bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring the differences and influencing factors between top-down and opinion-reflective approaches regarding public acceptance of final disposal of soils removed after the Fukushima nuclear accident
Authors: Murakami Michio , Takada Momo , Shibata Yukihide , Shirai Kosuke , Ohnuma Susumu , Yasutaka Tetsuo
Published: November 2024

The final disposal of the soils removed from the area affected by the Fukushima nuclear accident will be carried out by 2045. This study investigated how acceptance of final disposal differed between top-down, opinion-aggregative, and opinion-reflective approaches to the decision outcome, and what factors influenced these differences. In 2022, a survey of 3000 randomly selected participants living outside Fukushima Prefecture was conducted using the postal method, with responses obtained from 871 consenting participants. The proportions of respondents who agreed to accept the final disposal were 22.6, 37.6 and 56.9% for the top-down, opinion-aggregative, and opinion-reflective approaches, respectively. The preferences for both opinion-aggregative and opinion-reflective approaches showed significant positive associations with interest in final disposal and social benefits, and significant negative associations with intergenerational expectations and age. This study highlights the importance of procedural fairness in determining final disposal sites, and identifies factors that contribute to greater acceptance through this process.
Tritium concentration in monthly precipitation in Okinawa and Kagoshima, southern Japan
Authors: Akata Naofumi , Ohno Kaho , Kuwata Haruka , Kheamsiri Khemruthai , Yoshinaka Yukiko , Yamada Ryohei , Kitayama Yuisa , Aizawa Sana , Nakasone Shunya , Ishimine Akinobu , Tanaka Masahiro , Shiroma Yoshitaka , Tokonami Shinji , Furukawa Masahide
Published: November 2024

This study aimed at understanding the background concentration level of tritium in precipitation in southern Japan, where precipitation samples were collected monthly in 2022 in Okinawa and Kagoshima. Tritium concentration in monthly precipitation collected in Okinawa since 2014 ranged from 0.05 to 0.39 Bq per L with the mean value (2015–2022) of 0.15 ± 0.06 Bq per L. That of Kagoshima since 2022 ranged from < 0.11 to 0.58 Bq per L with the mean value of 0.30 ± 0.13 Bq per L. Our observed values were summarized with reported values, from which a clear latitude effect for tritium concentration was found in precipitation of southern Japan.
An efficient and simple method for enriching metaphase cells for dicentric chromosome assay
Authors: Nakayama Ryo , Tran Thanh-Mai , Anderson Donovan , Takebayashi Kai , Goh Valerie Swee Ting , Fujishima Yohei , Miura Tomisato
Published: November 2024

As compared to peripheral blood mononuclear cell (PBMC) culture, a lower mitotic index (MI) is seen in whole blood (WB) culture, but WB can be directly used for culture in dicentric chromosome assay (DCA). The purpose of this study is to develop a simple protocol for metaphase enrichment to improve the metaphase frequency of WB culture. Fixed cells were obtained after performing WB and PBMC cultures for DCA after conventional fixation. An additional low-speed centrifugation of 200 × g for 1 min was performed, separating the fixed cells of WB culture into a pellet and a supernatant fraction. The additional low-speed centrifugation enriched metaphase frequency and provided an MI comparable to the PBMC culture in the pellet fraction. Our study suggests that it is possible to increase the number of metaphase cells on slides using the slow centrifugation method, which could contribute to the efficiency of chromosome aberration analysis in biodosimetry.
Development of compact electrolytic enrichment system for environmental tritium analysis
Authors: Tamari Toshiya , Shima Nagayoshi , Yamanaka Junji
Published: November 2024

The new electrolytic enrichment system with compact glass cell was designed. Three (Ni–Fe–Ni) electrodes are used, and electrolysis is carried out at a rate of 2.45 g per h with constant current density of 120 mA per cm2. This enrichment system allows the enrichment for small, limited sample volumes (e.g. Tritiated Water (HTO) recovered from air). With an initial water volume of 100 ml, the tritium enrichment factor of 7 within 2 days and a detection limit of 0.12 Bq per L can be obtained by Liquid Scintillation Counter (LSC) measurement for 1000 minutes, which is better than the direct measurement with 50 ml sample water using large vial. It is also possible to perform the high enrichment process. The initial sample volume of 700 ml enriched for 12 days by manual refilling yields a tritium enrichment factor of around 43 and detection limit of 0.02 Bq per L for 1000 minutes of LSC measurement.
Radiocarbon in aquatic biota samples in a brackish lake adjacent to a reprocessing plant in Rokkasho, Japan, from 2006 to 2022
Authors: Ueda Shinji , Kakiuchi Hideki , Hasegawa Hidenao
Published: November 2024

The commercial spent-nuclear-fuel reprocessing plant in Rokkasho, Japan, is scheduled for completion in 2024. Its fuel rods were cut into segments and chemically processed between 2006 and 2008, as part of the plant’s test operations. During the test, 14C (4.4 TBq) were discharged from the plant’s main stack into the atmosphere. At reprocessing plants, 14C has the largest contribution to the effective dose to the public among the nuclides released into the atmosphere, and it important to understand the concentration distribution and impact of 14C in the surrounding environment. This study conducts a continuous monitoring of 14C in aquatic biota samples around the plant from 2006 to 2022. The 14C concentration in most samples was determined at the background level, and the effect of the plant was slightly recognized in some samples. Moreover, the specific radioactivity of 14C decreased faster than the theoretical decay from 0.242 to 0.225 Bq-g C−1.
Investigation of short-term chemical changes in stable ruthenium added to soil by using X-ray absorption fine-structure analysis
Authors: Unno Yusuke , Takeda Akira
Published: November 2024

