bluuebunny/crossref_metadata_2025 huggingface dataset:
Single-stage off-pump repair of coarctation of the aorta and ventricular septal defects in children
Authors: Kulyabin Yuriy Y , Voitov Alexey V , Nichay Nataliya R , Soynov Ilya A , Zubritskiy Alexey V , Bogachev-Prokophiev Alexander V
Published: June 2022

OBJECTIVES

The appropriate approach for surgical repair of coarctation of the aorta with a ventricular septal defect (VSD) remains controversial. This study evaluated the outcomes of primary repair of VSDs with periventricular device closure without cardiopulmonary bypass through a left thoracotomy in patients without arch hypoplasia.

METHODS

We selected 21 patients aged <1 year, including 7 neonates, who underwent repair of coarctation of the aorta with periventricular device closure of a VSD.

RESULTS

The median occluder size was 6 (range, 5–8) mm. The median mechanical ventilation time was 14 (range, 2–68) h, and the median duration of hospital stay was 11 (range, 7–16) days. No reoperations were required to correct VSD shunting, and the median residual shunt size was 1 (range, 1–2) mm. The median follow-up period was 13 (range, 4–31) months. No late deaths were reported, and no haemodynamically significant pressure gradient at the anastomotic site was observed. The median distal aortic arch z-score was 0.39 (range, −0.1–to 0.9). Only 1 patient had a permanent pacemaker implanted towards the end of the follow-up period.

CONCLUSIONS

Periventricular device closure can be used safely for closure of VSD in children with coarctation of the aorta without a hypoplastic aortic arch, even in neonates, to reduce the risk of prolonged cardiopulmonary bypass. This hybrid approach can be performed with a low incidence of rhythm disturbances and residual shunting. However, a meticulous assessment of the VSD anatomy is essential to avoid any unfavourable events.
Validation of the 3M™ Molecular Detection Assay 2—STEC Gene Screen (stx) for Detection of Shiga Toxin Gene (stx1 and/or stx2) in Dried Cannabis Flower and Dried Hemp Flower: AOAC Performance Tested MethodSM 071903
Authors: Rosauer Micki L , Lopez-Velasco Gabriela , Silbernagel Karen M , Horine Leo , Tudor Alexandra
Published: June 2022

Background

The 3M™ Molecular Detection Assay 2—STEC Gene Screen (stx) method is based on gene amplification by the use of real-time loop-mediated isothermal amplification when used with the 3M Molecular Detection System for the rapid and specific detection of Shiga toxin gene (stx1 and/or stx2) from Shiga toxin-producing Escherichia coli (STEC) in enriched products. The 3M Molecular Detection Assay 2—STEC Gene Screen (stx) was approved as AOAC Performance Tested MethodSM Certificate No. 071903.

Objective

This matrix extension study evaluated the 3M Molecular Detection Assay 2—STEC Gene Screen (stx) method for detection of STECs in dried cannabis flower [>0.3% delta 9-tetrahydrocannabinol (THC)] and dried hemp flower (≤0.3% THC) at a 10 g test portion size.

Method

Testing followed procedures outlined in 3M Molecular Detection Assay 2—STEC Gene Screen (stx) product instructions and Standard Method Performance Requirement (SMPR®) for Detection of Shiga Toxin-Producing Escherichia coli in Cannabis and Cannabis Products (AOAC SMPR 2020.012). The method was evaluated at low, high, and non-inoculated levels.

Results

Results showed no statistically significant difference between the presumptive positive 3M Molecular Detection Assay 2—STEC Gene Screen (stx) results and the SMPR 2020.012 recommended cultural confirmations.

Conclusions

This study provides data that demonstrate the 3M Molecular Detection Assay 2—STEC Gene Screen (stx) is a reliable method for the rapid and specific detection of STECs in dried cannabis flower and dried hemp flower.

Highlights

The 3M Molecular Detection Assay 2—STEC Gene Screen (stx) method is suitable for the rapid and specific detection of STECs in dried cannabis flower and dried hemp flower.
Relative habitability of exoplanet systems with two giant planets
Authors: Bailey Nora A , Fabrycky Daniel C
Published: June 2022

The architecture of a planetary system can influence the habitability of a planet via orbital effects, particularly in the areas of stability and eccentricity. Some of these effects are readily apparent, particularly when they occur on short time-scales that are easily numerically calculable. However, the appearance and evolution of life can take place on gigayear time-scales, long enough that secular effects become important. These effects are difficult to investigate, as a direct integration requires significant computational time. In this paper, we apply a semi-analytic framework in conjunction with N-body integrations and predictive techniques to determine the relative habitability for an Earth-like planet in a system with two giant companions over a multidimensional parameter space. Relative habitability quantifies the integrated habitability probability compared to a system containing only a single Earth-like planet. We find trends with mass, eccentricity, location, spacing, inclination, and alignment of the giant planets, including configurations where the system is more habitable due to the giant planets. As long as the system remains stable, a moderate eccentricity excitation of the terrestrial planet can be beneficial by increasing the outer boundary of the habitable zone through higher mean irradiance. In our simulations, the median (±1σ) habitable planet has an eccentricity of $0.11^{+0.16}_{-0.08}$, though it started circular. Low-mass, widely separated, and moderately eccentric perturbing giants can accomplish this, an ‘ultra-habitable’ configuration of companions.
Quadrupole and octupole order resonances in non-restricted hierarchical planetary systems
Authors: Lei Hanlun , Huang Xiumin
Published: June 2022

