bluuebunny/crossref_metadata_2025 huggingface dataset:
Formation and desorption of sulphur chains (H2Sx and Sx) in cometary ice: effects of ice composition and temperature
Authors: Carrascosa H , Muñoz Caro G M , Martín-Doménech R , Cazaux S , Chen Y -J , Fuente A
Published: July 2024

The reservoir of sulphur accounting for sulphur depletion in the gas of dense clouds and circumstellar regions is still unclear. One possibility is the formation of sulphur chains, which would be difficult to detect by spectroscopic techniques. This work explores the formation of sulphur chains experimentally, both in pure H$_2$S ice samples and in H$_2$O:H$_2$S ice mixtures. An ultrahigh vacuum chamber, ISAC, eqquipped with FTIR and QMS, was used for the experiments. Our results show that the formation of H$_2$S$_x$ species is efficient, not only in pure H$_2$S ice samples, but also in water-rich ice samples. Large sulphur chains are formed more efficiently at low temperatures ($\approx$10 K), while high temperatures ($\approx$50 K) favour the formation of short sulphur chains. Mass spectra of H$_2$S$_x$, x = 2–6, species are presented for the first time. Their analysis suggests that H$_2$S$_x$ species are favoured in comparison with S$_x$ chains. Nevertheless, the detection of several S$_x^+$ fragments at high temperatures in H$_2$S:H$_2$O ice mixtures suggests the presence of S$_8$ in the irradiated ice samples, which could sublimate from 260 K. ROSINA instrument data from the cometary Rosetta mission detected mass-to-charge ratios 96 and 128. Comparing these detections with our experiments, we propose two alternatives: (1) H$_2$S$_4$ and H$_2$S$_5$ to be responsible of those S$_3^+$ and S$_4^+$ cations, respectively, or (2) S$_8$ species, sublimating and being fragmented in the mass spectrometer. If S$_8$ is the parent molecule, then S$_5^+$ and S$_6^+$ cations could be also detected in future missions by broadening the mass spectrometer range.
Cabin air dynamics: Unraveling the patterns and drivers of volatile organic compound distribution in vehicles
Authors: Zhang Rui , Zhao Minglu , Wang Hengwei , Wang Haimei , Kong Hui , Wang Keliang , Koutrakis Petros , Huang Shaodan , Xiong Jianyin
Published: July 2024

Volatile organic compounds (VOCs) are ubiquitous in vehicle cabin environments, which can significantly impact the health of drivers and passengers, whereas quick and intelligent prediction methods are lacking. In this study, we firstly analyzed the variations of environmental parameters, VOC levels and potential sources inside a new car during 7 summer workdays, indicating that formaldehyde had the highest concentration and about one third of the measurements exceeded the standard limit for in-cabin air quality. Feature importance analysis reveals that the most important factor affecting in-cabin VOC emission behaviors is the material surface temperature rather than the air temperature. By introducing the attention mechanism and ensemble strategy, we present an LSTM-A-E deep learning model to predict the concentrations of 12 observed typical VOCs, together with other five deep learning models for comparison. By comparing the prediction–observation discrepancies and five evaluation metrics, the LSTM-A-E model demonstrates better performance, which is more consistent with field measurements. Extension of the developed model for predicting the 10-day VOC concentrations in a realistic residence further illustrates its excellent environmental adaptation. This study probes the not-well-explored in-cabin VOC dynamics via observation and deep learning approaches, facilitating rapid prediction and exposure assessment of VOCs in the vehicle micro-environment.
Awareness without time
Authors: Frischhut Akiko
Published: July 2024

Recently, philosophers with an interest in consciousness have turned their attention towards ‘fringe states of consciousness’. Examples include dreams, trances, and meditative states. Teetering between wakefulness and non-consciousness, fringe states illuminate the limits and boundaries of consciousness. This paper aims to give a coherent conceptualization of deep meditative states, focussing in particular on phenomenal temporality during meditation. Advanced meditators overwhelmingly describe deep states of meditation as atemporal and timeless; however, they also report being continuously alert while meditating. I intend to give a coherent interpretation of this apparent contradiction. After introducing some candidate interpretations, I shall argue that during (deepest) meditation, the subject experiences ‘pure duration’ without temporal structure. This, I argue, explains best why meditators describe deep meditation as ongoing but timeless awareness. A central part of the paper will expand on an account of phenomenal duration without phenomenal succession. The conclusion points towards some further avenues of research.
Good Lawmaking, Democracy, and Accountability
Authors: Economou Emmanouil M L , Kyriazis Nicholas C
Published: July 2024

In the present paper, we analyze good lawmaking under the general aspect of democracy and accountability. We present briefly the procedure of lawmaking and accountability under the direct democracy of ancient Athens during the Classical times (508–323 BC), giving one characteristic example, followed with a comparison with modern lawmaking under representative democracy. We argue that accountability in present-day democracies has three drawbacks, that are related to (i) the principal-agent problem, (ii) the fact that accountability is only periodic since elections are held every four years (iii) the information asymmetry between government and citizens, which makes difficult for citizens to understand the issues (regarding lawmaking) in depth or hold a government accountable for its actions and decisions on various matters. We explain how the ancient Athenian democrats dealt effectively with these institutional inconsistencies. We finally conclude by offering some proposals for improving the quality of democracy nowadays, inspired by the functioning of the Athenian-related institutions.
Semi-biological photosystem: harnessing carbon dots and Geobacter sulfurreducens for solar-driven hydrogenation
Authors: Yau Mandy Ching Man , Kalathil Shafeer
Published: July 2024