Radioactive ruthenium may be accidentally released from spent nuclear fuel reprocessing plants to the surrounding environment. However, research on the chemical behavior of radioactive Ru in the environment is limited, and the complex chemical properties of this element complicate the application of extraction methods for the analyses of its chemical forms. To obtain basic information regarding the outcome of radioactive Ru in the environment, we investigated the changes in the form of stable Ru added to soil through X-ray absorption fine-structure (XAFS) analysis. This study uses ruthenium tetroxide (RuO4), ruthenium dioxide (RuO2), ruthenium nitrosyl nitrate (Ru(NO)(NO3)3) and ruthenium chloride (RuCl3) as test sources. These are added to ultrapure water, soil solution or fresh soil samples, which are analyzed using XAFS immediately or 5 days after Ru addition. The Ru K-edge X-ray absorption near edge structure spectra acquired immediately after Ru addition differed with respect to the source. The XAFS results suggest that RuO4 immediately changes to tetravalent form after deposition from air to soil. For RuCl3, the ionic structure in the vicinity of Ru is affected by the soil even if the valence does not change immediately. By contrast, RuO2 and Ru(NO)(NO3)3 are highly stable in soil. The results show that the chemical forms of RuO2 and Ru(NO)(NO3)3 added to the soil solution and soil are retained for 5 days, whereas those of RuCl3 and RuO4 are affected by the soil solution and soil within a short period. These results emphasize the need to focus on the chemical form of Ru deposits and the form change after Ru addition when investigating the environmental fate of radioactive Ru.
A room of one’s own? The consequences of living density on individual well-being and social anomie
Authors: Hadziabdic Sinisa , Kohl Sebastian
Published: November 2024

The global housing affordability crisis and COVID shutdowns have put living space inequality back on the political agenda. Drawing on Durkheim’s theory of anomie and density, this paper argues that on how many square meters a society lives matters for how stable or anomic it develops. Using data from the Swiss Household Panel, we examine the selection, short-term, and dynamic effects associated with transitions to overcrowded and under-occupied dwellings. We conceptualize these transitions as disruptive events that require a reconfiguration of personal and social equilibria in individuals’ lives. While overcrowded housing leads to a heightening of emotional states and more tense internal household dynamics, people respond by adjusting their leisure activities and restructuring their support networks from strong to weak ties. Conversely, moving to an under-occupied dwelling is associated with melancholic emotional stabilization, but improves household balance and leads to consolidation of the core network of relatives at the expense of outer social circles. We conclude that the classical characterization of anomie as a mismatch between personal means and societal ends should be understood as a multifaceted phenomenon in which meso-level social networks can be a crucial means to cope with disruptions that arise at other levels.
Rapid disease progression of myelodysplastic syndrome is reflected in transcriptomic and functional abnormalities of bone marrow mesenchymal stromal cells
Authors: Than Hein , Fan Xiubo , Cheung Alice M S , Hwang William Y K , Poon Zhiyong
Published: November 2024

Bone marrow (BM) mesenchymal stromal cells (MSCs) are important regulators of hematopoietic stem and progenitor cells (HSPCs). When transformed into a dysplastic phenotype, MSCs contribute to hematopoietic diseases such as myelodysplastic syndromes (MDS), but it remains unclear if there are specific properties in MDS-MSCs that contribute to the disease course. To understand this, we investigated MDS-MSCs from fast (MDSfast) vs slow (MDSslow) progressing disease groups and discovered differences between these groups. MDSfast-MSCs secrete more inflammatory factors, support myeloid-skewed differentiation of HSPCs, and importantly, show poorer response to hypomethylation as a key differentiator in GSEA analysis. When exposed to long-term in vivo stimulation with primary MDSfast-MSCs-based scaffolds, healthy donor (HD) HSPCs show elevated NF-κB expression, similar to leukemic HSPCs in MDS. Those “MDSfast-MSCs-primed” HD-HSPCs continue to show enhanced engraftment rates in secondary MDS-MSC-based scaffolds, providing evidence for the microenvironmental selection pressures in MDS toward leukemic HSPCs. Together, our data point toward a degree of co-development between MSCs and HSPCs during the progression of MDS, where changes in MDS-MSCs take place mainly at the transcriptomic and functional levels. These unique differences in MDS-MSCs can be utilized to improve disease prognostication and implement targeted therapy for unmet clinical needs.
Ocular outcomes of toxoplasmosis in the Amazon–Cerrado transition zone, Brazil: a population-based study
Authors: Salamoni Ana Paula , da Costa Kelly Clair de Moura , Giachini Fernanda R , Bressan Alecsander F
Published: November 2024

Background

Eye damage represents one of the gravest outcomes of toxoplasmosis, potentially leading to varying degrees of vision impairment, up to and including blindness. Monitoring ophthalmological indicators in individuals affected by toxoplasmosis, alongside understanding its impact on visual acuity, can motivate the scientific community to advocate for strategies to prevent vision loss associated with toxoplasmosis.

Methods

This is a retrospective study analysing medical records and clinical documentation from patients at an ophthalmological clinic in a city located at the intersection of the Cerrado and Amazon Forest biomes.