Non-restricted hierarchical three-body configurations are common in various scales of astrophysical systems. Dynamical structures of the quadrupole-order resonance (the von Zeipel–Lidov–Kozai resonance) and the octupole-order resonance (the apsidal resonance) under the non-restricted hierarchical planetary systems are investigated in this work by taking advantage of perturbative treatments. Under the quadrupole-order Hamiltonian model, the distribution of libration and circulation regions as well as the distribution of flipping region are analytically explored in the parameter space spanned by the conserved quantities. The fundamental frequencies of system are produced and then the nominal location of octupole-order resonance is identified. From the viewpoint of perturbative theory, the quadrupole-order Hamiltonian determines the unperturbed dynamical model and the octupole-order Hamiltonian plays a role of perturbation to the quadrupole-order dynamics. The resonant Hamiltonian for octupole-order resonances is formulated by means of averaging theory, giving rise to a new constant of motion. Phase portraits are produced to analyse dynamical structures of octupole-order resonance, including resonant centres, saddle points, dynamical separatrices and islands of libration. By analysing phase portraits, it is found that there are four branches of libration centre and eight libration zones in the considered space. Applications to orbit flips show that there are five flipping regions.
Shifting the Focus to Teachers: A New Approach for Music Therapists Working in Schools
Authors: Steele Megan , McFerran Katrina Skewes , Crooke Alexander Hew Dale
Published: June 2022

This paper presents a new approach for music therapists in schools wishing to support the work of teachers. This music therapy approach is underpinned by theoretical resources drawn from community music therapy and a critical inclusive approach to education. Illustrative examples of the first authors’ music therapy practice as part of a teacher professional learning program, Music for Classroom Wellbeing, are offered. Two practice principles, “focus on the teacher” and “enable sharing,” are presented to provide a framework for music therapists striving to support teachers. Following these principles may allow teachers to grow their musicality, teaching, and self-care practices. This paper concludes with implications of reframing the focus of music therapy practice with teachers for other music therapists working in the current performance-driven schooling system.
Comparison of Motivational Short Interventions to Improve Smokers’ Health Behavior (The COSMOS Study): A Pragmatic Cluster-Randomized Two-Arm Trial in General Practice
Authors: Grischott Thomas , Senn Oliver , Frei Anja , Rosemann Thomas , Neuner-Jehle Stefan
Published: June 2022

Introduction

Helping smokers to quit is an important task of general practitioners (GPs). However, achieving tobacco abstinence is difficult, and smokers who fail may still want to improve their health in other ways. Therefore, Swiss GPs developed a multithematic coaching concept that encourages health behavior changes beyond smoking cessation alone.

Aims and Methods

To compare the effectiveness of such coaching with state-of-the-art smoking cessation counseling, we conducted a pragmatic cluster-randomized two-arm trial with 56 GPs in German-speaking Switzerland and 149 of their cigarette smoking patients. GPs were instructed in either multithematic health coaching or smoking cessation counseling. After 12 months, we compared their patients’ improvements in cigarette consumption, body weight, physical inactivity, alcohol consumption, stress, unhealthy diet, and a health behavior of their own choice, using hierarchical logistic regression models and Fisher’s exact and t tests.

Results

Over 95% of all participants achieved clinically relevant improvements in at least one health behavior, with no difference between study arms (health coaching vs. smoking cessation counseling: aOR = 1.21, 95% CI = [0.03–50.76]; and aOR = 1.78, 95% CI = [0.51–6.25] after non-responder imputation). Rates of clinically relevant improvements in the individual health behaviors did not differ between study arms either (they were most frequent in physical activity, achieved by 3 out of 4 patients), nor did the extent of the improvements.

Conclusions

Multithematic health coaching and state-of-the art smoking cessation counseling were found to be comparable interventions, both in terms of smoking cessation success and, quite unexpectedly, their effects on other health behaviors.

Implications

The findings of our study suggest that in general practice, multithematic health coaching is an effective smoking cessation intervention, and conversely, monothematic smoking cessation counseling also achieves the beneficial effects of a multithematic health behavior intervention. This opens up the possibility for GPs to support their smoking patients in improving their health behavior in additional and more flexible ways.
Successful weaning of a patient with severe COVID-19 pneumonia under prolonged midazolam sedation using morphine
Authors: Kunimasa Kei , Ohashi Yoshifumi , Okawa Megumi , Iida Hiroshi , Sonoda Shunji , Hiuge Yuki , Hachimine Masaaki , Yamamura Ai , Kawamura Takahisa , Inoue Takako , Tamiya Motohiro , Kuhara Hanako , Nishino Kazumi , Nakamoto Naoki , Kumagai Toru , Tanigami Hironobu
Published: June 2022

