bluuebunny/crossref_metadata_2025 huggingface dataset:
Water T2 could predict functional decline in patients with dysferlinopathy
Authors: Moore Ursula , Caldas de Almeida Araújo Ericky , Reyngoudt Harmen , Gordish‐Dressman Heather , Smith Fiona E. , Wilson Ian , James Meredith , Mayhew Anna , Rufibach Laura , Day John W. , Jones Kristi J. , Bharucha‐Goebel Diana X. , Salort‐Campana Emmanuelle , Pestronk Alan , Walter Maggie C. , Paradas Carmen , Stojkovic Tanya , Mori‐Yoshimura Madoka , Bravver Elena , Pegoraro Elena , Mendell Jerry R. ,   The Jain COS Consortium, Bushby Kate , Blamire Andrew M. , Straub Volker , Carlier Pierre G. , Diaz‐Manera Jordi
Published: September 2022

Background

Water T2 (T2H2O) mapping is increasingly being used in muscular dystrophies to assess active muscle damage. It has been suggested as a surrogate outcome measure for clinical trials. Here, we investigated the prognostic utility of T2H2O to identify changes in muscle function over time in limb girdle muscular dystrophies.

Methods

Patients with genetically confirmed dysferlinopathy were assessed as part of the Jain Foundation Clinical Outcomes Study in dysferlinopathy. The cohort included 18 patients from two sites, both equipped with 3‐tesla magnetic resonance imaging (MRI) systems from the same vendor. T2H2O value was defined as higher or lower than the median in each muscle bilaterally. The degree of deterioration on four functional tests over 3 years was assessed in a linear model against covariates of high or low T2H2O at baseline, age, disease duration, and baseline function.

Results

A higher T2H2O at baseline significantly correlated with a greater decline on functional tests in 21 out of 35 muscles and was never associated with slower decline. Higher baseline T2H2O in adductor magnus, vastus intermedius, vastus lateralis, and vastus medialis were the most sensitive, being associated bilaterally with greater decline in multiple timed tests. Patients with a higher than median baseline T2H2O (>40.6 ms) in the right vastus medialis deteriorated 11 points more on the North Star Ambulatory Assessment for Dysferlinopathy and lost an additional 86 m on the 6‐min walk than those with a lower T2H2O (<40.6 ms). Optimum sensitivity and specificity thresholds for predicting decline were 39.0 ms in adductor magnus and vastus intermedius, 40.0 ms in vastus medialis, and 40.5 ms in vastus lateralis from different sites equipped with different MRI systems.

Conclusions

In dysferlinopathy, T2H2O did not correlate with current functional ability. However, T2H2O at baseline was higher in patients who worsened more rapidly on functional tests. This suggests that inter‐patient differences in functional decline over time may be, in part, explained by different severities of the active muscle damage, assessed by T2H2O measure at baseline. Significant challenges remain in standardizing T2H2O values across sites to allow determining globally applicable thresholds. The results from the present work are encouraging and suggest that T2H2O could be used to improve prognostication, patient selection, and disease modelling for clinical trials.
Learning outcomes of a mobile application for dental infection control education
Authors: Choi Eun‐Mi , Mun So‐Jung , Han Sun‐Young , Kang Jung‐Yun , Choi Ji‐Hea , Noh Hie‐Jin
Published: September 2022

Purpose/objectives

This study aimed to apply and verify the effectiveness of a mobile‐based dental infection control education application to enable students majoring in dental hygiene to learning dental infection control education without time and space constraints.

Methods

This study used a nonequivalent control group pretest–posttest design to examine differences in learning outcomes between an experimental group that learned through the mobile application and a control group that learned with handouts. The Infection Prevention and Control Mobile Application (IPC App) and handouts were developed by referring to the Center for Disease Control's (CDC) guidelines for Infection Prevention and Control in Dental Settings. Both the experimental and control groups were guided to perform self‐regulated learning, where they independently led and managed their learning for two weeks. The study was conducted at the D university college with 42 students from the second grade in the Department of Dental Hygiene from August to October 2021. Differences in knowledge, self‐efficacy, and summative evaluation were analyzed using an independent samplet‐test and repeated measures analysis of variance (p < 0.05).

Results

The findings confirmed that the experimental group who learned through the IPC mobile application had improved their knowledge and indicated a higher summative evaluation than the control group that learned via learning documents (p < 0.05).

Conclusions

Owing to the high accessibility and repeatability of the learning content, the mobile application recommended in this study may serve as an effective self‐directed learning tool for students to gain knowledge on the standard precautions for dental infection control.
Exploring why religious faith may distinguish faith‐based from non‐faith‐based NGOs: Theoretical insights from Cambodia
Authors: Frame John
Published: September 2022

Faith‐based and non‐faith‐based non‐governmental organisations (NGOs) are significant service providers in the developing world, yet limited research has compared these organisations, especially in the context of Southeast Asia. This paper explores a theoretical concept related to why religious faith may distinguish Christian faith‐based organisations (FBOs) from non‐faith‐based NGOs. Qualitative data were analysed from 41 interviews across 13 Christian FBOs and 12 non‐faith‐based NGOs working with women and children in Cambodia who have been (or were at risk of being) sexually exploited, trafficked or involved in sex work. Faith was found to distinguish FBOs from non‐faith‐based NGOs in all four of the dimensions comparatively examined in the study: (1) goals and missions, (2) motivations, (3) approaches to care and (4) conceptions of success. It is argued that the contrasts between these two types of organisations, in terms of faith, are related to the combination of both the infusion of faith in FBOs and factors related to the development context in which these organisations worked, a theoretical concept posited as Context‐Infusion Convergence.
Alternative sources of valine and isoleucine for prompt reduction of plasma leucine in maple syrup urine disease patients: A case series
Authors: Ziadlou Maryam , MacDonald Anita
Published: September 2022