Semi-biological photosynthesis utilizes the unique ability of microbial catalysts together with synthetic photosensitizers (semiconductors) to produce high-value chemicals from sustainable feedstocks. In this work, we devise a semi-biological hybrid system consisting of sustainable photosensitizers, carbon dots in the size range of 5–35 nm (CDs) interfaced with bacteria, Geobacter sulfurreducens, to reduce fumarate to succinate as a model hydrogenation reaction. After 7 days of solar irradiation, using quantitative proton nuclear magnetic resonance spectroscopy (qNMR), the CD−G. sulfurreducens photosystem produced ∼18 mM of succinate without the need for a redox mediator. Moreover, in reusing the CDs, ∼70% of the succinate (compared to the previous cycle) was recovered. The proposed photobiohybrid system paves a new avenue for sustainable solar-to-chemical conversion in high-value chemical production.
Leadership and Followership Dynamics in Interprofessional Health Care Teams: Attending Physician Perspectives
Authors: Barry Erin S. , Teunissen Pim , Varpio Lara , Vietor Robert , Kiger Michelle
Published: July 2024

Purpose

Effective interprofessional health care team (IHT) members collaborate to reduce medical errors, use resources effectively, and improve patient outcomes, making interprofessional collaboration imperative. Because physicians are often designated as the positional leaders of IHTs, understanding their perspectives on collaboration within IHTs could help to mitigate the disconnects between what is suggested in theory and what is happening in practice. This study aimed to explore leader-follower dynamics within medical teams that are commonly working in clinical care contexts.

Method

Using a constructivist approach, the authors conducted 12 individual, semistructured interviews from November 2022 to September 2023 with attending physicians who have led IHTs in perioperative (i.e., preoperative clinic, operating room, postoperative and recovery unit) or emergency department settings. The transcripts were analyzed from December 2022 to December 2023 using inductive thematic analysis.

Results

Three themes explained the physician perceptions of IHT leadership-followership dynamics: (1) physicians are comfortable sharing leadership intraprofessionally, (2) the clinical culture and environment constrain interprofessional followership and shared leadership, and (3) hierarchical models hold true even while active followers are appreciated, when appropriate.

Conclusions

The data in this study suggest that, in perioperative and emergency department settings, shared leadership largely may not occur interprofessionally but occurs intraprofessionally. Participants suggested that the clinical culture and environment (i.e., legal concerns, hierarchical assumption, patient care ownership responsibilities) constrained interprofessional followership and shared leadership. On the basis of the study’s findings and how they align with previous research, future research into interprofessional collaboration and followership roles should focus on what factors enable and constrain active followership and shared leadership. Such collaboration can only be achieved when active followership and shared leadership are allowed and promoted. These findings and others suggest that not all contexts are enabling such types of interprofessional collaboration due to legal concerns, hierarchical traditions, and patient ownership considerations.
Malignant Catatonia in the Setting of Acute Methamphetamine and Cocaine Intoxication
Authors: Mullen Nicholas J. , Meyer Karre VaKara M. , Balasanova Alëna A.
Published: July 2024

Background

Malignant catatonia is a potentially lethal neuropsychiatric syndrome characterized by psychomotor abnormalities and autonomic instability. Patients with this syndrome require immediate treatment. Various psychiatric conditions and nonpsychiatric medical problems can trigger malignant catatonia. Use of psychostimulant drugs, including methamphetamine and cocaine, has not been previously reported to precipitate malignant catatonia.

Case Summary

This case concerns a 35-year-old man hospitalized for psychosis due to methamphetamine and cocaine intoxication. He developed malignant catatonia the day after admission. He was treated with lorazepam for malignant catatonia, and his blood pressure was controlled with clonidine. Over 7 days, his condition resolved, and his mental status and vital signs returned to baseline. He was discharged to the community in stable condition and has returned to his baseline functional status. He remains free of catatonia and has maintained abstinence from methamphetamine and cocaine.

Conclusions

Acute intoxication with psychostimulant drugs is a possible trigger for malignant catatonia, and administration of high potency first-generation antipsychotics in this setting may increase the risk. Patients hospitalized for stimulant intoxication should be monitored for signs and symptoms of catatonia, and D2 receptor antagonist medications should be used with caution in this population. Our case supports the potential role of altered dopamine and norepinephrine signaling in the pathogenesis of malignant catatonia. The patient provided written and verbal consent to publish the information in this case report.
High Positive End-expiratory Pressure (PEEP) with Recruitment Maneuvers versus Low PEEP during General Anesthesia for Surgery: A Bayesian Individual Patient Data Meta-analysis of Three Randomized Clinical Trials
Authors: Mazzinari Guido , Zampieri Fernando G. , Ball Lorenzo , Campos Niklas S. , Bluth Thomas , Hemmes Sabrine N. T. , Ferrando Carlos , Librero Julian , Soro Marina , Pelosi Paolo , Gama de Abreu Marcelo , Schultz Marcus J. , Serpa Neto Ary ,   for REPEAT on behalf of the PROVHILO, iPROVE, and PROBESE investigators and the PROVE Network investigators
Published: July 2024

Background:

The influence of high positive end-expiratory pressure (PEEP) with recruitment maneuvers on the occurrence of postoperative pulmonary complications after surgery is still not definitively established. Bayesian analysis can help to gain further insights from the available data and provide a probabilistic framework that is easier to interpret. The objective was to estimate the posterior probability that the use of high PEEP with recruitment maneuvers is associated with reduced postoperative pulmonary complications in patients with intermediate-to-high risk under neutral, pessimistic, and optimistic expectations regarding the treatment effect.