Results

It was noted that >20% of patients exhibited visual acuity ≤20/200, a condition medically recognized as blindness for the affected eye. Our study highlights a significant portion of individuals experiencing lasting visual impairments due to toxoplasmosis.

Conclusions

These findings remain obscured by the existing national guidelines, which only mandate reporting for congenital and gestational toxoplasmosis cases, thereby overlooking sporadic manifestations and their consequential effects. The effort to identify ophthalmologic consequences is crucial both for personalized clinical care and for shaping national guidelines for managing toxoplasmosis.
Entomological investigation after an outbreak of dengue at the riverside of Rio Doce, Espírito Santo State, Brazil
Authors: Rezende Helder Ricas , Vicente Creuza Rachel , Chahad-Ehlers Samira , Cardoso Orlei Amaral , Cerutti Crispim , Romano Camila Malta , de Souza Caio Santos , Caleiro Giovana Santos , Guedes Bruno Luiz Miranda , Ferreira Lucas Mendes , de Alencar Filomena Euridice Carvalho
Published: November 2024

Background

In 2019, a dengue outbreak involving Aedes albopictus occurred in a rural area of Espírito Santo, Brazil, motivating our study in Sooretama and Linhares.

Methods

We set traps to sample immature mosquito larvae at 40 sites, with weekly inspections from July 2022 to January 2023. Adult specimens were collected monthly at 19 sites, each collection lasting 15 min. The collections were performed during daylight using a Castro vacuum device, a small electric vacuum suction device, a net capture device and insect cages. We conducted molecular analyses of adult Aedes to identify arbovirus infection.

Results

Among 20 217 immature forms, we identified Aedes aegypti (n=16 340), Aedes albopictus (n=3403), Culex quinquefasciatus (n=426) and Limatus durhami Theobald 1901 (n=48). Of the 3026 adult specimens, there were C. quinquefasciatus (n=2857), A. aegypti (n=141) and A. albopictus (n=28). Each site had an average of 159 adult specimens, 16 per house. Among the 159 specimens, 150 were C. quinquefasciatus. The average frequency of adult A. aegypti per house was 1.2 (0.08 per minute of collection). Adult Aedes were not infected.

Conclusions

Entomological surveillance should consider A. albopictus and A. aegypti in rural areas, providing proper vector control strategies to prevent the spread of arboviruses.
Perioperative Medicine for Ambulatory Surgery
Authors: Monteith Kelsey , Pai Sher-Lu , Lander Heather , Atkins Joshua H. , Lang Tyler , Gloff Marjorie
Published: November 2024

Ambulatory anesthesia for same-day surgery is a fast-growing and ever-improving branch of modern anesthesia. This is primarily driven by the involvement of anesthesiologists as perioperative physicians working in multidisciplinary groups. These groups work together to improve patient safety, patient outcomes, and overall efficiency of both in-patient and out-patient surgery. Appropriate patient selection and optimization are critical to maintain and improve the foundational entities of best ambulatory anesthesia practice. In this review article, a selection of considerations in the field of ambulatory anesthesia are featured, such as the aging population, sleep apnea, obesity, diabetes, cardiac disease, substance abuse, preoperative medication management, multimodal analgesia, social determinants of health, and surgical facility resources.
Epigenetics Embedding of Oral Feeding Skill Development in Preterm Infants
Authors: Griffith Thao , White-Traut Rosemary , Tell Dina , Green Stefan J. , Janusek Linda
Published: November 2024

Background:

Preterm infants face challenges to feed orally, which may lead to failure to thrive. Oral feeding skill development requires intact neurobehaviors. Early life stress results in DNA methylation of NR3C1 and HSD11B2, which may disrupt neurobehaviors. Yet, the extent to which early life stress impairs oral feeding skill development and the biomechanism whereby this occurs remains unknown. Our team is conducting an NIH funded study (K23NR019847, 2022-2024) to address this knowledge gap.

Purpose:

To describe an ongoing study protocol to determine the extent to which early life stress, reflected by DNA methylation of NR3C1 and HSD11B2 promoter regions, compromises oral feeding skill development.

Methods:

This protocol employs a longitudinal prospective cohort study. Preterm infants born between 26 and 34 weeks gestational age have been enrolled. We evaluate early life stress, DNA methylation, cortisol reactivity, neurobehaviors, and oral feeding skill development during neonatal intensive care unit hospitalization and at 2-week post-discharge.

Results:

To date, we have enrolled 70 infants. We have completed the data collection. Currently, we are in the data analysis phase of the study, and expect to disseminate the findings in 2025.

Implications for Practice and Research:

The findings from this study will serve as a foundation for future clinical and scientific inquiries that support oral feeding and nutrition, reduce post-discharge feeding difficulties and lifelong risk of maladaptive feeding behaviors and poor health outcomes. Findings from this study will also provide further support for the implementation of interventions to minimize stress in the vulnerable preterm infant population.
Impact of Obstructive Sleep Apnea on Outcomes after Anterior Cervical Discectomy and Fusion
Authors: Narayanan Rajkishen , Tarawneh Omar H. , Dalton Jonathan , Miller Mark , Oris Robert J. , Issa Tariq Z , Meade Matthew , Pohl Nicholas B. , Tomlak Alexa , Mehta Aayush , Witt Logan , Bhamidipati Abhi , Ponna Anish , Berthiaume Emily , Kaye Ian D. , Kurd Mark F. , Canseco Jose A. , Hilibrand Alan S. , Vaccaro Alexander R. , Schroeder Gregory D. , Kepler Christopher K.
Published: November 2024

Study Design.

