bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficiency of Community Face Coverings and Surgical Masks to Limit the Spread of Aerosol
Authors: Chazelet Sandrine , Pacault Stephanie
Published: September 2021

In the current pandemic context of COVID-19, people wear different types of masks, particularly in their workplace, to limit the spread of the virus. Depending on their activity and work environment, employees are required to wear community face coverings, cloth masks with a transparent windows, surgical masks, reusable masks, or respirators. The objective of this study was to evaluate the efficiency as source control of these masks, i.e., when worn to protect the environment from the spread of particles emitted by the wearer. An experimental test bench including a dummy head and a breathing simulator associated with a DEHS droplet generator emitting 1 or 3 µm particles in the exhaled stream is used. Source control efficiency is calculated from the total flux of particles emitted in the test section without and with a mask. Seventeen models of masks are tested. Three breathing rate conditions were studied: from rest to heavy breathing, with average rates of 13, 27, and 45 L/min. Source control efficiencies vary from one mask to another. Among community face coverings (seven models) the values ranged from 15.6 to 33.8% for a medium intensity breath. The efficiencies of surgical masks (three models) ranged from 17.4 to 28.3% for the same breathing cycle. The community face coverings and the disposable surgical masks present equivalent values of source control efficiency, respectively, 25.9 and 24.1% at 1 µm and 31.5 and 23.2% at 3 µm. The respirators show higher source control efficiency than the other types of masks (76.7% at 1 µm and 82.5% at 3 µm). The statistical analysis of the data shows no effect of the breathing flow rate and an interaction effect between mask type and particle size. No differences in source control were found for the two particle sizes or the different experimental breathing rates for the respirators and the surgical masks. But the community face coverings and the cloth masks with transparent window present a source control efficiency which increases with the particle size. Varying levels of efficiency were measured with higher source control for respirators than for other types of masks. In the context of a respiratory protection programme, they can provide an effective barrier to the spread of the virus. But these results show also that no mask can stop all the particles emitted by its wearer. Regardless of the type of mask, other barrier measures (ventilation, social distancing, and hygiene) are then necessary.
ShinyArchR.UiO: user-friendly,integrative and open-source tool for visualization of single-cell ATAC-seq data using ArchR
Authors: Sharma Ankush , Akshay Akshay , Rogne Marie , Eskeland Ragnhild
Published: September 2021

Motivation

Mapping of chromatin accessibility landscapes in single-cells and the integration with gene expression enables a better understanding of gene regulatory mechanisms defining cell identities and cell-fate determination in development and disease. Generally, raw data generated from single-cell Assay for Transposase-Accessible Chromatin sequencing (scATAC-seq) are deposited in repositories that are generally inaccessible due to lack of in-depth knowledge of computational programming.

Results

We have developed ShinyArchR.UiO, an R-based shiny app, that facilitates scATAC-seq data accessibility and visualization in a user-friendly, interactive and open-source web interface. ShinyArchR.UiO is an application that can streamline collaborative efforts for interpretation of massive chromatin accessibility datasets and allow for open access data sharing for wider audiences.

Availability and implementation

https://Github.com/EskelandLab/ShinyArchRUiO and a demo server with a hematopoietic tutorial dataset https://cancell.medisin.uio.no/ShinyArchR.UiO

Supplementary information

Supplementary data are available at Bioinformatics online.
Dynamic connectivity predicts acute motor impairment and recovery post-stroke
Authors: Bonkhoff Anna K , Rehme Anne K , Hensel Lukas , Tscherpel Caroline , Volz Lukas J , Espinoza Flor A , Gazula Harshvardhan , Vergara Victor M , Fink Gereon R , Calhoun Vince D , Rost Natalia S , Grefkes Christian
Published: September 2021

Thorough assessment of cerebral dysfunction after acute lesions is paramount to optimize predicting clinical outcomes. We here built random forest classifier-based prediction models of acute motor impairment and recovery post-stroke. Predictions relied on structural and resting-state fMRI data from 54 stroke patients scanned within the first days of symptom onset. Functional connectivity was estimated via static and dynamic approaches. Motor performance was phenotyped in the acute phase and 6 months later. A model based on the time spent in specific dynamic connectivity configurations achieved the best discrimination between patients with and without motor impairments (out-of-sample area under the curve, 95% confidence interval: 0.67 ± 0.01). In contrast, patients with moderate-to-severe impairments could be differentiated from patients with mild deficits using a model based on the variability of dynamic connectivity (0.83 ± 0.01). Here, the variability of the connectivity between ipsilesional sensorimotor cortex and putamen discriminated the most between patients. Finally, motor recovery was best predicted by the time spent in specific connectivity configurations (0.89 ± 0.01) in combination with the initial impairment. Here, better recovery was linked to a shorter time spent in a functionally integrated configuration. Dynamic connectivity-derived parameters constitute potent predictors of acute impairment and recovery, which, in the future, might inform personalized therapy regimens to promote stroke recovery.
Neoadjuvant chemoradiotherapy followed by resection for esophageal cancer: clinical outcomes with the ‘CROSS-regimen’ in daily practice
Authors: Cloos-v.Balen Marissa , Portier Edmée S H , Fiocco Marta , Hartgrink Henk H , Langers Alexandra M J , Neelis Karen J , Lips Irene M , Peters Femke P , Slingerland Marije
Published: September 2021

Background and objectives

Since the first results of the Dutch randomized CROSS-trial, neoadjuvant chemoradiotherapy (CRT) using carboplatin and paclitaxel followed by resection for primary resectable nonmetastatic esophageal cancer (EC) has been implemented as standard curative treatment in the Netherlands. The purpose of this retrospective study is to evaluate the clinical outcomes of this treatment in daily practice in a large academic hospital.