In maple syrup urine disease (MSUD), leucine (Leu) accumulation, and its metabolites cause brain toxicity, and at diagnosis rapid plasma Leu reduction is essential. Valine (Val) and isoleucine (Iso) supplements are necessary to promote anabolism and enable prompt reduction of plasma Leu. Val/Iso supplements are unavailable in Iran, so an alternative source was necessary. An emergency protocol was developed using an unconventional source of Val and Iso to prompt reduction of high plasma Leu levels during an acute metabolic crisis to prevent brain encephalopathy and neurological sequelae. Five children with classical MSUD were referred aged 1–25 months, with a prolonged high plasma Leu of more than 1500 μmol/L and acute symptoms (irritability, poor feeding, and hypotonia). Initially, breast milk/regular infant formula was stopped. Val and Iso were given in calculated amounts from a Leu‐free formula containing Iso/Val (Xleu Maxamaid, Nutricia Ltd.) to promote anabolism. It was prescribed for a controlled and limited time with a branched chain amino acid (BCAA) free formula. Frequent amino acid monitoring was conducted. Natural protein was re‐added after normalizing plasma Leu. Plasma Leu declined by a median (range) of 1677 (1501–1852) μmol/L within 3–4 days of intervention. The median follow‐up time was 24 months (range: 14–32) and patients showed improvement in motor and cognitive skills after normalizing plasma Leu (75–200 μmol/L). Most had improvement in their head circumference (n = 4). Due to the unavailability of individual Val/Iso supplements, a Leu‐free formula rapidly lowered plasma Leu concentrations during acute crisis, to prevent cerebral edema and brain damage in MSUD.
Porosomes in uterine epithelial cells: Ultrastructural identification and characterization during early pregnancy
Authors: Kalam Sadaf N. , Dowland Samson , Lindsay Laura , Murphy Christopher R.
Published: September 2022

Porosomes are plasma membrane structures in secretory cells that allow transient docking and/or partial fusion of vesicles during which they release their content then disengage. This is referred to as “kiss and run” exocytosis. During early pregnancy, at the time of receptivity, there is a high level of vesicle activity in uterine epithelial cells (UECs). One of the secretory pathways for these vesicles could be via porosomes, which have yet to be identified in UECs. This study identified porosomes in the apical plasma membrane of UECs for the first time. These structures were present on days 1, 5.5, and 6 of early pregnancy, where they likely facilitate partial secretion via “kiss and run” exocytosis. The porosomes were measured and quantified on days 1, 5.5, and 6, which showed there are significantly more porosomes on day 5.5 (receptive) compared to day 1 (nonreceptive) of pregnancy. This increase in porosome numbers may reflect major morphological and molecular changes in the apical plasma membrane at this time such as increased cholesterol and soluble NSF attachment protein receptor proteins, as these are structural and functional components of the porosome complex assembly. Porosomes were observed in both resting (inactive) and dilated (active) states on days 1, 5.5, and 6 of early pregnancy. Porosomes on day 5.5 are significantly more active than on day 1 as demonstrated by the dilation of their base diameter. Further two‐way ANOVA analysis of base diameter in resting and dilated states found a significant increase in porosome activity in day 5.5 compared to day 1. This study therefore indicates an increase in the number and activity of porosomes at the time of uterine receptivity in the rat, revealing a mechanism by which the UECs modify the uterine luminal environment at this time.
The relationship between myocardial bridge and frontal QRS‐T angle
Authors: Tascanov Mustafa Begenc , Tanriverdi Zulkif , Gungoren Fatih , Tapar Gulsen Genc , Bicer Asuman
Published: September 2022

Aim

Although Myocardial bridge (MB) is known as a benign condition, it has been demonstrated to be associated with cardiac arrhythmias and poor outcomes. Frontal QRS‐T angle (fQRSTa) is a novel indicator of repolarization and depolarization heterogeneity. Last studies indicated that associated with fQRSTa and adverse cardiac events. No study evaluated the relationship between fQRSTa and MB. In the present study, we aimed to investigate the relationship between MB and fQRSTa.

Methods

This study included 91 patients with normal coronary arteries and 89 patients with MB. Coronary angiography was performed in all patients due to ischemia findings on treadmill exercise test or myocardial scintigraphy.2‐lead surface electrocardiograms (ECGs) of all patients were evaluated. QT interval, fQRSTa, QTc interval were measured from surface ECGs.

Results

Baseline clinical, echocardiographic and laboratory parameters were similar between MB and control group. However, when compared to control group, patients with MB had importantly raised fQRSTa [27 (20–41) vs. 23 (12–37) p = 0.007]. In correlation analysis, fQRSTa was positively correlated with MB length (r = 0.411, p < 0.001). Linear regression analysis showed that MB length was the just considerable predictor of fQRSTa (β = 0.247, p = 0.041).