Methods:

Multilevel Bayesian logistic regression analysis was performed on individual patient data from three randomized clinical trials carried out on surgical patients at intermediate to high risk for postoperative pulmonary complications. The main outcome was the occurrence of postoperative pulmonary complications in the early postoperative period. This study examined the effect of high PEEP with recruitment maneuvers versus low PEEP ventilation. Priors were chosen to reflect neutral, pessimistic, and optimistic expectations of the treatment effect.

Results:

Using a neutral, pessimistic, or optimistic prior, the posterior mean odds ratio for high PEEP with recruitment maneuvers compared to low PEEP was 0.85 (95% credible interval, 0.71 to 1.02), 0.87 (0.72 to 1.04), and 0.86 (0.71 to 1.02), respectively. Regardless of prior beliefs, the posterior probability of experiencing a beneficial effect exceeded 90%. Subgroup analysis indicated a more pronounced effect in patients who underwent laparoscopy (odds ratio, 0.67 [0.50 to 0.87]) and those at high risk for postoperative pulmonary complications (odds ratio, 0.80 [0.53 to 1.13]). Sensitivity analysis, considering severe postoperative pulmonary complications only or applying a different heterogeneity prior, yielded consistent results.

Conclusions:

High PEEP with recruitment maneuvers demonstrated a moderate reduction in the probability of postoperative pulmonary complication occurrence, with a high posterior probability of benefit observed consistently across various prior beliefs, particularly among patients who underwent laparoscopy.
The Association of Preoperative Bone Mineral Density and Outcomes After Anterior Cervical Discectomy and Fusion
Authors: Gong Davin C. , Baumann Anthony N. , Muralidharan Aditya , Piche Joshua D. , Anderson Paul A. , Aleem Ilyas
Published: July 2024

Study Design:

This is a systematic review.

Objective:

To evaluate anterior cervical discectomy and fusion (ACDF) outcomes and complications as a function of preoperative bone mineral density (BMD).

Summary of Background Data:

Preoperative BMD optimization is commonly initiated before lumbar spinal fusion, but the effects of BMD on ACDF are less known. Consequently, it remains unclear whether preoperative BMD optimization is recommended before ACDF.

Methods:

This systematic review included relevant clinical articles using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched PubMed, Web of Science, SCOPUS, and MEDLINE from database inception until October 1, 2023. Eligible studies included those evaluating low BMD and outcomes after ACDF. All articles were graded using the Methodological Index for Non-Randomized Studies (MINORS) scale and Critical Appraisal Skills Programme (CASP) assessment tools.

Results:

The initial retrieval yielded 4271 articles for which 4 articles with 671 patients were included in the final analysis. The mean patient age was 56.4 ± 3.9 years, and 331 patients (49.3%) were female. A total of 265 (39.5%) patients had low BMD (T score<-1.0) before ACDF. Preoperative low BMD was associated with cage subsidence in single-level ACDF (odds ratio (OR) 2.57; P=0.063; 95% Confidence Interval (CI): 0.95–6.95), but this result did not reach statistical significance. Osteoporosis (T score<-2.5) was associated with the development of adjacent segment disease following ACDF (OR 4.41; P<0.01; 95% CI: 1.98–9.83). Low pre-operative BMD was associated with reoperation within 2 years (P<.05) and strongly associated with pseudarthrosis (OR: 11.01; P=0.002; 95% CI 2.4–49.9).

Conclusions:

Patients with low BMD who undergo ACDF have higher rates of subsidence, adjacent segment disease, and pseudarthrosis than those with normal BMD. Given the individual and system-wide burdens associated with these complications, some patients may benefit from preoperative BMD screening and optimization before undergoing ACDF.
A randomized, pilot trial comparing vaginal hyaluronic acid to vaginal estrogen for the treatment of genitourinary syndrome of menopause
Authors: Agrawal Surbhi , LaPier Zoe , Nagpal Shavy , Oot Antoinette , Friedman Steven , Hade Erinn M. , Nachtigall Lila , Brucker Benjamin M. , Escobar Christina
Published: July 2024

Objective

The aim of this study was to compare the efficacy of a non-hormone alternative, vaginal hyaluronic acid (HLA), to a standard-of-care therapy, vaginal estrogen, for the treatment of genitourinary syndrome of menopause (GSM).

Methods

This was a randomized, parallel arm pilot trial. Women with GSM were randomized to an HLA vaginal suppository or vaginal estrogen cream for 12 wk to compare the primary outcome, the vulvovaginal symptom questionnaire (VSQ) score. Secondary outcomes included the following: the female sexual function index (FSFI), the vaginal symptom index (VSI), visual analog scale (VAS) for dyspareunia, vaginal itching, and vaginal dryness, patient global impression of improvement (PGI-I) at follow-up, vaginal maturation index, and vaginal pH. Differences between treatment groups were estimated using the two-sided, two-sample t-test and 95% confidence intervals.