Methods

Medical records of patients treated for primary resectable nonmetastatic EC between May 2010 and December 2015 at our institution were reviewed. Treatment consisted of five weekly courses of carboplatin (area under the curve 2) and paclitaxel (50 mg/m2) with concurrent external beam radiotherapy (23 fractions of 1.8 Gy), followed by transthoracic or transhiatal resection. Data on survival, progression, acute and late toxicity were recorded.

Results

A total of 145 patients were included. Median follow-up was 43 months. Median overall survival (OS) and progression-free survival (PFS) were 35 (95% confidence interval [CI] 29.8–40.2) and 30 (95% CI 19.7–40.3) months, respectively, with corresponding 3-year OS and PFS of 49.6% (95% CI 40.4–58.8) and 45.6% (95% CI 36.6–54.6). Acute toxicity grade ≥3 was observed in 25.5% of patients. Late adverse events grade ≥3 were seen in 24.8%, mostly esophageal stenosis.

Conclusion

Neoadjuvant CRT followed by resection for primary resectable nonmetastatic EC in daily practice results in a 3-year OS of 49.6% (95% CI 40.4–58.8) and PFS of 45.6% (95% CI 36.6–54.6), compared with 58% (51–65%) and 51% (43–58%) within the CROSS-trial. The slightly poorer survival in our daily practice group might be due to the presence of less favorable patient and tumor characteristics in daily practice, as is to be expected in daily practice. Toxicity was comparable with that in the CROSS-trial and considered acceptable.
A case report: symptomatic pericarditis post-COVID-19 vaccination
Authors: Ashaari Sarah , Sohaib Hafiz Ahmed , Bolger Kenneth
Published: September 2021

Background 

The Coronavirus disease 2019 (COVID-19) pandemic has led to the rapid development of COVID-19 vaccine. The Centers for Disease Control and Prevention (CDC) has recently reported increase in myopericarditis incidence post-COVID-19 vaccination. Post-vaccination myopericarditis as side effect has been reported, however, is infrequent. We described a case of pericarditis post-first dose of Pfizer-BioNTech vaccine.

Case summary

A patient presented with typical symptoms of pericarditis and related electrocardiogram and echocardiogram changes, 7 days post receiving the first dose of COVID-19 vaccine. No other causes were identified from series of investigations. Patient had good symptomatic relief with non-steroidal anti-inflammatory medication.

Discussion

The incidence of pericarditis post-vaccination is rare, with limited reporting in previous literatures. No causal relationship has yet to be established due to small number of cases. The benefits of COVID-19 vaccination currently outweigh the side effect profile and are recommended as the first-line approach to control the current pandemic.
Sex Differences in Recovery Across Multiple Domains Among Older Adults With Hip Fracture
Authors: Orwig Denise L , Abraham Danielle S , Hochberg Marc C , Gruber-Baldini Ann , Guralnik Jack M , Cappola Anne R , Golden Justine , Hicks Gregory E , Miller Ram R , Resnick Barbara , Shardell Michelle , Sterling Robert S , Bajracharya Rashmita , Magaziner Jay
Published: September 2021

Background

Hip fractures are a public health problem among older adults, but most research on recovery after hip fracture has been limited to females. With growing numbers of hip fractures among males, it is important to determine how recovery outcomes may differ between the sexes.

Methods

168 males and 171 females were enrolled within 15 days of hospitalization with follow-up visits at 2, 6, and 12 months postadmission to assess changes in disability, physical performance, cognition, depressive symptoms, body composition, and strength, and all-cause mortality. Generalized estimating equations examined whether males and females followed identical outcome recovery assessed by the change in each outcome.

Results

The mean age at fracture was similar for males (80.4) and females (81.4), and males had more comorbidities (2.5 vs 1.6) than females. Males were significantly more likely to die over 12 months (hazard ratio 2.89, 95% confidence interval: 1.56–5.34). Changes in outcomes were significantly different between males and females for disability, gait speed, and depressive symptoms (p < .05). Both sexes improved from baseline to 6 months for these measures, but only males continued to improve between 6 and 12 months. There were baseline differences for most body composition measures and strength; however, there were no significant differences in change by sex.

Conclusions

Findings confirm that males have higher mortality but suggest that male survivors have continued functional recovery over the 12 months compared to females. Research is needed to determine the underlying causes of these sex differences for developing future prognostic information and rehabilitative interventions.
Identification of Fall-Related Injuries in Nursing Home Residents Using Administrative Claims Data
Authors: Mintz Joel , Duprey Matthew S , Zullo Andrew R , Lee Yoojin , Kiel Douglas P , Daiello Lori A , Rodriguez Kenneth E , Venkatesh Arjun K , Berry Sarah D
Published: September 2021

Background

Fall-related injuries (FRIs) are a leading cause of morbidity, mortality, and costs among nursing home (NH) residents. Carefully defining FRIs in administrative data is essential for improving injury-reduction efforts. We developed a series of novel claims-based algorithms for identifying FRIs in long-stay NH residents.