Conclusions

The fQRSTa is a novel electrocardiographic marker that can be easily obtained from surface ECG. We have shown for the first time that MB length is a significant predictor of fQRSTa.
Role of C‐reactive protein in the bone marrow of Modic type 1 changes
Authors: Dudli Stefan , Heggli Irina , Laux Christoph J. , Spirig José M. , Wanivenhaus Florian , Betz Michael , Germann Christoph , Farshad‐Amacker Nadja A. , Herger Nick , Mengis Tamara , Brunner Florian , Farshad Mazda , Distler Oliver
Published: September 2022

Modic type 1 changes (MC1) are vertebral bone marrow lesions and associate with low back pain. Increased serum C‐reactive protein (CRP) has inconsistently been associated with MC1. We aimed to provide evidence for the role of CRP in the tissue pathophysiology of MC1 bone marrow. From 13 MC1 patients undergoing spinal fusion at MC1 levels, vertebral bone marrow aspirates from MC1 and intrapatient control bone marrow were taken. Bone marrow CRP, interleukin (IL)‐1, and IL‐6 were measured with enzyme‐linked immunosorbent assays; lactate dehydrogenase (LDH) was measured with a colorimetric assay. CRP, IL‐1, and IL‐6 were compared between MC1 and control bone marrow. Bone marrow CRP was correlated with blood CRP and with bone marrow IL‐1, IL‐6, and LDH. CRP expression by marrow cells was measured with a polymerase chain reaction. Increased CRP in MC1 bone marrow (mean difference: +0.22 mg CRP/g, 95% confidence interval [CI] [−0.04, 0.47], p = 0.088) correlated with blood CRP (r = 0.69, p = 0.018), with bone marrow IL‐1β (ρ = 0.52, p = 0.029) and IL‐6 (ρ = 0.51, p = 0.031). Marrow cells did not express CRP. Increased LDH in MC1 bone marrow (143.1%, 95% CI [110.7%, 175.4%], p = 0.014) indicated necrosis. A blood CRP threshold of 3.2 mg/L detected with 100% accuracy increased CRP in MC1 bone marrow. In conclusion, the association of CRP with inflammatory and necrotic changes in MC1 bone marrow provides evidence for a pathophysiological role of CRP in MC1 bone marrow.
Infusion timing and sleep habits of adults receiving home parenteral and enteral nutrition: A patient‐oriented survey study
Authors: Dashti Hassan S. , Rhyner Jordan J. , Mogensen Kris M. , Godbole Meghna , Saxena Richa , Compher Charlene , Winkler Marion F.
Published: September 2022

Background

The emerging field of chrononutrition investigates the effects of the timing of nutritional intake on human physiology and disease pathology. It remains largely unknown when patients receiving home nutrition support routinely administer home parenteral nutrition (HPN) and/or home enteral nutrition (HEN).

Methods

The present descriptive study included data collected from a patient‐oriented survey designed to assess the timing of infusions and sleep habits of patients receiving HPN and HEN in the United States.

Results

A total of 100 patients were included. Patients had a mean age of 44.1 years and 81% were female. Among 73 patients supported with HPN and 27 patients supported with HEN, 86% and 44% reported overnight infusions, respectively. The median start and end times of overnight infusions were 2100 (interquartile range [IQR] = 1900–2200) and 0800 (IQR = 0700–1000), respectively, for HPN and 2000 (IQR = 1845–2137) and 0845 (IQR = 0723–1000), respectively, for HEN. Overnight infusions started 2.0 h (IQR = 1.1–3.0) and 2.0 h (IQR = 0.6–3.3) before bedtime for HPN and HEN, respectively, and stopped 12.9 min (IQR = −21.3 to 29.1) and 30.0 min (IQR = −17.1 to 79.3) after wake time for HPN and HEN, respectively. Sleep disruption because of nutrition support or urination was most common among patients receiving infusions overnight compared with those receiving infusions continuously or during the daytime.

Conclusions

Our survey study focusing on a novel and medically relevant dimension of nutrition found that most HPN‐dependent and HEN‐dependent patients receive infusions overnight while asleep. Our findings suggest that overnight infusions coinciding with sleep may result in sleep and circadian disruption.
New tools for dead roots: Radioisotope labelling and compound‐specific analysis reveal how subsoil hotspots work
Authors: Banfield Callum C.
Published: September 2022

Subsoils are increasingly studied as they, first, store a great deal of terrestrial carbon (C) and possibly even more, and second, offer resources like water and nutrients to plants, potentially mitigating negative consequences of global change. As subsoil access is often hampered by compacted soil layers, the key to accessing subsoil resources and storing more C below ground might be in biopores. Appropriately nicknamed ‘highways of root growth’, biopores are macropores left behind by dying roots and earthworm activities, often enriched with organic matter (OM) and nutrients. They are thought to be the most abundant microbial hotspots in the subsoil, thus possibly accounting for a large part of C turnover, as well as offering pore wall nutrients to subsequent crops. Understanding the multifunctionality and complexities of biopores remains challenging. This contribution aims to showcase analytical ways to deepen our understanding of origin and functioning of biopores and hotspots. Regarding their biogeochemistry, biopore OM quality and its turnover can be better unravelled through compound‐specific analysis to deduct biopore‐specific OM turnover. Biopores can be reliably differentiated by their OM quality. A more profound understanding of subsoil C turnover in very contrasting hotspots is crucially important for managing subsoil functions. Biopores are often assumed to be beneficial in crop sequences. Roots making use of specific biopores can be, for the first time, quantified after radiotracer application, two‐step phosphor imaging, and image processing. Combining radioactive with stable isotopes as well as plant and microbial biomarkers allows to investigate the relevance of individual pore wall nutrients in plant growth in consideration of physical biopore properties. Biopore‐friendly management practices (e.g., reduced tillage, perennial cover cropping) could be part of smart subsoil management. Faster access to subsoil water and concentrated biopore nutrients may safeguard agricultural production—especially in times of rising fertiliser costs (both monetary and environmental) and more frequent droughts.
Assessment of biogas production and bacterial load from manure of layer chicken fed with two different types of feed
Authors: Haque Mohammad Enamul , Ryndin Roman , Mang Heinz‐Peter , Kabir Humayun , Rahman Mohummad Muklesur , Khasruzzaman Abul Kalam Mohammad , Uddin Mohammad Asir , Islam Mohammad Alimul
Published: September 2022