Retrospective Cohort

Objective.

To evaluate the impact of having a history of Obstructive Sleep Apnea (OSA) in patients undergoing anterior cervical discectomy and fusion (ACDF) on postoperative outcomes.

Summary of Background Data.

With an aging population and rates of obesity increasing, comorbidities that influence patient safety are increasingly common. One frequently overlooked comorbidity is OSA which affects nearly 24% of the population. Despite its prevalence, the impact of OSA on outcomes following ACDF is poorly understood.

Methods.

A retrospective analysis of patients >18 years who underwent 1-4 level ACDF at an academic medical center from 2014-2020 was performed. Patient’s age, sex, BMI, CCI, hypertension, diabetes, and levels fused were propensity matched in a 3:1 fashion. Outcomes assessed included inpatient complications, 30 and 90-day ED visits, 30 and 90-day readmissions, reoperations, and one-year PROMs.

Results.

A total of 344 ACDF patients (86 OSA, 258 No OSA) were included. 30-day ED visits were higher among the OSA compared to the non-OSA group (5.85% vs 0%, P=0.001). Among ED visits, there were 2 patients with pneumonia, 1 with dysphagia, and 1 with extremity weakness, none of which warranted readmission. ED visits equalized in the 30–90-day window. There were no significant differences in inpatient complications, LOS, discharge disposition, readmissions, reoperations, and one-year PROMs.

Conclusion.

Patients with a history of OSA underwent ACDF without an increased risk of postoperative complications, readmissions, or reoperations and experienced a complication rate much lower than previously suggested by current literature. OSA patients experienced similar improvements in PROMs at 1-year follow-up. Surgeons should counsel OSA patients regarding the increased risk of 30-day ED visits. But overall, patients can expect safe and equivalent outcomes compared to non-OSA patients which lends support for safe outpatient surgery in this population.
Changes in Physical Function After Long Corrective Fusion to the Ilium for Adult Spinal Deformity
Authors: Watanabe Kei , Ohya Wataru , Hatsushikano Shun , Shimoda Haruka , Hasegawa Kazuhiro
Published: November 2024

Study Design.

Prospective cohort study.

Objective.

To investigate longitudinal changes in physical functional status after long corrective fusion in patients with adult spinal deformity (ASD) during 2 years of follow-up.

Summary of Background Data.

In ASD surgery, reports assessing physical functional status in long-term observations for more than a year are lacking. Assessing whether patients maintain significant improvements in their physical status with a longer follow-up duration is crucial.

Methods.

A total of 70 female patients with ASD who underwent long corrective fusion of ≥ 7 segments between June 2016 and June 2022 were included in this study. Preoperative and postoperative assessments (at 6 months, 1 year, and 2 years) included radiographic spinopelvic parameters, health-related quality of life (HRQOL) using the Scoliosis Research Society Outcome Instrument-22 (SRS-22) questionnaire, and physical function tests conducted by a physical therapist.

Results.

All domains of the SRS-22 improved the most in the first 6 months after surgery (P <0.0001); however, the Pain and Function domains continued to improve gradually until 2 years postoperatively. Regarding trunk dynamic balance, the timed up-and-go test score improved gradually until 2 years postoperatively (P <0.0001). Regarding gait performance, gait speed and the 6-minute walking test improved the most in the first 6 months after surgery (P <0.01) and almost reached a plateau 1 year postoperatively.

Conclusions.

Long corrective fusion for ASD significantly enhanced physical function and HRQOL within 2 years, with the greatest improvement in the first 6 months after surgery. These findings underscore the importance of increasing activities of daily living through early exercise instruction, as well as preventive measures to avoid early surgery-related complications.

Level of Evidence.

3
Clinical Subtype Trajectories in Sepsis Patients Admitted to the ICU: A Secondary Analysis of an Observational Study
Authors: Slim Marleen A. , van Amstel Rombout B. E. , Müller Marcella C.A. , Cremer Olaf L. , Vlaar Alexander P. J. , van der Poll Tom , Wiersinga W. Joost , Seymour Christopher W. , van Vught Lonneke A. ,   MARS Consortium
Published: November 2024

OBJECTIVES:

Sepsis is an evolving process and proposed subtypes may change over time. We hypothesized that previously established sepsis subtypes are dynamic, prognostic of outcome, and trajectories are associated with host response alterations.

DESIGN:

A secondary analysis of two observational critically ill sepsis cohorts: the Molecular diAgnosis and Risk stratification of Sepsis (MARS) and the Medical Information Mart for Intensive Care-IV (MIMIC-IV).

SETTING:

ICUs in the Netherlands and United States between 2011–2014 and 2008–2019, respectively.

PARTICIPANTS:

Patient admission fulfilling the Sepsis-3 criteria upon ICU admission adjudicated to one of four previously identified subtypes, comprising 2,416 admissions in MARS and 10,745 in MIMIC-IV.

MAIN OUTCOMES AND MEASURES:

Subtype stability and the changes per subtype on days 2, 4 and 7 of ICU admission were assessed. Next, the associated between change in clinical subtype and outcome and host response alterations.