The coronavirus disease 2019 (COVID-19) pandemic continues to spread around the world. In April 2021, Japan experienced a fourth wave of COVID-19 infections, which led to the breakdown of the medical system. Osaka, Japan, was particularly affected, with many severe cases and the highest number of COVID-19-associated deaths in Japan. Herein, we present a patient with severe COVID-19 infection who received prolonged midazolam (MDZ) treatment since propofol was not available due to shortage of medical resources. Moreover, the duration of mechanical ventilation was extended due to the development of a pneumothorax. When MDZ tapering was initiated, tachypnea was observed, which resulted failure in ventilator weaning. However, the use of continuous morphine infusion led a successful weaning off the ventilator. We suggest that the administration of morphine may allow for a smoother weaning process for some patients with severe COVID-19 infection.
Acute bilateral suppurative parotitis following treatment of acute decompensated heart failure with noninvasive positive-pressure ventilation
Authors: Yasuoka Kenta , Sai Seika , Tsukahara Nana , Machiki Kenji , Yamanouchi Takayoshi
Published: June 2022

We present a case of acute bilateral suppurative parotitis in an elderly patient with acute heart failure who was hospitalized and treated with noninvasive positive-pressure ventilation. In this case, sepsis due to infection occurred, leading to severe illness.
Chyloperitoneum due to gastric carcinoma: a case report
Authors: Pinto J C , Oliveira S , Duarte L , Ferreira M , Marques C , Casimiro C
Published: June 2022

Chyloperitoneum is a rare manifestation of gastric carcinoma, generally occurring late in the course of the disease with a poor prognosis. We report an unusual case of chyloperitoneum in a patient with gastric carcinoma. A 61-year-old male patient presented with postprandial fullness, nausea and weight loss. The upper gastrointestinal endoscopy demonstrated a stenosing lesion of the esophagogastric junction. A biopsy was made and revealed a signet-ring cell gastric adenocarcinoma. The staging CT scan showed multiple abdominal lymphadenopathies and mild ascites. The patient underwent a staging laparoscopy that revealed a large carcinoma of the gastric cardia and a milky-appearing peritoneal fluid. A peritoneal washing and abdominal drainage were performed. The fluid analysis showed a high concentration of triglycerides, compatible with a chyloperitoneum. The patient started medium chain triglycerides-based diet with good response. This case report emphasizes that chyloperitoneum should be considered when assessing patients with gastric carcinoma.
Heterotopic pancreatic tissue in the gall bladder neck and lymph node surrounding cystic duct identified during cholecystectomy for chronic calculous cholecystitis: a rare case report from Syria
Authors: Al-janabi Moatasem Hussein , Ismail Leen , Wassouf Marah Yousef , Sulaiman Jamal , Salloum Rabab , Al-shehabi Zuheir
Published: June 2022

Heterotopic pancreas is a congenital anomaly defined as the presence of the pancreatic tissue outside its normal location, which is usually discovered incidentally. We describe a rare case of heterotopic pancreatic tissue in the neck and the node surrounding the cystic duct of the gallbladder. A 33-year-old female presented with right upper quadrant abdominal pain aggravated after fat meals. The diagnosis was made as chronic cholecystitis. Laparoscopic cholecystectomy was performed. Pathologic examination showed a lobulated nodule connected to the cystic duct. Microscopically, this node consisted of all components of pancreatic tissue. Localization of heterotopic pancreatic tissue in the gallbladder is exceedingly rare. Less than 40 cases of heterotopic pancreas in the gallbladder have been reported worldwide. The ectopic pancreas is an extraordinary congenital entity. Although pancreatic tissue in the lymph node is an exceptional finding, pathologists should be aware of it because it may be confused with tumor or metastasis.
Du Bois, Social Theory, and Agency
Authors: Go Julian
Published: June 2022

This chapter explores Du Bois’s thinking on agency and how it fits into the larger landscape of social theory regarding action and practice. Covering his early work at the turn of the twentieth century through his later work on Black Reconstruction and other writings, the chapter shows that Du Bois offers four related but analytically separable conceptualizations of agency: (1) agency as social action, (2) agency as the creative use of structures in the face of oppressive conditions, (3) agency as independent free will that countervails social laws, and (4) agency as the action of subaltern actors that alters the course of historical events. Each of these reflects the distinct historical context of its emergence and the wider scholarly and political debates in which Du Bois was engaged. They stand as important contributions to social theories of action.
Tradition and Adaptation in Russian Folk Art
Authors: Hilton Alison
Published: June 2022

Objects made for the Russian peasant household reflect the customs, beliefs, and resources of each region. Decoration of the dwelling (izba), implements such as distaffs, and festive clothing accompanied religious rituals and social life; and their designs often shared the rhythms of folk music and dance. Peasant families engaged in weaving, woodwork, and pottery for their own use or for trade, while specialists handled architectural carving and other complex crafts. The interdependence of peasant villages, gentry estates, and markets near monasteries and towns affected the evolution of all folk arts. This chapter describes the main forms and materials, the sources and meanings of designs, and the variations that show artists’ adaptations to historical events and social change. The relationships among elements of folk culture and concepts of national identity continue to stimulate research and creative responses. What one folk artist described as an elastic “thread of tradition,” the merging of individual creativity with a sense of regional and national culture, is essential to the cumulative originality of folk art.
Indigenous Perspectives on Disability
Authors: Rivas Velarde Minerva
Published: June 2022