Methods

This is a retrospective cohort of residents of NH residing there for at least 100 days who were continuously enrolled in Medicare Parts A and B in 2016. FRIs were identified using 4 claims-based case-qualifying (CQ) definitions (Inpatient [CQ1], Outpatient and Provider with Procedure [CQ2], Outpatient and Provider with Fall [CQ3], or Inpatient or Outpatient and Provider with Fall [CQ4]). Correlation was calculated using phi correlation coefficients.

Results

Of 153 220 residents (mean [SD] age 81.2 [12.1], 68.0% female), we identified 10 104 with at least one FRI according to one or more CQ definition. Among 2 950 residents with hip fractures, 1 852 (62.8%) were identified by all algorithms. Algorithm CQ4 (n = 326–2 775) identified more FRIs across all injuries while CQ1 identified less (n = 21–2 320). CQ2 identified more intracranial bleeds (1 028 vs 448) than CQ1. For nonfracture categories, few FRIs were identified using CQ1 (n = 20–488). Of the 2 320 residents with hip fractures identified by CQ1, 2 145 (92.5%) had external cause of injury codes. All algorithms were strongly correlated, with phi coefficients ranging from 0.82 to 0.99.

Conclusions

Claims-based algorithms applied to outpatient and provider claims identify more nonfracture FRIs. When identifying risk factors, stakeholders should select the algorithm(s) suitable for the FRI and study purpose.
Quantifying representativeness in randomized clinical trials using machine learning fairness metrics
Authors: Qi Miao , Cahan Owen , Foreman Morgan A , Gruen Daniel M , Das Amar K , Bennett Kristin P
Published: September 2021

Objective

We help identify subpopulations underrepresented in randomized clinical trials (RCTs) cohorts with respect to national, community-based or health system target populations by formulating population representativeness of RCTs as a machine learning (ML) fairness problem, deriving new representation metrics, and deploying them in easy-to-understand interactive visualization tools.

Materials and Methods

We represent RCT cohort enrollment as random binary classification fairness problems, and then show how ML fairness metrics based on enrollment fraction can be efficiently calculated using easily computed rates of subpopulations in RCT cohorts and target populations. We propose standardized versions of these metrics and deploy them in an interactive tool to analyze 3 RCTs with respect to type 2 diabetes and hypertension target populations in the National Health and Nutrition Examination Survey.

Results

We demonstrate how the proposed metrics and associated statistics enable users to rapidly examine representativeness of all subpopulations in the RCT defined by a set of categorical traits (eg, gender, race, ethnicity, smoking status, and blood pressure) with respect to target populations.

Discussion

The normalized metrics provide an intuitive standardized scale for evaluating representation across subgroups, which may have vastly different enrollment fractions and rates in RCT study cohorts. The metrics are beneficial complements to other approaches (eg, enrollment fractions) used to identify generalizability and health equity of RCTs.

Conclusion

By quantifying the gaps between RCT and target populations, the proposed methods can support generalizability evaluation of existing RCT cohorts. The interactive visualization tool can be readily applied to identified underrepresented subgroups with respect to any desired source or target populations.
On embedding Lambek calculus into commutative categorial grammars
Authors: Slavnov Sergey
Published: September 2021

We consider tensor grammars, which are an example of ‘commutative’ grammars, based on the classical (rather than intuitionistic) linear logic. They can be seen as a surface representation of abstract categorial grammars (ACG) in the sense that derivations of ACG translate to derivations of tensor grammars and this translation is isomorphic on the level of string languages. The basic ingredients are tensor terms, which can be seen as encoding and generalizing proof nets. Using tensor terms makes the syntax extremely simple and a direct geometric meaning becomes transparent. Then we address the problem of encoding noncommutative operations in our setting. This turns out possible after enriching the system with new unary operators. The resulting system allows representing both ACG and Lambek grammars as conservative fragments, while the formalism remains, as it seems to us, rather simple and intuitive.
Regionalization of EMS Medical Direction for Naval Medical Forces Pacific
Authors: Raetz Emily , Ross Elliot , Dickerson Brittany , Walrath Benjamin
Published: September 2021

Introduction

Medical direction has been the cornerstone to safe and effective prehospital and enroute care since the establishment of emergency medical services (EMS). Medical oversight by a physician has been shown to improve clinical outcomes in both settings. When the Navy Regional Office of the EMS Medical Director was established in 2016, it brought additional resources, including the addition of a paramedic and nurse EMS analyst and recruitment of additional local medical directors (LMDs). This, combined with the engagement of military leadership, allowed for expansion and improvement of medical direction in our prehospital and enroute care system and the establishment of a continuous quality improvement (CQI) program.

Materials and Methods

In 2017, a database was created to collect total run volume, acuity of calls, number of certain time-sensitive conditions, and CQI performance. A retrospective review of this database was conducted. This project was deemed institutional review board exempt.

Results

LMD reports that submission went from 17% for 2017 to 64% for 2018, 91% for 2019, and 79% for 2020. In 2019, 67% of the sites had verifiable CQI programs and, in 2020, this improved to 80% of sites. The review also revealed insight into levels of acuity seen by prehospital and enroute care providers.