RESULTS:

In MARS, upon ICU admission, 6% (n = 150) of the patient admissions were α-type, 3% (n = 70) β-type, 55% (n = 1317) γ-type, and 36% (n = 879) δ-type; in MIMIC-IV, this was α = 22% (n = 2398), β = 22% (n = 2365), γ = 31% (n = 3296), and δ = 25% (2686). Overall, prevalence of subtypes was stable over days 2, 4, and 7. However, 28–56% (MARS/MIMIC-IV) changed from α on ICU admission to any of the other subtypes on day 2, 33–71% from β, 57–32% from γ, and 50–48% from δ. On day 4, overall subtype persistence was 33–36%. γ or δ admissions remaining in, or transitioning to, subtype γ on days 2, 4, and 7 exhibited lower mortality rates compared with those remaining in, or transitioning to, subtype δ. Longitudinal host response biomarkers reflecting inflammation, coagulation, and endothelial dysfunction were most altered in the δ-δ group, followed by the γ-δ group, independent of the day or biomarker domain.

CONCLUSIONS AND RELEVANCE:

In two large cohorts, subtype change to δ was associated with worse clinical outcome and more aberrant biomarkers reflecting inflammation, coagulation, and endothelial dysfunction. These findings underscore the importance of monitoring sepsis subtypes and their linked host responses for improved prognostication and personalized treatment strategies.
Evaluation of factors effecting survival of patients following massive transfusion and analyzing characteristics of massive transfusion protocol
Authors: Ram Nakhul , Ganvir Aditya , Pathinangil Antony Joseph , Jumkhawala Khatija , Bhusare Dattatray B. , Alla Sai Santhosha Mrudula , Gowda Anoushka , Alla Deekshitha , Pillai Sanjay , Thapa Rubina , Alluri Hanisha , Sree Krithi , Tulala Ramakrishna
Published: November 2024

Objective:

To examine the impact of the time elapsed between a traumatic event and the implementation of a massive transfusion protocol on the patient outcomes and to analyze the characteristics of the protocol depending on the type of injury sustained.

Methods:

A total of 50 polytrauma patients who received blood transfusion by massive transfusion were included in the study. Demographic details, mechanism of injury, duration of time between injury, and other vital data were collected for analysis.

Results:

Our study revealed that the mean duration between the occurrence of injury and massive transfusion protocol activation (185 min) was highest among individuals who succumbed to their injuries within 1 hour and shortest among individuals who survived beyond the 24 hours following trauma (20.3 min) (P < 0.005). Blunt trauma had a lesser mortality rate (35.1%) than the penetrating type of trauma (61.5%). The average amount of fresh frozen plasma administered to patients with penetrating trauma (3.15) was significantly higher than that of blunt trauma (2.35) (P < 0.05).

Conclusion:

Delaying massive transfusion increases trauma patient mortality. Swift initiation of massive transfusion stabilizes severe blood loss cases. Varied blood product ratios and initiation times highlight the necessity for a standardized protocol.
The WHO surgical safety checklist for cesarean section in an Ethiopian teaching hospital: a prospective cross-sectional study
Authors: Mogessie Yidnekachew , Woldehana Nathnael Abera , Rhee Daniel S. , Kennedy Caitlin , Baral Stefan , Tufa Tesfaye
Published: November 2024

Background:

Implementing the World Health Organization (WHO) Surgical Safety Checklist is crucial for preventing post-surgical complications, including surgical site infections, in low-resource settings such as Ethiopia. The country has the lowest measured rate of safe surgery worldwide, with a significant unmet need for safe and affordable surgical care. The WHO checklist can improve maternal health equity by enhancing surgical and obstetric care safety, ultimately improving maternal outcomes in low- and middle-income countries (LMICs).

Objective:

This study aimed to assess the compliance, completeness, and determinants of using the WHO’s Surgical Safety Checklist during cesarean section (CS).

Methods:

This prospective study was conducted in the Obstetrics and Gynecology Department of a large tertiary hospital in Addis Ababa, Ethiopia. Primary data were collected from observations of clinical interactions in the obstetrics operating room (OR) during CSs. The rates of performing the checklist and completing each section were analyzed.

Results:

Of 250 observed CSs, 26.4% were elective, and 73.6% were emergency procedures. Patient ages ranged from 18 to 45 years, with a median age of 28. The overall compliance rate for the WHO surgical safety checklist was 98%, with 100% compliance for elective procedures and 97.2% for emergency procedures. The completeness rates for sign-in, time-out, and sign-out were 80.1%, 66.4%, and 45.3%, respectively.

Conclusion:

The study revealed high compliance but low completeness rates for the surgical safety checklist during CS. A noticeable distinction was observed, with elective procedures exhibiting superior compliance and completeness rates compared to emergency procedures. This could be attributed to the sense of urgency and limitations in available time.
Eccentric Superficial Anterior Lamellar Keratoplasty for Bilateral Limbal Stem Cell Deficiency
Authors: Ashton Christopher , Sibley Daniel , Balal Shafi , Ahmad Sajjad
Published: November 2024

Purpose:

To describe and report the outcomes of allogeneic eccentric superficial anterior lamellar keratoplasty (SALK), a novel surgical technique, in the management of total bilateral limbal stem cell deficiency (LSCD).

Methods:

Data were collected retrospectively on all patients with total bilateral LSCD who underwent SALK. Previous surgery, preexisting glaucoma, conjunctivalization, vascularization, lens status, and preoperative best-corrected visual acuity (BCVA) were collected from medical notes.

