased miR-570-3p expression hindered the progression of aggressive AML by downregulating TSPAN3. Furthermore, circ_0004136 worked as a miR-570-3p sponge to modulate TSPAN3 expression. Our findings identified a novel regulatory mechanism in which exosome-mediated circ_0004136 knockdown restrained AML cell malignant progression at least partly through targeting the miR-570-3p/TSPAN3 axis, highlighting a novel therapeutic strategy for AML management.
Assessment of causal association between thyroid function and lipid metabolism: a Mendelian randomization study
Authors: Wang Jing-Jia , Zhuang Zhen-Huang , Shao Chun-Li , Yu Can-Qing , Wang Wen-Yao , Zhang Kuo , Meng Xiang-Bin , Gao Jun , Tian Jian , Zheng Ji-Lin , Huang Tao , Tang Yi-Da
Published: April 2021

Background:

Thyroid dysfunction is associated with cardiovascular diseases. However, the role of thyroid function in lipid metabolism remains partly unknown. The present study aimed to investigate the causal association between thyroid function and serum lipid metabolism via a genetic analysis termed Mendelian randomization (MR).

Methods:

The MR approach uses a genetic variant as the instrumental variable in epidemiological studies to mimic a randomized controlled trial. A two-sample MR was performed to assess the causal association, using summary statistics from the Atrial Fibrillation Genetics Consortium (n = 537,409) and the Global Lipids Genetics Consortium (n = 188,577). The clinical measures of thyroid function include thyrotropin (TSH), free triiodothyronine (FT3) and free thyroxine (FT4) levels, FT3:FT4 ratio and concentration of thyroid peroxidase antibodies (TPOAb). The serum lipid metabolism traits include total cholesterol (TC) and triglycerides, high-density lipoprotein, and low-density lipoprotein (LDL) levels. The MR estimate and MR inverse variance-weighted method were used to assess the association between thyroid function and serum lipid metabolism.

Results:

The results demonstrated that increased TSH levels were significantly associated with higher TC (β = 0.052, P = 0.002) and LDL (β = 0.041, P = 0.018) levels. In addition, the FT3:FT4 ratio was significantly associated with TC (β = 0.240, P = 0.033) and LDL (β = 0.025, P = 0.027) levels. However, no significant differences were observed between genetically predicted FT4 and TPOAb and serum lipids.

Conclusion:

Taken together, the results of the present study suggest an association between thyroid function and serum lipid metabolism, highlighting the importance of the pituitary-thyroid-cardiac axis in dyslipidemia susceptibility.