Conclusion

Our results demonstrate that improvement in medical oversight in a large regional prehospital system can be achieved through persistence and engagement of nonmedical leadership.
Late-presenting Plasmodium falciparum Malaria in a Non-Endemic Setting During COVID-19 Travel Restrictions
Authors: Robben Paul m , Dunbar Christopher r , Akin Elgin h , Pichugin Alexander , Regules Jason a
Published: September 2021

We report a case of febrile Plasmodium falciparum malaria in a 36-year-old male patient occurring 14 years after immigration from and more than 12 months since a return visit to the endemic area. The critical need for awareness regarding late presentations of P. falciparum is discussed.
Repetitive Low-level Blast Exposure and Neurocognitive Effects in Army Ranger Mortarmen
Authors: Woodall Julia l.a , Sak Jordyn a , Cowdrick Kyle R , Bove Muñoz Brady m , McElrath Jessica h , Trimpe Grace r , Mei Yajun , Myhre Remington l , Rains James k , Hutchinson Charles r
Published: September 2021

Introduction

Occupational exposure to repetitive, low-level blasts in military training and combat has been tied to subconcussive injury and poor health outcomes for service members. Most low-level blast studies to date have focused on explosive breaching and firing heavy weapon systems; however, there is limited research on the repetitive blast exposure and physiological effects that mortarmen experience when firing mortar weapon systems. Motivated by anecdotal symptoms of mortarmen, the purpose of this paper is to characterize this exposure and its resulting neurocognitive effects in order to provide preliminary findings and actionable recommendations to safeguard the health of mortarmen.

Materials and Methods

In collaboration with the U.S. Army Rangers at Fort Benning, blast exposure, symptoms, and pupillary light reflex were measured during 3 days of firing 81 mm and 120 mm mortars in training. Blast exposure analysis included the examination of the blast overpressure (BOP) and cumulative exposure by mortarman position, as well as comparison to the 4 psi safety threshold. Pupillary light reflex responses were analyzed with linear mixed effects modeling. All neurocognitive results were compared between mortarmen (n = 11) and controls (n = 4) and cross-compared with blast exposure and blast history.

Results

Nearly 500 rounds were fired during the study, resulting in a high cumulative blast exposure for all mortarmen. While two mortarmen had average BOPs exceeding the 4 psi safety limit (Fig. 2), there was a high prevalence of mTBI-like symptoms among all mortarmen, with over 70% experiencing headaches, ringing in the ears, forgetfulness/poor memory, and taking longer to think during the training week (n ≥ 8/11). Mortarmen also had smaller and slower pupillary light reflex responses relative to controls, with significantly slower dilation velocity (P < 0.05) and constriction velocity (P < 0.10).

Conclusion

Mortarmen experienced high cumulative blast exposure coinciding with altered neurocognition that is suggestive of blast-related subconcussive injury. These neurocognitive effects occurred even in mortarmen with average BOP below the 4 psi safety threshold. While this study was limited by a small sample size, its results demonstrate a concerning health risk for mortarmen that requires additional study and immediate action. Behavioral changes like ducking and standing farther from the mortar when firing can generally help reduce mortarmen BOP exposure, but we recommend the establishment of daily cumulative safety thresholds and daily firing limits in training to reduce cumulative blast exposure, and ultimately, improve mortarmen’s quality of life and longevity in service.
Heplisav-B in Prior Hepatitis B Vaccine Nonresponders: A Case Series
Authors: Williams Alan l
Published: September 2021

Introduction

Hepatitis B is a potentially deadly infection that can be acquired by exposure to infectious human blood or body fluids. While service members and others at occupational risk are routinely vaccinated to prevent hepatitis B, non-responders to this vaccine are at continued risk. Heplisav-B is a newer vaccine that may offer additional protection to those at risk.

Materials and Methods

Cases of hepatitis B vaccine non-responders who were given Heplisav-B after receiving six or more doses of standard hepatitis B vaccine were collected from existing health records within the military health system after Uniformed Services University of the Health Sciences Institutional Review Board review.

Results

Twelve of thirteen (92%) prior non-responders who were tested at least 1 month after completing the recombinant Heplisav-B vaccine series demonstrated seroprotection against hepatitis B.

Conclusions

Ideally, all service members and other at-risk workers should be protected from hepatitis B. This case series suggests that prior non-responders are likely to gain protection from hepatitis B with Heplisav-B vaccination. A prospective trial is warranted for further evaluation of this potential indication.
Calcium-dependent protein kinase CPK32 mediates calcium signaling in regulating Arabidopsis flowering time
Authors: Li Xidong , Chen Limei , Yao Li , Zou Junjie , Hao Jie , Wu Weihua
Published: September 2021