Results

Forty-nine women were randomized and 45 participants (vaginal estrogen = 23, vaginal HLA = 22) provided data at week 12. Baseline characteristics were similar in both groups. On the VSQ, there was no observed difference in overall scores between the HLA and vaginal estrogen groups at 12 wk (P = 0.81). Improvement was seen within both treatment groups on the VSQ after 12 wk. The VAS score, total VSI score, total FSFI score, and vaginal pH improved over time; however, improvement did not differ between study arms. Over 90% participants noted improvement on the PGI-I in both groups (P = 0.61). No treatment-related serious adverse events occurred.

Conclusions

There were no clinically meaningful differences between vaginal HLA and vaginal estrogen for the treatment of GSM after 12 wk. Vaginal HLA may be a promising non-hormone therapy for GSM.
Rules of medication for leucorrhea in ancient books of traditional Chinese medicine based on latent structure model and association rules
Authors: Zhang Yuxin , Wang Wenlai , Yang Xinming , Chu Ce , Chen Xiangyun , Ding Wei , He Zhanzhan , Yuan Yulu , Wei Tong , Xu Yongqi , Yang Zhen , Zhao Hongxia
Published: July 2024

Objective:

To analyze syndrome differentiation and medication rules for leucorrhea in ancient books of traditional Chinese medicine (TCM) based on the “Chinese Medical Code” using the latent structure model.

Methods:

The formulations for leucorrhea were searched in the Chinese Medical Code (software), based on which an Excel sheet was created to conduct frequency analysis and construct a matrix of high-frequency medications. The high-frequency medications for leucorrhea were then analyzed using the Latent 5.0 software and a latent structure model. With SPSS Modeler and Latent 5.0 as the main analysis methods, Chinese medications with a frequency >1.00% were investigated using the latent structure model and association rules, and the medication rules in treating leucorrhea with TCM were dissected based on the data of frequency.

Results:

For 373 kinds of Chinese medicines retrieved from 236 TCM prescriptions, the total medication frequency was 2522. Chinese Angelica (Angelicae Sinensis Radix), White Peony Root (Paeoniae Radix Alba), Indian Buead Tuckahoe (Poria), Common Oyster Shell (Ostreae Concha), and Largehead Atractylodes Rhizome (Atractylodis Macrocephalae Rhizoma) were high-frequency medicines for leucorrhea. Tonic, heat-clearing, and qi-regulating medicines had a high frequency of usage. According to a formula-based analysis of the evidence, the main syndromes of leucorrhea included liver qi affecting the spleen pattern, damp heat accumulation pattern, liver qi stagnation pattern, liver-stomach disharmony pattern, yin deficiency of the liver and kidney pattern, and spleen deficiency with dampness pattern, which are generally in line with the etiology and pathogenesis of leucorrhea, namely pathogenic dampness as the detrimental factor together with spleen-kidney dysfunction. However, in ancient books, emphasis was laid out on the regulation of the liver. This study determined 31 association rules for treating leucorrhea, where the primary compatible medicines contained Chinese Angelica (Angelicae Sinensis Radix)-Nutgrass Galingale Rhizome (Cyperus rotundus), Chinese Angelica (Angelicae Sinensis Radix)-Szechwan Lovage Rhizome (Ligusticum chuanxiong Hort.), White Peony Root (Paeoniae Radix Alba)-Szechwan Lovage Rhizome (Ligusticum chuanxiong Hort.), White Peony Root (Paeoniae Radix Alba)-Adhesive Rehmannia Root Tuber (Rehmanniae Radix) and Tangerine Peel (Citri Reticulatae Pericarpium)-Ternate Pinellia (Rhizoma Pinelliae).

Conclusion:

The medication rules targeting leucorrhea in the Chinese Medical Code were mainly represented by the regulation of qi and blood, as well as the 3 internal organs—the kidney, spleen, and liver.
Exploring barriers to employee voice among certified nursing assistants: A qualitative study
Authors: Kee Karin , Nies Henk , van Wieringen Marieke , Beersma Bianca
Published: July 2024

Background

Research shows that voice—the communication of ideas, concerns, and perspectives by employees to those in positions to instigate changes—is related to job satisfaction, retention, and organizational improvement. Nevertheless, health care professionals often do not exercise voice. Although researchers have explored the barriers registered nurses working in hospitals experience in expressing their voices, there has been a notable lack of attention in research and practice to the voice of certified nursing assistants working in long-term care settings.

Purposes

Ensuring that certified nursing assistants can exercise voice is essential for the welfare and well-being of this occupational group and critical for the success of their organizations. Therefore, we explore the barriers certified nursing assistants encounter that hinder them from exercising voice.

Methodology

We conducted seven focus groups in which 24 Dutch certified nursing assistants participated.

Results

The results show that respondents were not always willing to exercise voice, which stemmed primarily from negative prior experiences with exercising voice. Respondents were further not always able to exercise voice, as the conditions under which they had to do so were unfavorable. Finally, respondents sometimes lacked the necessary skills to convey their ideas, concerns, and perspectives effectively.