Background

The focus of this research was to assess the biogas production of Chicken Manure (CM) collected from hybrid layer chickens fed non‐commercial (CMNC) and commercial (CMC) feed, as well as to evaluate the bacterial load of feeding stock and digested slurry samples before and after Anaerobic Digestion (AD). The effects of the feedstock and digestion composition of CM on biogas production were measured. The experiment was carried out utilizing lab‐based proto‐type digesters for CM with or without inoculum. For each commercial and non‐commercial feed, four experimental groups (CMNC1, CMNC2, CMC1, and CMC2) were designed using mixing ratios of CM: H2O: inoculum (25:25:50) and CM: H2O (50:50). For Hydraulic Retention Time (HRT), the digesters were set up at ambient temperature (28–34°C) for 30 days. The spread plate technique was used to determine the Total Viable Count (TVC), E. coli, and Salmonella spp. counts.

Results

The highest average cumulative biogas yield was achieved from CMC2 > CMNC2 > CMC1 > CMNC1. The biogas production of inoculum added groups were statistically significant (p < 0.01) than the without inoculum groups. The average concentration of CH4 and CO2 in biogas was 49% and 51% for CMNC1, 58% and 42% for CMNC2, 46% and 54% for CMC1, 52% and 42% for CMC2. However, the H2S content was within the acceptable range except for the CMNC2 group. The bacterial load was decreased by 2–3 logs before and after AD, and this reduction was statistically significant (p < 0.05).

Conclusion

The study concluded that the CM diluted with water and inoculum (25:25:50) ratio was recommended for sustainable biogas production.
Comprehensive analysis of dihydromyricetin metabolites in rats using ultra‐high‐performance liquid chromatography coupled with high‐resolution mass spectrometry
Authors: Jing Xu , Pingping Dong , Yifang Cui , Huajian Li , Shan Jiang , Yong Wang , Jiayu Zhang
Published: September 2022

As the most abundant and bioactive constituent in vine tea (Ampelopsis grossedentata), dihydromyricetin possesses numerous biological activities. A rapid profiling and identification method for dihydromyricetin metabolites in rats after the oral administration has been established using ultra‐high‐performance liquid chromatography‐Q‐Exactive Orbitrap mass spectrometry coupled with multiple data‐mining methods. Herein, an efficient analytical strategy characterized by a parallel reaction monitoring mode combining diagnostic fragment ions filtering techniques was developed for the comprehensive identification of dihydromyricetin metabolites in rat plasma, urine, and feces. And then, the biotransformation pathways of dihydromyricetin were further revealed. As a result, a total of 49 metabolites were finally identified by comparing diagnostic fragment ions, chromatographic retention times, neutral loss fragment ions, and accurate mass measurement with those of the dihydromyricetin reference standard. These metabolites were presumed to be dominantly generated through hydroxylation, dehydroxylation, methylation, reduction, sulfation, decarbonylation, glucuronidation, glucosylation, and their composite reactions. In a word, our present results not only supplied a solid foundation to better understand the action mechanism of dihydromyricetin, but also provided some models for the metabolism study of the other compounds in traditional Chinese medicines or natural plants.
Sexual compulsivity, erectile dysfunction, and suicidality among male survivors of military sexual violence
Authors: Blais Rebecca K. , Xu Bingyu , Hoyt Tim , Lorenz Tierney , Monteith Lindsey L.
Published: September 2022

Although military sexual trauma (MST) is associated with an increased risk of suicide, suicide attempts, and suicidal ideation among service members and veterans, there is limited knowledge regarding the mechanisms of MST and suicidality among men. The current study examined whether MST was associated with sexual compulsivity and/or erectile dysfunction and if these, in turn, explained elevated suicidal thoughts and the likelihood of engaging in future suicidal behavior after accounting for mental health, military, and demographic characteristics. Service members and veterans who reported their gender as male (N = 508) were recruited via social media and completed online self‐report measures assessing MST, erectile dysfunction, sexual compulsivity, suicidal ideation frequency, and the likelihood of engaging in future suicidal behavior. Path analysis was used to examine the study hypotheses. In total, 67 participants (13.2%) reported a history of MST; of these individuals, 27 (40.3%) reported suicidal ideation in the past 12 months, and 29 (43.9%) reported an increased likelihood of engaging in future suicidal behavior. MST was associated with increased sexual compulsivity, which, in turn, predicted more frequent suicidal ideation as well as a higher self‐reported likelihood of engaging in future suicidal behavior. MST was associated with higher levels of erectile dysfunction, but erectile dysfunction was not associated with suicidal ideation in the adjusted model. Although the data were cross‐sectional, precluding determinations of causality, the results support assessing and intervening with regard to sexual compulsivity to mitigate the risk for suicide‐related outcomes among men who experience MST.
Teaching the Teachers: A Flexible, Cognitive‐Focused Curriculum in Point‐of‐Care Ultrasound Education for Hospital Medicine Faculty
Authors: Anstey James , Jensen Trevor , Lalani Farhan , Conner Stephanie McCarty
Published: September 2022

Objectives

We aimed to decrease barriers to acquiring Point‐of‐Care Ultrasound (POCUS) knowledge among attending physicians and improve the safety of trainee POCUS use through a novel flexible and cognitive based curriculum.