The way Indigenous persons perceive disability has profound social, economic, and political implications. The most influential models of disability, however, have failed to engage with common experiences of social oppression, ongoing colonization, and ontologies of disability from the perspective of Indigenous persons with disabilities. This chapter explores the emerging scholarship on disability in Spanish, English, and French and from both low- and high-income countries on the intersectionality of indigeneity and disability. It examines the theoretical and methodological shortcomings in what are currently the most influential disability models, namely the literature on the International Classification of Functioning, Disability, and Health (ICF), the social model of disability, and relational model of disability, in relation to Indigenous persons with disabilities. This chapter incorporates the growing body of academic and green literature documenting the marginalization of Indigenous persons with disabilities. It also examines the emerging literature on Indigenous views of disability. Insights from this analysis will be useful for exploring how agency in Indigenous communities can be better represented and will expand on the conceptualization of social and political participation on the basis of specific Indigenous issues. The chapter concludes with an analysis of recent international advocacy initiatives such as the Indigenous Persons with Disabilities Global Network (IPWDGN) and activities on the framework of the Permanent Forum on Indigenous Issues within the United Nations system.
The Religious Landscape and Its Architecture in Contemporary Europe
Authors: Fernández-Cobián Esteban
Published: June 2022

This chapter presents an overview of the contemporary religious landscape in Europe and the architecture that defines it. In a continent historically divided along several lines of friction, the last of them—the Iron Curtain footprint—is taken as basis for structuring the chapter. Three phenomena that deserve independent analysis are examined: the decline of religion in Western Europe, the emergence of religiosity in Eastern Europe, and the relationship between religious architecture and mass population movements, both forced and voluntary. The study of these three aspects of contemporary Europe raises questions about the specific ways religion is lived in Europe, about the reuse of religious heritage, the survival of national identity through architecture, and the capacity of social interaction to define new cultural landscapes.
Visualizing Himalayan Buddhist Sacred Sites in 3D/VR
Authors: Leve Lauren , Erickson Bradley Charles
Published: June 2022

Much has been written about the value of spatial approaches to the study of religion and about the importance of attending to material objects that locate religion for culturally positioned practitioners in specific places and times. This chapter explores the use of digital space for religious studies pedagogy and as the grounds for community-engaged scholarship. It describes a project, begun in 2018, of creating 360-degree videos and 3D models of Buddhist sacred sites and objects in the Kathmandu Valley of Nepal that could be accessed online and also become the basis for immersive experiences using virtual reality (VR) and augmented reality (AR) devices. In partnership with diverse Himalayan Buddhist stakeholders to create new representations, the project goal is to use technology to challenge misperceptions of Buddhism that reproduce colonial knowledge hierarchies by identifying Buddhism with philosophy and texts, revealing it instead as an embodied, emplaced, dynamic material tradition.
National Treasures versus Alien Species
Authors: Ambros Barbara R.
Published: June 2022

This chapter employs multispecies ethnography to investigate how permeable religious spaces in Japan have become focal points in assessing the ecological and cultural health of a nation facing external threats embodied by invasive raccoons. It first traces the history of North American raccoons in Japan, from cute cartoon character and desirable pet in the late 1970s to proverbial trash animal—a despised pest and proscribed alien species. Then, it analyzes how ideas about national identity, pitting an alien species against national treasures, have shaped the contemporary discourse in Japanese news media and scientific studies of the raccoon damage to temples and shrines. The situation with raccoons provides insight into the shifting cultural meanings and vulnerabilities of religious spaces. In this case, temple and shrine precincts have served as a metaphor for the nation and cultural heritage; their spaces, a barometer to measure the alien threat.
Transcranial magnetic stimulation coils
Authors: Ilmoniemi Risto J. , Deng Zhi-De , Gomez Luis , Koponen Lari M. , Nieminen Jaakko O. , Peterchev Angel V. , Epstein Charles M.
Published: June 2022

Many different types of TMS coils have been proposed and implemented, but all share certain common features. The induced electric field is always maximum in the superficial parts of the brain, nearest the coil, and attenuates toward the center of the head. Power requirements are high. Design tradeoffs are present between specific coil features including focality, relative penetration, size, weight, efficiency, heating, and noise. Because of the high voltages and currents involved, electrical safety, cooling, and the need for hearing protection must always be considered. Special situations such as placebo stimulation, small animal studies, and stimulation inside MRI systems generally require coils designed specifically for these applications.
Associations of a family history of lupus with the risks of lupus and major psychiatric disorders in first-degree relatives
Authors: Lin P -C , Liang C -S , Tsai C -K , Tsai S -J , Chen T -J , Bai Y -M , Chen M -H
Published: June 2022

Background

Genetic factors link psychiatric disorders, particularly major depressive disorder (MDD), bipolar disorder, and obsessive-compulsive disorder (OCD), with systemic lupus erythematosus (SLE). Additionally, maternal SLE is a risk factor for long-term developmental problems, particularly learning disabilities, attention disorders, autism spectrum disorder (ASD) and speech disorders, in children.

Aim

We aimed to determine whether first-degree relatives (FDRs) of patients with SLE have increased risks of SLE and major psychiatric disorders.