Practice Implications

Our findings indicate that health care managers must address multiple factors if they wish to enhance the voice of certified nursing assistants.
The Power of Nursing
Authors: Snow Francine , Brown Linda M. , Scheller Suzanne
Published: July 2024

The COVID 19 pandemic has had a tremendous impact on nursing and health care delivery systems. Recent research demonstrates a correlation between the stress of providing complex health care and the decline of nurse well-being. Investing in the well-being of nurses can benefit the entire health care system. Educational institutions can play a role in enhancing nurse well-being by incorporating holistic nursing education principles into the curriculum, including reflective practice methods to promote self-awareness and self-care. This may be challenging for some nursing programs, but the Power of Nursing course can help close this gap. This noncommercial course incorporates key elements of holistic nursing including authenticity, empathy, compassion, unconditional acceptance, and self-care; elements not always emphasized in a traditional curriculum. Power of Nursing, offered as an elective in nursing schools or part of nursing residency programs, provides attendees with tools and strategies to boost resilience, strengthen personal commitment to nursing, and increase well-being preparing them to thrive in any health care environment.
A Qualitative Analysis of a Mindfulness-Based Stress Management Program to Reduce Stress and Burnout for Health Care Staff
Authors: Sos Tammy , Melton Bridget
Published: July 2024

Occupational stress in the work setting can lead to burnout. Health care workers are at a higher risk of experiencing stress and burnout. Mindfulness has gained momentum as a coping mechanism for stress and feelings of burnout, although it is unknown which mindfulness practices are the most effective for reducing feelings of occupational stress. The purpose of the qualitative portion of this mixed-methods study was to explore health care staff’s perceptions of the characteristics of mindfulness interventions that were effective in reducing their stress and feelings of burnout. Health care staff consisting of nurses, State Tested Nursing Aides, housekeeping staff, culinary staff, activities staff, social workers, and chaplain staff (N = 48) in a senior care and rehabilitation setting in a Midwestern city were invited to attend a semi-structured focus group, post-intervention. Thematic analysis was used to identify 3 main themes: ease of use promotes effective implementation, positive impact of mindfulness on self and others, and home- and work-related factors affect implementation. Overall, participants perceived benefit from various mindfulness practices for reducing their feelings of stress and burnout in the workplace. Guidance, ease of use of the mindfulness practice, and addressing barriers such as time and location can help with implementation.
The Effect of Reiki on Fatigue Symptoms of Cancer Patients
Authors: Bayülgen Melek Yeşil
Published: July 2024

Fatigue is one of the most common symptoms experienced by cancer patients. This systematic review aimed to investigate the effect of reiki on fatigue symptoms of cancer patients. The databases “PubMed,” “ScienceDirect,” “Scopus,” “Web of Science,” and “Cochrane Library” were screened between July 12, 2023, and July 25, 2023, using the keywords “Reiki,” “Fatigue,” and “Cancer” without any restriction to the publication year. The selected studies were evaluated using the Jadad scale, a quality assessment checklist for randomized controlled trials. Among 794 studies initially found, 5 studies meeting the inclusion criteria were included in the present systematic review. Of these studies, 2 were randomized controlled trials, 2 were quasi-experimental studies, and 1 was a cross-over study. It was found that reiki applied to cancer patients in the studies included in the systematic review reduced fatigue while being effective in pain and stress alleviation and improvement of quality of life.
Effects of Auricular Acupressure on Nurses’ Perceived Stress, Sleep Quality, and Presenteeism
Authors: Sim Hyunseo , Park Younghee
Published: July 2024

The physical and psychological health management of nurses is very important not only for individual nurses but also for organizations and patients. However, nurses are exposed to high stress, sleep problems, and high presenteeism. Therefore, this study aimed to examine the effects of auricular acupressure (AA) on nurses’ stress, sleep problems, and presenteeism. This randomized controlled trial encompassed 60 nurses divided into an experimental group (n = 30) and a control group (n = 30). Auricular acupressure using AA stickers with small magnets attached was performed in the experimental group, and a placebo AA using simple AA stickers (without the small magnets) was performed in the control group. The treatment lasted 7 weeks. To confirm the results, stress, sleep quality, and presenteeism were measured at pre- and posttest. There was a statistically significant difference in scores for sleep quality (t = −1.98, P = .047), health problems (z = −2.38, P = .017), and work impairment (t = −4.46, P < .001) between the experimental and control groups at posttest. Auricular acupressure increased sleep quality scores and decreased presenteeism. Auricular acupressure using AA stickers with small magnets attached was effective in improving sleep quality and reducing presenteeism in nurses.
MicroRNAs as Bile-based biomarkers in pancreaticobiliary cancers (MIRABILE): a cohort study
Authors: Liu Daniel S.K. , Puik Jisce R. , Venø Morten T. , Mato Prado Mireia , Rees Eleanor , Patel Bhavik Y. , Merali Nabeel , Galloway Daniel , Chan Grace , Phillips Natalie , Wadsworth Christopher , Vlavianos Panagiotis , Potts Jonathan , Sivakumar Shivan , Davidson Brian R. , Besselink Marc G. , Swijnenburg Rutger-Jan , Jiao Long R. , Kazemier Geert , Giovannetti Elisa , Krell Jonathan , Frampton Adam E.
Published: July 2024

Background:

Biliary obstruction can be due to both malignant and benign pancreaticobiliary disease. Currently, there are no biomarkers that can accurately help make this distinction. MicroRNAs (miRNAs) are stable molecules in tissue and biofluids that are commonly deregulated in cancer. The MIRABILE study aimed to identify miRNAs in bile that can differentiate malignant from benign pancreaticobiliary disease.