Methods

We developed three educational pathways using varied approaches to educational delivery: a novel and asynchronous cognitive curriculum to allow Educational Supervision, a hands‐on pathway for Limited Practice, and a more robust pathway for Independent Practice and credentialing.

Results

From November 2018 through June 2021, 102 of 116 hospitalists engaged in some portion of the curriculum. Twenty‐four completed the Educational Supervision pathway, 31 completed the Limited Practice pathway, and 17 enrolled in the Independent Practice pathway with three achieving independent practice. Faculty who completed the Educational Supervision pathway had improved scores on a comprehensive POCUS knowledge assessment, 43.5% [95% Confidence Interval (CI) 38.2–48.8] versus 72.0% [95% CI 65.2–78.8], P < .001. Junior faculty were more likely to engage in the supervision pathway and senior faculty were more likely to complete an intensive course to complete the Limited Practice pathway.

Conclusions

A flexible, cognitive focused POCUS curriculum was effective in creating high levels of engagement, and a cognitive only curriculum resulted in significant improvement in hospitalists' POCUS knowledge without hands on training. Finally, we found that hospitalist engagement in the curriculum did not follow the lowest barrier to entry or time commitment and engagement varied by time in practice. Training faculty to independent practice remains a substantial challenge.
Follow Up Imaging in Hepatocellular Cancer Ultrasound Screening Exams With Poor Visualization Scores
Authors: Bley Edward , Mohan Nandakumar , Jackson Inimfon , Chaisidhivej Natapat , Jarrett Simone , Lo Kevin Bryan , Navarro Victor , Rossi Simona , Rodgers Shuchi K. , Kalman Richard S.
Published: September 2022

Objectives

The Ultrasound Liver Imaging Reporting and Data Systems (LI‐RADS) provides standardized terminology and reporting for ultrasound (US) examinations performed for hepatocellular cancer (HCC) screening. However, there are no recommendations regarding follow up imaging for visualization scores with suboptimal visualization. Therefore, the aim of this study is to examine follow up imaging practices in the setting of US studies scored as B (moderate limitations) and C (severe limitations).

Methods

A single center retrospective analysis of studies from 2017 to 2021 with HCC US screening visualization scores of B and C was performed. Follow up imaging with US, CT, or MRI within 6 months with visualization score B or C on initial US were included.

Results

Five hundred and sixty HCC US studies with suboptimal imaging were reviewed. Of those with follow up imaging, patients with a visualization score of B underwent US in more than half (58%) of the cases while those with visualization score of C underwent more CT/MRI studies (62.5%, P = .12) Patients with visualization score of B had more MRI exams performed (55%) while patients with a visualization score of C underwent more CT exams (70%, P = .16).

Conclusions

Currently, there are no guidelines instructing follow up imaging on HCC screening ultrasounds with poor visualization, and the data suggests that providers have taken a heterogeneous approach. This suggests a need for society recommendations on how to approach HCC screening ultrasounds in patients with suboptimal studies.
The Texas Health Resources Clinical Scholars Program: Learning healthcare system workforce development through embedded translational research
Authors: Masica Andrew L. , Velasco Ferdinand , Nelson Tanna L. , Medford Richard J. , Hughes Amy E. , Pandey Ambarish , Peterson Eric D. , Lehmann Christoph U.
Published: September 2022

Introduction

Texas Health Resources (THR), a large, nonprofit health care system based in the Dallas‐Fort Worth area, has collaborated with the University of Texas Southwestern Medical Center (UTSW) to develop and operate a unique, integrated approach for Learning Health System (LHS) workforce development. This training model centers on academic health system faculty members conducting later‐stage translational research within a partnering regional care delivery organization.

Methods

The THR Clinical Scholars Program engages early career UTSW faculty members to conduct studies that are likely to have an impact on care delivery at the health system level. Interested candidates submit formal applications to the program. A joint committee comprised of senior research faculty from UTSW and THR clinical leadership reviews proposals with a focus on the shared LHS needs of both institutions—developing high quality research output that can be applied to enhance care delivery. A key prioritization criterion for funding is the degree to which the research addresses a question relevant to THR as a high‐volume network with multiple channels for consumers to access care. The program emphasis is on supporting embedded research initiatives using health system data to generate knowledge that will improve the quality and efficiency of care for the patient populations served by the participant organizations.

Results

We discuss specific strategic and tactical components of the THR Clinical Scholars Program including an overview of the academic affiliation agreement between the collaborating organizations, criteria for successful program applications, data sharing, and funding. We also share project summaries from selected clinical scholars as examples of the LHS research done in the program to date.