Appropriate flowering time is critical for the reproductive success of plant species. Emerging evidence indicates that calcium may play an important role in the regulation of flowering time. However, the underlying molecular mechanisms remain unclear. In this study, we demonstrate that calcium-dependent protein kinase 32 (CPK32) regulates flowering time by affecting the alternative polyadenylation of FLOWERING CONTROL LOCUS A (FCA) and altering the transcription of FLOWERING LOCUS C (FLC), a central repressor of flowering time. The knockdown of CPK32 results in an obvious late flowering phenotype and dramatically enhanced FLC transcription. CPK32 interacts with FCA, and phosphorylates the serine592 of FCA in a Ca2+-dependent manner. Moreover, the ratio of abundance of the FCA transcripts (FCA-D and FCA-P) changes significantly in the cpk32 mutant, which subsequently affects FLC expression and consequently regulates floral transition. The present evidence demonstrates that CPK32 modulates flowering time by regulating FCA alternative polyadenylation and consequent FLC expression.
Neither sex appears to benefit from divorce within migratory Northern Flickers consistent with accidental loss and bet-hedging
Authors: Wiebe Karen L
Published: September 2021

Divorce is widespread among species of birds and may either be an adaptive strategy to secure a better mate or territory or be a nonadaptive result of a failure to maintain the pairbond. I examined the causes and consequences for divorce in the Northern Flicker (Colaptes auratus), a migratory woodpecker with a high annual mortality rate. In a long-term population study of 1,793 breeding pairs over 17 years, the within-season divorce rate was 4.6% and the between-season divorce rate was 15.5%. Retained pairs within a season initiated their renest 5 days faster than divorced birds that had no greater fledgling production, suggesting that within-season divorce was making the best of a bad job with severe time constraints. Poor performance in the year prior to divorce was not strongly associated with divorce, and analysis of multiple breeding stages revealed that divorcing individuals in the subsequent year had later laying dates, smaller clutches, and fewer fledglings than retained pairs but no better performance than widowed individuals. Analyzing the data separately by sex showed that neither males nor females benefitted from divorce. Thus, there is a reproductive cost linked to finding a new partner per se, but no reproductive advantage associated with divorce. New mates after divorce were usually not older (not higher quality) than previous mates, so intrasexual competition was probably not driving partnership splits. The most plausible explanation seems to be a “bet-hedging” hypothesis in which birds re-pair rapidly in spring if their previous mate does not quickly arrive during spring migration. Divorce in Northern Flickers does not appear to be adaptive and future studies on arrival and interactions of individuals in spring will elucidate proximate constraints on relocating the previous partner.
Welfare Effects of Dynamic Matching: An Empirical Analysis
Authors: Verdier Valentin , Reeling Carson
Published: September 2021

Allocating resources without monetary payments is expected to yield inefficient allocations. Theory suggests that introducing rationing when resources are allocated repeatedly over time can mitigate this issue, while the magnitude of the resulting efficiency gains is an empirical question in most settings. We study a dynamic assignment mechanism used by the Michigan Department of Natural Resources to allocate bear hunting licenses and find that it yields a more efficient allocation than static mechanisms, allocating participants to types of resources for which they have a higher value without crowding out participants with a high overall value for hunting. Our empirical analysis also highlights the importance of heterogeneity across participants and across allocated resources for determining the efficiency of a dynamic allocation mechanism.
Sleep duration, sleep problems, and perceived stress are associated with hippocampal subfield volumes in later life: findings from The Irish Longitudinal Study on Ageing
Authors: De Looze Céline , Feeney Joanne C , Scarlett Siobhan , Hirst Rebecca , Knight Silvin P , Carey Daniel , Meaney James F , Kenny Rose Anne
Published: September 2021

Study Objectives

This study examines the cross-sectional and 2-year follow-up relationships between sleep and stress and total hippocampal volume and hippocampal subfield volumes among older adults.

Methods

Four hundred seventeen adults (aged 68.8 ± 7.3; 54% women) from the Irish Longitudinal Study on Ageing completed an interview, a questionnaire, and multiparametric brain magnetic resonance imaging. The relationships between self-reported sleep duration, sleep problems, perceived stress, and total hippocampal volume were examined by using ordinary least squares regressions. Linear mixed-effects models were used to investigate the relationships between sleep duration, sleep problems, perceived stress, changes in these measures over 2-years, and hippocampal subfield volumes.

Results

No cross-sectional and follow-up associations between sleep and total hippocampal volume and between stress and total hippocampal volume were found. By contrast, Long sleep (≥9–10 h/night) was associated with smaller volumes of molecular layer, hippocampal tail, presubiculum, and subiculum. The co-occurrence of Short sleep (≤6 h) and perceived stress was associated with smaller cornu ammonis 1, molecular layer, subiculum, and tail. Sleep problems independently and in conjunction with higher stress, and increase in sleep problems over 2 years were associated with smaller volumes of these same subfields.

Conclusion

Our study highlights the importance of concurrently assessing suboptimal sleep and stress for phenotyping individuals at risk of hippocampal subfield atrophy.
Nursing Education Leaders Decision-Making During a Pandemic Crisis
Authors: Farra Sharon , Smith Sherrill , Qureshi Kristine , Stalter Ann M.
Published: September 2021

Academic nursing leaders faced unprecedented decision-making during the recent global pandemic. Although some universities had emergency response plans, many did not, and those that did have plans did not address the specific needs of nursing education programs. This descriptive survey study sought to describe the decision-making and response of nursing education leaders during the pandemic and provide recommendations for the future. Themes identified in the study include preparedness, emergency response, uncertainty, leadership and policy, and communication. Results of the study provide nursing program administrators with insights for preparing to lead in future emergencies.
The Current State and Future of Fetal Therapies
Authors: Sparks Teresa N.
Published: September 2021