Design and methods

Using the Taiwan National Health Insurance Research Database, we recruited 40 462 FDRs of patients with SLE as well as 161 848 matched controls. The risks of major psychiatric disorders, including schizophrenia, bipolar disorder, OCD, MDD, ASD and attention-deficit/hyperactivity disorder (ADHD), were assessed.

Results

The FDRs of patients with SLE had higher risks of SLE (reported as the adjusted relative risk and 95% confidence interval: 14.54; 12.19–17.34), MDD (1.23; 1.12–1.34), ADHD (1.60; 1.55–1.65), OCD (1.41; 1.14–1.74) and bipolar disorder (1.18; 1.01–1.38) compared with controls. Specifically, male FDRs of patients with SLE had higher risks of SLE and bipolar disorder, whereas female FDRs of patients with SLE had higher risks of MDD and OCD. Differences in the familial relationship (i.e. parents, children, siblings and twins) were consistently associated with higher risks of these disorders compared with controls.

Conclusions

The FDRs of patients with SLE had higher risks of SLE, MDD, ADHD, OCD and bipolar disorder than the controls.
Genetic contributions to female gout and hyperuricaemia using genome-wide association study and polygenic risk score analyses
Authors: Lin Chien-Yu , Chang Ya-Sian , Liu Ting-Yuan , Huang Chung-Ming , Chung Chin-Chun , Chen Yu-Chia , Tsai Fuu-Jen , Chang Jan-Gowth , Chang Shun-Jen
Published: June 2022

Objectives

To identify genetic variants and polygenic risk score (PRS) relating to female gout and asymptomatic hyperuricaemia (AH) in a genome-wide association study (GWAS).

Methods

Gout, AH and normouricemia controls were included from Taiwan biobank and China Medical University Hospital. All participants were divided into discovery and replication cohorts for GWAS. PRS was estimated according to whether the variant exhibited a protective effect on the phenotypes or not. Each cohort was separated into two groups by the age of 50 years old.

Results

A total of 59 472 females were enrolled, and gout and AH occupied 1.60% and 19.59%, respectively. Six variants located in genes SLC2A9, C5orf22, CNTNAP2 and GLRX5 were significantly predictors of female gout in those aged ≥50. For those aged <50 years old, only the variant rs147750368 (SPANXN1) on chromosome X was found. Most variants located in genes SLC2A9, ZNF518B, PKD2 and ABCG2 were found to be significantly related to AH in both age groups. The PRS could explain ∼0.59% to 0.89% of variance of gout in variants with protective effects, which showed 6.2 times of mean PRS in the risk variants, but only 1.2 times in the AH phenotype. Moreover, the PRS also revealed a dose-response trend between AH rates and quartile scores.

Conclusion

The variants in gene SLC2A9 are the major genetic factors for females associated with gout in those aged ≥50. PRS can provide a more robust prediction of the gout/AH under a homogeneous selection of variants that show effects on the traits.
Effect of Intranasal Oxytocin on Resting-state Effective Connectivity in Schizophrenia
Authors: Korann Vittal , Jacob Arpitha , Lu Bonian , Devi Priyanka , Thonse Umesh , Nagendra Bhargavi , Maria Chacko Dona , Dey Avyarthana , Padmanabha Anantha , Shivakumar Venkataram , Dawn Bharath Rose , Kumar Vijay , Varambally Shivarama , Venkatasubramanian Ganesan , Deshpande Gopikrishna , Rao Naren P
Published: June 2022

Objectives

Evidence from several lines of research suggests the critical role of neuropeptide oxytocin in social cognition and social behavior. Though a few studies have examined the effect of oxytocin on clinical symptoms of schizophrenia, the underlying neurobiological changes are underexamined. Hence, in this study, we examined the effect of oxytocin on the brain’s effective connectivity in schizophrenia.

Methods

31 male patients with schizophrenia (SCZ) and 21 healthy male volunteers (HV) underwent resting functional magnetic resonance imaging scans with intra-nasal oxytocin (24 IU) and placebo administered in counterbalanced order. We conducted a whole-brain effective connectivity analysis using a multivariate vector autoregressive granger causality model. We performed a conjunction analysis to control for spurious changes and canonical correlation analysis between changes in connectivity and clinical and demographic variables.

Results

Three connections, sourced from the left caudate survived the FDR correction threshold with the conjunction analysis; connections to the left supplementary motor area, left precentral gyrus, and left frontal inferior triangular gyrus. At baseline, SCZ patients had significantly weaker connectivity from caudate to these three regions. Oxytocin, but not placebo, significantly increased the strength of connectivity in these connections. Better cognitive insight and lower negative symptoms were associated with a greater increase in connectivity with oxytocin.

Conclusions

These findings provide a preliminary mechanistic understanding of the effect of oxytocin on brain connectivity in schizophrenia. The study findings provide the rationale to examine the potential utility of oxytocin for social cognitive deficits in schizophrenia.
Concept Analysis of Systems Thinking in the Context of Interprofessional Practice and Improved Patient Outcomes
Authors: Merriam Deborah , Wiggs Carol , Provencio Robyn , Goldschmidt Karen , Bonnett Pamela , Valazza Veronica , Brodhead Josette , Scardaville Debra , Stalter Ann
Published: June 2022

AIM

The purpose of this study was to explore the definition and application of systems thinking (ST) in interprofessional practice and improved patient outcomes.