Materials and methods:

There were 111 patients recruited prospectively at endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTC) for obstructive jaundice, and bile was aspirated for cell-free RNA (cfRNA) extraction and analysis. In a discovery cohort of 78 patients (27 with pancreatic ductal adenocarcinoma (PDAC), 14 cholangiocarcinoma (CCA), 37 benign disease), cfRNA was subjected to small-RNA sequencing. LASSO regression was used to define bile miRNA signatures, and NormFinder to identify endogenous controls. In a second cohort of 87 patients (34 PDAC, 14 CCA, 39 benign disease), RT-qPCR was used for validation.

Results:

LASSO regression identified 14 differentially-expressed bile miRNAs of which 6 were selected for validation. When comparing malignant and benign pancreaticobiliary disease, bile miR-340 and miR-182 were validated and significantly differentially expressed (P<0.05 and P<0.001, respectively). This generated an AUC of 0.79 (95% CI: 0.70–0.88, sensitivity 65%; specificity 82%) in predicting malignant disease.

Conclusion:

Bile collected during biliary drainage contains miRNAs able to differentiate benign from malignant pancreaticobiliary diseases in patients with obstructive jaundice. These bile miRNAs have the potential to increase diagnostic accuracy.
Clinical guidelines for early hepatocellular carcinoma treatment options: a systematic review and bibliometric analysis
Authors: Wu Chun-Ying , Lin Lee-Yuan , Lee Teng-Yu , Hsu Yao-Chun , Yeh Chun-Chieh , Chen Chiehfeng , Kang Yi-No , Huang Tsai-Wei
Published: July 2024

Background:

Hepatocellular carcinoma remains a major cause of cancer-related mortality worldwide, with treatment options including radiofrequency ablation (RFA) and surgical resection. This study evaluates the evolving guidelines for these treatments to identify the current consensus and divergences.

Method:

The authors conducted a systematic review following PRISMA 2020 guidelines of documents from 2017 to 2024 by major liver societies. The AGREE-II framework assessed guideline quality. This study is registered with PROSPERO (CRD42022342266).

Results:

The authors analyzed 23 guidelines and noted significant shifts in treatment recommendations over recent updates. This analysis reveals an increasing endorsement of RFA for certain patient groups and sustained strong support for surgical resection based on robust evidence levels. All demonstrated high quality, with the 2023 Japan Guidelines receiving the highest AGREE-II score. A significant finding was the low level of stakeholder involvement in the development of guidelines.

Conclusion:

The study highlights the dynamic nature of clinical guidelines for early-stage hepatocellular carcinoma, underscoring the need for ongoing updates and direct, high-quality comparative studies. The evolving recommendations for RFA, especially its role in managing small, localized tumors, reflect its emerging importance in the treatment paradigm.
Comparing health care outcomes before and after employing nurse practitioners in cardiovascular hospitals in Japan: A retrospective chart review
Authors: Suzuki Miho , Sekiguchi Natsuko , Saitoh Masato , Koda Masahide , Harada Nahoko , Honda Kazuya , Araki Tomoko , Kudo Takemi , Watanabe Takako
Published: July 2024

Background:

There are approximately 872 certified nurse practitioners (NPs) in Japan as of April 2024. However, research on the results of their specific activities is still scarce.

Purpose:

This study aimed to compare health care outcomes before (i.e., 2019) and after (i.e., 2021) employing NPs in cardiovascular hospitals in Japan.

Methodology:

We conducted a retrospective chart review and analyzed 114 patients who underwent cardiac surgery in Hospital A and 381 patients who received pacemaker implantation/replacement in Hospital B. Hospital A hired one NP for cardiac surgery service, and Hospital B hired one NP for pacemaker device service. The NPs assisted in the surgical procedures and provided postsurgical management.

Results:

In Hospital A, the median length of hospitalization and intubation were shorter in 2021 than in 2019 (p = .02 and .01, respectively). In Hospital B, medical fee reimbursement was lower in 2021 (p < .001) than in 2019, and the median procedure duration was shorter (p = .01), which remained statistically significant after controlling for age, comorbidities, and device types. Some outcomes improved following the employment of NPs, whereas others remained unchanged.

Conclusions:

Nurse practitioners managed surgical patients well and contributed to the quality care of cardiovascular medicine.

Implications:

The employment of NPs in Japan is encouraged because even a single NP can have a positive, although not large, impact on patients and organizations.
Improving oral health screening and dental referrals for patients with diabetes in a community health clinic
Authors: McGowen Joy , Shaw Kathy
Published: July 2024

Background:

Oral health screening and access to dental care in adults with diabetes lead to improved health outcomes and quality of life. Patients with barriers to accessing health services have a greater risk of poor medical and dental outcomes. People with diabetes are more likely to have periodontal disease and less likely to visit a dentist.

Local Problem:

Oral screening and dental referrals were not being done at a community health clinic in Plano, Texas.

Methods:

The aim of this 6-month quality-improvement project was to increase oral health screenings in adults with diabetes from 0% to 80%; subaim was to increase access to dental services by increasing referrals from 0% to 50%. Adults with diabetes without insurance or dental care in the past 12 months were eligible for the project (n = 263). Outcome measures were tracked using a longitudinal chart.

Interventions:

Eligible patients were screened and referred to a dental office with an income-based financial assistance program using Plan-Do-Study-Act methodology. Staff education, referral order set, and follow-up calls were additional processes implemented.

Results:

Fifty-two percent of eligible patients were screened, 35.9% were referred to dental services, and 17.7% of those referred established care with dental clinic.