Through next-generation sequencing, we can now detect a myriad of rare genetic diseases in utero that were previously not diagnosed until after birth. Fetal therapies hold strong promise for transforming prenatal management of genetic diseases, preventing adverse effects from organ damage in utero, and improving the grim perinatal outcomes of numerous genetic diseases. Many novel, in utero therapies are under investigation for genetic diseases using hematopoietic stem cells, cellular pathway inhibitors, viral vectors, and other biotechnologies. This article reviews emerging fetal therapies, as well as existing guidance for their development, considerations for their safety, and ethical and societal implications.
A nurse practitioner–led care bundle approach for primary care of patients with complex health needs
Authors: Christianson-Silva Paula , Russell-Kibble Audrey , Shaver Joan
Published: September 2021

Background:

Often developed for acute care and less frequently for primary care, care bundles are clusters of evidence-based practices for improving care delivery and patient outcomes. Care bundles usually arise when ineffective or costly outcomes are identified, are meant to make care more reliable, and require superb teamwork and communication.

Local problem:

Patients using the highest proportion of health care services are those living with complex health conditions and challenging sociocultural lives, statistics corroborated within our primary care clinic. In our nurse practitioner (NP)-led, interprofessional, team-based primary care program serving mainly low-income patients, we noted that many patients with multiple chronic conditions had an excess of clinic encounters, emergency department visits, and hospitalizations.

Methods:

To improve health status for these patients and reduce costly care inefficiencies, we developed a unique bundle of care practices for embedding within our NP-led complex care program. Our goals were to improve patient efficacy for self-management of chronic conditions and promote appropriate use of health care resources and services.

Interventions:

Using AEIØOU as a mnemonic, the derived care bundle better focused our team efforts and provided us with a planning, communication, and documentation schema for quality improvement. It was particularly useful for team-based care because tasks could be documented or communicated by letter or number and easily reviewed by team members or others involved in patients' care.

Results:

Use of the AEIØOU bundle within our program resulted in better coordination of team-based comprehensive care for our high-needs patients, seen anecdotally in fewer unnecessary contacts and missed appointments and in patient appreciation comments. Emergency department visits and hospitalization data for the six months before compared with 6 months after enrollment in the program showed significant reductions.

Conclusions:

To improve the primary care of complex patient populations, we recommend further use and testing of the AEIØOU bundle within other care models.
The analgesic efficacy of pregabalin for shoulder arthroscopy
Authors: Liu Chunhong , Cheng Ling , Du Bo , Cheng Shuang , Jiang Yangming , Tan Xiaohong , Qian Ke
Published: September 2021

Introduction:

The efficacy of pregabalin for pain management of shoulder arthroscopy remains controversial. We conduct this meta-analysis to explore the influence of pregabalin versus placebo on the postoperative pain intensity of shoulder arthroscopy.

Methods:

We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through November 2019 for randomized controlled trials assessing the effect of pregabalin versus placebo on pain control of shoulder arthroscopy. This meta-analysis was performed using the random-effect model.

Results:

Three randomized controlled trials were included in the meta-analysis. Overall, compared with control group for shoulder arthroscopy, pregabalin remarkably decreased pain scores at 0 to 1 hour (Std. MD = −0.57; 95% CI = −1.04 to −0.09; P = .02) and 12 hours (Std. MD = −0.37; 95% CI = −0.72 to −0.02; P = .04), as well as analgesic consumption (Std. MD = −1.84; 95% CI = −2.24 to −1.44; P < .00001), but showed no notable influence on pain scores at 24 hours (Std. MD = −0.54; 95% CI = −1.47 to 0.38; P = .25), nausea or vomiting (RR = 0.84; 95% CI = 0.53–1.33; P = .45), dizziness (RR = 1.14; 95% CI = 0.89–1.47; P = .30).

Conclusions:

Pregabalin may benefit to pain control after shoulder arthroscopy.
Increased PYCR1 mRNA predicts poor prognosis in kidney adenocarcinoma
Authors: Zhang Tianyi , Liu Ying , Liu Wenqiang , Li Qunwang , Hou Wei , Huang Ying , Lv Pan , Meng Lu , Li Yinhua , Jia Yunge , Liu Xuezheng , Zuo Zhongfu
Published: September 2021

The pyrroline-5-carboxylate reductase 1 (PYCR1) plays important roles in cancers, but its contribution to adenocarcinoma of the kidney (AK) and the potential mechanism remain to be clarified. In this study, we aimed to demonstrate the relationship between PYCR1 mRNA and AK based on The Cancer Genome Atlas database.

PYCR1 mRNA in AK and normal tissues was compared using Wilcoxon rank sum test. The relationship between PYCR1 mRNA and clinicopathological characters was evaluated using logistic regression. The association between PYCR1 mRNA and survival rate was evaluated using Kaplan-Meier test and Cox regression of univariate and multivariate analysis. Additionally, Gene Set Enrichment Analysis was conducted to annotate the biological function of PYCR1 mRNA.