Results:

Fifteen eyes underwent eccentric SALK between November 2018 and October 2021. The average age of patients at the time of SALK was 50.3 (SD ± 21.0). There were 4 male and 11 female patients, 9 left eyes and 6 right eyes. The mean difference between pre- and post-BCVA scores were 0.43 LogMAR (95% CI, 0.23–0.63). Ten patients noted an improvement in the features of LSCD with an improvement in BCVA. Five cases were deemed a complete success with a complete resolution of corneal epithelium, no recurrence of LSCD features and an improvement in BCVA. Patients who developed fungal keratitis had poor outcomes.

Conclusions:

This study describes a new surgical technique of eccentric SALK to treat anterior stromal opacity and restore limbal stem cell function without systemic immunosuppression. The surgery improves the vision in most patients. However, in this complicated patient group, close postsurgical management is vital to recognize complications and intervene with treatment as needed.
Patient Education in Health Care: Exploring Strategies for Effective Comprehension, Recall, and Compliance
Authors: Casey Erin , Sherman Jeremy
Published: November 2024

Introduction

Patient education is recognized to be essential in orthotic and prosthetic care. However, there are no current standardized methods of educating patients. This literature review looked at the most effective current methods of educating patients in terms of comprehension, recall, and compliance.

Methods

Inclusion and exclusion criteria for articles were determined. Search strategy was developed using keywords, MeSH terms, and Boolean operators and applied to three different databases (Medline Ovid, Embase, and Web of Science).

Results

After searching on Medline Ovid, Embase, and Web of Science, 833 articles were found after deduplication, with 49 articles included in the final review.

Conclusions

The review found that delivering the education in terms of behavioral advice and multimodal methods was the most effective. Patients’ preference of education delivery, mood, attitude toward their condition, and relationship with their provider also need to be considered. Further research needs to be done on effective methods of delivering patient education.

Clinical Relevance

This research has the potential to lead to future studies in educating patients who utilize orthotic and prosthetic devices. The aim of the project is to eventually standardize or create best practice guidelines for patient education in the field of Orthotics and Prosthetics with the intent of improving comprehension, recall, and compliance.
Emergence of hypervirulent Klebsiella pneumoniae isolates from some Iraqi hospitals
Authors: Alansary Iman Mohammad Mahmood , Al-Saryi Nadal Abdulamer
Published: November 2024

HypervirulentKlebsiella pneumoniae(hvKp) is an emerging pathotype, which first appeared in Asian Pacific Rim but spread globally. This pathotype usually causes the acquired community infections, which infect healthy individuals. The infections by hvKp pathotype affect multiple sites or subsequently metastatically spreads, which required an urgent source control. The hvKp pathotype strains have increased their ability to infect endophthalmitis and central nervous system. Therefore, the rapid treatment is required to control these infections. This study aimed to detect hvKp in some of Iraqi hospitals and confirm the emergence of this pathotype. One hundred isolates ofK. pneumoniaewere collected during this study over the period from October 2021 to January 2022. Primary identification of these hvKp isolates was done by string and tellurite resistant tests. Later, the isolates that were positive for both string and tellurite tests (33%) were selected for molecular identification of this pathotype and siderophore production test. Two out of 33 of selected isolates (5.8%) were identified as hvKp in this study. These isolates contain four or five of suggested gene biomarkers borne on virulence plasmid (peg-344, iroB,iucA,prmpA, andprmpA2) to detect hvKp isolates. Furthermore, 19 isolates (57.57%) had one or more of these genes, which suggested that they have the potential to be hvKp. Out of 33 isolates, 17 isolates showed a PCR product foriucAgene (belongs toiucoperon encoding aerobactin) selected for siderophore production test. Two methods were used to measure production of siderophore. Most of the tested isolates showed a high level of siderophore production but hvKp isolate, which was positive foriucAandiroBshowed the highest siderophore production.
Annual Survey of State and Territorial Chronic Disease Prevention and Health Promotion Capacity and Organizational Development Needs—United States, 2023
Authors: Lankau Emily W. , Chiang Monica , Dudley Julie , Miller Kimberly , Shields Ann Marie , Alongi Jeanne , Macchi Marti , Hohman Katherine H.
Published: November 2024

Objective:

The National Association of Chronic Disease Directors (NACDD) is a nonprofit organization that supports state and territorial chronic disease prevention and health promotion efforts through capacity building and technical assistance. Each year, NACDD surveys health department leaders who oversee chronic disease prevention and health promotion (hereafter, Chronic Disease Directors). We have previously used the annual survey results to inform strategic planning and resource allocation but have not historically published key findings in the peer-reviewed literature. In this paper, we report on NACDD’s 2023 survey outcomes and place those findings into the broader public health policy context.

Design:

State Chronic Disease Directors completed a survey about their organizational capacity and development needs. Responses were summarized in aggregate and by jurisdiction size.

Results:

State chronic disease units have varied staffing and responsibilities, but most address diabetes, cardiovascular diseases, and cancer screening and prevention. Chronic Disease Directors generally reported strong or improving capacity in most practice areas but ranked workforce development lower. Staffing increased slightly during 2023 compared with the 2020 baseline (median of 1.3 and 1.1 employees per 100 000 jurisdiction population, respectively). However, Chronic Disease Directors expressed ongoing concerns about turnover, hiring, and training of inexperienced staff, as well as about funding limitations and uncertainty. Looking forward to 2024, many Chronic Disease Directors expressed intentions to focus on supporting their workforce with training and development opportunities and addressing health equity.