Conclusion

This experience report provides an implementation framework for other academic health systems interested in adopting similar LHS workforce training models with community partners.
Qualitative evaluation of two web‐based tools to improve accessibility of evidence reports
Authors: Paez Kathryn A. , Shapiro Rachel , Thompson Lee
Published: September 2022

Introduction

The Agency for Healthcare Research and Quality (AHRQ) Evidence‐based Practice Center (EPC) Program produces evidence reports to assist health systems in improving patient care. To make EPC evidence reports more accessible and usable, AHRQ convened a panel of learning health system (LHS) senior leaders to develop two web‐based tools—a table‐based tool presenting high‐level results, and a graphical display that presented detailed data—to disseminate the reports and test the tools. Researchers examined (1) the context under which interview participants reviewed and used the evidence reported by the tools, (2) their experiences using the tools, (3) the tools' influence on clinical practice, and (4) how the tools could be improved.

Methods

Researchers collected and inductively analyzed qualitative data from tool implementation meetings with six LHSs and interviews with 27 LHS leaders and clinical staff who used the tools. Researchers used website utilization metrics to augment qualitative results.

Results

The tools were efficient, complementary, and useful sources of summarized evidence to promote system change, educate trainees and clinicians, inform research, and support shared decision making with patients and families. Clinical leaders appreciated the evidence review thoroughness and quality and viewed AHRQ as a trusted source of information. However, many felt the tools were not practical for bedside use because of their complex content. Participants also noted the reports had limited evidence strength and robustness. They suggested optimizing the tools for mobile device use to facilitate tool uptake and developing training resources about tool navigation and statistical content interpretation.

Conclusions

LHSs found the tools to be useful resources for making the EPC Program reports more accessible to and usable for health system leaders. The tools have the potential to meet some, but not all, LHS evidence needs. Their value depends on reports' usefulness, which ultimately depends on the evidence quality.
Spinal muscular atrophy carrier frequency in Saudi Arabia
Authors: Al Jumah Mohammed , Al Rajeh Saad , Eyaid Wafaa , Al‐Jedai Ahmed , Al Mudaiheem Hajar , Al Shehri Ali , Hussein Mohammed , Al Abdulkareem Ibrahim
Published: September 2022

Background

Spinal Muscular Dystrophy (SMA) is one of the leading causes of death in infants and young children from heritable diseases. Although no large‐scale popultion‐based studies have been done in Saudi Arabia, it is reported that the incidence of SMA is higher in the Saudi population partly because of the high degree of consanguineous marriages.

Methods

The final analysis included 4198 normal volunteers aged between 18 and 25 years old, 54.7% males, and 45.3% females. Whole blood was spotted directly from finger pricks onto IsoCode StixTM and genomic DNA was isolated using one triangle from the machine. To discern the SMN1 copy number independently from SMN2, Multiplex PCR with Dral restriction fragment analysis was completed. We used the carrier frequency and population‐level data to estimate the prevalence of SMA in the population using the life‐table method.

Results

This data analysis showed the presence of one copy of the SMN1 gene in 108 samples and two copies in 4090 samples, which resulted from a carrier frequency of 2.6%. The carrier frequency was twofold in females reaching 3.7% compared to 1.6% in males. 27% of participants were children of first‐cousin marriages. We estimated the birth incidence of SMA to be 32 per 100,000 birth and the total number of people living with SMA in the Kingdom of Saudi Arabia to be 2265 of which 188 are type I, 1213 are type II, and 8,64 are type III.

Conclusion

The SMA carrier rate of 2.6% in Saudi control subjects is slightly higher than the reported global frequency of 1.25 to 2% with links to the high degree of consanguinity.
Measurement system of ultra‐low moisture content in oil based on the microwave transmission method
Authors: Zeng Qunfeng , Li Gaokai , Liu Qi , Jiang Hao , Wang Zhao
Published: September 2022

As an important index of industrial oil, moisture content affects the performance of oil. With the increase of requirement to the oil quality, the measurement of ultra‐low moisture content is gradually concerned. To achieve nondestructive measurement of the moisture content in oil, this paper analyzes the principle of dielectric loss of oil‐water mixture and proposes a measurement system based on the microwave transmission method. The hardware of the system, horn antenna, and experimental device were designed and built. The system uses a subtracter circuit together with a high‐performance microwave chip and high‐precision analog‐to‐digital converter to detect 1dB microwave attenuation. The results showed that the system can measure the moisture content of 0.01%–0.8% in quenching oil and the single detection absolute error is less than ±0.05%, and the average detection absolute error of 10 detections is less than ±0.02%. This study is useful for nondestructive detection of the moisture content in oil and provides a reference for related product development.
Technical note: Short‐time sequential high‐energy gamma photon imaging using list‐mode data acquisition system for high‐dose‐rate brachytherapy
Authors: Nagata Jura , Yamamoto Seiichi , Yabe Takuya , Yogo Katsunori , Nakanishi Kohei , Noguchi Yumiko , Okudaira Kuniyasu , Kamada Kei , Yoshikawa Akira , Kataoka Jun
Published: September 2022

Purpose

Measurement of the dwell time and moving speed of a high‐activity iridium‐192 (Ir‐192) source used for high‐dose‐rate (HDR) brachytherapy is important for estimating the precise dose delivery to a tumor. For this purpose, we used a cerium‐doped yttrium aluminum perovskite (YA1O3:YAP(Ce)) gamma camera system, combined with a list‐mode data acquisition system that can acquire short‐time sequential images, and measured the dwell times and moving speeds of the Ir‐192 source.