Conclusions:

Interventions were successful in improving access to dental care, although target goal was not met. Creating systems that facilitate interdisciplinary care improved health equity and standards of health in chronic disease.
Cystatin C and the difference between cystatin C and serum creatinine: Improved metrics to predict waitlist mortality among patients with decompensated cirrhosis
Authors: Cullaro Giuseppe , Allegretti Andrew S. , Patidar Kavish R. , Verna Elizabeth C. , Lai Jennifer C.
Published: July 2024

Among patients with decompensated cirrhosis, serum creatinine (sCr) is biased by sex, frailty, and hepatic synthetic function, while Cystatin C (cysC) is not. We found that sCr would better associate with waitlist mortality and that the difference between cysC and sCr (cysCsCrdiff) would quantify this bias and be independently associated with outcomes. We measured cysC levels at ambulatory liver transplant visits among 525 consecutive patients seen at our center. We defined the cysCsCrdiff as the difference between cysC minus sCr. We compared demographics and clinical characteristics in patients with low, intermediate, and high cysCsCrdiff, divided by tertile. We used Cox regression to compare the association between sCr and cysC and waitlist mortality and demonstrate the independent association between cysCsCrdiff and waitlist mortality. In Cox regression, cysC was significantly more associated with waitlist mortality than sCr (p < 0.001). We found that as compared to those with a low cysCsCrdiff, those with an intermediate or high cysCsCrdiff were more likely to be female, have ascites, have higher frailty, and have higher MELD 3.0 scores (p < 0.05 for all). Compared to those with a low cysCsCrdiff, we found that those in the intermediate and high groups were more likely to die during follow-up (low: 6% vs. intermediate: 8% vs. high: 11%, p = 0.007). We found that after adjusting for the components of the MELD 3.0 score, each 1-point increase in the cysCsCrdiff was associated with 1.72× (1.27–2.32) the hazard of waitlist mortality. Our study demonstrates that not only is cysC more associated with waitlist mortality than sCr, but that cysCsCrdiff represents a novel independent metric associated with waitlist mortality.
Knowledge of Patients’ Activation Level Changes Expert US Physicians’ Communication in GERD Management
Authors: Kamal Afrin N. , Achalu Sudharshan , Jani Shilpa , Triadafilopoulos George , Clarke John O. , Wang C. Jason
Published: July 2024

Background:

Gastroesophageal reflux disease (GERD) is common. Treatment is to manage symptoms, but medication nonadherence is common. To date, little emphasis has been on understanding patient behaviors and reasons for medication nonadherence.

Methods:

We performed a cross-sectional survey study among expert gastroenterologists specializing in esophageal disease. Survey studies consisted of a 6-item questionnaire measuring physician knowledge of patient activation, the Clinician Support for Patient Activation Measure (CS-PAM), and an adapted 20-item Patient Assessment of Chronic Illness Care (PACIC). All question stems were specified to GERD management.

Results:

Thirty-six experts participated. Most indicated hearing the term patient engagement before this survey (88.9%), but fewer were aware of the term patient activation (33.3%). Respondents were then made aware of the clinical significance of patient activation and asked, based on this knowledge, the likelihood that patients' activation level before the clinic would impact their communication. Responses varied between “to a great extent” and “not at all.” Overall, CS-PAM activation scores were high, indicating a high level of support for patient activation. Lastly, respondents indicated their frequency of participating in partnership-building behaviors with patients. More than half (52.8%) of expert physicians “almost always” asked how GERD affected their lives, while less often asked patients about their health habits (22.2%), help set specific goals to improve their eating or exercise lifestyle (19.4%), or refer patients to a dietician, health educator, or counselor for their GERD (11.1%).

Conclusion:

Patient activation is an important strategy and may provide a behavioral approach to address medication adherence in GERD.
Inspirational Professional Practice Model Redesign Using Shared Decision-Making
Authors: Proffitt Melissa S. , Bilyeu Teresa E. , Doyle Courtney R. , Hermansen-Parker James L. , Morin Mary M. , Williams-Reed Joanne , Winslow Susan A.
Published: July 2024

An integrated health system including 12 hospitals, an expansive network of ambulatory settings, and health insurance plans began a systematic review of the existing nursing professional practice model (PPM) created in 2007 to assess current relevancy. The goal was to determine PPM concepts and imagery that represent present-day nursing workforce. This article shares how a formal review of literature, utilization of focus groups, and system-wide shared decision-making influenced creation and evaluation of a revised PPM.
Comparing the Use of Crotaline-Polyvalent Immune Fab (Ovine) Versus Observation in Children
Authors: Rohl Stephen , Meredith Mark , Anderson Tucker , Clark Alexander , Snider Mark , Bruccoleri Rebecca , Williams Saralyn , Hayes Tristan , Tolley Elizabeth , Gienapp Andrew J. , Seger Donna
Published: July 2024

Objectives

In the United States, studies are inconclusive regarding the indications for polyvalent antivenom administration for crotaline envenomation. We compared polyvalent antivenom administration versus observation used at 2 separate institutions. We hypothesized that deferring antivenom leads to increased hospital length of stay and surgical interventions.

Methods

Retrospective chart review of children who presented to Le Bonheur Children's Hospital (LBCH) in Memphis, Tennessee, and Monroe Carell Jr Children's Hospital at Vanderbilt (MCJCHV) in Nashville, Tennessee, from 2009 to 2021. Patient demographics, treatment utilization, bite location, and outcomes from both sites were statistically examined.