Conclusions:

During this period of pandemic recovery, turnover, hiring, and training—particularly of the many new public health staff—remain key areas of concern for many chronic disease units. Continued stabilization of public health funding and increased prioritization of organizational capacity development—particularly workforce development, chronic disease data systems, and tools for addressing health equity—could help ensure chronic disease units can better address current and emerging challenges in chronic disease prevention and health promotion.
Genomic Surveillance of Foodborne Pathogens: Advances and Obstacles
Authors: Gensheimer Kathleen , Allard Marc W. , Timme Ruth E. , Brown Eric , Hintz Leslie , Pettengill Jamie , Strain Errol , Tallent Sandra M. , Vélez Lili F. , King Ewa , Shea Sharon L.
Published: November 2024

Context:

The genomic surveillance of foodborne pathogens in the United States has grown exponentially in the past decade, grounded in a powerful combination of novel sequencing technologies, bioinformatic approaches, data-sharing networks, and metadata harmonization efforts. This practice report examines recent advances in genomic epidemiology as applied to food safety programs and delineates State, Tribal, Local, and Territorial infrastructure necessary for continued life-saving improvements in public health.

Program:

National databases of foodborne pathogen genomes, along with data sharing and evaluation networks such as GenomeTrakr and PulseNet, have transformed how connections are made among isolates and how root causes of outbreaks are determined, allowing much more timely interventions to protect public health. Freely available bioinformatics tools such as GalaxyTrakr and the National Center for Biotechnology Information Pathogen Detection database have allowed laboratories with limited local computing resources to participate in surveillance efforts and contribute to traceback investigations.

Implementation:

In this report, we describe advances in genomic epidemiology that have occurred over the past decade and examine obstacles to fully implementing this technology within State, Tribal, Local, and Territorial public health systems.

Evaluation:

Despite a clear return on investment from governmental expenditures on genomic surveillance of foodborne pathogens, we identify significant obstacles to further sustained progress. These obstacles include workforce gaps, ineffective data sharing, and lack of constitutive and sustained funding.

Discussion:

Many public health laboratories face major obstacles to widespread and routine adoption of genomic surveillance technologies. While whole genome sequencing has become an integral part of routine public health microbiology, the seamless integration of these protocols into the existing practices, laboratory workflows, and information systems remains challenging. Centralized efforts to address these issues include (1) support through the Food and Drug Administration Laboratory Flexible Funding Model, (2) training and proficiency assessments, (3) open-source, standardized protocols for collecting high-quality genomic data, and (4) open access informatics software.
Development of 3D-printed braces protocol for juvenile idiopathic scoliosis: From the torso measurement and mechanical properties to preliminary experience on fitting
Authors: Liu Xue-Cheng , Rizza Robert , Hebert Claire , Thometz John , Tassone Channing , Escott Benjamin , Thiessen Adam , Anewenter Vincent
Published: November 2024

Background:

There has been no standard for a rapid prototyping process in manufacturing of the 3D-printed brace with respect to its design, biomechanical properties, procedures, and brace adjustment and fitting.

Objective:

Objective of this study was to develop the 3D-printed brace protocol for juvenile idiopathic scoliosis.

Methods:

With the help of the Torso Measurement Frame, the child stands still and is positioned with 1 of 2 manipulation techniques by the physician. Although the patient is in the corrected position, a hand-held scanner registers the three-dimentional (3D) torso, and then the brace is designed using computer aided design (CAD) model. Finite element analysis is used to determine the minimum required thickness of the brace. Acrylonitrile Butadiene Styrene (ABS) material (thermoplastic polymers) and DuraForm PA plastic (Nylon) material were printed by 2 different systems, respectively, and were tested using standard tensile test procedures.

Results:

The minimum thickness of the brace should be 2 mm to maintain a standard structural factor of safety twice that of the material failure strength. The strain in elongation was less for the ABS compared to the 3D-printed Nylon (6% vs. 14%), and the tensile strength was reduced more for ABS as compared to Nylon (42% vs. 14%). The ABS brace could not withstand changes in tension and cracked when drilled into, heat flared, or donned tightly. However, the Nylon brace improved strength and eliminated the vulnerable aspects.

Conclusions:

The Nylon material for the 3D-printed brace improved ease of adjustments in trimming, drilling, and heat modifications for better fit and function.
Development and Clinical Evaluation of a Contrast Optimizer for Contrast-Enhanced CT Imaging of the Liver
Authors: Setiawan Hananiel , Ria Francesco , Abadi Ehsan , Marin Daniele , Molvin Lior , Samei Ehsan
Published: November 2024

Objective

Patient characteristics, iodine injection, and scanning parameters can impact the quality and consistency of contrast enhancement of hepatic parenchyma in CT imaging. Improving the consistency and adequacy of contrast enhancement can enhance diagnostic accuracy and reduce clinical practice variability, with added positive implications for safety and cost-effectiveness in the use of contrast medium. We developed a clinical tool that uses patient attributes (height, weight, sex, age) to predict hepatic enhancement and suggest alternative injection/scanning parameters to optimize the procedure.

Methods

The tool was based on a previously validated neural network prediction model that suggested adjustments for patients with predicted insufficient enhancement. We conducted a prospective clinical study in which we tested this tool in 24 patients aiming for a target portal-venous parenchyma CT number of 110 HU ± 10 HU.

Results

Out of the 24 patients, 15 received adjustments to their iodine contrast injection parameters, resulting in median reductions of 8.8% in volume and 9.1% in injection rate. The scan delays were reduced by an average of 42.6%. We compared the results with the patients' previous scans and found that the tool improved consistency and reduced the number of underenhanced patients. The median enhancement remained relatively unchanged, but the number of underenhanced patients was reduced by half, and all previously overenhanced patients received enhancement reductions.