Methods

Gamma photon imaging was conducted using the gamma camera in list mode for the Ir‐192 source of HDR brachytherapy with fixed dwell times and positions. The acquired list‐mode images were sorted to millisecond‐order interval time sequential images to evaluate the dwell time at each position. Time count rate curves were derived to calculate the dwell time at each source position and moving speed of the source.

Results

We could measure the millisecond‐order time sequential images for the Ir‐192 source. The measured times for the preset dwell times of 2 s and 10 s were 1.98 to 2.00 s full width at half maximum (FWHM) and 10.0 s FWHM, respectively. The dwell times at the first dwell position were larger than those at other positions. We also measured the moving speeds of the source after the dwells while moving back to the afterloader and found the speed increased with the distance from the edge of the field of view to the last dwell position.

Conclusion

We conclude that millisecond‐order time sequential imaging of the Ir‐192 source is possible by using a gamma camera and is useful for evaluating the dwell times and moving speeds of the Ir‐192 source.
IMPULSED model based cytological feature estimation with U‐Net: Application to human brain tumor at 3T
Authors: Wu Jian , Kang Taishan , Lan Xinli , Chen Xinran , Wu Zhigang , Wang Jiazheng , Lin Liangjie , Cai Congbo , Lin Jianzhong , Ding Xin , Cai Shuhui
Published: September 2022

Purpose

This work introduces and validates a deep‐learning‐based fitting method, which can rapidly provide accurate and robust estimation of cytological features of brain tumor based on the IMPULSED (imaging microstructural parameters using limited spectrally edited diffusion) model fitting with diffusion‐weighted MRI data.

Methods

The U‐Net was applied to rapidly quantify extracellular diffusion coefficient (Dex), cell size (d), and intracellular volume fraction (vin) of brain tumor. At the training stage, the image‐based training data, synthesized by randomizing quantifiable microstructural parameters within specific ranges, was used to train U‐Net. At the test stage, the pre‐trained U‐Net was applied to estimate the microstructural parameters from simulated data and the in vivo data acquired on patients at 3T. The U‐Net was compared with conventional non‐linear least‐squares (NLLS) fitting in simulations in terms of estimation accuracy and precision.

Results

Our results confirm that the proposed method yields better fidelity in simulations and is more robust to noise than the NLLS fitting. For in vivo data, the U‐Net yields obvious quality improvement in parameter maps, and the estimations of all parameters are in good agreement with the NLLS fitting. Moreover, our method is several orders of magnitude faster than the NLLS fitting (from about 5 min to <1 s).

Conclusion

The image‐based training scheme proposed herein helps to improve the quality of the estimated parameters. Our deep‐learning‐based fitting method can estimate the cell microstructural parameters fast and accurately.
Deuterium metabolic imaging of the human brain in vivo at 7 T
Authors: Serés Roig Eulalia , De Feyter Henk M. , Nixon Terence W. , Ruhm Loreen , Nikulin Anton V. , Scheffler Klaus , Avdievich Nikolai I. , Henning Anke , de Graaf Robin A.
Published: September 2022

Purpose

To explore the potential of deuterium metabolic imaging (DMI) in the human brain in vivo at 7 T, using a multi‐element deuterium (2H) RF coil for 3D volume coverage.

Methods

1H‐MR images and localized 2H MR spectra were acquired in vivo in the human brain of 3 healthy subjects to generate DMI maps of 2H‐labeled water, glucose, and glutamate/glutamine (Glx). In addition, non‐localized 2H‐MR spectra were acquired both in vivo and in vitro to determine T1 and T2 relaxation times of deuterated metabolites at 7 T. The performance of the 2H coil was assessed through numeric simulations and experimentally acquired B1+ maps.

Results

3D DMI maps covering the entire human brain in vivo were obtained from well‐resolved deuterated (2H) metabolite resonances of water, glucose, and Glx. The T1 and T2 relaxation times were consistent with those reported at adjacent field strengths. Experimental B1+ maps were in good agreement with simulations, indicating efficient and homogeneous B1+ transmission and low RF power deposition for 2H, consistent with a similar array coil design reported at 9.4 T.

Conclusion

Here, we have demonstrated the successful implementation of 3D DMI in the human brain in vivo at 7 T. The spatial and temporal nominal resolutions achieved at 7 T (i.e., 2.7 mL in 28 min, respectively) were close to those achieved at 9.4 T and greatly outperformed DMI at lower magnetic fields. DMI at 7 T and beyond has clear potential in applications dealing with small brain lesions.
Guanidinium and amide CEST mapping of human brain by high spectral resolution CEST at 3 T
Authors: Wang Kexin , Park Sooyeon , Kamson David Olayinka , Li Yuguo , Liu Guanshu , Xu Jiadi
Published: September 2022

Purpose

To extract guanidinium (Guan) and amide CEST on the human brain at 3 T MRI with the high spectral resolution (HSR) CEST combined with the polynomial Lorentzian line‐shape fitting (PLOF).

Methods

Continuous wave (cw) turbo spin‐echo (TSE) CEST was implemented to obtain the optimum saturation parameters. Both Guan and amide CEST peaks were extracted and quantified using the PLOF method. The NMR spectra on the egg white phantoms were acquired to reveal the fitting range and the contributions to the amide and GuanCEST. Two types of CEST approaches, including cw gradient‐ and spin‐echo (cwGRASE) and steady state EPI (ssEPI), were implemented to acquire multi‐slice HSR‐CEST.