Increased PYCR1 mRNA was found in AK tissues. Increased PYCR1 mRNA was related to high histologic grade, clinical stage, and lymph node and distant metastasis. Kaplan-Meier survival analysis and univariate analysis showed that AK patients with increased PYCR1 mRNA had worse prognosis than those without. PYCR1 mRNA remained independently associated with overall survival (HR: 1.34; 95% CI: 1.07–1.66; P = .009) in multivariate analysis. The Gene Set Enrichment Analysis suggested that ribosome, proteasome, inhibition of p53 signaling pathway, extracellular matrix receptor interaction, and homologous recombination were differentially enriched in increased PYCR1 mRNA phenotype.

Increased PYCR1 mRNA is a potential marker in patients with AK. More importantly, p53 pathway, ribosome, proteasome, extracellular matrix receptor interaction, and homologous are differentially enriched in AK patients with increased PYCR1 mRNA.
Predictors of acute deep venous thrombosis in patients hospitalized for COVID-19
Authors: Riyahi Sadjad , Hectors Stefanie J. , Prince Martin R. , Sweeney Elizabeth M. , Lane Elizabeth G. , Honya Ricky , Margolis Daniel J.
Published: September 2021

Deep venous thrombosis (DVT) is associated with high mortality in coronavirus disease 2019 (COVID-19) but there remains uncertainty about the benefit of anti-coagulation prophylaxis and how to decide when ultrasound screening is indicated. We aimed to determine parameters predicting which COVID-19 patients are at risk of DVT and to assess the benefit of prophylactic anti-coagulation.

Adult hospitalized patients with positive severe acute respiratory syndrome coronavirus-2 reverse transcription-polymerase chain reaction (RT-PCR) undergoing venous duplex ultrasound for DVT assessment (n = 451) were retrospectively reviewed. Clinical and laboratory data within 72 hours of ultrasound were collected. Using split sampling and a 10-fold cross-validation, a random forest model was developed to find the most important variables for predicting DVT. Different d-dimer cutoffs were examined for classification of DVT. We also compared the rate of DVT between the patients going and not going under thromboprophylaxis.

DVT was found in 65 (14%) of 451 reverse transcription-polymerase chain reaction positive patients. The random forest model, trained and cross-validated on 2/3 of the original sample (n = 301), had area under the receiver operating characteristic curve = 0.91 (95% confidence interval [CI]: 0.85–0.97) for prediction of DVT in the test set (n = 150), with sensitivity = 93% (95%CI: 68%–99%) and specificity = 82% (95%CI: 75%–88%). The following variables had the highest importance: d-dimer, thromboprophylaxis, systolic blood pressure, admission to ultrasound interval, and platelets. Thromboprophylaxis reduced DVT risk 4-fold from 26% to 6% (P < .001), while anti-coagulation therapy led to hemorrhagic complications in 14 (22%) of 65 patients with DVT including 2 fatal intra-cranial hemorrhages. D-dimer was the most important predictor with area under curve = 0.79 (95%CI: 0.73–0.86) by itself, and a 5000 ng/mL threshold at 7 days postCOVID-19 symptom onset had 75% (95%CI: 53%–90%) sensitivity and 81% (95%CI: 72%–88%) specificity. In comparison with d-dimer alone, the random forest model showed 68% versus 32% specificity at 95% sensitivity, and 44% versus 23% sensitivity at 95% specificity.

D-dimer >5000 ng/mL predicts DVT with high accuracy suggesting regular monitoring with d-dimer in the early stages of COVID-19 may be useful. A random forest model improved the prediction of DVT. Thromboprophylaxis reduced DVT in COVID-19 patients and should be considered in all patients. Full anti-coagulation therapy has a risk of life-threatening hemorrhage.
Identification of risk factors for the prognosis of Chinese patients with endometrial carcinoma
Authors: Wang Na , Zhang Jun , Fan Xiaomei , Ma Junying , He Jing , Kang Shan , Cheng Jianxin , Ma Jing
Published: September 2021

This study aimed to retrospectively analyze risk factors for the prognosis of Chinese patients with endometrial carcinoma.

Total 600 patients who were admitted to the Department of Gynecology, the Fourth Hospital of Hebei Medical University and were pathologically diagnosed as endometrial carcinoma after surgery from January 1, 1997 to December 31, 2006 were selected, and the related factors affecting their prognosis were analyzed.

The survival of 600 patients with endometrial carcinoma was 2 to 136.5 months (average survival 57.39 ± 33.55 months), and 109 cases (18.2%) died from endometrial cancer. The overall survival rate of 1, 3, and 5 years after surgery was 96.8%, 89.9%, and 82.1%, respectively. Univariate analysis showed that age, menopausal status, pathological type, histological grade, pathological staging, tumor size, myometrial invasion, cervical involvement, ovarian metastasis, lymph node metastasis, and treatment method were the factors affecting the prognosis of endometrial carcinoma. Multivariate regression analysis showed that pathological type, histological grade, pathological staging, and cervical involvement were independent risk factors for the prognosis of endometrial carcinoma. The patients with high-grade and deep myometrial invasion, cervical involvement, full cavity tumor, and lymph node metastasis had a high incidence of ovarian metastasis.