BACKGROUND

Nurse educators need a universal definition of ST to implement in curricula to foster quality and safety while enhancing outcomes for nursing students.

METHOD

The QSEN RN-BSN Task Force used the hybrid model of concept analysis to identify the process of fostering ST in clinical and didactic learning experiences and how ST changed over time from the perspective of educators.

RESULTS

The definition of ST in the context of interprofessional practice and outcomes was “a dynamic, analytical process that looks at complex patterns, relationships, and connections within elements and structures, resulting in the ability to recognize the whole picture.”

CONCLUSION

The concept of ST in the context of interprofessional practice and improved patient outcomes may be integrated within nursing curricula.
Adaptive Hearing Aid Benefit in Children With Mild/Moderate Hearing Loss: A Registered, Double-Blind, Randomized Clinical Trial
Authors: Stewart Hannah J. , Cash Erin K. , Pinkl Joseph , Nakeva von Mentzer Cecilia , Lin Li , Hunter Lisa L. , Moore David R. ,   the CCHMC Division of Audiology
Published: June 2022

Objectives:

We completed a registered double-blind randomized control trial to compare acclimatization to two hearing aid fitting algorithms by experienced pediatric hearing aid users with mild to moderate hearing loss. We hypothesized that extended use (up to 13 months) of an adaptive algorithm with integrated directionality and noise reduction, OpenSound Navigator (OSN), would result in improved performance on auditory, cognitive, academic, and caregiver- or self-report measures compared with a control, omnidirectional algorithm (OMNI).

Design:

Forty children aged 6 to 13 years with mild to moderate/severe symmetric sensorineural hearing loss completed this study. They were all experienced hearing aid users and were recruited through the Cincinnati Children’s Hospital Medical Center Division of Audiology. The children were divided into 20 pairs based on similarity of age (within 1 year) and hearing loss (level and configuration). Individuals from each pair were randomly assigned to either an OSN (experimental) or OMNI (control) fitting algorithm group. Each child completed an audiology evaluation, hearing aid fitting using physically identical Oticon OPN hearing aids, follow-up audiological appointment, and 2 research visits up to 13 months apart. Research visit outcome measures covered speech perception (in quiet and in noise), novel grammar and word learning, cognition, academic ability, and caregiver report of listening behaviors. Analysis of outcome differences between visits, groups, ages, conditions and their interactions used linear mixed models. Between 22 and 39 children provided useable data for each task.

Results:

Children using the experimental (OSN) algorithm did not show any significant performance differences on the outcome measures compared with those using the control (OMNI) algorithm. Overall performance of all children in the study increased across the duration of the trial on word repetition in noise, sentence repetition in quiet, and caregivers’ assessment of hearing ability. There was a significant negative relationship between age at first hearing aid use, final Reading and Mathematical ability, and caregiver rated speech hearing. A significant positive relationship was found between daily hearing aid use and study-long change in performance on the Flanker test of inhibitory control and attention. Logged daily use of hearing aids related to caregiver rated spatial hearing. All results controlled for age at testing/evaluation and false discovery rate.

Conclusions:

Use of the experimental (OSN) algorithm neither enhanced nor reduced performance on auditory, cognitive, academic or caregiver report measures compared with the control (OMNI) algorithm. However, prolonged hearing aid use led to benefits in hearing, academic skills, attention, and caregiver evaluation.
Osteoporosis epidemiology using international cohorts
Authors: Lorentzon Mattias , Abrahamsen Bo
Published: June 2022

Purpose of review

To provide an update on the most important new cohort studies within osteoporosis and their bearing on clinical management and directions for future research.

Recent findings

We identified a collection of new observational cohort studies - including new reports from already established large cohorts - and intervention studies providing new insights into osteoporosis pathophysiology, risk finding, intervention, and treatment barriers.

Recent cohort studies in osteoporosis highlight the importance of timely identification and treatment of people who are at high risk of suffering osteoporotic fractures. Physical performance is a strong indicator of fracture risk and one that is tightly linked to a number of chronic conditions, not least inflammatory conditions like rheumatoid arthritis. Advances in case finding may involve opportunistic screening for low Bone Mineral Density (BMD) and vertebral fractures of radiology images obtained for other purposes, polygenic risk scores, and routinely collected medication and comorbidity information.
The Relation of Patient Expectations, Satisfaction, and Outcome in Surgery of the Cervical Spine
Authors: Krauss Philipp , Reinartz Feline , Sonnleitner Clara , Vazan Martin , Ringel Florian , Meyer Bernhard , Meyer Hanno S.
Published: June 2022

Study Design.

We performed a prospective nonblinded single center observational study.

Objective.

To investigate the relationship between expectations, outcome, and satisfaction with the outcome in patients undergoing cervical spine stabilization surgery.

Summary of Background Data.

In modern healthcare, patient-reported outcome measures and patient satisfaction have become an important aspect of quality control. Therefore, outcome benchmarks for specific diseases are highly desired. Numerous studies have investigated patient-reported outcome measures and what constitutes satisfaction in degenerative lumbar spine disease. In cervical spine surgery, it is less clear what drives the postoperative symptom burden and patient satisfaction and how this depends on the primary diagnosis and other patient factors.