Results

GuanCEST can be extracted with the PLOF method at 3 T, and the optimum was determined for GuanCEST in white matter (WM) and 1.0 μT in gray matter (GM). The optimum B1 = 0.8‐1 μT was found for amideCEST. AmideCEST is lower in both WM and GM collected with ssEPI compared to those by cwGRASE (ssEPI = [1.27‐1.63]%; cwGRASE = [2.19‐2.25]%). The coefficients of variation (COV) of the amide and Guan CEST in both WM and GM for ssEPI (COV: 28.6‐33.4%) are significantly higher than those of cwGRASE (COV: 8.6‐18.8%). Completely different WM/GM contrasts for Guan and amide CEST were observed between ssEPI and cwGRASE. The amideCEST was found to have originated from the unstructured amide protons as suggested by the NMR spectrum of the unfolded proteins in egg white.

Conclusion

Guan and amide CEST mapping can be achieved by the HSR‐CEST at 3 T combing with the PLOF method.
Intervention training of urology healthcare staff to counsel acute care inpatients on smoking cessation: An evaluation study
Authors: Tsemach Ronit , Enden‐Izhaki Anat , Amit Aharon Anat
Published: September 2022

Aim

To evaluate the differences, following intervention training, in the knowledge, attitudes, role perception, self‐capacity and intention of urology staff to counsel inpatients on smoking cessation.

Design

A descriptive evaluation study of intervention training in counselling on smoking cessation. The study was designed following guidance by the Medical Research Council.

Methods

The evaluation was based on a closed‐end questionnaire with four time‐point measurements from May 2018–December 2019 (N = 29 at each time‐point). A repeated measure within‐subjects ANOVA was conducted to explore the variance in participants' attitudes, role perception, self‐capacity and intention to counsel patients regarding smoking cessation. Eta squared and Bonferroni post hoc tests were used to interpret the results.

Results

No change was observed in the research variables after theoretical science‐based learning of the smoking hazards and the benefits of cessation. A statistically significant difference was found following procedural knowledge based on training, practical experience and skill development.
Uncertainty and perinatal post‐traumatic stress disorder in the neonatal intensive care unit
Authors: Malin Kathryn J. , Johnson Teresa S. , Brown Roger L. , Leuthner Jonathan , Malnory Margaret , White‐Traut Rosemary , Rholl Erin , Lagatta Joanne
Published: September 2022

Parents of infants in the neonatal intensive care unit (NICU) are at increased risk of developing perinatal post‐traumatic stress disorder (PPTSD), a mental health condition known to interfere with healthy parental and infant attachment. Feelings of uncertainty about illness have been theorized as an antecedent to post‐traumatic stress, however the relationship has not been explored in parents of infants requiring care in the NICU. The purpose of this prospective study was to explore parental uncertainty during and after NICU discharge and the relationship between uncertainty and PPTSD. The sample consisted of 319 parents during NICU hospitalization and 245 parents at 3 months postdischarge. Parents who screened positive for PPTSD 3 months after hospital discharge reported more uncertainty both while in the NICU and 3 months after hospital discharge (p < 0.001). In parents with a personal or family history of mental illness, the moderated/mediating structural probit analysis showed no direct or indirect effect of uncertainty during hospitalization or at 3 months after hospital discharge on screening positive for PPTSD. In parents who did not report personal or family history of mental illness, uncertainty at 3 months after hospital discharge had a direct effect (b = 0.678, p < 0.001) and indirect mediating effect (b = 0.276, p < 0.001) on screening positive for PPTSD. The results provide actionable implications for mental health and NICU providers: (1) routine screening for uncertainty and risk factors including previous personal and family history of mental illness, and (2) the development of NICU follow‐up support services to mitigate risk for PPTSD.
Effect of low skeletal muscle mass and sarcopenic obesity on chronic kidney disease in patients with type 2 diabetes
Authors: Seo Da Hea , Suh Young Ju , Cho Yongin , Ahn Seong Hee , Seo Seongha , Hong Seongbin , Lee Yong‐ho , Choi Young Ju , Lee Eunjig , Kim So Hun
Published: September 2022

Objective

This study aimed to investigate the association between low muscle mass or sarcopenic obesity and the risk of incident chronic kidney disease (CKD) in patients with type 2 diabetes mellitus (T2DM).

Methods

A total of 3123 patients with T2DM with preserved renal function were followed up for incident CKD. Skeletal muscle mass was estimated from bioelectrical impedance analysis. CKD was defined as estimated glomerular filtration rate < 60 mL/min/1.73 m2. Sarcopenic obesity was defined as the coexistence of sarcopenia and abdominal obesity.

Results

During 8.9 years of follow‐up, 530 (17.0%) patients developed incident CKD. When patients were divided into three groups based on sex‐specific tertiles, lower muscle mass was not associated with an increased risk of incident CKD after adjustment for risk factors. However, when patients were divided into four groups according to the presence of sarcopenia and obesity, sarcopenic obesity was associated with an increased risk of incident CKD (adjusted hazard ratio 1.77; 95% CI: 1.24‐2.51; p = 0.001) compared with the other groups.

Conclusions

Sarcopenic obesity, but not low muscle mass alone, may increase the risk of CKD in patients with T2DM.