Pathological type, histological grade, pathological staging, and cervical involvement are independent risk factors affecting the prognosis of Chinese patients with endometrial carcinoma.
Comparison of the effects of retroperitoneoscopic ureterolithotomy and ureteroscopic lithotripsy in the treatment of upper ureteral calculi
Authors: Gao Sheng-Lin , Wu Hao , Su Quan-Xin , Zhang Zi-Yi , Zhang Ze , Lu Chao , Zhang Li-Feng , Zuo Li
Published: September 2021

This study compares the efficacy of retroperitoneoscopic ureterolithotomy (RPUL) and ureteroscopic lithotripsy (URL) in the treatment of upper ureteral calculi.

The clinical data of 150 patients with upper ureteral calculi who underwent RPUL and 136 patients who underwent URL between January 2014 and October 2019 were retrospectively analyzed. The operation time, postoperative hospital stay, operation success rate, stone clearance rate, and surgical complications were evaluated between the two groups.

For the RPUL and URL groups, respectively, the average operation time was 74.5 ± 24.6 minutes and 54.5 ± 13.2 minutes; the postoperative hospital stay was 5.8 ± 1.4 days and 3.2 ± 1.2 days; the operation success rate was 96.0% (144/150) and 85.3% (116/136); the incidence rate of complications was 3.5% (5/144) and 17.5% (18/103); and the stone clearance rate was 100% (144/144) and 88.8% (103/116), which were all statistically significant (P < .05).

Both RPUL and URL had the advantages of low trauma and fast recovery rate for patients with upper ureteral calculi. However, patients who underwent RPUL showed higher success and fewer complication rate. RPUL might be a safe and effective laparoscopic method for the treatment of patients with upper ureteral calculi.
Reversible cerebral vasoconstriction syndrome with basilar artery stenosis
Authors: Joh Sang Woo , Kim Sang Yeon , Shin Byoung-Soo , Kang Hyun Goo
Published: September 2021

Introduction:

Acute severe headaches in young patients may be associated with fatal neurological complications that necessitate imaging examinations. Among acute severe headaches, a thunderclap headache may indicate the rupture of a cerebral aneurysm or the onset of reversible cerebral vasoconstriction syndrome for which emergent evaluation is required.

Patient concerns:

We report the case of a 36-year-old man who presented to our hospital with an acute severe headache after excessive exercise the previous day. He was prescribed a pain reliever and discharged under the suspicion of vestibular migraine but returned to the emergency room after 4 hours due to right hemiparesis, right facial palsy, severe dysarthria, and a mild drowsy mental status.

Diagnosis:

After cerebral angiography, we diagnosed basilar artery stenosis with acute infarction in the posterior circulation due to reversible cerebral vasoconstriction syndrome.

Interventions:

Brain computed tomography angiography revealed complete occlusion of the vertebrobasilar artery. Transfemoral cerebral angiography showed spontaneous improvement in the occlusion before thrombectomy.

Outcomes:

Ten months later, high-resolution vessel wall magnetic resonance angiography showed persisting severe stenosis of the basilar artery.

Conclusions:

A headache in young patients with risk factors of atherosclerosis, such as smoking history, uncontrolled hypertension, and dyslipidemia may be caused by reversible cerebral vasoconstriction syndrome or ischemic stroke, which has fatal neurological complications. Therefore, reversible cerebral vasoconstriction syndrome or ischemic stroke should be suspected and appropriately evaluated in such patients, even if the headache is not the thunderclap type.
The potential of big data for obstetrics discovery
Authors: Clapp Mark A. , McCoy Thomas H.
Published: September 2021

Purpose of review

The purpose of this article is to introduce the concept of ‘Big Data’ and review its potential to advance scientific discovery in obstetrics.

Recent findings

Big Data is now ubiquitous in medicine, being used in many specialties to understand the pathophysiology, risk factors, and treatment for many diseases. Big Data analyses often employ machine learning methods to understand the complex relationships that may exist within these sources. We review the basic principles of supervised and unsupervised machine learning methods, including deep learning. We highlight how these methods have been used to study genetic risk factors for preterm birth, interpreting electronic fetal heart rate tracings, and predict adverse maternal and neonatal outcomes during pregnancy and delivery. Despite its promise, there are challenges with using Big Data, including data integrity, generalizability (namely the concerns about perpetuating inequalities), and confidentiality.

The combination of new data and enhanced methods present a synergistic opportunity to explore the complex relationships common to human illness and medical practice, including obstetrics. With prediction as a primary objective instead of the more familiar goals of hypothesis testing, these analytic methods can capture multifaceted, rare, and nuanced relationships between exposures and outcomes that exist within these large data sets.
Breastfeeding Experiences of Autistic Women
Authors: Wilson Jane C. , Andrassy Bri
Published: September 2021

Purpose:

The purpose of this study was to explore the experiences of autistic women who breastfed.

Study Design and Methods:

We used a qualitative phenomenology design and a thematic analysis method. Semistructured interviews were conducted using a purposive sample from social media support groups for autistic adults. The interview involved one overarching question about their breastfeeding experience.

Results:

Twenty-three autistic women who breastfed their infant(s) participated in our study. Three main themes were identified including intense sensory perception, focused determination, and one size doesn't fit all. Three subthemes helped to describe intense sensory perception: overstimulated, overtouched, and overwhelmed.

Clinical Implications:

Autistic adults can have social interaction and expressive communication differences. Nurses can promote positive communication and provide appropriate care through supportive action. These findings offer a guide for nurses to better understand the experiences of autistic breastfeeding women.