Results

A total of 183 patients met the inclusion criteria (123 at LBCH, 60 at MCJCHV). At LBCH, mean age was 9.2 years, 54% were male, and 79% of known snakes identified as copperheads. At MCJCHV, mean age was 8.9 years, 65% were male, and 88% of known snakes identified as copperheads. The most commonly envenomated areas for both sites were the foot (42%), hand (27%), and ankle (26%). Patients at LBCH were managed with antivenom only 25% of the time, whereas 75% were observed; 82% of MCJCHV patients were managed with antivenom (P < 0.001). There were no significant differences in length of stay (mean, 1.5 days at LBCH and 1.8 days at MCJCHV; P = 0.136) or surgical intervention (3.3% of LBCH encounters, 5.0% of MCJCHV encounters; P = 0.685). Secondary outcomes aside from coagulopathy and admission location (intensive care unit vs floor) were also not significant.

Conclusions

The use of antivenom did not impact hospital length of stay or surgical interventions. Our results should be interpreted cautiously as our study reflects regional experiences with snake species in the Southeast United States and not North America as a whole. Other institutional differences in management and smaller n at MCJCHV may have contributed to different outcomes. Further study is needed to determine intermediate and long-term effects of deferring antivenom use.
Late Identification of Perinatal Transmission of HIV in an Infant at High Risk
Authors: O’Grady Thomas J. , Kaufman Suzanne , Stolz Amanda , Styer Linda M. , Haskin Lisa , Suresh Prapitha , Ryman Nko L. , Shah Dipal , Sullivan Timothy J. , Torian Lucia , Gonzalez Charles , Parker Monica M. , Swain Carol-Ann
Published: July 2024

The focus of this case study is the delayed diagnosis of a perinatal HIV transmission, which was identified when the infant reached 4 months of age, and the social conditions and structural determinants that contributed to the increased transmission risk. Despite adhering to the diagnostic testing protocols and neonatal antiretroviral (ARV) guidelines of the New York State Department of Health, this transmission still occurred. This transmission event prompted strategies to address criminalization of substance use during pregnancy and a reevaluation of the HIV testing and treatment protocols, including the timing of testing. Obtaining a diagnostic specimen at birth before initiating prophylactic or presumptive therapy, without causing delays in therapy, and incorporating HIV-1 DNA or RNA testing 2 to 6 weeks after discontinuing ARV therapy might have facilitated earlier detection and a quicker resumption of ARV therapy for this high-risk infant. Subsequently, the New York State HIV perinatal testing guidelines were updated. These changes included the recommendation to obtain a diagnostic specimen at birth before initiating ARV medications, whenever feasible, without causing delays in ARV initiation. Additionally, an extra virologic diagnostic test is recommended at 2 to 6 weeks after discontinuing ARVs for infants at high risk of perinatal HIV transmission, especially those with possible DNA or RNA suppression due to ARV prophylaxis or presumptive HIV therapy.
Living Donor Availability Improves Patient Survival in a North American Center
Authors: Li Zhihao , Jones Owen , Magyar Christian T.J. , Claasen Marco P.A.W. , Ivanics Tommy , Choi Woo Jin , Rajendran Luckshi , Winter Erin , Bucur Roxana , Rukavina Nadia , Jaeckel Elmar , Selzner Nazia , Sayed Blayne A. , Ghanekar Anand , Cattral Mark , Sapisochin Gonzalo
Published: July 2024

Objective:

Assess the impact of having a living donor on waitlist outcomes and overall survival through an intention-to-treat analysis.

Background:

Living-donor liver transplantation (LDLT) offers an alternative to deceased donation in the face of organ shortage. An as-treated analysis revealed that undergoing LDLT, compared to staying on the waiting list, is associated with improved survival, even at Model for End-stage Liver Disease-sodium (MELD-Na) score of 11.

Methods:

Liver transplant candidates listed at the Ajmera Transplant Centre (2000-2021) were categorized as pLDLT (having a potential living donor) or pDDLT (without a living donor). Employing Cox proportional-hazard regression with time-dependent covariates, we evaluated pLDLT’s impact on waitlist dropout and overall survival through a risk-adjusted analysis.

Results:

Of 4,124 candidates, 984 (24%) had potential living donors. The pLDLT group experienced significantly lower overall waitlist dropouts (5.2%vs. 34.4%, P<0.001) and mortality (3.8%vs. 24.4%, P<0.001) compared to the pDDLT group. Possessing a living donor correlated with a 26% decline in the risk of waitlist dropout (adjusted hazard ratio 0.74, 95%CI 0.55-0.99, P=0.042). The pLDLT group also demonstrated superior survival outcomes at 1- (84.9%vs. 80.1%), 5- (77.6%vs. 61.7%), and 10-year (65.6%vs.52.9%) from listing (log-rank P<0.001) with a 35% reduced risk of death (adjusted hazard ratio 0.65, 95%CI 0.56-0.76, P<0.001). Moreover, the predicted hazard ratios consistently remained below 1 across the MELD-Na range 11-26.

Conclusions:

Having a potential living donor significantly improves survival in end-stage liver disease patients, even with MELD-Na scores as low as 11. This emphasizes the need to promote awareness and adoption of LDLT in liver transplant programs worldwide.