Methods.

This was a prospective, single center, observational study on patients undergoing cervical spine stabilization surgery for degenerative disease, trauma, infection, or tumor. Using the visual analogue scale for neck and arm pain, the neck disability index (NDI), the modified Japanese Orthopedic Association Score (mJOA) and patient-reported satisfaction, patient status and expectations before surgery, at discharge, 6 and 12 months after surgery were evaluated.

Results.

One hundred five patients were included. Score-based outcome correlated well with satisfaction at 6 and 12 months. Except for low NDI expectations (≥15 points) that correlated with dissatisfaction, expectations in no other score were correlated with satisfaction. Expectations did influence the outcome in some subgroups and meeting expectations resulted in higher rates of satisfaction. Pain reduction plays an important role for satisfaction, independently from the predominant symptom or pathology.

Conclusion.

Satisfaction correlates well with outcome. Meeting expectations did influence satisfaction with the outcome. The NDI seems to be a valuable preoperative screening tool for poor satisfaction at 12 months. In degenerative pathology, pain is the predominant variable influencing satisfaction independently from the predominant symptom (including myelopathy).

Level of Evidence.

5
Clinical Benefits of Early Concurrent Use of Cryoprecipitate and Plasma Compared With Plasma Only in Bleeding Trauma Patients
Authors: Endo Akira , Senda Atsushi , Otomo Yasuhiro , Firek Matthew , Kojima Mitsuaki , Coimbra Raul
Published: June 2022

OBJECTIVES:

The effectiveness of cryoprecipitate (Cryo) in trauma has not been well established; the benefits of Cryo might have been overestimated in previous studies since the difference in the total amount of administered clotting factors was not considered. We aimed to evaluate the benefits of the concurrent use of Cryo in combination with fresh frozen plasma (FFP) for bleeding trauma patients.

DESIGN:

Retrospective cohort study.

SETTING:

The American College of Surgeons Trauma Quality Improvement Program database between 2015 and 2019.

PATIENTS:

Patients who received greater than or equal to 5 units of packed RBCs and at least 1 unit of FFP within the first 4 hours after arrival to a hospital were included and dichotomized according to whether Cryo was used within the first 4 hours of hospital arrival.

Intervention:

None.

MEASUREMENTS AND MAIN RESULTS:

The outcomes of patients treated with Cryo and FFP were compared with those treated with FFP only using propensity score-matching analysis. The dose of administered clotting factors in each group was balanced. The primary outcome was inhospital mortality, and the secondary outcome was the occurrence rate of adverse events. A total of 24,002 patients (Cryo+FFP group: 6,018; FFP only group: 17,984) were eligible for analysis, of whom 4,852 propensity score-matched pairs were generated. Significantly lower inhospital mortality (1,959 patients [40.4%] in the Cryo+FFP group vs 2,142 patients [44.1%] in the FFP only group; odds ratio [OR], 0.86; 95% CI, 0.79–0.93) was observed in the Cryo+FFP group; no significant difference was observed in the occurrence rate of adverse events (1,857 [38.3%] vs 1,875 [38.6%]; OR, 1.02; 95% CI, 0.94–1.10). Several sensitivity analyses showed similar results.

CONCLUSIONS:

Cryo use combined with FFP was significantly associated with reduced mortality in bleeding trauma patients. Future randomized controlled trials are warranted to confirm these results.
Better outcomes with desmopressin melt than enuretic alarm therapy in children with nocturnal enuresis during coronavirus disease 2019 (COVID-19)
Authors: Unal Umut , Anil Hakan , Deniz Mehmet Eflatun , Vuruskan Ediz , Altunkol Adem , Ercil Hakan
Published: June 2022

Objectives:

This study aimed to investigate the effect of the coronavirus disease 2019 (COVID-19) pandemic on the treatment of children with primary monosymptomatic nocturnal enuresis (MNE) with desmopressin melt versus an enuresis alarm.

Materials and methods:

This study included 56 children with primary MNE who were taking desmopressin melt or using an alarm. Their anxiety levels were evaluated using the Social Anxiety Scale for Children-Revised. For both treatment methods, data from a 3-month bedwetting diary between the third and sixth months of the pre-pandemic treatment were compared with those assessed during the same period during the pandemic.

Results:

Prior to the COVID-19 pandemic, the median 3-month mean frequency of MNE was 1 (0–7.67) in children using desmopressin melt versus 1.33 (0–6) in those using alarm treatment (p = 0.095). During the COVID-19 pandemic period, the median monthly mean frequency of MNE was 1.33 (0–7.33) in children using desmopressin melt versus 6 (1.33–13) in those using alarm treatment (p < 0.001).

Conclusions:

The COVID-19 pandemic and its accompanying psychological effects did not affect the treatment efficacy of desmopressin melt in children with primary MNE but did adversely affect that of enuresis alarms.
Polymedication and its association with individual factors in Portuguese older adults–a cross-sectional study
Authors: Pedroso-Remelhe Mariana , Amaral Teresa F. , Santos Alejandro , Padrão Patricia , Moreira Pedro , Afonso Cláudia , Borges Nuno
Published: June 2022

Background:

Population aging is a reality resulting in polymedication and its harmful consequences. Therefore, determining polymedication state in Portugal and identifying its associated characteristics is vital.