Conclusions

Our study showed that the proposed patient-informed clinical framework can predict optimal contrast enhancement and suggest empiric injection/scanning parameters to achieve consistent and sufficient contrast enhancement of hepatic parenchyma. The described GUI-based tool can prospectively inform clinical decision-making predicting optimal patient's hepatic parenchyma contrast enhancement. This reduces instances of nondiagnostic/insufficient enhancement in patients.
Risk of Infertility in Reproductive-Age Patients With Thyroid Cancer Receiving or Not Receiving 131I Treatment
Authors: Lin Chun-Yi , Lin Cheng-Li , Kao Chia-Hung
Published: November 2024

Background

Fertility is the crucial concern for many survivors of cancer diagnosed as children, adolescents, and young adults. The objective of this study was to determine the risk of infertility in reproductive-age patients with thyroid cancer receiving or not receiving radioiodine treatment in Taiwan.

Methods

This nationwide population-based cohort study was conducted using data obtained from the Taiwan National Health Insurance Database from 2009 to 2019. A total of 20,259 thyroid cancer patients aged from 15 to 50 years (8037 did not receive 131I treatment, and 12,222 received 131I treatment) and 20,259 controls were enrolled. A Cox proportional hazards model was applied to estimate the risk of infertility in thyroid cancer patients receiving or not receiving 131I treatment in terms of hazard ratios and 95% confidence intervals.

Results

The incidence rates of infertility in thyroid cancer receiving 131I therapy, those not receiving 131I therapy, and controls were 5.55, 5.07, and 3.61 per 1000 person-years, respectively. Compared with thyroid cancer patients treated with a cumulative 131I dose of 4.44 GBq or less, the risk of infertility was not significantly increased in those treated with a cumulative 131I dose of more than 4.44 GBq (adjusted hazard ratio, 1.13; 95% confidence interval, 0.95–1.36).

Conclusions

The greatest increased risk of infertility in reproductive-age patients with thyroid cancer is associated with the fact that the patient has thyroid cancer regardless of 131I administration. 131I treatment or cumulative dose of 131I greater than 4.44 GBq did not further increase the risk of infertility.
Standardized Patient Education Focused on Equity Deserving Groups
Authors: Sheth Urmi T. , Last Nicole A. , Keuhl Amy C. , Azim Arden R.K. , Chen Ruth P. , Dhir Jasdeep , Farrugia Patricia R. , Geekie-Sousa Aaron G. , McCarthy Jeffrey M. , Tong X. Catherine , Monteiro Sandra D. , Sibbald Matthew G.
Published: November 2024

Introduction

Health professions training programs must train future healthcare providers to meet the needs of equity-deserving patient populations. Standardized patient (SP) programs are one mechanism by which this training can occur. Our aim was to develop a set of recommendations for SP programs and educators around planning, organizing, and delivering SP-based education involving equity-deserving groups.

Methods

We undertook a qualitative analysis of interview transcripts of SPs, educators, and trainers involved in SP work with equity-deserving groups. Subsequently, we conducted a three-stage modified Delphi process to generate recommendations.

Results

We derived 10 tips to help stakeholders improve SP-based education involving equity-deserving groups. The underlying themes included collaborative involvement, including co-creation and co-delivery of content with members of equity-deserving groups, as well as consistent prioritization of the needs of SPs throughout the process.

Conclusions

Our findings suggest ways in which SP programs and educators can better train future healthcare providers to meet the needs of equity-deserving patient populations.
Value in acute care surgery, part 4: The economic value of an acute care surgery service to a hospital system
Authors: Leichtle Stefan , Murphy Patrick , Nahmias Jeffry , Bruns Brandon , Agapian John , Smith Sawyer , Kim Phillip , Dowzicky Phillip , Haddad Diane , Adams Raeanna C. , Hu Parker , Ayung Chee Patricia , Crandall Marie , Martin R. Shayn , Staudenmayer Kristan ,   AAST Health Economics Committee
Published: November 2024

The Healthcare Economics Committee of the American Association for the Surgery of Trauma has published a series of three articles on the topic of value in acute care surgery (ACS). In this series, the key elements of value, cost and outcomes, and the impact of stakeholder perspective on what constitutes high-value care are discussed. The fourth article in this series continues the discussion by focusing on the unique economic value that an ACS service brings to a hospital system and its patients. Characterized by the immediate 24-hour availability of surgeons trained in trauma management, emergency general surgery, and surgical critical care, acute care surgeons extend the benefits of surgical rescue and critical care to all hospitalized patients. As such, an ACS service acts as a vital part of a hospital's infrastructure to successfully care for complex and seriously ill patients, in addition to enabling the establishment of other, high revenue-generating services such as vascular, transplant, and complex oncologic surgery programs. The trauma service acts as intake for patients that lead to downstream revenue creation by other disciplines such as orthopedic and neurological surgery, while trauma center designation itself results in dedicated state funding to ensure trauma readiness in many states in the United States. The traditional “value equation” in health care of outcomes achieved per dollar spent is ill-suited to capture many of these unique aspects and benefits of ACS. This article provides the background to understand the economic value of an ACS service and future directions toward improving overall value of care.

LEVEL OF EVIDENCE

Economic & Value-based Evaluations: Level IV.