Methods:

Among the cross-sectional study Nutrition UP 65, information on socio-demographic data, cognitive performance, lifestyle, health, and nutritional status was collected in the Portuguese older population. Frequency of polymedication (self-reported concomitant administration of ≥5 medications and/or supplements) was calculated. Associated factors were determined.

Results:

A total of 1317 individuals were included in the sample and the frequency of polymedication was 37.1%. Characteristics associated with higher odds of polymedication were living in an institution (OR: 1.97; CI: 1.04-3.73); being overweight (OR: 1.52; CI: 1.03–2.25) or obese (OR: 1.57; CI: 1.06–2.34); perceiving health status as reasonable (OR: 1.68; CI: 1.25–2.27) or bad/very bad (OR: 2.04; CI: 1.37–3.03); having illnesses of the circulatory system (OR: 2.91; CI: 2.14–3.94) or endocrine, metabolic, and nutritional diseases (OR: 1.79; CI: 1.38–2.31).

Conclusions:

A 3 to 4 out of 10 Portuguese older adults are polymedicated. Intervention in modifiable factors and the monitorization of others is an important strategy in the care of the elderly.
The effectiveness of e-healthcare interventions for mental health of nurses
Authors: Park Jung-Hyun , Jung Su-Eun , Ha Da-Jung , Lee Boram , Kim Myo-Sung , Sim Kyo-Lin , Choi Yung Hyun , Kwon Chan-Young
Published: June 2022

Background:

Mental health problems, including burnout among nurses, are common and important. With the rapid development of information and communication technologies and the rise in use of smartphones, the use of e-mental health strategies is increasing in public and clinical settings, and initial clinical trials using this intervention have been conducted. This systematic review evaluated whether e-healthcare interventions improve burnout and other mental health aspects in nurses.

Methods:

Six electronic databases including MEDLINE (via PubMed), EMBASE (via Elsevier), the Cochrane Library Central Register of Controlled Trials, the Cumulative Index of Nursing and Allied Health Literature, the Allied and Complementary Medicine Database, and PsycARTICLES were searched to collect relevant randomized controlled trials up to January 28, 2021, using e-healthcare interventions for mental health in nurses. The e-healthcare intervention was classified as web-based, smartphone-based, and real-time online interventions. The primary outcome was burnout in this population. Due to the heterogeneity of the interventions used in the included studies, quantitative synthesis was not performed, but included studies were analyzed qualitatively. Also, the details of e-healthcare for the mental health of nurses were analyzed. The methodological quality of included studies was assessed using Cochrane's Risk of Bias tool.

Results:

Seven randomized controlled trials were included in this study. The 20-minute session of an online form of the emotional freedom technique was reported to significantly improve burnout severity compared to no intervention (P < .001). Other outcomes, such as career identity, quality of work life, workplace bullying, job stress, turnover intention, distress, anxiety, and resilience in nurses, were also reported to be improved by e-healthcare interventions. The methodological quality of the included studies was generally poor.

Conclusions:

In conclusion, there was some evidence that e-healthcare interventions may improve mental health outcomes, including burnout in nurses, compared with no intervention. However, due to the poor methodological quality and wide heterogeneity of the interventions and outcomes in the included studies, we were not able to reach sufficiently reliable conclusions. E-healthcare intervention for nurses in the new coronavirus disease era was discussed. High-quality clinical trials in this area should be conducted in the future.
The relationship between a fish-rich diet and poststroke cognitive impairment
Authors: Li Jia-Rui , Yu Yang , Meng Fan-Xia , Luo Ben-Yan , Gao Jian
Published: June 2022

Whether a fish-rich diet is positively associated with cognitive function after stroke remains unclear; thus, the present study investigated the relationship between them.

The present study was part of a prospective multicenter study, in which 920 individuals (609 males, mean age, 62.78 ± 11.79 years) were included from November 2013 to December 2015. The cognitive function of the patients was evaluated, and the diagnosis of poststroke cognitive impairment (PSCI) was made during their stay in the hospital. A subgroup of 439 patients from a single center was followed up for 4 to 6 years and was reassessed for cognitive function.

According to the diagnostic criteria, the PSCI prevalence was lower in the fish-rich diet group (P < .05). After adjusting for demographic and clinical variables by logistic regression, patients with a habit of consuming a fish-rich diet had a lower risk of developing PSCI than patients without a fish-rich diet (odds ratio [OR]: 0.74; 95% confidence interval [CI]: 0.46–0.95). When MMSE score was considered the cognitive function outcome variable, the long-term cognitive function of the fish-rich diet group was better (28 [26–30] vs 27 [25–29], P < .01), but the statistical results were not significant after correcting for the related confounding factors (β: 0.13; 95% CI: −0.99–1.25; P = .82).

There was a negative relationship between consuming a fish-rich diet and the prevalence of PSCI, and there was no statistically significant difference in the relationship of a fish-rich diet on long-term cognitive function after stroke, which requires further study.